Inflammatory lesions of the basal ganglia and thalamus: review of twenty-one cases

We report a series of 21 patients with basal ganglia and thalamic granulomas or abscesses treated over 7 years. Among them, 15 were tubercular, 5 were pyogenic, and 1 was fungal. Pyogenic abscesses, usually hematogenous, also occurred secondary to osteomyelitis of the skull and chronic otitis media. The fungal abscess developed in a nonimmunocompromised patient with no intercurrent malignancy. Evidence of tuberculosis elsewhere in the body was detected in only 7 patients with tuberculomas. The computed tomographic (CT) image morphology characterizing an abscess or a tuberculoma was present in all except 2 patients with tuberculomas. The fungal abscess resembled a malignant glioma. The only hospital mortality occurred in a deeply unconscious patient with a thalamic pyogenic abscess. A 12-month or longer follow-up in 16 patients showed that 3 continued to be handicapped neurologically, and 2 died 13 and 16 months later, respectively. We conclude that inflammatory lesions at these sites are not uncommon and that CT scans are diagnostic in the great majority. Doubtful diagnosis merits stereotactic aspiration or biopsy of the lesion. Satisfactory results follow adequate medical therapy.

Nasal septal deviation: effective intervention and long term follow-up

Nasal septal deviation (DNS) occurs more frequently during childhood although it occurs at any age due to trauma. Recently, it has been increasingly recognized that nasal septal deviation is seen also at birth and a number of explanations for this occurrence is forwarded. Awareness of such occurrence and its recognition at birth both by pediatricians and obstetricians is essential for early interventional management of this condition in close collaboration with the otorhinolaryngologists. Closed surgical intervention of this defect carried out early after it was detected at birth benefitted the afflicted in terms of nasal airway improvement and its maintenance resulting in normalization of its anatomy and physiology in long term follow-up. Septal deviation detected at birth if left alone without interventional procedure continues to persist. It is furthermore accompanied by statistically valied symptoms like upper respiratory infections, cough, earache, ear discharge, fever, mouth breathing and at times feeding difficulty during infancy and childhood. Long term follow-up of children who underwent closed surgical correction of DNS at birth, revealed no untoward effects such as nasofacial disproportion or retardation of facial growth. Early interventional management of DNS detected at birth therefore appears to be a safe procedure. It can even be performed by neonatologists or an obstetrician. Such an intervention procedure early in life can prevent septoplasty surgery at a latter date besides preventing a number of nasal airway-related conditions.

Abnormal eye-head coordination in Parkinson's disease patients after administration of levodopa: a possible substrate of levodopa-induced dyskinesia

Head oscillations in response to whole body oscillation of Parkinsonian patients before and after administration of levodopa were compared with those of normal subjects. Parkinsonian patients developed large increases in the amplitude of their head movements while fixating a stationary target after administration of levodopa. This increase was proportional to disease severity and was maximal in stage IV patients with levodopa induced dyskinesias. These findings indicate a fundamental yet reversible change in the strategy of eye-head coordination in Parkinsonian patients after administration of levodopa which may be due to release of normally inhibited visuo-vestibular reflexes.

Chorionic villi sampling changes maternal serum alpha-fetoprotein

Second trimester amniocentesis has traditionally been utilized for prenatal genetic diagnosis. Chorionic villi sampling (CVS) is presently offered as an alternative. The occurrence of fetomaternal bleed (FMB) during CVS could increase the rate of post sampling abortion and, additionally, be of significance in patients at risk for isoimmunization. Detection and quantitation of FMB can be accomplished by the determination of changes in maternal serum alpha-fetoprotein (MSAFP) before and after CVS.

Antenatal phenobarbital for the prevention of neonatal intracerebral hemorrhage

Forty-six pregnant women less than 35 weeks of gestation were enrolled in a prospective randomized controlled study evaluating the effects of antenatal phenobarbital on neonatal intracerebral hemorrhage. The women were randomly assigned to control (n = 22) or treatment (n = 24) groups; the treatment group received 500 mg of phenobarbital intravenously. The time interval between the dose of phenobarbital and delivery was 5.5 +/- 4.8 hours (mean +/- SD). The infants in the control group (n = 23) and those in the phenobarbital-treated group (n = 25) were comparable regarding birth weight, gestational age, and other obstetric and neonatal risk factors associated with intracerebral hemorrhage. The incidence of intracerebral hemorrhage was 56.5% (13 of 23 infants) in the control group and 32% (eight of 25 infants) in the phenobarbital-treated group (p = 0.08). Moderate or severe hemorrhage was diagnosed in six of 13 control infants and in none of the phenobarbital-treated infants (p less than 0.01). The mortality rate was significantly lower in the phenobarbital-treated group (two of 25 infants) than in the control group (eight of 23 infants; p less than 0.05). Our study suggests that antenatal phenobarbital administration results in a decrease in mortality and in the severity of intracerebral hemorrhage in the preterm neonate.

Bilateral decerebration in head-injury patients. An analysis of sixty-two cases

The factors that contributed to recovery were reviewed in 62 head-injured patients with bilateral decerebration. The most important prognostic variables were age, mode of accident, time interval since injury, results of initial neurological evaluations, and the type of intracranial mass lesion. A higher survival rate was recorded in patients less than 20 years of age, those involved in nonvehicular accidents, those admitted within 6 hours of the accident, and where the vestibuloocular reflexes were preserved. Patients with extradural hematomas and those with nonsurgical intracerebral mass lesions also had a relatively better prognosis. In no patient was elective ventilation, steroid, or megadose barbiturate therapy utilized. Twenty patients (32%) of the 62 survived, and 11 patients had a good functional recovery.

Medullomyoblastoma. A teratoma

Three cases of medullomyoblastoma in children are reported. The second case is unique in that in addition to areas of medulloblastoma and rhabdomyosarcoma, there were areas of well-differentiated teratoma containing all mature elements. This observation lends support to the teratomatous nature of medullomyoblastoma.

Neuroenteric cyst of the cerebellum

Intracranial neuroenteric cysts are rarely encountered and no more than 13 cases have been reported in the literature. This paper reports another case located in the cerebellum. These occur mostly in adults and there is no typical clinical presentation. The computed tomographic scan shows them as low attenuating lesions with no peripheral contrast enhancement. These cysts are believed to be developmental in origin.

Cellulose acetate precipitation test in sero-diagnosis of amoebiasis

Cellulose acetate precipitation (CAP) test for the detection of antibody against Entamoeba histolytica using the axenic antigen, was performed on the 127 serum samples obtained from patients with amoebic liver abscess (14), amoebic hepatitis (21), amoebic dysentry (11), amoebic colitis (31), other parasitic infestations (25) and normal individuals (25). The percent positivity was 100, 95.23, 90.9, 67.74 and 16 and 12 respectively whereas the corresponding figures for the indirect immunoflourescence (IFAT) test were 100, 100, 100, 74.19, 12 and 8 respectively. Although CAP is not as good a test as IFAT, yet it can be recommended for routine testing due to its sensitivity, speed of performance and applicability to a single serum sample.

Antibody response to human diploid cell antirabies vaccine in human volunteers--a preliminary study

HDCS was given to 12 healthy volunteers in three different schedules. The levels of neutralising antibodies were determined by ELISA test. The antibodies could be detected on day 7 after vaccination. With 3 doses (D-0, D-15, D-30) satisfactory high level of neutralising antibodies could be detected in 3 out of 4 volunteers till 2 years. With 2 doses (D-0, D-15) similar levels could be observed only till day 270, and with single dose significant levels could be seen till day 30 only after which levels declined and no antibodies could be detected on day 270. Reactogenicity of the vaccine was nil as no major or minor side-effects were observed in any of the volunteer.

Immunodiagnosis of bacterial meningitis

The quest for the search of rapid, cheap, easy to perform and highly sensitive and specific tests has resulted into the introduction and application of various new tests for the diagnosis of bacterial meningitis. Most of these tests are based on immunological principles, viz. counter-immunoelectrophoresis, latex agglutination test, co-agglutination, radio-immunoassay, haemagglutination inhibition as well as study of immune profile of cerebrospinal fluid. Apart from these certain non-immunological tests viz. Limulus amoebecyte lysate test, gas liquid chromatography, nitroblue tetrazolium dye reduction test have also been evaluated to make the laboratory diagnosis of this important clinical entity rapid and more reliable. These tests have been discussed and their current status presented.

Immunoprophylaxis against rabies

Rabies is responsible for a large extent of morbidity and mortality in human beings. However, the long incubation period of the disease allows the effective utilization of post exposure immunization. Till recently neural tissue vaccines were the mainstay of antirabic immunoprophylaxis. These vaccines are, associated with severe neuroparalytic complications. The recent introduction of human diploid cell vaccine and chick embro fibroblast vaccines have heralded a new era in antirabic vaccination because of their high immunogenicity and lack of major side effects.