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Aditya Gupta

Publications and source records attributed to Aditya Gupta.

13 recordsLinked to original sources
PubMed2006

Pediatric intracranial aneurysms-clinical characteristics and outcome of surgical treatment.

OBJECT: Intracranial aneurysms are rare in children and have different epidemiological, clinical, and morphological characteristics and outcome from those in adults. MATERIALS AND METHODS: We analyzed demographic, clinical, radiologic features, treatment, and outcome in 55 patients <18 years of age, treated from Jan 1995 through December 2005. RESULTS: Intracranial aneurysms in children below 18 years constituted 4% of all intracranial aneurysms. Internal Carotid artery (ICA) bifurcation was the commonest location. About half of the aneurysms were complex. Three-fourth of the patients required surgical treatment. Two patients died, constituting 5% mortality. Two patients (5%) had poor outcome, whereas the majority (90%) had a favorable outcome. CONCLUSIONS: Pediatric aneurysms have male predominance, higher incidence of clinical features of mass effect or seizures, high incidence of large, traumatic/mycotic aneurysms, associated illnesses and ICH/IVH and hydrocephalus, better Hunt and Hess grades at presentation, ICA bifurcation as the commonest site, and better outcome than their adult counterparts.

Adolescent↗
PubMed2006

Neuropathological spectrum of lesions associated with intractable epilepsies: a 10-year experience with a series of 153 resections.

BACKGROUND: Surgical management of intractable epilepsies is currently an established mode of therapy in various clinical settings. AIMS: To retrospectively evaluate the neuropathological findings in both temporal and extratemporal lobe resections in such patients. MATERIALS AND METHODS: The study included resected specimens from patients with intractable epilepsy managed at a tertiary care hospital of India, during a 10-year period (1995-2004). RESULTS: A total of 153 patients, with mean age of 19.4 years and male predominance (73.2%) were included in the study. Overall, there was a predilection for the temporal lobe (73.2%), while 41cases were extratemporal in location. On histopathology, mesial temporal sclerosis (MTS) (24.8%) was the commonest lesion, followed by tumors (19.6%) and isolated focal cortical dysplasia (FCD - 15.11%). Other less common findings included Rasmussen encephalitis, non-specific gliosis and vascular malformations. In addition, 20.9% (32 cases) had dual lesions, majority of which included FCD with ganglioglioma (15 cases) or with dysembryoplastic neuroepithelial tumor (12 cases). In the temporal lobe, neoplasms and dual lesions formed the majority (apart from MTS), unlike dual lesions followed by neoplasms and FCD, in the extratemporal location. CONCLUSION: This series demonstrates that most patients with chronic intractable epilepsy have significant histopathological findings and highlights the neuropathological spectrum of such lesions, in the Indian context. This was similar to that reported from the West, but different from the single Indian series available in the literature. Further, the overall profile of temporal lobe lesions was not different from the extratemporal ones.

Adolescent↗
PubMed2005

Meningioangiomatosis with meningioma: an uncommon association of a rare entity--report of a case and review of the literature.

INTRODUCTION: Meningioangiomatosis (MA) is a rare lesion, probably of malformative origin, consisting of meningovascular proliferation and leptomeningeal calcification. Patients with MA usually present with seizures or persistent headaches. Neurofibromatosis may be associated in a variable proportion of patients, while in others it may be sporadic. Surgical treatment is usually recommended, and is gratifying in most cases. Rarely, MA has been described coexisting with meningiomas, arteriovenous malformations, encephaloceles, oligodendrogliomas, meningeal haemangiopericytomas and orbital erosion. Among these, meningiomatosis with meningioma is the most frequent combination. CASE REPORT: We report a case of MA with meningioma in an 18-month-old girl, who presented with recurrent seizures. DISCUSSION: In these situations, it is extremely important for the pathologist to be aware of this entity and to distinguish it from other lesions, like cortical invasion by a meningioma, intraparenchymal meningioma and intracerebral schwannoma, which it may mimic.

Angiomatosis↗
PubMed2005

Cerebellopontine angle paraganglioma - report of a case and review of literature.

Majority of the cerebellopontine angle (CPA) tumors are acoustic neuromas, while bulk of the non-acoustic tumors are formed by meningiomas and epidermoid cysts. Primary paraganglioma is a rare tumor in this location, with only two such cases having been reported in the literature, till date. Recently, a case has been described wherein a paraganglioma was apparently arising as a primary lesion in the cerebellar hemisphere. We report another case of an intracranial paraganglioma of the CPA in a 40-year-old female, which did not have any vascular attachment but had focal cerebellar extension.

Adult↗
PubMed2005

Brain abscess due to Enterococcus avium.

We report the first case of brain abscess due to Enterococcus avium in a 19-year-old man with chronic otitis media since childhood. The patient presented to the emergency department in a comatose condition. Contrast-enhanced brain computed tomography scan showed a hypodense area with ring enhancement in the right temporal lobe and mass effect with subfalcine and transtentorial herniation. Emergency temporal burr hole operation was performed and pus drained out, but the patient succumbed to his illness. Culture of the aspirated pus yielded growth of gram-positive cocci identified as E avium, an infrequent pathogen of human infections. The association of E avium with brain abscess further extends the clinical spectrum of this rare pathogen.

Adult↗
PubMed2005

Clinical indications of the use of antineutrophil cytoplasmic antibodies and anti-Saccharomyces cerevisiae antibodies in the evaluation of inflammatory bowel disease at an Academic Medical Center.

BACKGROUND: Serological markers for inflammatory bowel disease (IBD), including anti-neutrophil cytoplasmic antibody (ANCA) and anti-Saccharomyces cerevisiae antibody (ASCA), have a high specificity and positive predictive value in diagnosing IBD. However, neither indication nor use in clinical practice has been clearly established. This study aimed to determine the clinical impact of ANCA/ASCA testing by evaluating how these tests were used in an academic referral center. METHODS: Retrospective chart review to classify the indications for testing and effect on diagnosis or management. RESULTS: Seventy-six patients had serological tests for IBD. Indications included differentiating ulcerative colitis (UC) from Crohn's disease (CD) in established patients with IBD (13%); establishing a diagnosis in patients with atypical signs of inflammation as detected by endoscopy, histology, or radiology (50%); evaluation of chronic diarrhea (22%); evaluation of a family history of IBD (4%); and differentiating pouchitis from CD (4%). Review of the subsequent course indicated that serologic testing had an important role in diagnosis in 28% of patients, a supportive role in 26%, and was not helpful in 46%. Serologic testing clarified the clinical presentation in 61% of those presenting with atypical inflammatory changes. It proved valuable in establishing a diagnosis of UC or CD in a subset of middle-aged patients with inflammatory changes in the sigmoid colon. For patients with chronic diarrhea, the yield was lower: 36% had a significant effect on diagnosis, but test results changed immediate treatment in only 1 (6%). In patients being considered for operative management (n = 8), serologic testing was valuable in clarifying the diagnosis in 75% of patients and had an impact on the operative plan in 62% of patients. CONCLUSION: Serological testing for ANCA/ASCA may have a significant role in the diagnosis and treatment in individuals presenting with sigmoid inflammation or atypical inflammation but was less useful in those with chronic diarrhea.

Academic Medical Centers↗
PubMed2005

Role of shunt surgery in pediatric tubercular meningitis with hydrocephalus.

This study was designed to evaluate the indications for ventriculoperitoneal shunting in cases of children with tubercular meningitis, presenting with hydrocephalus. Thirty seven children (less than 18 years of age) of tubercular meningitis with hydrocephalus (TBMH) who underwent ventriculoperitoneal shunting over a three year period (1999 to 2001) were included in the study. Sixteen (43%) children were Palur stage II, 15 (40%) stage III, and 6 (16%) stage IV. Fifteen (40%) children had received antitubercular therapy for less than 4 months and 17 (46%) received therapy for more than 4 months prior to presentation. Five (14%) children had not previously received antitubercular therapy. Shunt related complications occurred in 11 (30%) children and 3 children had undergone revision of the shunt multiple times. Good outcome was seen in 16 (43%) children. Thirteen (35%) had moderate disability and 6 (16%) had severe disability at 3 months of follow up. 62% (n =10) children in grade II had a good outcome compared to 40% (n = 6) in grade III. All six children in grade IV had a poor outcome. 2 children, both having multiple infarcts, died and the remaining 4 were left with severe disability. We recommend shunt placement in all children of grade II and III TBMH as this policy has yielded the best results. For grade IV children external ventricular drainage, followed by shunting if improvement occurs remains the most cost-effective procedure.

Child↗
PubMed2005

Association of craniovertebral and upper cervical anomalies with dermoid and epidermoid cysts: report of four cases.

OBJECTIVE AND IMPORTANCE: Four patients with craniovertebral junction anomalies (CVJ) and Klippel-Feil cervical fusion defects associated with dermoid and epidermoid cysts are described. CLINICAL PRESENTATION: During the 10-year period from 1994 until May 2004, 435 patients with developmental CVJ anomalies presented to our institution. Four of these patients harbored a constellation of CVJ anomalies with dermoid and epidermoid cysts (hospital prevalence, 0.9%). All patients (ages 18, 23, and 25 yr) presented with features of spastic quadriparesis, restriction of neck movements, and raised intracranial pressure. Magnetic resonance imaging showed features of CVJ anomalies in all patients (occipitalization of C1, 3 patients; basilar invagination, 3 patients; atlantoaxial dislocation, 4 patients; and an abnormal posteriorly pointed dens, 1 patient), along with a Klippel-Feil anomaly (Patients 1-3, 2nd and 3rd cervical vertebrae). Patient 4 also had a Chiari malformation with syrinx. In addition, all four patients had coexisting dermoid or epidermoid cysts (Patients 1 and 3, midline posterior fossa epidermoid; Patient 2, midline posterior fossa dermoid; Patient 4, quadrigeminal cistern epidermoid). INTERVENTION: Patients 1 and 2 underwent a posterior midline approach, excision of the tumor, and an occipitocervical fusion (the atlantoaxial dislocation was reducible). Patient 3 underwent transoral excision of the odontoid, followed by tumor excision and occipitocervical fusion via the posterior route. These patients had uneventful recovery. Patient 4 did not undergo an operation. CONCLUSION: Association of CVJ anomalies with Klippel-Feil and dermoid and epidermoid cysts is extremely rare, with only two previously reported cases. The patient who presented with a quadrigeminal cistern epidermoid with a craniovertebral junction anomaly and Chiari malformation with syrinx is the first such case ever reported in the literature. Apart from therapeutic implications, these patients may shed new light on the embryogenesis. Furthermore, the gathering of these manifestations may constitute components of a new syndrome that has gone unnoticed until now.

Adolescent↗
PubMed2003

Intramedullary subependymoma of the spinal cord: a case report and review of literature.

A case of cervical spine intramedullary subependymoma in a 52-year-old female is reported. Also, the relevant literature on the 40 cases reported till date is reviewed. Magnetic resonance imaging, even with enhancement, does not show any distinctive features making pre-operative diagnosis often difficult. These tumours are eccentrically located within the spinal cord, thus enabling complete tumour removal in most cases. They are benign with low proliferative potential and hence no post-operative radiotherapy should be administered.

Diagnosis, Differential↗
PubMed2003

Large cystic fibrous dysplasia of the temporal bone: case report and review of literature.

Fibrous dysplasia is an uncommon benign disorder of unknown aetiology. It most likely represents a disorder of normal bone development. As it may occasionally involve the temporal bone, and encroach on the middle cranial fossa, it is of interest to the neurosurgeon. Fibrous dysplasia of the cystic variety is very uncommon. We report a case of a large cystic fibrous dysplasia involving predominantly the squamous temporal bone. The radiology and histology are discussed, and its differentiation from other lesions.

Craniotomy↗
PubMed2003

Safety and efficacy of nonsteroid pimecrolimus cream 1% in the treatment of atopic dermatitis in infants.

OBJECTIVE: The safety and efficacy of a 1% cream formulation of pimecrolimus, a selective, nonsteroid immunomodulator, was studied in infants with atopic dermatitis (AD). METHODS: During a 6-week double-blind phase, 186 infants with mild/moderate AD were randomly assigned to twice-daily pimecrolimus cream 1% or vehicle. All patients were subsequently treated with open-label pimecrolimus for 20 weeks. RESULTS: At the end of the double-blind phase, 54.5% and 23.8% of patients in the pimecrolimus and vehicle groups, respectively, were clear or almost clear of AD (P <.001). Similar improvements were observed in the Eczema Area and Severity Index, pruritus assessment, and the care giver's assessment. By the first return visit, 69.9% and 36.5% of pimecrolimus and vehicle-treated patients, respectively, achieved absent or mild pruritus. Efficacy during the double-blind phase was maintained throughout the open-label phase. Vehicle-treated patients transferring to open-label pimecrolimus rapidly achieved disease control comparable to those receiving continuous pimecrolimus. There were no significant differences between groups in application site reactions or skin infections. Most adverse events were mild or moderate and unrelated to treatment. CONCLUSIONS: Pimecrolimus was safe in infants with AD, with rapid and sustained efficacy. Pimecrolimus holds promise as a valuable new treatment option for the youngest patients with AD.

Administration, Cutaneous↗
PubMedDate not supplied

Itraconazole in the treatment of tinea capitis caused by Microsporum canis: experience in a large cohort.

Mycotic scalp infection caused by Microsporum canis is one of the more recalcitrant disorders, with increasing incidence during the last decade. We report our experience with administration of itraconazole in 163 children (86 girls, 77 boys) with M. canis tinea capitis. Fifty-five patients had previous treatment with terbinafine without success. In all children, the dosage of itraconazole was adjusted according to body weight, with 5 mg/kg/day given in a continuous regimen either as a capsule (116 patients) or an oral suspension (47 patients). In all children, there was both clinical and mycologic cure after a mean treatment period of 39 +/- 12 days (range 10-77 days). Eleven children (6.7%) had side effects: diarrhea in five children, cutaneous eruption in four, and abdominal pain in two. Itraconazole was effective and safe for the treatment of M. canis tinea capitis.

Administration, Oral↗