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Biomedical subjects

P C Sanchetee

Publications and source records attributed to P C Sanchetee.

At least 19 recordsLinked to original sources
PubMed1999

Toxoplasmic encephalitis in acquired immunodeficiency syndrome.

OBJECTIVES: To study the clinical course and outcome of toxoplasmic encephalitis (TE) in patients with acquired immunodeficiency syndrome (AIDS). METHODS: Patients infected with human immunodeficiency virus (HIV) and neurological abnormality compatible with diagnosis of TE were enrolled in the study. These patients were treated with combination of trimethoprim/sulfamethoxazole and pyrimethamine. Response to therapy was assessed by clinical examination and repeat CT/MRI scan done after three weeks of starting treatment. Those showing response were put on prophylactic therapy. RESULTS: A total of 451 patients of HIV infections were admitted to this centre during the study period, of these 11 patients were diagnosed to have TE. The common presenting symptoms were fever (80%), seizures (45%), headache (45%) and altered sensorium (25%). Focal neurological deficit was present in 80% of cases. Nine cases had ring-enhancing lesions on CT scan while in the remaining two patient's ring lesions were seen on MRI. These were either multiple (55%) or solitary (45%). Antitoxoplasma antibody was detected in 10 patients. It was absent in one patient. Ten patients had clinical and radiological improvement with trimethoprim/sulfamethoxazole and pyrimethamine within 10 +/- 3 days of starting therapy. One patient died within 10 days of starting therapy. CONCLUSION: Toxoplasmosis is a common opportunistic infection of the central nervous system in patients with AIDS. Majority of patients with cerebral toxoplasmosis present with focal neurological abnormality in presence of characteristic neuroradiological abnormality and positive antitoxoplasma antibody titer. Response to empirical therapy helps to confirm the diagnosis, lifelong prophylaxis there after prevents relapse of potentially fatal and easily treatable condition.

AIDS-Related Opportunistic Infections↗
PubMed1999

Cryptococcal meningitis in acquired immunodeficiency syndrome.

OBJECTIVE: To study the clinical course and outcome of cryptococcal meningitis (CM) in patients with acquired immunodeficiency syndrome (AIDS). METHOD: Patients infected with human immunodeficiency virus (HIV) and symptoms suggestive of meningitis were evaluated with detailed history, clinical examination and investigations. Diagnosis of CM was based on positive India ink preparation or positive fungal culture of CSF. All patients were treated with amphotericin those showing response were put on oral fluconazole. RESULT: A total of 431 patients with HIV infection were admitted to this centre during the study period, of these 15 were diagnosed to have CM. Majority of the patients had a subacute presentation with signs of meningeal irritation seen in only seven patients. India ink preparation and positive fungal culture on cerebrospinal fluid (CSF) established diagnosis in all cases. All patients were treated with amphotericin B and fluconazole. Complete response was noticed in seven patients, two patients were lost to follow-up and six patients died during the course of therapy. Raised intracranial tension (ICT) and disseminated disease were associated with poor prognosis. CONCLUSION: CM is a common opportunistic fungal infection in patients with AIDS. A high index of clinical suspicion and routine mycological surveillance is required to diagnose this infection. Majority of patients respond to therapy except those who have disseminated infection, altered sensorium and features of raised ICT at presentation.

AIDS-Related Opportunistic Infections↗
PubMed1996

Clinical and etiological profile of ataxic hemiparesis.

We studied the clinical profile and etiology of 28 cases of ataxic hemiparesis. After a detailed neurological examination, CT scan brain (plain and after IV contrast) was done in all. Age ranged from 18 to 80 years. Acute onset of symptoms was in 22, while 6 had insidious onset. 18 patients had major infarct, while 4 patients had lacunar infarct. 2 patients were found to have haematoma (1 following head injury) and 1 each had tuberculoma, meningioma, glioma and toxoplasma granuloma. The lesions were seen in various parts of brain stem, thalamus, basal ganglion, internal capsule and frontal, parietal and temporal region. Heterogeneity as regards to etiology and localisation is being highlighted.

Adolescent↗
PubMed1994

Albendazole therapy for neurocysticercosis.

Based on clinical evaluation and computed tomography (CT) of the brain, 30 cases of neurocysticercosis were diagnosed. Diagnosis was supported by presence of histopathologically proven subcutaneous cysticerci in 12 cases. Three primary neurological syndromes were established i.e. epilepsy in 22 cases, increased intracranial tension in 6 cases and meningoencephalitis in 2 cases. Albendazole was administered orally in a dose of 15 mg/kg bodyweight/day for 30 days without prophylactic steroids. Follow up CT study at 3 months and 12 months revealed complete regression of all lesions in 2 cases, partial regressions in 14 cases and change in morphology in 4 cases. Transient appearence of fresh subcutaneous cysticerci as a side effect of therapy was noted in 4 cases. Albendazole, though acting slow, is considered a suitable alternative to praziquantel in medical management of parenchymal neurocysticercosis.

Adolescent↗
PubMed1994

MRI (magnetic resonance imaging) spectrum of epilepsy.

In 361 patients with strong clinical suspicion of secondary epilepsy magnetic resonance imaging (MRI) was performed. Three hundred and forty-five patients revealed a positive study. Maximum number of patients (28.3%) were in the age group of 2 to 12 years without any significant sex predilection. More than 70% patients presented with generalised seizures. MRI revealed definite evidence of tuberculoma in 98, neurocysticercosis in 86, tumour in 60 and cerebrovascular accident in 23 patients. There were 78 patients in miscellaneous group which included patients with magnetic resonance (MR) diagnosis of generalised or focal atrophy, demyelinating disease, hydrocephalus with or without basal exudates, calcification and disappearing lesion. In 16 patients MR was found to be within normal limits.

Adolescent↗
PubMed1992

MR observations on the effects of praziquantel in neurocysticercosis.

Eight patients with neurocysticercosis treated with praziquantel (PZQ) were studied with serial MR imaging to demonstrate the early effects of the drug in brain lesions. Increase in cyst size and appearance of pericystic edema were observed as early as 24 hr, followed by gradual degeneration of the scolex and cyst contents. Cysts showed varied degree of response to the drug and in their rate of disappearance. MRI was found to be a sensitive technique to objectively document early changes in the parasite and patterns of response to the cysticidal drug in brain cysticercosis.

Adult↗
PubMed1992

Acute filarial myositis.

An uncommon case of filariasis presenting as acute myositis is described. The patient was treated initially with steroids and antihistamines with no response. Later on with the confirmation of filariasis he was treated with diethyl carbamazine with complete recovery.

Acute Disease↗
PubMed1992

Peripartum cerebral venous thrombosis.

The clinical and computed tomography (CT) features of 25 patients with peripartum CVT are described. Majority of the patients presented in postpartum period and did not receive proper antenatal care. Headache (92%), altered sensorium (80%, seizures (76%), papilloedema (80%) and hemiplegia (52%) were the common modes of presentation. CT findings included diffuse brain oedema (52%), haemorrhagic or nonhaemorrhagic infarctions on one or both sides of brain (48%), gyral enhancement (40%) and tentorial enhancement (16%). While 15 patients made good recovery, 3 cases (12%) died during acute stage of illness.

Adult↗
PubMed1991

Clinical spectrum of myasthenia gravis and problems of management.

Seventeen cases of myasthenia gravis, aged 20-79 years, including one case of ocular myasthenia gravis, seen over a 3 year period, were analysed. Dysphagia was the presenting symptom in two cases. One patient had ectopic thymus gland in relation to the cardiac border, which posed difficulty in diagnosis. A majority of the patients were on medical treatment, including neostigmine, prednisolone and azathioprim. Plasmapheresis was done in 4 cases during crisis, with significant benefit. One patient was put on intermittent ventilatory support for 14-16 hours a day for over 2 years; she died during a power failure. Seven patients were subjected to thymectomy.

Adult↗
PubMed1991

Epilepsy as a manifestation of neurocysticercosis.

Epilepsy is the commonest manifestation of neurocysticercosis. Epilepsy was observed in 127 of 150 cases (84.7%) of neurocysticercosis seen over a period of 17 years. The basis of diagnosis was clinical presentation and concomitant evidence of extraneural cysticercosis in the pre-computed tomography (CT) scan era, and typical CT findings in later years. Eighty one cases (54%) who primarily presented as epilepsy without any neurological deficit have been analysed in detail. In the pre-CT period the occurrence of epilepsy as a presenting feature in neurocysticercosis was 43.5% whereas in later years it was 61.4%. Primary generalised seizure (49 cases) was more common than partial seizure (29) and partial complex seizure (3). Status epilepticus was seen in 6 cases. Magnetic resonance imaging, done in 8 cases, proved to be more sensitive in demonstrating various stages in the development of noncalcified cysticercosis. The new larvicidal drugs offer a potential cure and cysticercosis should be entertained as a cause of epilepsy especially in endemic areas.

Brain Diseases↗
PubMed1990

Cysticercal meningoencephalitis.

Meningoencephalitic syndrome can be caused by many infective agents. Over a period of 13 years, 15 of 170 cases of neurocysticercosis (NCC) presented as meningoencephalitis. The basis of diagnosis of NCC was positive subcutaneous nodule histopathology (4), CT scan (9) and autopsy (3) findings. The age of the patients ranged from 7-68 years (mean 32). Fever was encountered in 12, altered sensorium in 7, seizures in 10 and abnormal behaviour in 3 cases. All cases had papilloedema. Focal neurological signs included optic atrophy, lateral rectus palsy, hemiplegia, internuclear ophthalmoplegia and cerebellar ataxia. Cerebrospinal fluid was abnormal in 8 of 13 cases, leading to a suspicion of tuberculous meningitis. Twelve patients improved with therapy. Three cases ended fatally and autopsy confirmed the diagnosis.

Adolescent↗
PubMed1990

Acute paralysis due to barium carbonate.

Poisoning due to barium carbonate (rat poison) resulting in areflexic quadriplegia and respiratory muscle paresis in a young patient is described. The various effects of barium salts on the human body and their treatment are highlighted.

Adult↗
PubMed1990

Computed tomographic spectrum of neurocysticercosis.

Computed tomography (CT) is a very sensitive modality for the diagnosis of neurocysticercosis. Fifty eight patients were evaluated by plain radiography and CT scans. The initial presentation was as seizure disorder (33), raised intracranial tension (19), meningoencephalitis (5) and psychiatric manifestation (1). Histologically confirmed subcutaneous nodules were seen in 20 cases and ocular cyst in 2 cases. CT scan showed multiple calcification in 8 cases, disc lesions in 30,ring lesions in 3, and a combination of disc and ring lesions in another 13 cases. Low attenuation lesions were seen in 4 cases in combination with disc/disc and ring lesions. All 58 cases had supratentorial lesions while 19 cases had infratentorial lesions in addition. Perifocal or generalised oedema was seen in 33 and 11 cases respectively. The ventricles were compressed in one case, large in 2 cases and normal in the rest. CT scan is valuable in the diagnosis of neurocysticercosis. Its significance is different in the various clinical and radiological groups.

Adolescent↗
PubMed1988

Cysticercosis of the brain shown by magnetic resonance imaging.

Fifteen patients in whom the diagnosis of cysticercosis of the brain was suggested by computed tomography (CT) were further studied with magnetic resonance imaging (MRI). Besides lesions in the substance of the hemispheres, cysts were found adjacent to and within the ventricles, the brainstem, cerebellum and subarachnoid space. Magnetic resonance imaging showed brain involvement out of proportion to what was shown by CT. The eccentrically placed mural nodule within a cyst, the pathognomonic lesion of cysticercosis, was seen in all cases with MRI. The various stages of development of the cysticercus larva were seen in one individual. An attempt is made to illustrate the various stages of development by means of MR images, and a possible pathological explanation is offered. The authors believe that MRI provides diagnostic information in this disease and dispenses with the need for enhanced CT examination.

Adolescent↗