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Gaikwad SB, Charan BD, Jain S. Imaging Feature of Leukoencephalopathy with Calcifications and Cysts (Labrune Syndrome). World Neurosurg 2024; 187:147-148. [PMID: 38649023 DOI: 10.1016/j.wneu.2024.04.083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Revised: 04/12/2024] [Accepted: 04/15/2024] [Indexed: 04/25/2024]
Abstract
Labrune syndrome is an uncommon central nervous system disorder characterized by leukoencephalopathy, cerebral calcifications, and cysts on brain imaging. The basic pathology is microangiopathy resulting from a mutation in the SNORD118 gene. Radiological imaging is the hallmark of the disease.
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Affiliation(s)
- Shailesh B Gaikwad
- Departments of Neuroimaging and Interventional Neuroradiology, All India Institute of Medical Sciences, New Delhi, India
| | - Bheru Dan Charan
- Departments of Neuroimaging and Interventional Neuroradiology, All India Institute of Medical Sciences, New Delhi, India.
| | - Savyasachi Jain
- Departments of Neuroimaging and Interventional Neuroradiology, All India Institute of Medical Sciences, New Delhi, India
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Nayak MK, Mishra B, Levejoseph S, Garg A, Sarma K, Sahoo B, Tripathi M, Gaikwad SB. Emerging insights into cephalic neural crest disorders: A single center experience. J Clin Imaging Sci 2024; 14:3. [PMID: 38469176 PMCID: PMC10927042 DOI: 10.25259/jcis_87_2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Accepted: 11/19/2023] [Indexed: 03/13/2024] Open
Abstract
Objectives Neural crest cells (NCCs) are transient structures in the fetal life in vertebrates, which develop at the junctional site of the non-neural and neural ectoderm, sharing a common developmental origin for diverse diseases. After Epithelio-mesenchymal (EMT) of the NCCs within the neural tube, delamination of NCCs occurs. After delamination, the transformation of these cells into various cell lineages produces melanocytes, bones, and cartilage of the skull, cells of the enteric and peripheral nervous system. After the conversion, these cells migrate into various locations of the entire body according to the cell lineage. Abnormalities in neural crest (NC) formation and migration result in various malformations and tumors, known as neurocristopathy. Material and Methods Herein, this case series describes a single-center experience in cephalic NC disorders over the past 3 years, including 17 cases of varying composition (i.e., vascular, dysgenetic, mixed, and neoplastic forms) involving the brain and occasionally skin, eyes, and face of the patients. Results In our study of 17 patients with cephalic NC disease, 6 (35.3%) patients had vascular form, 5 (29.4%) had dysgenetic form, 4 (23.5%) had mixed form, and 2 (11.7%) had neoplastic form. Brain involvement in the form of vascular or parenchyma or both vascular and parenchymal was seen in all of our patients (100%), skin in 6 (35.3%) patients, eye in 2 (11.7%), and face in 1 (5.9%) patient. Treatment was planned according to the various manifestations of the disease. Conclusion Neural crest diseases (NCDs) are a rare and under-recognized group of disorders in the literature and may have been under-reported due to a lack of awareness regarding the same. More such reporting may increase the repertoire of these rare disorders such that clinicians can have a high degree of suspicion leading to early detection and timely counseling and also improve preventive strategies and help in developing new drugs for these disorders or prevent them.
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Affiliation(s)
- Manoj Kumar Nayak
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Biswamohan Mishra
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | - Sebastian Levejoseph
- Department of Neuroimaging and Interventional Neuroradiology, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | - Ajay Garg
- Department of Neuroimaging and Interventional Neuroradiology, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | - Kalyan Sarma
- Department of Radiology, All India Institute of Medical Sciences, Guwahati, India
| | - Biswajit Sahoo
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Manjari Tripathi
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | - Shailesh B. Gaikwad
- Department of Neuroimaging and Interventional Neuroradiology, All India Institute of Medical Sciences, New Delhi, Delhi, India
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Phuyal S, Gaikwad SB, Garg A, Jain N, Nayak M, Devarajan LJ. Radiological Features and Management of Intracranial Aneurysms Associated With Moyamoya Disease: A Case Series of Single-Center Experience. Cureus 2024; 16:e52370. [PMID: 38361698 PMCID: PMC10867726 DOI: 10.7759/cureus.52370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/15/2024] [Indexed: 02/17/2024] Open
Abstract
Background Moyamoya disease (MMD) can be a major cause of hemorrhagic stroke. Though extensive angiographic studies have been undertaken, the understanding of the association between aneurysms and MMD remains unanswered. In this study, we explore the association of the aneurysm with MMD and its management. We have also reviewed such associations described in the literature and how the present cases differ from those previously described. Materials and methods The clinical and radiologic data of moyamoya disease cases were accessed from medical and radiological records between January 2010 and July 2017. Two neuroradiologists independently analyzed the data and imaging details. Results Out of 103 patients with MMD, eight patients (7.77%) had associated intracranial aneurysms with eleven aneurysms. Out of the 11 aneurysms, five were the tip of the basilar artery aneurysms and were the most common location for aneurysm (45.5%), followed by lenticulostriate artery, PCA perforator, and distal ACA (DACA) in the P1 PCA, P2 PCA, and P3 PCA artery aneurysms. Out of eight patients, five (62.5%) had a hemorrhage on a non-contrast computed tomography (NCCT) scan of the brain, whereas three (37.5%) had an ischemic presentation. Out of 11 aneurysms, seven aneurysms, including three basilar tip aneurysms (unruptured) and one PCA perforator (ruptured), and three saccular PCA (P1, P2, and P3) (ruptured) were treated by endovascular coiling. Follow-up angiography showed stable aneurysmal occlusion except in one basilar tip, where recurrence was observed. Conclusions MMD-intracranial aneurysm is commonly observed in patients with intracranial hemorrhage and carries a higher risk of rupture. Therefore, identification of the aneurysm is essential for management. Endovascular treatment, either with coil or glue embolization, can be a safe and effective treatment method for such aneurysms with long-term good results.
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Affiliation(s)
- Subash Phuyal
- Neuroimaging and Interventional Neuroradiology, Upendra Devkota Memorial (UDM) National Institute of Neurological and Allied Sciences, Kathmandu, NPL
| | - Shailesh B Gaikwad
- Neuroimaging and Interventional Neuroradiology, All India Institute of Medical Sciences, New Delhi, New Delhi, IND
| | - Ajay Garg
- Neuroimaging and Interventional Neuroradiology, All India Institute of Medical Sciences, New Delhi, New Delhi, IND
| | - Nishchint Jain
- Neuroimaging and Interventional Neuroradiology, All India Institute of Medical Sciences, New Delhi, New Delhi, IND
| | - Manoj Nayak
- Radiodiagnosis, All India Institute of Medical Sciences, Bhubaneswar, Bhubaneswar, IND
| | - Leve J Devarajan
- Neuroimaging and Interventional Neuroradiology, All India Institute of Medical Sciences, New Delhi, New Delhi, IND
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Gupta A, Rajan R, Joy S, Yadav CS, Tripathi M, Gaikwad SB, Vishnu VY, Singh MB, Bhatia R, Mahadevan A, Srivastava MVP. Neuronal Antibody-Associated Corticobasal Syndrome. Ann Indian Acad Neurol 2023; 26:787-789. [PMID: 38022470 PMCID: PMC10666851 DOI: 10.4103/aian.aian_560_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Revised: 08/15/2023] [Accepted: 08/16/2023] [Indexed: 12/01/2023] Open
Affiliation(s)
- Anu Gupta
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Roopa Rajan
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Shiny Joy
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | | | - Madhavi Tripathi
- Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Shailesh B. Gaikwad
- Department of Neuroimaging and Interventional Neuroradiology, All India Institute of Medical Sciences, New Delhi, India
| | - VY Vishnu
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Mamta B. Singh
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Rohit Bhatia
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Anita Mahadevan
- Department of Neuropathology, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
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Mahajan A, Nayak MK, Gaikwad SB, Sharma K, Padma Srivastava MV, Anand P, Oinam R, Mishra BM. Post-Vaccination/Post-COVID Immune-Mediated Demyelination of the Brain and Spinal Cord: A Novel Neuroimaging Finding. Neurol India 2023; 71:86-91. [PMID: 36861579 DOI: 10.4103/0028-3886.370449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/03/2023]
Abstract
Introduction Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causes coronavirus disease 2019 (COVID-19), which not only produces respiratory symptoms but is known to involve almost every system, and its neuroinvasive properties have been well demonstrated throughout the pandemic. Also, to combat the pandemic, there was rapid development and induction of various vaccination drives, following which many adverse events following immunization (AEFIs) have been reported, which include neurological complications as well. Method We present a series of three cases, post vaccination, with and without a history of COVID illness that showed remarkably similar findings on magnetic resonance imaging (MRI). Result A 38-year-old male presented with complaints of weakness of the bilateral lower limbs with sensory loss and bladder disturbance a day after receiving his first dose of ChadOx1 nCoV-19 (COVISHIELD) vaccine. A 50-year-old male with hypothyroidism characterized by autoimmune thyroiditis and impaired glucose tolerance experienced difficulty in walking 11.5 weeks after being administered with COVID vaccine (COVAXIN). A 38-year-old male presented with subacute onset progressive symmetric quadriparesis 2 months after their first dose of a COVID vaccine. The patient also had sensory ataxia, and his vibration sensation was impaired below C7. All three patients had typical pattern of involvement of the brain and spine on MRI with signal changes in bilateral corticospinal tracts, trigeminal tracts in the brain, and both lateral and posterior columns in the spine. Conclusion This pattern of brain and spine involvement on MRI is a novel finding and is likely a result of post-vaccination/post-COVID immune-mediated demyelination.
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Affiliation(s)
- Ashima Mahajan
- Department of Neuroimaging and Interventional Neuro-Radiology, All India Institute of Medical Sciences, New Delhi, India
| | - Manoj K Nayak
- Department of Neuroimaging and Interventional Neuro-Radiology, All India Institute of Medical Sciences, New Delhi, India
| | - Shailesh B Gaikwad
- Department of Neuroimaging and Interventional Neuro-Radiology, All India Institute of Medical Sciences, New Delhi, India
| | - Kalyan Sharma
- Department of Neuroimaging and Interventional Neuro-Radiology, All India Institute of Medical Sciences, New Delhi, India
| | | | - Pooja Anand
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Rahul Oinam
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Biswa Mohan Mishra
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
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Nair P, Prasad K, Balasundaram P, Vibha D, Nand Dwivedi S, Gaikwad SB, Srivastava AK, Verma V. Multimodal imaging of the aging brain: Baseline findings of the LoCARPoN study. Aging Brain 2023; 3:100075. [PMID: 37180873 PMCID: PMC10173278 DOI: 10.1016/j.nbas.2023.100075] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 04/07/2023] [Accepted: 04/11/2023] [Indexed: 05/16/2023] Open
Abstract
We quantified and investigated multimodal brain MRI measures in the LoCARPoN Study due to lack of normative data among Indians. A total of 401 participants (aged 50-88 years) without stroke or dementia completed MRI investigation. We assessed 31 brain measures in total using four brain MRI modalities, including macrostructural (global & lobar volumes, white matter hyperintensities [WMHs]), microstructural (global and tract-specific white matter fractional anisotropy [WM-FA] and mean diffusivity [MD]) and perfusion measures (global and lobar cerebral blood flow [CBF]). The absolute brain volumes of males were significantly larger than those of females, but such differences were relatively small (<1.2% of intracranial volume). With increasing age, lower macrostructural brain volumes, lower WM-FA, greater WMHs, higher WM-MD were found (P = 0.00018, Bonferroni threshold). Perfusion measures did not show significant differences with increasing age. Hippocampal volume showed the greatest association with age, with a reduction of approximately 0.48%/year. This preliminary study augments and provides insight into multimodal brain measures during the nascent stages of aging among the Indian population (South Asian ethnicity). Our findings establish the groundwork for future hypothetical testing studies.
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Affiliation(s)
- Pallavi Nair
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Kameshwar Prasad
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
- Department of Neurology, Rajendra Institute of Medical Sciences, Ranchi, Jharkhand, India
- Corresponding author at: Director’s Cell, Rajendra Institute of Medical Sciences, Ranchi 834009, Jharkhand, India.
| | - Parthiban Balasundaram
- Department of Neuroradiology, All India Institute of Medical Sciences, New Delhi, India
- Department of Neuroradiology, Kings College Hospital, London, UK
| | - Deepti Vibha
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Sada Nand Dwivedi
- Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India
| | | | - Achal K. Srivastava
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Vivek Verma
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
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Gupta D, Kedia S, Rath GP, Pandia MP, Chauhan S, Sharma R, Raheja A, Darbari S, Kamra D, Malik V, Saxena A, Hote M, Lodha R, Gulati S, Jauhari P, Sankar J, Sinha A, Bagga A, Kapil A, Singhal M, Chauhan S, Tiwari R, Prabhakar A, Gaikwad SB, Takizawa K, Sabapathy SR, Mazzeo AT, Jaryal A, Kale SS, Mahapatra AK. A Century With Craniopagus Twin Separation Surgeries: Nihilism to Optimism. Neurosurgery 2022; 91:27-42. [PMID: 35506944 DOI: 10.1227/neu.0000000000001962] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 01/08/2022] [Indexed: 11/19/2022] Open
Abstract
Craniopagus conjoined twins are extremely rare, reported 1 in 2.5 million live births. To date, 62 separation attempts in 69 well-documented cases of craniopagus twins have been made. Of these, 34 were performed in a single-stage approach, and 28 were attempted in a multistage approach. One or both twins died of massive intraoperative blood loss and cardiac arrest in 14 cases. We report our surgical experience with conjoined craniopagus twins (JB) with type III total vertical joining and shared circumferential/circular sinus with left-sided dominance. A brief review of the literature is also provided. In our twins, the meticulous preoperative study and planning by the multidisciplinary team consisting of 125-member, first-staged surgical separation consisted of creation of venous conduit to bypass part of shared circumferential sinus and partial hemispheric disconnection. Six weeks later, twin J manifested acute cardiac overload because of one-way fistula development from blocked venous bypass graft necessitating emergency final separation surgery. Unique perioperative issues were abnormal anatomy, hemodynamic sequelae from one-way fistula development after venous bypass graft thrombosis, cardiac arrest after massive venous air embolism requiring prolonged cardiopulmonary resuscitation, and return of spontaneous circulation at 15 minutes immediately after separation. This is the first Indian craniopagus separation surgery in a complex total vertical craniopagus twin reported by a single-center multidisciplinary team. Both twins could be sent home, but one remained severely handicapped. Adequate perioperative planning and multidisciplinary team approach are vital in craniopagus twin separation surgeries.
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Affiliation(s)
- Deepak Gupta
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Shweta Kedia
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Girija Prasad Rath
- Department of Neuroanesthesia, All India Institute of Medical Sciences, New Delhi, India
| | - Mihir Prakash Pandia
- Department of Neuroanesthesia, All India Institute of Medical Sciences, New Delhi, India
| | - Sandeep Chauhan
- Department of Cardiac Anesthesia, All India Institute of Medical Sciences, New Delhi, India
| | - Rajeev Sharma
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Amol Raheja
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Shaurya Darbari
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Devasheesh Kamra
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Vishwas Malik
- Department of Cardiac Anesthesia, All India Institute of Medical Sciences, New Delhi, India
| | - Anita Saxena
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India
| | - Milind Hote
- Department of Cardiothoracic and Vascular Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Rakesh Lodha
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Sheffali Gulati
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Prashant Jauhari
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Jhuma Sankar
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Aditi Sinha
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Arvind Bagga
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Arti Kapil
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India
| | - Maneesh Singhal
- Department of Plastic and Reconstructive Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Shashank Chauhan
- Department of Plastic and Reconstructive Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Raja Tiwari
- Department of Plastic and Reconstructive Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Anuj Prabhakar
- Department of Neuroimaging and Interventional Neuroradiology, All India Institute of Medical Sciences, New Delhi, India
| | - Shailesh B Gaikwad
- Department of Neuroimaging and Interventional Neuroradiology, All India Institute of Medical Sciences, New Delhi, India
| | - Katsumi Takizawa
- Department of Neurosurgery, Asahikawa Red Cross Hospital, Asahikawa, Japan
| | - S Raja Sabapathy
- Division of Plastic Surgery, Hand Surgery, Reconstructive Surgery and Burns, Ganga Hospital, Coimbatore, India
| | - Anna Teresa Mazzeo
- Department of Adult and Pediatric Pathology, University of Messina, Messina, Italy
| | - Ashok Jaryal
- Department of Physiology, All India Institute of Medical Sciences, New Delhi, India
| | - Shashank Sharad Kale
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Ashok Kumar Mahapatra
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
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Bhatia R, Sylaja PN, Srivastava MVP, Komakula S, Iype T, Parthasarathy R, Khurana D, Pardasani V, Pamidimukkala V, Kumaravelu S, Pandian J, Kushwaha S, Chowdhury D, Gupta S, Rajendran SP, Reddy R, Roy J, Sharma A, Nambiar V, Rai NK, Upadhyay AD, Parkipandla S, Singh MB, Vibha D, Vishnu VY, Rajan R, Gupta A, Pandit AK, Agarwal A, Gaikwad SB, Garg A, Joseph L, Sreedharan SE, Reddy S, Sreela K, Ramachandran D, George GB, Panicker P, Suresh MK, Gupta V, Ray S, Suri V, Ahuja C, Kajal K, Lal V, Singh RK, Oza H, Halani H, Sanivarapu S, Sahonta R, Duggal A, Dixit P, Kulkarni GB, Taallapalli AVR, Parmar M, Chalasani V, Kashyap M, Misra B, Pachipala S, Yogeesh PM, Salunkhe M, Gupta P. Clinical profile and outcome of non-COVID strokes during pandemic and the pre pandemic period: COVID-Stroke Study Group (CSSG) India. J Neurol Sci 2021; 428:117583. [PMID: 34375915 PMCID: PMC8282445 DOI: 10.1016/j.jns.2021.117583] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 05/02/2021] [Accepted: 07/13/2021] [Indexed: 11/26/2022]
Abstract
Background As the health systems around the world struggled to meet the challenges of COVID-19 pandemic, care of many non-COVID emergencies was affected. Aims The present study examined differences in the diagnosis, evaluation and management of stroke patients during a defined period in the ongoing pandemic in 2020 when compared to a similar epoch in year 2019. Methods The COVID stroke study group (CSSG) India, included 18 stroke centres spread across the country. Data was collected prospectively between February and July 2020 and retrospectively for the same period in 2019. Details of demographics, stroke evaluation, treatment, in-hospital and three months outcomes were collected and compared between these two time points. Results A total of 2549 patients were seen in both study periods; 1237 patients (48.53%) in 2019 and 1312 (51.47%) in 2020. Although the overall number of stroke patients and rates of thrombolysis were comparable, a significant decline was observed in the month of April 2020, during the initial period of the pandemic and lockdown. Endovascular treatment reduced significantly and longer door to needle and CT to needle times were observed in 2020. Although mortality was higher in 2020, proportion of patients with good outcome were similar in both the study periods. Conclusions Although stroke admissions and rates of thrombolysis were comparable, some work flow metrics were delayed, endovascular stroke treatment rates declined and mortality was higher during the pandemic study period. Reorganization of stroke treatment pathways during the pandemic has likely improved the stroke care delivery across the globe.
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Affiliation(s)
- Rohit Bhatia
- Department of Neurology, All India Institute of Medical Sciences (AIIMS), New Delhi, India.
| | - P N Sylaja
- Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology (SCTIMST), Thiruvananthapuram, India
| | - M V Padma Srivastava
- Department of Neurology, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Snigdha Komakula
- Department of Neurology, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Thomas Iype
- Department of Neurology, Government Medical College, Thiruvananthapuram, India
| | | | - Dheeraj Khurana
- Department of Neurology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | | | - Vijaya Pamidimukkala
- Department of Neurology, Lalitha Super Specialities Hospital Pvt. Ltd, Guntur, India
| | - S Kumaravelu
- Department of Neurology, Ramesh Hospitals, Guntur, India
| | - Jeyaraj Pandian
- Department of Neurology, Christian Medical College, Ludhiana, India
| | - Suman Kushwaha
- Department of Neurology, Institute of Human Behavior and Allied Sciences (IBHAS), New Delhi, India
| | - Debashish Chowdhury
- Department of Neurology, Gobind Ballabh Pant Institute of Postgraduate Education and Research (GIPMER), New Delhi, India
| | - Salil Gupta
- Department of Neurology, Command Hospital, Bengaluru, India
| | - Srijithesh P Rajendran
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), India
| | - Rajshekar Reddy
- Department of Neurology, Max Hospital Saket, New Delhi, India
| | - Jayanta Roy
- Department of Neurology, Institute of Neurosciences, Kolkata, India
| | - Arvind Sharma
- Zydus Hospital, BJMC & Civil Hospital, Ahmedabad, India
| | - Vivek Nambiar
- Department of Neurology, Amrita Institute of Medical Sciences, Kochi, India
| | - Nirendra Kumar Rai
- Department of Neurology, All India Institute of Medical Sciences, Bhopal, India
| | - Ashish Datt Upadhyay
- Department of Biostatistics, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Sathish Parkipandla
- Department of Neurology, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Mamta Bhushan Singh
- Department of Neurology, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Deepti Vibha
- Department of Neurology, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Venugopalan Y Vishnu
- Department of Neurology, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Roopa Rajan
- Department of Neurology, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Anu Gupta
- Department of Neurology, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Awadh Kishore Pandit
- Department of Neurology, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Ayush Agarwal
- Department of Neurology, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Shailesh B Gaikwad
- Department of Neuroimaging and Interventional Neuroradiology, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Ajay Garg
- Department of Neuroimaging and Interventional Neuroradiology, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Leve Joseph
- Department of Neuroimaging and Interventional Neuroradiology, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Sapna Erat Sreedharan
- Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology (SCTIMST), Thiruvananthapuram, India
| | - Sritheja Reddy
- Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology (SCTIMST), Thiruvananthapuram, India
| | - Krishna Sreela
- Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology (SCTIMST), Thiruvananthapuram, India
| | - Dileep Ramachandran
- Department of Neurology, Government Medical College, Thiruvananthapuram, India
| | - Githin Benoy George
- Department of Neurology, Government Medical College, Thiruvananthapuram, India
| | - Praveen Panicker
- Department of Neurology, Government Medical College, Thiruvananthapuram, India
| | - M K Suresh
- Department of Medicine, Government Medical College, Thiruvananthapuram, India
| | - Vipul Gupta
- Department of Neurointerventional Surgery, Artemis Hospital, Gurgaon, India
| | - Sucharita Ray
- Department of Neurology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Vikas Suri
- Department of Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Chirag Ahuja
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Kamal Kajal
- Department of Anaesthesia, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Vivek Lal
- Department of Neurology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | | | - Harsh Oza
- Department of Neurology, Bombay Hospital, Mumbai, India
| | - Hiral Halani
- Department of Neurology, Bombay Hospital, Mumbai, India
| | | | | | - Ashish Duggal
- Department of Neurology, Gobind Ballabh Pant Institute of Postgraduate Education and Research (GIPMER), New Delhi, India
| | - Prashant Dixit
- Department of Neurology, Command Hospital, Bengaluru, India
| | - Girish Baburao Kulkarni
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), India
| | - A V R Taallapalli
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), India
| | - Mamta Parmar
- Zydus Hospital, BJMC & Civil Hospital, Ahmedabad, India
| | - Vamsi Chalasani
- Department of Neurology, Amrita Institute of Medical Sciences, Kochi, India
| | - Manshi Kashyap
- Department of Neurology, All India Institute of Medical Sciences, Bhopal, India
| | - Biswamohan Misra
- Department of Neurology, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Sudheer Pachipala
- Department of Neurology, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - P M Yogeesh
- Department of Neurology, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Manish Salunkhe
- Department of Neurology, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Pranjal Gupta
- Department of Neurology, All India Institute of Medical Sciences (AIIMS), New Delhi, India
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Gaikwad SB, Puneeth KT, Nadarajah J, Gupta MM. Complex basilar artery fenestration aneurysm successfully treated with single flow diverter using novel "crossing flow diverter technique" - A rare case report and review of literature. Interv Neuroradiol 2021; 27:391-396. [PMID: 33601975 DOI: 10.1177/1591019921996094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Basilar artery fenestration aneurysms are very rare and endovascular management of large and complex aneurysms is extremely challenging. Most of these type of cases are managed with stent assisted coiling, dual flow diverters (FD) and single FD with additional coiling of aneurysm and occlusion of one of the vertebral artery. Here, we report a case of large complex basilar artery fenestration aneurysm successfully treated with single FD using novel technique called "crossing flow diverter technique" without any additional coiling of aneurysm or occlusion of vertebral artery. Using this technique cost of procedure and procedural complexity inherent with other above mentioned techniques can be significantly reduced.
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Affiliation(s)
- Shailesh B Gaikwad
- Department of Neuroimaging and interventional Neuroradiology, CN Center, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - K T Puneeth
- Department of Neuroimaging and interventional Neuroradiology, CN Center, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Jeyaseelan Nadarajah
- Department of Neuroimaging and interventional Neuroradiology, CN Center, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Madan M Gupta
- Department of Neuroimaging and interventional Neuroradiology, CN Center, All India Institute of Medical Sciences (AIIMS), New Delhi, India
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10
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Nadarajah J, Sebastian LJD, Puneeth KT, Prabhakar A, Garg A, Gaikwad SB, Kumar A. Filar arteriovenous fistula associated with anomalous common posterior intercostal arterial trunk - A case report and review of literature. Interv Neuroradiol 2020; 26:514-518. [PMID: 32524864 DOI: 10.1177/1591019920931650] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
An anomalous common trunk giving rise to bilateral intercostal arteries at multiple levels is exceedingly rare and its association with spinal filar AVF and low-lying cord has not been reported so far. Here, we report this uncommon anatomical variation in a 60-year-old male who presented with paraplegia and on imaging found to have low-lying spinal cord with filar AVF and venous congestive myelopathy and discuss its embryological basis and associated malformations. Although rare, interventional radiologists should be aware of this entity, as these trunks may be a major source of bleeding in patients with hemoptysis, and also may be involved in vital spinal cord supply.
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Affiliation(s)
- Jeyaseelan Nadarajah
- Department of Neuroimaging and Interventional Neuroradiology, All India Institute of Medical Sciences, New Delhi, India
| | | | - K T Puneeth
- Department of Neuroimaging and Interventional Neuroradiology, All India Institute of Medical Sciences, New Delhi, India
| | - Anuj Prabhakar
- Department of Neuroimaging and Interventional Neuroradiology, All India Institute of Medical Sciences, New Delhi, India
| | - Ajay Garg
- Department of Neuroimaging and Interventional Neuroradiology, All India Institute of Medical Sciences, New Delhi, India
| | - S B Gaikwad
- Department of Neuroimaging and Interventional Neuroradiology, All India Institute of Medical Sciences, New Delhi, India
| | - Amandeep Kumar
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
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11
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Nadarajah J, Jain N, Sebastian LJD, Gaikwad SB, Garg A, Prabhakar A. Endovascular management of a ruptured aneurysm associated with distal PICA fenestration. Interv Neuroradiol 2019; 25:430-433. [PMID: 30922197 DOI: 10.1177/1591019919838194] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Fenestrations are rare but well-known arterial anatomic variations in which a segment of artery divides into two parallel channels that reunite distally. Although fenestrations as such are asymptomatic, they have gained clinical significance because of their association with aneurysms and other intracranial vascular pathologies. Here we present a 35-year-old woman with history of sudden severe occipital headache and vomiting. Imaging revealed a ruptured aneurysm in the distal posterior inferior cerebellar artery arising from one of the limbs of the fenestration. The aneurysm was successfully managed by coiling, and the patient made complete recovery without neurological sequelae.
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Affiliation(s)
- Jeyaseelan Nadarajah
- Department of Neuroimaging and Interventional Neuroradiology, All India Institute of Medical Sciences, New Delhi, India
| | - Nishchint Jain
- Department of Neuroimaging and Interventional Neuroradiology, All India Institute of Medical Sciences, New Delhi, India
| | | | - S B Gaikwad
- Department of Neuroimaging and Interventional Neuroradiology, All India Institute of Medical Sciences, New Delhi, India
| | - Ajay Garg
- Department of Neuroimaging and Interventional Neuroradiology, All India Institute of Medical Sciences, New Delhi, India
| | - Anuj Prabhakar
- Department of Neuroimaging and Interventional Neuroradiology, All India Institute of Medical Sciences, New Delhi, India
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12
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Garg A, Kaur KP, Devaranjan Sebastian LJ, Gaikwad SB, Bhatia R, Singh MB, Srivastava A, Pandey RM. Conglomerate Ring-Enhancing Lesions are Common in Solitary Neurocysticercosis and do not always Suggest Neurotuberculosis. Ann Indian Acad Neurol 2019; 22:67-72. [PMID: 30692762 PMCID: PMC6327694 DOI: 10.4103/aian.aian_221_18] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Background and Purpose: Differentiating between neurocysticercosis (NCC) and neurotuberculosis has serious therapeutic implications and this distinction relies heavily on neuroimaging. Few case reports discuss the conglomeration of ring-enhancing lesions (RELs) in patients with solitary NCC. The aim of our study is to describe the imaging findings of conglomerate RELs in a cohort of patients with solitary NCC, emphasizing the frequency of conglomeration. Materials and Methods: This retrospective study included 100 patients with solitary NCC. Two neuroradiologists analyzed contrast-enhanced computed tomography (CT) images regarding morphology, enhancement pattern, location, number of lesions, and degree of perilesional edema. The solitary lesions were classified as solitary discrete RELs (SD-RELs) when a well-defined lesion was seen and solitary conglomerate RELs (SC-RELs) when two or more ring lesions or ring/rings plus disc lesions were present contiguously. Follow-up CT scans were evaluated for the resolution of lesions and surrounding edema. Results: Out of 100 patients, 42 were SD-RELs and 58 were SC-RELs. No statistically significant difference was found between both groups in terms of age of presentation, clinical presentation, lesion size and location, and degree of perilesional edema. Larger lesions (>10 mm) were more likely to show scolex and were associated with greater degree of edema in both subgroups. During follow-up, 13 patients had new lesions (SD-RELs-5, SC-RELs-8). In SD-RELs, follow-up lesions were in the same location in four patients and new location in one; and in SC-RELs, lesions were in the same location in seven and in new location in one case. Conclusion: Conglomeration of RELs is a common finding in patients with solitary NCC.
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Affiliation(s)
- Ajay Garg
- Department of Neuroimaging and Interventional Neuroradiology, All India Institute of Medical Sciences, New Delhi, India
| | - Khush Preet Kaur
- Department of Neuroimaging and Interventional Neuroradiology, All India Institute of Medical Sciences, New Delhi, India
| | | | - Shailesh B Gaikwad
- Department of Neuroimaging and Interventional Neuroradiology, All India Institute of Medical Sciences, New Delhi, India
| | - Rohit Bhatia
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Mamta Bhushan Singh
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Achal Srivastava
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Ravindra Mohan Pandey
- Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India
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13
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Balasundaram P, Garg A, Prabhakar A, Joseph Devarajan LS, Gaikwad SB, Khanna G. Evolution of epidermoid cyst into dermoid cyst: Embryological explanation and radiological-pathological correlation. Neuroradiol J 2019; 32:92-97. [PMID: 30604653 DOI: 10.1177/1971400918821086] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Intracranial dermoid and epidermoid cysts are usually considered to be two different entities in the radiological and surgical literature. Epidermoid cysts are classically off midline in location, isointense to cerebrospinal fluid on T1 and T2-weighted images and have restricted diffusion, whereas dermoid cysts are classically midline in location, have T1-hyperintense regions due to the presence of fat and show facilitated diffusion. We report a case of radiological epidermoid cyst in baseline imaging, which evolved into a radiological dermoid cyst over time, and explain this unique occurrence with a review of the embryology and histopathogenesis of these cysts.
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Affiliation(s)
- Parthiban Balasundaram
- 1 Department of Neuroimaging and Interventional Neuroradiology, All India Institute of Medical Sciences, India
| | - Ajay Garg
- 1 Department of Neuroimaging and Interventional Neuroradiology, All India Institute of Medical Sciences, India
| | - Anuj Prabhakar
- 1 Department of Neuroimaging and Interventional Neuroradiology, All India Institute of Medical Sciences, India
| | - Leve S Joseph Devarajan
- 1 Department of Neuroimaging and Interventional Neuroradiology, All India Institute of Medical Sciences, India
| | - Shailesh B Gaikwad
- 1 Department of Neuroimaging and Interventional Neuroradiology, All India Institute of Medical Sciences, India
| | - Gaurav Khanna
- 2 Department of Pathology, All India Institute of Medical Sciences, India
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14
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Nadarajah J, Sebastian LJD, Jain N, Gaikwad SB, Jauhari P, Saini A. Endovascular Management of a Rare Case of Pediatric Vertebral Artery Mycotic Aneurysm: A Case Report. Pediatr Neurosurg 2018; 53:346-350. [PMID: 29975956 DOI: 10.1159/000490063] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Accepted: 05/08/2018] [Indexed: 11/19/2022]
Abstract
Pediatric posterior-circulation aneurysms are uncommon, difficult-to-treat lesions associated with significant morbidity and mortality. Infections and trauma are important risk factors in children. Here, we present a 10-year-old boy with a lower respiratory tract infection, rapidly progressive right-neck swelling, and weakness of the right upper limb. Imaging revealed a partially thrombosed right vertebral-artery pseudoaneurysm with multiple cavitory lung lesions. Subsequent laboratory work-up showed underlying primary immunodeficiency disorder (chronic granulomatous disease). The aneurysm was successfully managed by parent-artery occlusion. The child made a complete recovery without neurological sequelae.
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Affiliation(s)
- Jeyaseelan Nadarajah
- Department of Neuroimaging and Interventional Neuroradiology, All India Institute of Medical Sciences, New Delhi, India
| | | | - Nishchint Jain
- Department of Neuroimaging and Interventional Neuroradiology, All India Institute of Medical Sciences, New Delhi, India
| | - S B Gaikwad
- Department of Neuroimaging and Interventional Neuroradiology, All India Institute of Medical Sciences, New Delhi, India
| | - Prashant Jauhari
- Child Neurology Division, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Ashish Saini
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
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15
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Shambanduram SS, Devarajan Sebastian LJ, Jain N, Garg A, Gaikwad SB. Management of a rare case of posterior condylar canal dural arteriovenous fistula presenting with subarachnoid haemorrhage: A case report and review of literature. Interv Neuroradiol 2017; 24:206-209. [PMID: 29199500 DOI: 10.1177/1591019917743703] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Posterior condylar canal dural arteriovenous fistula (PCC dAVF) is a rare entity with only three cases having been reported so far in the English literature. We describe the clinical presentation, imaging, and endovascular management of an elderly man with left PCC dAVF presenting with subarachnoid haemorrhage (SAH). Endovascular management of such cases requires thorough understanding of the vascular anatomy around the craniovertebral junction (CVJ) and variable bridging vein draining patterns. The fistula in our case was fed by the posterior meningeal branch of the left vertebral artery and was draining through a dilated and tortuous medullary bridging vein into the antero-lateral pontomedullary venous system. Transarterial glue embolisation was performed with complete exclusion of the fistula and venous pouches. The patient developed intractable hiccough and left-sided facial pain on the second post-procedural day, and MRI showed focal diffusion restriction in the left dorso-lateral medulla. He recovered completely after a short course of steroids.
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Affiliation(s)
- Somorendra Singh Shambanduram
- Department of Neuroimaging and Interventional Neuroradiology, All India Institute of Medical Sciences, New Delhi, India
| | | | - Nishchint Jain
- Department of Neuroimaging and Interventional Neuroradiology, All India Institute of Medical Sciences, New Delhi, India
| | - Ajay Garg
- Department of Neuroimaging and Interventional Neuroradiology, All India Institute of Medical Sciences, New Delhi, India
| | - Shailesh B Gaikwad
- Department of Neuroimaging and Interventional Neuroradiology, All India Institute of Medical Sciences, New Delhi, India
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16
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Agarwal H, Sebastian LJD, Gaikwad SB, Garg A, Mishra NK. Vein of Galen aneurysmal malformation-clinical and angiographic spectrum with management perspective: an institutional experience. J Neurointerv Surg 2016; 9:159-164. [PMID: 26880722 DOI: 10.1136/neurintsurg-2015-012137] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Revised: 01/15/2016] [Accepted: 01/18/2016] [Indexed: 12/20/2022]
Abstract
BACKGROUND AND PURPOSE Vein of Galen aneurysmal malformation (VGAM) is a rare developmental intracranial vascular malformation. We analyzed the clinical presentations, imaging findings, angioarchitecture, management options, and outcome in a demographically heterogeneous set of VGAM patients. METHODS We retrospectively analyzed cases of VGAM from our departmental archive collected between 1988 and January 2015. Demographic, clinical, therapeutic, and follow-up details were obtained for each patient from the available records. RESULTS We identified 36 patients with VGAM including 6 neonates, 18 infants, 7 children aged 2-10 years, and 5 adults. Macrocrania was the commonest presenting feature. Type of fistulae was mural in 14 and choroidal in 18 patients while 4 had a thrombosed sac at presentation. In 3 cases the dilated venous sac had connection with the deep venous system. Bilateral jugular atresia and stenosis were seen in 9 and 6 patients, respectively. Giant venous sac (>4 cm) was significantly correlated with mural type (p=0.0001). Dural arterial recruitment was seen in 4 patients including 3 adults. Among the 23 patients treated by endovascular means, 14 had a good outcome, 5 had a poor outcome, and 4 died. A significant correlation was noted between jugular atresia and poor outcome (p=0.003). CONCLUSIONS We encountered a wide range of demographic, clinical, and angiographic features in VGAM. Mural type malformations were associated with giant venous sacs. Good outcome after embolization was seen in selected neonates and in most of the infants, children, and adults. Jugular atresia was significantly associated with poor outcome.
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Affiliation(s)
- Himanshu Agarwal
- Department of Neuroimaging and Interventional Neuroradiology, CN Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Leve Joseph Devarajan Sebastian
- Department of Neuroimaging and Interventional Neuroradiology, CN Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Shailesh B Gaikwad
- Department of Neuroimaging and Interventional Neuroradiology, CN Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Ajay Garg
- Department of Neuroimaging and Interventional Neuroradiology, CN Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Nalini K Mishra
- Department of Neuroimaging and Interventional Neuroradiology, CN Centre, All India Institute of Medical Sciences, New Delhi, India
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17
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Agarwal H, Sebastian LJD, Gaikwad SB, Garg A, Mishra NK. Spinal cord involvement and contrast enhancement in posterior reversible encephalopathy syndrome. BJR Case Rep 2016; 2:20150326. [PMID: 30364367 PMCID: PMC6195939 DOI: 10.1259/bjrcr.20150326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2015] [Accepted: 10/06/2015] [Indexed: 11/05/2022] Open
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18
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Prasad K, Kumar A, Sahu JK, Srivastava MVP, Mohanty S, Bhatia R, Gaikwad SB, Srivastava A, Goyal V, Tripathi M, Bal C, Mishra NK. Mobilization of Stem Cells Using G-CSF for Acute Ischemic Stroke: A Randomized Controlled, Pilot Study. Stroke Res Treat 2011; 2011:283473. [PMID: 22007348 PMCID: PMC3191816 DOI: 10.4061/2011/283473] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2011] [Revised: 07/18/2011] [Accepted: 07/19/2011] [Indexed: 12/19/2022] Open
Abstract
Background. There is emerging evidence to support the use of granulocyte colony-stimulating factor (G-CSF) therapy in patients with acute ischemic stroke. Aims. To explore feasibility, safety, and preliminary efficacy of G-CSF therapy in patients with acute ischemic stroke. Patients and Method. In randomized study, 10 patients with acute ischemic stroke were recruited in 1 : 1 ratio to receive 10 μg/kg G-CSF treatment subcutaneously daily for five days with conventional care or conventional treatment alone. Efficacy outcome measures were assessed at baseline, one month, and after six months of treatment included Barthel Index (BI), National Institute of Health Stroke Scale, and modified Rankin Scale. Results. One patient in G-CSF therapy arm died due to raised intracranial pressure. No severe adverse effects were seen in rest of patients receiving G-CSF therapy arm or control arm. No statistically significant difference between intervention and control was observed in any of the scores though a trend of higher improvement of BI score is seen in the intervention group. Conclusion. Although this study did not have power to examine efficacy, it provides preliminary evidence of potential safety, feasibility, and tolerability of G-CSF therapy. Further studies need to be done on a large sample to confirm the results.
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Affiliation(s)
- Kameshwar Prasad
- Department of Neurology, Room No. 704, Neurosciences Centre, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India
| | - Amit Kumar
- Department of Neurology, Room No. 704, Neurosciences Centre, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India
| | - Jitendra Kumar Sahu
- Department of Neurology, Room No. 704, Neurosciences Centre, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India
| | - M. V. P. Srivastava
- Department of Neurology, Room No. 704, Neurosciences Centre, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India
| | - Sujata Mohanty
- Stem Cell Facility, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Rohit Bhatia
- Department of Neurology, Room No. 704, Neurosciences Centre, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India
| | - Shailesh B. Gaikwad
- Department of Neuro-Radiology, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Achal Srivastava
- Department of Neurology, Room No. 704, Neurosciences Centre, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India
| | - Vinay Goyal
- Department of Neurology, Room No. 704, Neurosciences Centre, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India
| | - Manjari Tripathi
- Department of Neurology, Room No. 704, Neurosciences Centre, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India
| | - Chandrashekar Bal
- Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Nalini Kant Mishra
- Department of Neuro-Radiology, All India Institute of Medical Sciences, New Delhi 110029, India
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20
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Sharma S, Kumar S, Gaikwad SB. Successful embolization of a conus medullaris arteriovenous malformation using onyx. Neurol India 2010; 58:817-8. [DOI: 10.4103/0028-3886.72207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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21
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Singh NG, Sarkar C, Sharma MC, Garg A, Gaikwad SB, Kale SS, Mehta VS. Paraganglioma of cauda equina: report of seven cases. Brain Tumor Pathol 2009; 22:15-20. [PMID: 18095099 DOI: 10.1007/s10014-004-0170-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2004] [Accepted: 10/25/2004] [Indexed: 10/25/2022]
Abstract
The authors report seven uncommon cases of paraganglioma of the cauda equina region with reference to their clinical, radiological, and pathological findings. The common presenting symptoms in all the patients were low backache with radiation to both thighs, sensory and motor deficits in four patients, and urinary retention in three patients. One patient presented with ataxia and superficial sidrosis of the brain. Magnetic resonance imaging (MRI) revealed well-circumscribed lesions that were isointense on T1- and T2-weighted images with flow voids. All the tumors were well circumscribed and could be excised completely; however, one recurred. Histological examination revealed a classic "zellballen" pattern in four tumors. Two mimicked ependymoma but were confirmed as paraganglioma by immunohistochemistry. MIB-1 LI was low in all the tumors. Thus, there were no identifying clinical or radiological features that helped in differentiating paraganglioma from other common tumors, such as ependymoma or neurinoma, in this region, and preoperative diagnosis was not possible in any of the cases. Morphologic features and immunohistochemical analysis proved to be the mainstay of arriving at a correct diagnosis. This report highlights the significance of important morphologic features and immunohistochemistry in the diagnosis of paraganglioma at this unusual site.
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Affiliation(s)
- Naorem Gopendro Singh
- Department of Pathology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India
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22
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Gaikwad SB, Padma MV, Moses EJ, Sethi K, Tripathi M, Bhatia R, Prasad K, Mishra NK. Intra-arterial thrombolysis in basilar artery occlusions combination of intra-arterial thrombolytics and Gp IIb/IIIa inhibitors in basilar artery thrombosis. Neurol India 2009; 57:313-9. [PMID: 19587474 DOI: 10.4103/0028-3886.53291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Basilar artery thrombosis has high morbidity and mortality. Though intra-arterial thrombolytics have proven efficacy in the treatment of acute basilar artery occlusion, the elevation of procoagulant factors in the blood after intra-arterial thrombolysis could result in subsequent thrombus formation and clinical deterioration. Glycoprotein IIb/IIIa inhibitors have been shown to reduce this elevation in procoagulants. We present a pilot study of three cases of acute basilar artery occlusion treated with a combination of intra-arterial thrombolytics and Gp IIb/IIIa inhibitor with remarkable clinical recovery seen in all the patients.
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Affiliation(s)
- S B Gaikwad
- Department of Neuroradiology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110 029, India.
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Gupta V, Tanvir R, Garg A, Gaikwad SB, Mishra NK. Heparin-induced thrombocytopenia in a case of endovascular aneurysm coiling. AJNR Am J Neuroradiol 2007; 28:155-8. [PMID: 17213447 PMCID: PMC8134106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
We report a case of 46-year-old man who underwent endovascular coil embolization for left anterior inferior cerebellar and posterior inferior cerebellar aneurysms. During embolization of both aneurysms, thrombotic complications were observed along with a relative lack of response to heparin. Intra-arterial abciximab was used to recanalize an almost completely occluded posterior inferior cerebellar artery. A marked decrease in platelet counts was found soon after embolization, which normalized within a few days. Serologic tests confirmed heparin-induced thrombocytopenia. This syndrome should be considered in cases with thromboembolic complications during endovascular procedures, particularly in patients undergoing repeated heparin exposure. A sudden decrease in platelet counts and lack of response to heparin, manifested as a relative lack of increasing activated clotting time, should make one suspect this syndrome.
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Affiliation(s)
- V Gupta
- Department of Neuroradiology, Neurosciences Center, All India Institute of Medical Sciences, New Delhi, India.
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Abstract
✓ Spinal dural arteriovenous fistulas (DAVFs), the most common of spinal vascular malformations, are AVFs in the dura mater of the nerve root and/or adjacent spinal dura. These fistulas are most often solitary and are fed by a single radicular artery that primarily supplies the dura mater. Multiple spinal DAVFs are rarely reported in the literature. Those that have been documented have been synchronous in their presentation in that they were found during the same examination or were present at the initial examination but missed and only recognized at the second examination. The authors report the case of a patient with two spinal DAVFs occurring at different spinal levels at different points in time (metachronous).
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Affiliation(s)
- Tanvir Rizvi
- Department of Neuroradiology, Neurosciences Centre, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
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Abstract
✓ The authors report the case of a 30-year-old man who presented with progressive neurological deficits due to a spinal arteriovenous malformation (AVM). There was sudden increase in his neurological deficits after diagnostic angiography was performed. Repeated magnetic resonance imaging and angiography revealed complete thrombosis of the malformation. Stenosis in the draining vein was the most probable cause of this postangiographic occlusion of the AVM. Contrast injection during angiography may have precipitated the thrombosis.
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Affiliation(s)
- Vipul Gupta
- Department of Neuroradiology, Neurosciences Centre, All India Institute of Medical Sciences, New Delhi, India.
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Sharma A, Garg A, Mishra NK, Gaikwad SB, Sharma MC, Gupta V, Suri A. Primary Ewing's sarcoma of the sphenoid bone with unusual imaging features: a case report. Clin Neurol Neurosurg 2004; 107:528-31. [PMID: 16202829 DOI: 10.1016/j.clineuro.2004.11.001] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2004] [Revised: 10/16/2004] [Accepted: 11/08/2004] [Indexed: 11/29/2022]
Abstract
Ewing's sarcomas (ES) account for approximately 10% of primary malignant bone tumors. Primary Ewing's sarcoma of the skull is a very rare entity. We report a case of Ewing's sarcoma of the sphenoid bone in a 5-year-old boy. CT scan showed heterogeneously enhancing mass with associated spiculated new bone formation along the posterolateral wall of the orbit. Magnetic resonance (MR) imaging showed markedly heterogeneously signal intensity mass lesion containing areas of hemorrhage and fluid-fluid levels. Spiculated new bone formation and fluid-fluid levels had not been reported previously in skull Ewing's sarcomas and may be helpful features for preoperative diagnosis.
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Affiliation(s)
- Ashwani Sharma
- Department of NeuroRadiology, Neurosciences Center, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India
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Garg A, Gupta V, Gaikwad SB, Mishra NK, Ojha BK, Chugh M, Sharma MC. Scalp malignant peripheral nerve sheath tumor (MPNST) with bony involvement and new bone formation: case report. Clin Neurol Neurosurg 2004; 106:340-4. [PMID: 15297012 DOI: 10.1016/j.clineuro.2004.01.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2003] [Revised: 11/24/2003] [Accepted: 01/12/2004] [Indexed: 02/07/2023]
Abstract
Malignant peripheral nerve sheath tumors (MPNSTs) are rare neoplasms, usually arising from somatic soft tissues or peripheral nerves. Primary MPNST of the scalp is extremely rare, with only a single case reported so far. Here, we describe an unusual case of scalp MPNST in a 50-year-old male. The tumor was associated with bony projection, intracranial extension and underlying bone destruction. The tumor was treated with complete surgical excision followed by adjuvant radiotherapy. Histologically, the tumor showed malignant spindle cells with focal S-100 positivity on immunohistochemistry and a diagnosis of MPNST was made. This case is being reported for its rarity and presence of associated bony projection, which to the best of our knowledge, has not been described before in soft tissue sarcomas.
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Affiliation(s)
- A Garg
- Department of Neuroradiology, Neurosciences Center, C.N. Centre, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India
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Garg A, Chugh M, Gaikwad SB, Chandra SP, Gupta V, Mishra NK, Sharma MC. Juvenile pilocytic astrocytoma presenting with subarachnoid hemorrhage. Case report and review of the literature. J Neurosurg 2004; 100:525-9. [PMID: 15287467 DOI: 10.3171/ped.2004.100.5.0525] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The authors report a case of a 13-year-old boy with juvenile pilocytic astrocytoma (JPA) presenting with subarachnoid hemorrhage (SAH). The patient experienced sudden onset of headache, vomiting, and loss of consciousness. Cranial computerized tomography scanning revealed blood within basal cisterns and the third ventricle. Angiography demonstrated normal cerebral vasculature and upward displacement of the bilateral A, segments of the anterior cerebral artery. Magnetic resonance (MR) imaging revealed a chiasmatic/hypothalamic mass with evidence of hemorrhage. The mass was surgically decompressed. Histopathological examination showed evidence of JPA. In all cases of SAH in which there is blood around the third ventricle and a raised A1 segment on angiography, MR imaging should be performed. The presence of a normal sella turcica, as well as indistinct margins between the tumor and the opticochiasmatic apparatus should raise suspicion about the lesion.
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Affiliation(s)
- Ajay Garg
- Department of Neuroradiology, All India Institute of Medical Sciences, New Delhi, India.
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Garg A, Gaikwad SB, Kanodia A, Suri A, Gupta V, Mishralf NK. Positional occlusion/stasis of vertebral arteries in a case of cervical rheumatoid arthritis presenting with multiple posterior circulation infarcts: a case report with angiographic demonstration. Spine (Phila Pa 1976) 2004; 29:E321-5. [PMID: 15284528 DOI: 10.1097/01.brs.0000132518.18374.19] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A case report of rheumatoid arthritis involving cervical spine, who presented with multiple posterior circulation infarcts, and pertinent literature review are presented. OBJECTIVE To describe a rare positional occlusion/stasis of vertebral arteries, which resolved following application of cervical traction. The likely mechanism of above findings is proposed. SUMMARY OF BACKGROUND DATA The mechanism of vertebrobasilar insufficiency with changes in head position in patients with rheumatoid arthritis can result from a number of causes; however, bilateral compromise of vertebral arteries during head extension had been described only once. There is no report of vertebral artery angiogram in any individual following application of traction and relief of compromise in extension. METHODS A 45-year-old man had rheumatoid arthritis for the last 10 years and presented with symptoms of posterior circulation infarcts. Cervical spine radiographs revealed "mobile" atlantoaxial dislocation and atlantoaxial impaction. Magnetic resonance imaging confirmed odontoid erosions, lateral masses destruction, atlantoaxial dislocation, and atlantoaxial impaction. Angiogram showed occlusion of the left vertebral artery and transient stasis of the right vertebral artery distal to foramen transversarium of C2 vertebra in extension position. The left vertebral artery had narrowing in the same segment in the neutral position. Following traction, repeat angiogram showed no occlusion or narrowing of either vertebral artery in any position. Transoral odontoidectomy and occipitocervical fusion were performed. RESULTS The patient had no fresh deficits following surgery. CONCLUSIONS We described a rare case of positional occlusion/stasis of vertebral arteries associated with rheumatoid arthritis, in which angiography following cervical traction showed complete resolution.
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Affiliation(s)
- Ajay Garg
- Neurosciences Center, Department of Neuroradiology, all India Institute of Medical Sciences, New Delhi, India
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Agarwal PP, Gaikwad SB, Garg A, Gupta V, Mishra NK, Mehta VS. Giant intraparenchymal neurocysticercosis: unusual MRI findings. Neurol India 2004; 52:259-60. [PMID: 15269488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
Abstract
We report a case of surgically proven giant neurocysticercosis (NCC). MR imaging revealed an unusually large solitary parenchymal cystic lesion showing signal intensity similar to CSF on all pulse sequences, with internal septations and a small nodule in the anterior aspect of this lesion compatible with this diagnosis. Identification of a scolex in a cystic lesion with CSF intensity plays a key role in the diagnosis of NCC. The presence of internal septations is an atypical feature.
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Affiliation(s)
- Prachi P Agarwal
- Department of Neuroradiology, Neurosciences Centre, All India Institute of Medical Sciences, New Delhi - 110 029, India
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Abstract
STUDY DESIGN A case report of bipartite atlas associated with os odontoideum and review of the pertinent literature are presented. OBJECTIVE To illustrate an unusual association of bipartite atlas and os odontoideum and explain the embryological basis. SUMMARY OF BACKGROUND DATA To the authors' knowledge, only one case of bipartite atlas with os odontoideum had been reported previously. Most of the previously reported cases of bipartite atlas are asymptomatic. METHODS A 16-year-old boy presented with a 2-month history of weakness and numbness of all four limbs after sustaining a minor head trauma. Radiographs of cervical spine revealed aplasia of anterior arch of atlas, ventral displacement of C1 over C2 on flexion, which reduced on extension. CT scan showed anterior arch aplasia, posterior arch midline defect, and os odontoideum, which had a small projection on the anterior surface at the level of anterior arch. MRI demonstrated increased cord signal at C1-C2 levels on T2-weighted image. Transoral odontoidectomy and posterior fixation of occiput with C2-C3 spinous processes was performed. RESULTS The patient had significant improvement over next 3 months. CONCLUSIONS We described a rare association of an anterior arch aplasia, posterior arch defect and os odontoideum. The natural history of patients with os odontoideum suggests that these people have a potentially precarious existence.
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Affiliation(s)
- Ajay Garg
- Department of NeuroRadiology, All India Institute of Medical Sciences, New Delhi, India.
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Gaikwad SB, Garg A, Mishra NK, Gupta V, Srivastava A, Sarkar C. Cerebrotendinous xanthomatosis: neuroimaging findings in two siblings from an Indian family. Neurol India 2003; 51:401-3. [PMID: 14652454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/27/2023]
Abstract
Cerebrotendinous xanthomatosis (CTX) is exceptionally rare in the Indian population. We present and discuss the clinical, radiological and histopathologic findings in 2 siblings with CTX. Both the patients had juvenile cataract, mental retardation and marked cerebellar ataxia. The Achilles tendon swelling was present in only 1 patient (Case 2). MR imaging showed typical bilateral and symmetrical involvement of the dentate nuclei, inferior olives, brainstem and cerebellar hemispheric white matter. Although the diagnosis of CTX was made in the 3rd decade in both our cases, early diagnosis is possible if neuroimaging is done in the early course of the disease.
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Affiliation(s)
- S B Gaikwad
- Department of Neuroradiology, Neurosciences Center, All India Institute of Medical Sciences, Ansari Nagar, New Delhi - 110029.
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Srivastava AK, Tripathi M, Gaikwad SB, Padma MV, Jain S. Internuclear ophthalmoplegia and torsional nystagmus: an MRI correlate. Neurol India 2003; 51:271-2. [PMID: 14571025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/27/2023]
Abstract
The association of internuclear ophthalmoplegia (INO) with torsional nystagmus is rare. We report a case of a 72-year-old male who developed brainstem stroke and was found to have left INO with torsional nystagmus. An MRI correlation in this case has been described.
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Affiliation(s)
- A K Srivastava
- Department of Neurology, Neurosciences Center, All India Institute of Medical Sciences, New Delhi 110-029, India.
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Abstract
Paroxysmal kinesigenic dyskinesia (PKD) is an uncommon neurological disorder characterised by abnormal episodic brief movements induced by sudden movements of the body. The recognition and understanding of this disorder has increased over the past few decades. While most cases are idiopathic, the association of PKD with various disorders, including metabolic abnormalities has also been reported. We report an interesting case of a 52 year old male who presented with PKD manifesting as subtle facio-brachial movements and apraxia of eyelid opening (ALO) secondary toidiopathic hypoparathyroidism.
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Affiliation(s)
- Reji Thomas
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, 110 029, India
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Gaikwad SB, Mishra NK, Goyal M, Padma MV, Sharma A. Spinal cord arteriovenous fistula associated with a giant venous pouch in a three-year-old child. Interv Neuroradiol 2001; 3:247-53. [PMID: 20678430 DOI: 10.1177/159101999700300307] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/1997] [Accepted: 07/25/1997] [Indexed: 12/16/2022] Open
Abstract
SUMMARY An unusual case of direct spinal cord arteriovenous fistula (SCAVF) associated with a large venous pouch in a three-year-old child is presented. Features of this rare vascular lesion on MRI and selective angiography are described.
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Affiliation(s)
- S B Gaikwad
- Department of Neuroradiology, All India Institute of Medical Sciences; New Delhi, India
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Deol PS, Mishra NK, Gupta V, Gaikwad SB, Garg A, Singh N. Post-Traumatic Cavernous Fistula Fed by Persistent Trigeminal Artery: Treatment by GDC Embolisation. Interv Neuroradiol 2001; 7:47-50. [PMID: 20663331 DOI: 10.1177/159101990100700107] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2001] [Accepted: 02/15/2001] [Indexed: 11/17/2022] Open
Abstract
SUMMARY A case of traumatic persistent pnmltlve trigeminal artery (PPTA) cavernous sinus fistula treated with GDC embolisation is reported. Because of the small lumen of PP TA, posteriorly directed course and flow contribution from the posterior circulation, balloon embolisation via the carotid system was not considered appropriate. The fistula was successfully closed by GDC embolisation.
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Affiliation(s)
- P S Deol
- Department of Neuroradiology, Neurosciences Centre, All India Institute of Medical Sciences; New Delhi, India -
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Sharma A, Gaikwad SB, Deol PS, Mishra NK, Kale SS. Partial aplasia of the posterior arch of the atlas with an isolated posterior arch remnant: findings in three cases. AJNR Am J Neuroradiol 2000; 21:1167-71. [PMID: 10871035 PMCID: PMC7973897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
We report the imaging findings in three symptomatic cases of partial aplasia of the posterior arch of the atlas with an isolated posterior remnant of the arch. These cases are instructive in illustrating the mechanism of cord impingement produced by the posterior arch remnant during extension of the cervical spine. Additionally, focal increased T2 signal was observed within the cord at the level of the anomaly in two of the patients.
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Affiliation(s)
- A Sharma
- Department of Neuroradiology, Neurosciences, Centre, All India Institute of Medical Sciences, New Delhi
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Sharma MC, Arora R, Mahapatra AK, Sarat-Chandra P, Gaikwad SB, Sarkar C. Intrasellar tuberculoma--an enigmatic pituitary infection: a series of 18 cases. Clin Neurol Neurosurg 2000; 102:72-7. [PMID: 10817892 DOI: 10.1016/s0303-8467(00)00063-9] [Citation(s) in RCA: 65] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Intrasellar tuberculomas are rare and only few case reports have been described in the literature. We report a series of 18 cases of histologically proven intrasellar tuberculomas, which, to the best of our knowledge, is the largest series in the English literature. METHODS A total of 1143 pituitary lesions, between 1984 and June 1999, were operated for various reasons in our institute. Of these, 18 cases were histopathologically proven intrasellar tuberculomas. The clinical profile was reviewed in detail. Radiological data and histopathological slides were also reviewed. RESULTS The age ranged from 8 to 43 years (average 23.6 years) with a female preponderance. The duration of symptoms varied from 15 days to 2 years (average 4 months), the most common symptoms being headache followed by decrease or loss of vision. Five patients had features of pan-hypopituitarism whereas three had raised prolactin (PRL) levels. In six patients, both sella as well as sphenoid sinus were involved. In one patient the lesion was extending from the sella over the clivus. Clinically as well as radiologically, these lesions were mistaken for pituitary adenomas except for one case where tuberculoma was suspected on imaging. In three patients, there was past history of pulmonary tuberculosis, in one patient of tuberculous meningitis, and in one patient, of spondilytis of the spine. In one patient there was cervical lymphadenopathy along with features of acromegaly (also proved by high levels of serum growth hormone) and radiology revealed a pituitary pathology. Microscopic examination of the excised lesion revealed a composite lesion consisting of a pituitary adenoma and tuberculoma, which has not been documented in literature to date. One patient died during the hospital stay. All the other patients were put on antitubercular chemotherapy following surgery and had good outcomes. CONCLUSION Intrasellar tuberculomas are rare. These may be suspected in female patients especially if radiological imaging shows involvement of paranasal sinuses and pituitary fossa along with thickening of pituitary stalk. Simultaneous involvement of clivus may also be an additional feature. The incidence of pituitary tuberculosis is likely to increase with a rise in the incidence of AIDS.
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Affiliation(s)
- M C Sharma
- Department of Pathology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
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Chandra S, Goyal M, Mishra NK, Gaikwad SB. Invasive aspergillosis presenting as a cavernous sinus mass in immuno competent individuals; report of 3 cases. Neuroradiology 2000; 42:108-11. [PMID: 10663485 DOI: 10.1007/s002340050025] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Aspergillosis of the cavernous sinus is rare, especially in immuno competent individuals. We report three such cases secondary to paranasal sinus aspergillosis, with imaging findings.
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Affiliation(s)
- S Chandra
- Department of Neuroradiology, Neurosciences Centre, All India Institute of Medical Sciences, New Delhi, India 110029
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Goyal M, Mishra NK, Sharma A, Gaikwad SB, Mohanty BK, Sharma S. Alcohol ablation of symptomatic vertebral hemangiomas. AJNR Am J Neuroradiol 1999; 20:1091-6. [PMID: 10445448 PMCID: PMC7056228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
Abstract
BACKGROUND AND PURPOSE Many therapeutic techniques have been used for the treatment of symptomatic vertebral hemangiomas (SVH), and each has its own limitations. Our objective was to evaluate the therapeutic efficacy of alcohol ablation for treating these lesions. METHODS Fourteen patients with SVH were treated by injection of absolute alcohol into the lesion via the percutaneous transpedicular route under CT guidance. Symptoms before treatment included neurologic deficit in 13 patients and debilitating pain in one. All patients underwent preprocedural MR imaging. All patients had clinical and MR imaging follow-up (14 patients at 48-96 hours and 2 months; six at 9-15 months). Results were divided into excellent (resumption of work, alleviation of pain), good (significant improvement), and failure of treatment categories on the basis of subjective assessment of clinical improvement. Clinical improvement/deterioration was correlated with MR-revealed changes. RESULTS All patients showed transient deterioration of neurologic status after alcohol ablation. Subsequently, excellent results were seen in five patients and eight were in the good category. One patient in whom treatment failed also developed a complication (paravertebral abscess). Four of the eight patients with good results had preprocedural cord changes. Total follow-up ranged from 5 to 31 months, with 11 patients showing stable improvement. One patient developed recurrent hemangioma within a month. Another patient became symptomatic after initial good response, secondary to the collapse of the involved vertebral body. Good correlation was found between clinical improvement and reduction of epidural soft-tissue masses on MR images. Cord signal alteration seen on MR images in four treated patients, however, did not show any change after treatment. CONCLUSION Alcohol ablation is an effective management option for symptomatic vertebral hemangiomas. Although encouraging results were seen in almost 86% of our patients, a longer follow-up period still is needed to assess the stability of improvement. Potential complications include vertebral collapse and infection.
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Affiliation(s)
- M Goyal
- Department of Neuroradiology, All India Institute of Medical Sciences, New Delhi
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Goyal M, Malik A, Mishra NK, Chandra S, Gaikwad SB, Jain K. Congenital maldevelopment of intervertebral disc simulating a neurofibroma. Skeletal Radiol 1998; 27:388-91. [PMID: 9730331 DOI: 10.1007/s002560050404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Intervertebral disc herniation is a common cause of radiculopathy and myelopathy in adulthood. It is an uncommon tumor mimic. We report on an extradural disc associated with an osseous defect ostensibly caused by pressure erosion and appearing as a neural tumor. It showed homogeneous enhancement on a contrast-enhanced MR examination, leading to an erroneous diagnosis of nerve sheath tumor. An attempt has been made to explain the likely mechanism of formation accounting for the imaging appearances, along with a review of the literature.
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Affiliation(s)
- M Goyal
- Department of Neuroradiology, All India Institute of Medical Sciences, New Delhi
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Affiliation(s)
- A Sharma
- Department of Neuroradiology, All India Institute of Medical Sciences, New Delhi
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Gupta V, Goyal M, Mishra NK, Sharma A, Gaikwad SB. Positional MRI: a technique for confirming the site of leakage in cerebrospinal fluid rhinorrhoea. Neuroradiology 1997; 39:818-20. [PMID: 9406210 DOI: 10.1007/s002340050512] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
We report confirmation of the site of leakage in two patients with spontaneous cerebrospinal fluid (CSF) rhinorrhoea by demonstrating CSF leaking on MRI. Both patients had midline anterior cranial fossa floor (cribriform plate/fovea ethmoidalis) dural-bone defects with arachnoid herniation with or without brain herniation into the upper part of the nasal cavity on MRI, which was subsequently confirmed surgically. Corresponding to the history of postural induction or aggravation of the rhinorrhoea, the CSF leak was demonstrated by the appearance of or increase in the sinonasal fluid collection by imaging the patient in the position of maximum leakage following initial images in the supine position.
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Affiliation(s)
- V Gupta
- Department of Neuroradiology, All India Institute of Medical Sciences, New Delhi.
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Abstract
OBJECTIVE The purpose of our study was to examine imaging findings in patients with pachymeningeal tuberculosis. Imaging studies of seven patients with pachymeningeal tuberculosis were retrospectively reviewed. The diagnosis had been established on the basis of histopathology in three patients and response to antitubercular treatment in four patients. CONCLUSION Tuberculosis can lead to localized or diffuse involvement of the pachymeninges. Most of the focal lesions were seen as en plaque, homogeneous, uniformly enhancing, dural-based masses. The lesions appeared hyperdense on plain CT scans, isointense to brain parenchyma on T1-weighted MR images, and isointense to hypointense on T2-weighted MR images. One patient had diffuse sheet-like thickening of the pachymeninges in the right hemicranium, involving both the supratentorial and infratentorial compartments.
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Affiliation(s)
- M Goyal
- Department of Neuroradiology, All India Institute of Medical Sciences, New Delhi, India
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Abstract
BACKGROUND Solitary intracranial schwannomas not related to major nerves or neurofibromatosis as well as paranasal schwannomas are rare. Schwannomas simultaneously involving the paranasal sinuses and intracranial cavity are even rarer. METHODS We report four cases of schwannomas simultaneously involving the intracranial cavity and paranasal sinuses. They were successfully managed by surgery. The literature on such tumors is reviewed. RESULTS All patients were young adults; the male to female ratio was 1:3. In two patients, the tumor was predominantly intracranial with extension into the sphenoid and ethmoid sinuses, whereas in the other patients, the tumor was located predominantly in the paranasal sinuses and nasopharynx with intracranial extension. Radiologically, bone destruction was seen in three cases. The tumors were totally removed piecemeal with repair of the basal dura. Histopathologic examination confirmed the diagnosis of schwannoma in all four cases. Three patients are alive and well; one of them was reoperated for a recurrence. CONCLUSIONS These tumors should be excised completely if possible. Radiologically, bone erosion or destruction are suggestive of malignancy but histopathology clinches the diagnosis. Therefore, drastic surgery should be avoided in these cases. Surgery is generally curative in these massive schwannomas.
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Affiliation(s)
- M C Sharma
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
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46
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Abstract
Hypertrophic pachymeningitis is extremely rare. It is a fibrosing inflammatory process which involves the dura mater, including the tentorium. Numerous pathological entities produce thickening of the pachymeninges, so that idiopathic hypertrophic pachymeningitis is a diagnosis of exclusion. We describe four patients with idiopathic hypertrophic pachymeningitis who had varied clinical presentation. Imaging studies revealed diffuse thickening of the pachymeninges; in one patient there was extensive dural sinus thrombosis. Since no identifiable cause was found, the cases were labelled as idiopathic.
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Affiliation(s)
- M Goyal
- Department of Neuroradiology, All India Institute of Medical Sciences, New Delhi, India
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47
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Abstract
Acute viral encephalitides have a high mortality and morbidity in all age groups. Early institution of appropriate medical treatment can alter the prognosis dramatically. Imaging studies may be normal or may show a wide variety of subtle findings in the initial stages. Knowledge of the extremely varied clinical as well as radiological expression of the disease is essential to enable timely diagnosis. A case is presented here of histopathologically proven Herpes simplex encephalitis (HSE), wherein a large intracerebral haematoma was seen on imaging studies. Observation of the accompanying subtle findings and knowledge of the variability of expression of this disease helped in reaching the correct diagnosis.
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Affiliation(s)
- A Malik
- Department of Neuroradiology, All India Institute of Medical Sciences, New Delhi, India
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48
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Abstract
OBJECTIVE The purpose of our study was to examine the spectrum of abnormalities seen on MR imaging in patients with tubercular spinal arachnoiditis. MATERIALS AND METHODS A retrospective analysis of MR findings in 22 cases of tubercular spinal arachnoiditis was carried out. The diagnosis had been established on the basis of clinical features, evidence of associated tubercular meningitis or of tubercular spondylitis, and CSF analysis. RESULTS Nineteen (86%) patients had involvement of more than one spinal region, with the dorsal region being most commonly involved. CSF showed increased signal intensity on T1-weighted images in 17 (77%) patients, leading to complete loss of cord-CSF interface in seven patients and shaggy cord outline in 10 patients. As suggested by increased signal intensity on T2-weighted images, we saw cord involvement in 18 (82%) patients. Three of these patients had evidence of cord cavitation. Other findings seen on unenhanced images were CSF loculations in five patients, nodules in subarachnoid space in six patients, and clumping of cauda equina nerve roots in six patients. Contrast-enhanced studies were available in 20 patients. Meningeal enhancement was seen in 16 (80%) of 20 patients, and nerve root enhancement was seen in six (30%) patients. Cord enhancement was seen in four (20%) of 20 patients. Enhancement was observed along the surface of the cord in two of these patients, whereas the other two patients showed central enhancement. Associated findings were tubercular spondylitis in two patients, basal exudate in eight patients, and intracranial granulomas in five patients. CONCLUSION MR imaging revealed several pathologic changes that occur in patients with tubercular spinal arachnoiditis and, hence, may play an important role in the diagnosis of this entity.
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Affiliation(s)
- A Sharma
- Department of Neuroradiology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
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49
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Abstract
Intraparenchymal schwannomas of the CNS are extremely rare. Between 1979 and 1993 400 cases of intracranial schwannomas were operated on and among them were eight patients with intraparenchymal schwannomas comprising 2% of intracranial benign nerve sheath tumours. Four of them were located in the cerebral hemispheres and two each in the brain stem and in the cerebellum. In two cases, there was associated neurofibromatosis (NF-1 and NF-2, one case each). The age ranged from 6 months to 45 years with a male/female ratio of 3:1 and, surprisingly, six of them were in the left cerebral or cerebellar hemisphere.
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Affiliation(s)
- M C Sharma
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
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