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Biomedical subjects

J M Murthy

Publications and source records attributed to J M Murthy.

At least 19 recordsLinked to original sources
PubMed2001

Sinocranial aspergillosis: a form of central nervous system aspergillosis in south India.

Of the 21 patients with aspergillosis of central nervous system seen during the years 1990-1997, 16 (76%) had aspergillosis of sino-cranial origin. The occupation in patients with sino-cranial aspergillosis was either agricultural or manual work and predisposing risk factors were present in only two (12.5%) patients. Skull-base syndromes were the presenting features in 13 patients and three patients presented with features of intracranial space-occupying lesion. Paranasal sinus mass lesions were seen in all the 16 patients. Computerized tomography showed intracranial extradural-enhancing mass lesions in the anterior, middle or posterior cranial fossa in nine (68%) patients, intracranial and orbital lesions in four and orbital lesions in three. Well-formed granuloma with dense fibrosis was the histological feature. Survival rates were not good even after surgical and antifungal chemotherapy. Surgical treatment was subradical in our series. The majority of cases of sinocranial aspergillosis are reported from countries with temperate climates and the high incidence in these regions is probably related to constant exposure to the high spore content of pathogenic Aspergillus species in the 'mouldy' work environment.

Adolescent↗
PubMed2001

Sleep apnoea syndromes : clinical and polysomnographic study.

Sleep apnoea syndromes have been known since long, and frequently the presenting symptoms are neurological in nature. However, these disorders have not been systematically studied and reported in the Indian literature. Out of 12,000 neurology outpatients seen by authors in 2 years, 60 had primary sleep disturbances. All these 60 patients underwent clinical evaluation and video EEG polysomnography. In 8 out of 60 (13%) patients, sleep apnoea was documented. Five patients had obstructive sleep apnoea, 3 had mixed sleep apnoea and none had pure central sleep apnoea syndrome. Three-fourths of the patients were obese (mean weight 82kg) middle aged males (mean age 46.3 years). The main symptoms encountered were excessive daytime somnolence and snoring. The symptom severity was found to correspond directly with the duration of symptoms as well as obesity. Sleep apnoea syndromes must be seriously considered and documented in all patients complaining of excessive daytime somnolence.

Adult↗
PubMed2001

Neurological intensive care in India--disease spectrum and outcome.

In recent years neurological and neurosurgical intensive care (NNICU) has evolved into a well-recognized subspeciality world over. However it is still a novel concept in the developing world. The admission criteria are variable and flexible. The pattern of disease in the NNICU varies according to the admission policy. In the west, cerebrovascular diseases account for a significant proportion of admissions. In a few studies from the developing countries infections of central nervous system are additional causes requiring intensive care. At our center the disease admission pattern was similar to the pattern reported from the developed countries. Predictors of outcome of neurointensive care have not been systematically evaluated. Limited available data concerns patients of neurotrauma. In addition to the disease severity indices, pre-existing chronic illness, adverse events during ICU stay, and the 24-hour presence of a physician also influence patient outcome in the NNICU.

Critical Care↗
PubMed2001

Severity-of-illness scoring systems and models: neurological and neurosurgical intensive care units.

Predicting the outcome of critically ill patients admitted to intensive care units (ICU) has undergone considerable evolution over the last two decades. Various general purpose severity-of-illness scoring systems, Acute Physiology and Chronic Health Evaluation score (APACHE II, APACHE III), Mortality Predicting Model (MPM II), and Simplified Acute Physiology Score (SAPS II), have been extensively validated for large groups of critical care patients with mixed diagnoses and found to correlate well with observed outcome in general. The general hypothesis underlying the use of severity-of-illness scoring systems is that clinical variables that can be assessed on ICU admission and subsequent days of stay in the ICU predict survival and other outcomes of critically ill patients. Variables included in severity-of-illness scoring systems measure specific clinical and physiological functions that are major determinants of mortality. These scoring systems may be used alone within a single disease category or any other independently defined patient group to perform relative risk stratification. Variation in death rates by disease reflects the nature of the underlying process. There is a need for using these scoring systems in specialized ICUs like neurological and neurosurgical ICU as they allow, in addition to predicting outcome, evaluation of new therapies, monitoring of resource utilization and quality assessment of intensive care units.

Critical Care↗
PubMed2000

Etiological spectrum of localization-related epilepsies in childhood and the need for CT scan in children with partial seizures with no obvious causation--a study from south India.

The etiological spectrum of 558 children (< 16 years) with partial seizures seen in a university hospital in south India, was analysed using syndromic classification proposed by the International League Against Epilepsy (ILAE). Partial seizures accounted for 57 per cent of childhood epilepsies. Idiopathic localization-related epilepsies accounted for 3 per cent, symptomatic localization-related epilepsies for 48 per cent and cryptogenic localization-related epilepsies for 49 per cent. Single CT enhancing lesion (SCTEL; solitary cysticercal granuloma), single small cerebral calcific CT lesion (SSCCCTL), and multiple small cerebral calcific CT lesions together accounted for 51 per cent of patients categorized under symptomatic localization-related epilepsies. Of the 138 patients with these CT lesions, only four patients with SCTEL had focal signs to suggest symptomatic etiology and in the remaining the putative etiology was established only after CT scan was obtained. A CT scan was carried out in 247 children with localization-related epilepsies with no obvious causation, and the proportion of CT scans showing one of these three etiologies was 0.54 [95 per cent confidence intervals (CI), 49-60]. Our observations suggest that in India a child with partial seizures with no obvious causation has a high probability of harboring one of these three lesions. In these patients, a CT scan should be the initial structural imaging investigation and will be cost effective.

Adolescent↗
PubMed2000

Frequency, clinical features and risk factors of lacunar infarction (data from a stroke registry in South India).

Analysis of 893 patients of ischaemic stroke in the stroke registry of Nizam's institute of Medical Sciences, Hyderabad is presented. 16% of them had lacunar infarction. The mean age at presentation was 56.9 years and male to female ratio was 3.5:1. The common risk factors included hypertension(62%),diabetes(38%) and smoking(28%). Six percent had an underlying cardiac source of embolism and none had significant (>50%) extracranial carotid atherosclerosis. In 22% of patients, no obvious risk factors could be identified. The frequency of risk factors was similar in patients with lacunar and non- lacunar infarctions. However, patients with lacunar infarction had higher frequency of diabetes and absence of significant (>50%) extracranial carotid artery disease. Pure motor hemiparesis was the presenting syndrome in 45% patients. Ataxic hemiparesis and sensorimotor stroke accounted for 18% each and dysarthria-clumsy hand syndrome for 14%. This study suggests that the frequency, risk factors and clinical profile of lacunar infarction in our stroke registry is similar to most of the western stroke registries.

Aged↗
PubMed2000

Spinal extradural abscess following local steroid injection.

A case of spinal extradural abscess following local steroid injection for back ache, in a 26 years old male is described. The abscess presented as a swelling externally. MRI localised the lesion to L2-S1 segments. Mechanism of such an infection has been discussed.

Abscess↗
PubMed2000

Clinical, pathological and magnetic resonance imaging features of focal myositis: report of three cases.

Focal myositis is a rare idiopathic form of inflammatory myositis involving a single muscle. The presentation is often as a soft tissue pseudotumour. Magnetic resonance imaging (MRI) is a useful noninvasive imaging modality to demonstrate focal nature of the lesion. We describe three patients presenting as pseudotumour of the lower leg. MRI showed hyperintense signals in the involved muscle.

Adolescent↗
PubMed2000

Aspergillosis of central nervous system: a study of 21 patients seen in a university hospital in south India.

AIM: To study the pattern of central nervous system aspergillosis in a tropical country. MATERIAL AND METHODS: Case records of patients with CNS aspergillosis seen by the authors in a university hospital in south India were reviewed. RESULTS: Of the 21 patients seen during the study period, 16 (76%) patients had intracranial invasion by contiguous spread from paranasal sinuses and one had from ear. Predisposing risk factors were present in two (12.5%) patients with sinocranial aspergillosis and in both patients with disseminated form. Skull bases syndromes were the presenting features in 13 patients, six patients presented with features of intracranial space occupying lesion and two patients had stroke like presentation. CT scans showed intracranial extradural contrast enhancing mass lesions in the anterior, middle or posterior cranial fossa in addition to mass lesions in the paranasal sinuses in 13 patients with sinocranial aspergillosis and in seven orbital lesions. Intracerebral contrast enhancing mass lesion was the CT finding in both the patients with solitary cerebral aspergillus granuloma and in the patient with otocranial aspergillus granuloma. Well-formed granuloma with dense fibrosis was the histological feature in patients with sinocranial and otocranial aspergillosis. Angioinvasion was the pathological feature in both the patients with disseminated form of aspergillosis. Surgical treatment was sub-radical in our series. Survival rates were not good even after surgical and antifungal chemotherapy. CONCLUSIONS: This study suggests that in this part of the world sinocranial aspergillosis is the most common form of histologically verified CNS aspergillosis. Associated predisposing factors and immune status of the host determine the clinical syndrome and type of pathology in patients with CNS aspergillosis.

Aspergillosis↗
PubMed1999

Acute disseminated encephalomyelitis: clinical and MRI study from South India.

Clinical and MRI appearances were reviewed in 25 cases of acute disseminated encephalomyelitis (ADEM) seen in a university hospital in South India. Specific viral infections and Semple antirabies vaccination together accounted for 56% of antecedent events. Clinical and MRI features were suggestive of diffuse/multifocal form in 15 patients. Of the 10 patients with clinically site restricted forms, two patients with dorsal myelitis and one patient with polyradiculitis had asymptomatic cerebral white matter lesions. MRI was essentially normal in all the four patients with acute ataxia following varicella infection. Of the 13 patients with multiple white matter lesions, lesions were asymmetrical in size and morphology in nine patients and symmetrical in four patients. Two of them had extensive destructive lesions and one patient had multiple discrete lesions. Lesions occurred at the corticomedullary junctions in seven patients. The distribution was subcortical and/or centrum semiovale in 10 patients. The regions affected include internal capsule(s), thalami, brainstem, cerebellar peduncles and cerebellum. No specific differences were observed in patients with ADEM following specific viral infections, Semple antirabies vaccination, and nonspecific upper respiratory tract infections. There was fairly good correlation between clinical and MRI findings in 81% of patients. Patients with incomplete recovery showed extensive and/or multifocal lesions.

Adolescent↗
PubMed1999

Acute symptomatic seizures - incidence and etiological spectrum: a hospital-based study from South India.

We analysed the incidence and etiological spectrum of acute symptomatic seizures in 2531 patients with seizure disorder, both in-patients and out-patients, seen in a university hospital in South India. Seizure(s) occurred in close temporal association with an acute systemic, metabolic, or toxic insult or in association with an acute central nervous system (CNS) insult in 22.5% of patients. Of the 572 patients, 8% could be grouped under the International League Against Epilepsy (ILAE) category 4.1 and 92% under category 1.2. The seizure type was generalized in all the patients included in category 4.1 and 78% of patients grouped in category 2.1 had simple or complex partial seizure(s) with or without secondary generalization. Sixteen (3%) patients developed status epilepticus during the acute phase of illness and 7% of patients had only single seizure. Infections of the central nervous system (CNS) and single CT enhancing lesions (SCTEL) together accounted for 77% of the provoking factors in patients grouped under category 2.1. These two etiological factors together accounted for 95% of etiologies in patients aged under 16 years. SCTEL and neurocysticercosis together accounted for 67% of the provoking factors. In 14% of patients cerebrovascular diseases were the etiological factors and 60% of the patients were aged over 40 years. In patients with cerebrovascular diseases, aged under 40 years, cortical sinovenous thrombosis accounted for 37%. SCTEL was the provoking factor in 61% of patients with isolated seizure. Infections of CNS and SCTEL together accounted for 62.5% of etiological factors for status epilepticus. This study illustrates that the etiological spectrum of acute symptomatic seizures in this part of the world is different from that described from developed countries and CNS infections account for a significant number of cases.

Acute Disease↗
PubMed1999

Somatosensory evoked potentials by paraspinal stimulation in acute transverse myelitis.

Somatosensory evoked potentials by paraspinal stimulation were studied in 6 patients with acute transverse myelitis. In one patient in whom posterior tibial somatosensory evoked potentials were not recordable, a poorly formed response was seen with paraspinal stimulation. Slowing of conduction across the involved segment was seen in the remaining 5 patients and fairly correlated with the clinical localization.

Acute Disease↗
PubMed1999

Factors of error involved in the diagnosis of juvenile myoclonic epilepsy: A study from South India.

The study was aimed at finding possible factors for delay in the diagnosis of juvenile myoclonic epilepsy (JME) in a developing country. Data was analyzed retrospectively through the medical records and prospectively through a re-evaluation of the history and EEGs of patients with JME registered in a university hospital in south India. Of the 131 patients, 23 (17.5%) patients were seen by neurologists before registration in the clinic. Diagnosis of JME was established in 118 patients at the time of registration and in 13 (10%) patients during follow-up in the clinic. The mean interval between onset of disease and the diagnosis was 6.8 + 6.3 years. In 20 patients the diagnosis was established 10 years after the onset. The mean interval between the first evaluation and diagnosis was 24. 2 months in the 13 patients in whom the diagnosis was established during follow-up in the clinic. Lack of familiarity with the clinical syndrome was probably the factor for delay in the diagnosis in 108 patients seen by practising physicians. The factors for delay in the diagnosis in patients seen by neurologists included failure to ask about myoclonic jerks resulting in misinterpretation of EEGs in 28 patients, misinterpretation of absences and/or unilateral jerks in 4 patients, and failure to ask about myoclonic jerks and misinterpretation of focal EEG abnormalities in 4 patients. This study suggests that the possible factors of error in the diagnosis of JME among the neurologists were similar to the observations reported from the developed countries; whereas the factor for delay in the diagnosis of JME among practising physicians was lack of familiarity with the epileptic syndrome.

Adolescent↗
PubMed1999

Carpal tunnel syndrome - electrodiagnostic aspects of fifty seven symptomatic hands.

Electrodiagnostic data of fifty seven symptomatic extremities with carpal tunnel syndrome (CTS) are described. Practice recommendations made by American Academy of Neurology, American Association of Electrodiagnostic Medicine and American Academy of Physical Medicine and Rehabilitation regarding electrodiagnostic studies were considered while confirming CTS diagnosis by electrodiagnostic studies. Median sensory nerve conduction studies were the commonest abnormalities noted. The median orthodromic sensory latencies were prolonged in 86% and sensory nerve action potential amplitude abnormalities were seen in 82%. Prolongation of the conduction in the short segment across the wrist in the median nerve was seen in 96.5% and the difference in the conduction between median and ulnar nerve across the wrist was significant in all the 57 extremities. The median motor latencies were prolonged in 67% of hands. Higher incidence of electrodiagnostic abnormalities observed in this study might be due to inclusion of patients with severe disease.

Carpal Tunnel Syndrome↗