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Biomedical subjects

J M Murthy

Publications and source records attributed to J M Murthy.

At least 37 records · Page 2Linked to original sources
PubMed1999

Acute transverse myelitis: MR characteristics.

Magnetic resonance imaging findings in 13 patients with acute transverse myelitis are reviewed. In 12 cases centrally located high intensity signal extending over few spinal segments was noted. The lesion occupied more than two thirds of the cord's cross-sectional area in 8 patients. Central dot sign was noted in 7 patients. Variable cord enlargement was seen in 5 patients. Contrast study in one patient showed peripheral enhancement. The MR characteristics that help in differentiating transverse myelitis from spinal form of multiple sclerosis are discussed.

Adolescent↗
PubMed1999

Pyomyositis - clinical and MRI characteristics report of three cases.

We report three patients with pyomyositis due to Staphylococcus aureus. Magnetic resonance imaging aided in the accurate diagnosis of the infection and of the extent of involvement. Incision, drainage and antibiotic therapy eradicated the infection in all the patients. We suggest clinical or subclinical bacteraemic seeding of the diseased muscle, as the most likely mechanism for pyomyositis.

Adult↗
PubMed1999

Clinical, electrophysiological and magnetic resonance imaging study of acute disseminated encephalomyelitis.

AIM: To study the clinical syndromes, antecedent events, evoked potential abnormalities and magnetic resonance image (MRI) findings in patients with acute disseminated encephalomyelitis (ADEM) and also to find differences if any when compared to ADEM reported from the Western countries. METHODS: Case records of 64 patients with ADEM seen over a period of 10 year were reviewed. RESULTS: Specific viral infections and Semple antirabies vaccination together accounted for 56% of antecedent events. Diffuse or multifocal form of ADEM was the clinical syndrome in 56.5% of patients with specific infections. Myeloradiculopathy formed 61% of neuroparalytic complications following Semple antirabies vaccination. Acute cerebellar ataxia made up 67% of post varicella encephalitis. Abnormalities observed on multimodality evoked potential studies corresponded to the clinical localisation of the lesion. White matter lesions observed on MR imaging were similar to the lesions observed in multiple sclerosis. However distribution was subcortical and/or centrum semiovale in 11 patients and thalamic in three patients. No signal alterations in the white matter were seen in all the four patients with acute cerebellar ataxia following varicella infections. Significant disability was seen in 23.5% of cases with diffuse or multifocal form of ADEM. Specific viral infection was the antecedent event in all of them. CONCLUSIONS: Specific viral infections and Semple antirabies vaccination still form important antecedenent events for ADEM in India. The type of clinical syndrome to some extent depends on the type of antecedent event.

Adolescent↗
PubMed1998

Prognosis of epilepsy associated with single CT enhancing lesion: a long term follow up study.

This is a retrospective analysis to study the long term prognosis of epilepsy associated with single CT enhancing lesion (SCTEL). Follow up CT scan showed resolution of the lesion in all of the 102 patients. Seizures did not recur in 64 (63%) patients after starting antiepileptic drugs. Twenty eight (27.5%) patients had recurrence of seizures for a median period of 2 months before remission was achieved. In the remaining ten (10%) patients seizures remitted only after albendazole therapy and the median period of seizure recurrence was 8 months. Sixteen (42%) of the 38 patients who had recurrence of seizures had type B CT lesion (ring lesion with central enhancing area, probably scolex) (P<0.02 (95% CI 3.2-40.3)). Patients with type B CT lesion had more numbers of seizures and also longer intervals between first and last seizure. Antiepileptic drugs were withdrawn in all the 102 patients. The mean period of follow up was 45 months (range 19-101). Only one patient had a relapse and his follow up CT showed gliotic scar at the site of the previous lesion. We conclude that epilepsy associated with SCTEL is a benign form of epilepsy and seizures recur as long as the lesion persists. Antiepileptic drugs can safely be withdrawn once the follow up CT shows resolution of the lesion.

Adolescent↗
PubMed1998

Etiological spectrum of symptomatic localization related epilepsies: a study from South India.

Putative etiology was studied in 991 patients with symptomatic localization-related epilepsies seen in a university hospital in South India. They formed 39% of patients with various types of epilepsies and epileptic syndromes seen during the study period. Seizure occurred in close temporal association with an acute central nervous system (CNS) insult in 53% of patients. Infections of CNS including single CT enhancing lesion (SCTEL) accounted for 77% of patients with acute symptomatic epilepsy. Cerebrovascular diseases were the risk factors in 48% of patients with remote symptomatic epilepsy. Neurocysticercosis, SCTEL and small single cerebral calcific CT lesion (SSCCCTL) together accounted for 40% of etiological factors and neurotuberculosis for 10%. Infections of the central nervous system and SCTEL together were the putative risk factors in 52% of patients aged < or =40 years. Cerebrovascular diseases were the etiological factors in 64% of patients aged >40 years. Neurological handicaps from birth manifested by mental retardation and/or cerebral palsy was the feature in 21% of children. The type of seizure was either simple partial or complex partial with or without secondary generalization in 76% of patients. The remaining patients presented with either generalized tonic clonic seizures or unlocalized seizures. Localization to a single site of seizure origin proposed by the International League Against Epilepsy (ILAE) was possible in only 67.5% of patients. The most readily identifiable was motor cortex. In patients with unlocalized or generalized seizures the type of pathology was diffuse in 17% of patients and in 48.5% of patients, the lesion was located in the frontal brontoparietal lobe.

Adolescent↗
PubMed1998

MRI in acute disseminated encephalomyelitis following Semple antirabies vaccine.

I reviewed MRI findings in five patients with acute disseminated encephalomyelitis following vaccination with Semple antirabies vaccine. MRI in two patients with encephalitis features showed multiple white matter lesions in the cerebrum, cerebellar peduncles and brain stem. Two patients who had features of cord involvement showed signal alterations in the cord extending over a few segments. Asymptomatic lesions in the cerebrum were seen in two patients. In a patient with encephalomyelitis MRI 50 days later showed resolution of the lesions. The white matter lesions described were indistinguishable from those seen in acute disseminated encephalomyelitis following other infections.

Adult↗
PubMed1998

Clinical characteristics, seizure spread patterns and prognosis of seizures associated with a single small cerebral calcific CT lesion.

Clinical characteristics of 97 patients with epilepsy associated with a small single cerebral calcific CT lesion (SSCCCTL), measuring 20 mm or less were analysed. The mean age was 20 years and 60% were in the first and second decades. Eighteen (18.5%) patients had a previous history of unprovoked seizures, with complex partial seizures (61%) being the most common type. Seizures could be localized to a single ILAE site in 73% of patients. None had neurological deficit and electroencephalograph abnormalities were noted in 29% of patients. Fifty-one (53%) patients had breakthrough seizures and were more common with frontal location. By 7 years 71.5% (95% confidence intervals (CI) 53.7-85.4) of patients achieved 3-year remission and 66% (CI 32.4-88.2) had achieved 5-year remission. The clinical pattern of the seizures was clearly distinctive to allow it to be localized to the location of the lesion on computerized tomography (CT) scan in 25 (26%) patients and in another 31 (31%) patients nearer to the anatomical site of the lesion on the CT scan. There was discordance between clinical localization and CT location of the lesion in 15 patients. Nine of the 10 patients with occipital or parieto-occipital location had focal tonic-clonic seizures with secondary generalization. Both patients with temporal location had motor seizures. The relevance of these findings to the seizure propagation was discussed.

Adolescent↗
PubMed1998

Clinical observations of juvenile myoclonic epilepsy in 131 patients: a study in South India.

We studied clinical features of 131 patients with juvenile myoclonic epilepsy (JME). The prevalence was 7.7% among the epileptic patients registered. The mean age at onset was 13.37+/-4.93 years and the diagnosis was established at a mean age of 19.53+/-7.85 years. Absence seizures were reported by 27 (20.6%) patients, myoclonic jerks by 131 (100%) and generalized tonic-clonic seizures (GTCS) by 111 (84.7%). The triad of absence seizures, myoclonic jerks and GTCS was noted in 23 (17.5%) patients, 88 (67.2%) had myoclonic jerks and GTCS, 4 (3%) had absence seizures and myoclonic jerks and 16 (12.2%) had only myoclonic jerks. Early onset absences were seen in 21 (16%) patients and the onset was late in 6 (4.6%). Absences antedated other types of seizures in all the patients. Myoclonic jerks were predominantly unilateral or had unilateral onset in 22 (16.8%). In 17 (13%) patients GTCS antedated myoclonic jerks. Myoclonic jerks had characteristic circadian distribution in 112 (85.5%) patients. On awakening GTCS occurred in 87 (78.4%) patients and in 4 (3.6%) patients they were purely nocturnal. Sleep deprivation was the most important precipitating factor (54.2%). Initial electroencephalogram (EEG) showed classical generalized spike or multiple-spike slow-wave paroxysms in 81% of records. Focal EEG abnormalities were noted in 20.6% of records. The most common focal abnormality was voltage asymmetry. A family history of epilepsy was noted in 31 (23.6%) probands. Diagnosis of JME was made in all the cases in the clinic. The factors responsible for delay in diagnosis of the 36 patients seen by neurologists included failure to ask or interpret the history which was otherwise suggestive of myoclonic jerks in all 36 (100%) cases, the type of seizure for which the patients sought medical attention, and misinterpretation of EEGs in 28 patients. Diagnosis of partial epilepsy was made in seven patients. The factors responsible for such diagnoses were, unilateral jerks in one patient, unilateral jerks and absence seizures in three patients and focal EEG abnormalities in three patients.

Adolescent↗
PubMed1998

Spinal epidural haematoma in a patient with haemophilia-B.

Spontaneous spinal epidural haematoma is rare. A case of haemophilia-B presenting with cervical spinal cord compression due to epidural haematoma, is reported. This is the second case in literature, to our knowledge, of intraspinal epidural haematoma in a patient with haemophilia-B. The importance of early diagnosis, especially with magnetic resonance imaging and surgical intervention, when deemed necessary, are emphasized.

Adult↗
PubMed1998

The syndromic classification of the International League Against Epilepsy: a hospital-based study from South India.

PURPOSE: To determine the distribution of various epilepsies and epileptic syndromes in the epileptic population treated in a university hospital in a developing country. METHODS: Data concerning 2,531 patients with epilepsy seen between January 1989 and June 1994 were analyzed using the International League Against Epilepsy (ILAE) classification. RESULTS: Of 2,531 cases, 48% fell into ILAE categories 1.3, 3.2, or 4.1 (cryptogenic, without unequivocal generalized or focal seizures; or situation-related seizures, respectively). Localization-related epilepsies (LREs) and epileptic syndromes (1.1, 1.2, 1.3) were found in 1,591 (62.9%) patients; of these patients, symptomatic localization-related epilepsies totaled 62.7%. and idiopathic localization-related epilepsies accounted for only 0.7%. Juvenile myoclonic epilepsy was the most common type of idiopathic generalized epilepsy (IGE), comprising 4.9% of the total study population and 7.7% of patients registered in the epilepsy clinic. A combination of childhood and juvenile absence epilepsies were found in only 0.4% of the total study population. Single computed tomography (CT) enhancing lesion (SCTEL) and focal cerebral calcification (FCC) accounted for 22% of the etiologic factors for localization-related epilepsies. Neurologic deficits were found in 9.5% of patients with SCTEL; none were found with FCC. None of the patients with these lesions had any history of antecedent events that suggested CNS involvement. In patients with localization-related epilepsies with unremarkable clinical data, the proportion of CT scans showing SCTELs was 39 (95% confidence interval [CI], 0.35-0.43) and 0.18 (95% CI, 15-0.21) for FCCs. The proportion for both lesions together was 0.57 (95% CI, 0.53-0.61). Seizures did not recur once the lesion resolved in patients with SCTELs. In patients with FCCs, seizure remission was 71.5% (95% CI, 53.7-85.4) at 3 years. CONCLUSIONS: This study illustrates the rarity in one patient population of some of the syndromes and categories described in the ILAE classification. Childhood and juvenile absence epilepsies together formed a small proportion. SCTEL and FCC were important etiologic factors for localization related epilepsies. The epilepsy associated with SCTEL was a form of benign epilepsy; epilepsy associated with FCC had remission rates similar to other remote symptomatic epilepsies. Without neuroimaging evidence, these 2 lesions would have been missed and the patients might have been grouped under cryptogenic localization related epilepsy. For this reason, we emphasize the need for neuroimaging in patients with localization related epilepsies with unremarkable clinical findings, before classification into the cryptogenic category. In the absence of neuroimaging, such patients should be classified as "probably cryptogenic."

Adolescent↗
PubMed1998

Nonsystemic vasculitic neuropathy.

The clinical, electrophysiological and pathological features and prognosis of 9 patients with nonsystemic vasculitic neuropathy are described. Nonsystemic vasculitic neuropathy accounted for 3% of cases of biopsy proven cases of various neuropathies and formed 56% of vasculitic neuropathy. Both clinically and on electrophysiological testing, mononeuritis multiplex was the form of neuropathy in 5 patients and 3 had sensory neuropathy. All the patients had a necrotizing vasculitis on nerve biopsy. Axonal degeneration was seen in teased fibers in all the patients. Eight patients showed good functional recovery one was left with mild bilateral claw hands.

Adolescent↗
PubMed1995

Entrapment neuropathies.

Relative frequency of entrapment neuropathies was studied from amongst the patients referred to an electrodiagnostic medicine laboratory for electrophysiological studies. During the study period electrophysiological procedures were done on 650 patients with various peripheral nerve disorders. The entrapment neuropathies constituted 8.5%. Carpal tunnel syndrome (CTS) was the commonest entrapment neuropathy (83.6%). Diagnosis of CTS was established in 84 Patients referred with the diagnosis of CTS. Electrophysiological tests confirmed the diagnosis of thoracic outlet syndrome in 4 (15.4%) of the 26 patients referred with this diagnosis and in 5 (19.3%) of them the diagnosis turned out to be CTS. Diagnosis of cubital tunnel syndrome was not suspected clinically in all the 3 patients, they were referred with the diagnosis of ulnar neuropathy. In both the patients with tarsal tunnel syndrome the initial diagnosis was peripheral neuropathy.

Electrodiagnosis↗
PubMed1994

Guillain-Barre syndrome following specific viral infections--an appraisal.

Fifteen cases of Gullian-Barre syndrome (GBS) following specific infection are reported. The infections include varicella, 7 infective hepatitis, 4 measles, 2 and mumps, 2. There are no specific clinical or electrophysiological features which serve to distinguish GBS seen in association of these infections from those seen in other clinical settings. There is epidemiological evidence to suggest the association between GBS and hepatitis A, and non A non B hepatitis is more of a chance occurrence. Detailed epidemiological studies are needed to established a clear relationship between other specific viral infections and GBS.

Adult↗
PubMed1992

Idiopathic hypereosinophilic syndrome presenting as childhood hemiplegia.

A case of childhood hemiplegia due to idiopathic hypereosinophilic syndrome is reported. There was no cardiac lesion. The neurological complications associated with hypereosinophilic syndrome and the pathophysiological mechanism of neurotoxicity of human eosinophils are discussed. It is likely that the neurological deficit was due to eosinophilic neurotoxicity.

Child↗