Biomedical subjects
Publications and source records attributed to I Dinakar.
A seventy eight year old man sustained penetrating injury to right orbit about 15 years ago. Later he developed right orbital infection leading to phthisis bulbi. Two months before admission he developed CSF leak from the right orbit, tension pneumocephalous and meningitis. A rare case of CSF orbitorrhoea is reported here along with the discussion on mechanisms and management.
Cerebellar mutism after surgery for posterior fossa tumours in children is a well-described, though rare, entity. Most of these tumours are located in the region of the cerebellar vermis extending to the hemispheres. The authors report a case of cerebellar mutism in an 8-year-old boy who underwent surgical evacuation of a spontaneous vermian haematoma. We feel that his mutism was an extreme form of cerebellar dysarthria.
Intratumoural bleeding into a trigeminal neurinoma is rare. The authors describe a case which had an apoplectic presentation with subsequent persistent unilateral ptosis, hemifacial pain and sensory loss. This proved to be due to a haemorrhage into a large trigeminal neurinoma.
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A case of solid hemangioblastoma in the IV ventricle in a 16-year-old boy is reported because of the rarity of this type of lesion. Microsurgical removal of the lesion was accomplished without any side effects in this highly vascular tumor in a strategic location.
The spinal cord injury centre of Nizam's Institute of Medical Sciences, Andhra Pradesh, India has been functioning now for 8 months and offers its services to the population of 80 million in the state. To date, 92 patients with a spinal cord injury have been treated; 51 had a thoracolumbar spinal injury. This report presents the results of the management of these 51 patients. Preoperatively both CT and MRI were performed and the radiological findings were correlated with outcome. Twenty five had a thoracic and 26 a lumber location. Twenty nine patients underwent surgical treatment (15 thoracic and 14 lumbar) and the others were treated conservatively (10 thoracic and 12 lumbar). All these operations were carried out within 2 weeks following trauma, and methylprednisolone therapy was instituted in those who reached the hospital early. Contraindications for surgery included a delay in admission of more than 3 weeks following trauma, a focus of sepsis, bedsores, a generalised bone disorder such as osteopenia, and medical illnesses. Transpedicular screw-plate fixation was performed in 27 patients, and two patients underwent decompressive laminectomy and interlaminar bone and wire fixation. Delayed spinal decompression was offered to one patient to relieve radiculopathy. Fracture-dislocation spinal injury and those with transection of the spinal cord had the worst outcome, whilst patients with a wedge compression fracture and cord oedema fared better. Operated cases had a shorter hospital stay, and complications of immobilisation were limited. Positive psychological influence of mobilisation and early acclimatisation to the altered style of living with their disability were the most significant outcomes following surgery.
A young man was seen at a neurologic center for a slowly progressive myelopathy involving the lower limbs in 1983. After examination and investigations, a diagnosis of chronic tuberculous spinal arachnoiditis was made and the patient was administered antituberculous treatment. However, his condition continued to deteriorate. He was reviewed at another center in 1985, where a diagnosis of demyelinating disorder was made, for which he was treated. However, this also did not help, and he was diagnosed as having a nonspecific spinal arachnoiditis at yet another center in 1988. His condition continued to worsen, and after ten years of symptoms, when magnetic resonance imaging (MRI) was done, an intramedullary cystic lesion opposite D-12 vertebrae was seen, which on histopathology was proved to be a vascular malformation. After excision of the lesion his neurologic status has been slowly improving. The conditions that a malformation could mimic, misleading a clinician, and the role of MRI in clinching the diagnosis are highlighted.
The case of an 18-year-old woman is reported who had developed progressive inability to use her left limbs since the age of 13 years. Ataxic hemiparesis was noted on the left side. A CT scan of the brain revealed a non-enhancing hypodense lesion in the cerebellopontine angle with a supratentorial extension consistent with an epidermoid. Ataxic hemiparesis has previously been reported only with intrinsic lesions of the brain, except for one case. An unusual clinical localization of this entity is reported.
Extramedullary gliomas are rare and usually have an intramedullary component. A case of extramedullary astrocytoma without intramedullary mass in an adolescent girl has been reported.
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The bacteriology of brain abscess is complex--both aerobic and anaerobic organisms are involved, and their incidence varies from centre to centre. In this study of 50 consecutive cases of brain abscess, the value of both modern imaging techniques and the time-honoured Gram's stain was demonstrated. The Gram's stain showed organisms in 41 cases (82%) and culture was positive in 44 cases (88%). Thirty cultures yielded pure aerobic growth: Staphylococcus aureus, beta-haemolytic streptococci and Proteus spp. were predominant. Five cases gave mixed aerobic cultures, and in seven cases anaerobes were isolated. Of these, three showed a mixed aerobic and anaerobic flora. Mycobacterium tuberculosis was cultured from one of the samples, which had shown acid-fast bacilli on direct smear. M. fortuitum was cultured from one sample, although no organisms were seen in the gram-stained preparation.
Cavernous hemangioma is the most common benign intraorbital tumor in the young and middle aged, producing painless proptosis. It is common in females in whom it may enlarge during pregnancy. There have however been very few series reported on this entity.
This is a report of a successfully treated case of a 55-year-old woman with posterior communicating artery aneurysm who had a partial 3rd nerve palsy with pupillary sparing, temporal lobe intracerebral hematoma and a subdural hematoma. Such an association has not been reported earlier.
True "multiple meningiomas" as defined by Cushing are rare. A case of multiple meningiomas without stigmata of neurofibromatosis, in a 53 year old man, treated surgically is reported. The relevant literature on multiple meningiomas has been reviewed.
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