Paediatrics Brain Imaging In Epilepsy: Common Presenting Symptoms And Spectrum Of Abnormalities Detected On MRI.

BACKGROUND: Epilepsy, a common neurological disorder can present at any age and has a number of aetiologies with underlying brain disease being the most common aetiology. Brain imaging becomes important and mandatory in the work up for epilepsy in localization and lateralization of the seizure focus. METHODS: This cross-sectional study was conducted in the department of Radiology Ayub Medical Teaching Institution Abbottabad from 1st March 2015 to 31st March 2016. A total of 209 children aged 28 days to 14 years were included in the study who presented with seizures to clinicians. Information obtained from history, clinical examination and investigations especially MRI brains were recorded in a prescribed pro forma. The data was analysed in SPSS 20. RESULTS: MRI examination was unremarkable in 44.01% (n=92) and mild generalized brain atrophy was noted in 12.91% (n=27). Arachnoid cysts, mild unilateral brain atrophy and hydrocephalous due to aqueduct stenosis were recorded in 3.82% (n=8) of each group. Neoplastic lesions were the second most common abnormal MRI finding and constituted 5.74% (n=12). Leukodystrophy was diagnosed in 4.78% (n=10). MRI examination showed ring enhancing lesions (tuberculomas) and AVM in 1.43% (n=3) of each group. Perinatal ischemia and intracranial infection, (focal or generalized) were recorded in 2.87% (n=6) of each group. A 0.95% (n=2) of children in each group had agenesis of corpus callosum and cavernoma. The radiological MRI diagnosis of Raussmussen encephalitis was made in 3.34% (n=7). Single case, each of mesial temporal sclerosis, subdural haemorrhage, infarct and craniopharyngioma was recorded making 0.47% of the total patients in each case. CONCLUSIONS: MRI examination was abnormal in significant number of patients (55.86%), so therefore if properly utilized, in a good clinical context, this can identify most of the structural brain abnormalities in paediatric patients presenting with seizures.

Association between carotid intima-media thickness and physical activity scores in middle aged Pakistani adults--a hospital based study.

BACKGROUND: The intima-media thickness of carotid arteries measured with B-mode ultrasound is a measurable index of the presence of atherosclerosis. Physical inactivity is known to be a risk factor for rapid onset and progression of atherosclerosis. Objective of the study was to evaluate the influence of leisure time physical activity on carotid intima media thickness in middle aged Pakistani population. METHODS: This cross-sectional study was carried out at the Department of Diagnostic Radiology Holy Family Hospital in collaboration with the Department of Pathology and the Department of Internal Medicine from July to December 2009. Subjects were attendants of patients admitted to the Department of Internal Medicine. All individuals underwent B-mode carotid ultrasound and physical activity assessment was done by using IPA Questionnaires. RESULTS: The study population consisted of 110 healthy men and women (male = 64, mean age of 55.1 ± 8.2 years and female = 46, mean age of 58.6 ± 6.7 years) with a mean physical activity of 438 ± 97 (male = 521 ± 62 MET-minutes/weeks, female = 394 ± 162 MET-minutes/week). Results revealed that physical activity has significant association with the thickness of carotid intima media (p-value = 0.042). A total of 11 individuals (10%) had a carotid intima media thickness that was classified as a localized carotid artery plaque (males n = 6 and female n = 5). CONCLUSION: The proportion of time and level of physical activities is associated with thickness of intima media of common carotid artery, independently of age and established atherosclerotic risk factors.

Calculus anuria and its remedy.

BACKGROUND: Urinary lithiases have been a major urological problem. The objective was to determine the out come of treatment for patients with calculus anuria. METHODS: A descriptive study was conducted at Department of Urology Chandka Medical College Hospital, Larkana from March 2007 to April 2009. All patients with a diagnosis of calculus anuria of all ages and either sex were included in the study. Detailed history, physical examination and examination of genitourinary tract was performed. Investigations included complete blood examination, blood urea, serum creatinine, ultrasonography of KUB area, and X-Ray KUB. RESULTS: Among the 66 patients the cause of anuria was bilateral obstruction by the calculi in 46 cases, unilateral obstruction with small/absent/nephrectomised contralateral kidney in 20 cases. In most of the cases, ureteric catheterisation was done to relieve the obstruction. Five deaths were observed, despite emergency urinary diversion and appropriate treatment. CONCLUSION: Calculus anuria is a urological emergency. Prompt and early intervention can save the life of patient and prevent to develop chronic renal failure.

Detection of cerebral atrophy in type-II diabetes mellitus by magnetic resonance imaging of brain.

BACKGROUND: Diabetes is a metabolic disorder that affects many systems in the body. Cerebral atrophy is one of the complications of diabetes and research is on going to find out its aetiopathological factors. The main aim of the study was to determine the frequency of cerebral atrophy in type-II diabetes mellitus using magnetic resonance imaging of the brain. METHODS: One hundred diabetic patients (Random blood sugar >126 mg/dl) were recruited in this study after the informed consent from every patient. Duration of diabetes was five years and more in all the patients as determined by their glycosylated haemoglobin which was >6 in all the patients. All the patients were undergone MRI of brain using 1.5 Tesla power magnetic resonance imaging machine ofPicker Company. Evan's index, a specific parameter for measurement of cerebral atrophy was calculated on MR images and was used in this study. RESULTS: In male group the frequency of cerebral atrophy was 22 (47%) and in female group it was found to be 23 (43%). When we study the overall population the frequency was found to be 45 (45%). The results are well in concordance with the previous data published on this issue. CONCLUSIONS: Cerebral atrophy, a complication of long standing diabetes is quite frequent in our population and is well diagnosed by MRI.

Clinical and radiological findings in Arnold Chiari malformation.

BACKGROUND: The Chiari Malformation I (CMI) is a disorder of uncertain origin that has been traditionally defined as downward herniation of the cerebellar tonsils through the foramen magnum. The anomaly is a leading cause of syringomyelia and occurs inassociation with osseus abnormalities at the craniovertebral junction. In contrast to other Chiari malformations, CMI tends to present in the second or third decade of life and is sometimes referred to as the 'adult-type' Chiari malformation. The objective was to document clinical and radiological findings in Arnold Chiari Malformation-I. METHOD: This was a descriptive study carried out in Ayub Teaching Hospital Abbottabad at Neurosurgery Department during July 2008-July 2010. We examined a prospective cohort of 60 symptomatic patients. All patients underwent magnetic resonance imaging of the head and spine. RESULTS: There were 40 female and 20 male patients. The age of onset was 24.9 +/- 15.8 years. Common associated radiological problems included syringomyelia (60%), scoliosis (25%), and basilarinvagination (12%), increased cervical lordosis 5 (8.5%), and Klippel Feil syndrome 2 (3.3%). The most consistent magnetic resonance imaging findings were obliteration of the retrocerebellar cerebrospinal fluid spaces (70% patients), tonsillar herniation of at least 5 mm (100% patients), and varying degrees of post fossa anomalies. Linical manifestations were headaches, pseudotumor-like episodes, a Meniere's disease-like syndrome, lower cranial nerve signs, and spinal cord disturbances in the absence of syringomyelia. CONCLUSION: These data support accumulating evidence that CMI is a disorder of the para-axial mesoderm that is characterised by underdevelopment of the posterior cranial fossa and overcrowding of the normally developed hindbrain. Tonsillar herniation of less than 5 mm does not exclude the diagnosis. Clinical manifestations of CMI seem to be related to cerebrospinal fluid disturbances (which are responsible for headaches, pseudotumor-like episodes, endolymphatic hydrops, syringomyelia, and hydrocephalus) and direct compression of nervous tissue.