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Vedantam Rajshekhar

Publications and source records attributed to Vedantam Rajshekhar.

32 records · Page 2Linked to original sources
PubMed2004

New solitary cysticercus granulomas causing recurrent symptoms in patients with resolved solitary granulomas.

Recurrence of symptoms in a patient with a resolved solitary cerebral cysticercus granuloma (SCCG) is uncommon. Recurrent seizures in these patients are generally attributed to an epileptogenic scar or calcific residue of the granuloma. We report two patients with recurrent seizures and one patient with headache; all three patients were previously diagnosed to have SCCG and had complete resolution of the granuloma on follow-up imaging. Computed tomography (CT) at the time of recurrent symptoms showed a SCCG at a site different from the initial lesion, but in the same cerebral hemisphere in all the three patients. Since a new lesion can cause recurrent symptoms in patients with a resolved SCCG, repeat imaging should be performed in all these patients. We also postulate that recurrent cysticercal lesions in patients who have previously had a SCCG, tend to be solitary.

Animals↗
PubMed2004

Glioblastoma multiforme in a child with acute lymphoblastic leukemia: case report and review of literature.

An 11-year-old boy with acute lymphoblastic leukemia had received prophylactic cranial irradiation (1800 cGy /10 fractions) and intrathecal methotrexate. Five years later, he developed a glioblastoma multiforme in the right frontal region while the leukemia was in remission. It is possible that the glioma may have been induced by radiation and /or chemotherapy.

Antimetabolites, Antineoplastic↗
PubMed2004

Unusual presentation of the "syndrome of the trephined".

A 45-year-old lady underwent right fronto-parietal craniotomy and subtotal excision of a parasagittal meningioma. Bone flap was not replaced as it was infiltrated by the tumor. In the postoperative period she developed episodes of altered sensorium associated with worsening of left hemiparesis and a sunken scalp at the site of bone defect. Computed tomography (CT) of brain showed sunken scalp flap in the right fronto-parietal region with compression of the underlying brain. A diagnosis of syndrome of the trephined was considered and her symptoms improved with cranioplasty. Pathophysiology of the syndrome of the trephined is discussed.

Female↗
PubMed2003

Measures for the prevention and control of Taenia solium taeniosis and cysticercosis.

Taeniosis and cysticercosis due to Taenia solium are public health problems in many developing countries. Many studies of this parasitic zoonosis have focused on clinical features, diagnosis, treatment, surveillance, epidemiology and risk factors analysis. More recently projects on community and mass intervention strategies had been conducted in several rural areas worldwide focused on pig vaccination, pig cysticercosis treatment, human mass treatment, infrastructure development, as well as health education campaigns. Their advantages, disadvantages and public health impact have been published. This document discusses the feasibility and limitations of these interventions in order to assist countries in selection the best strategy for the prevention and control of this disease; we emphasized the specific strategies that might be recommended in different demographical situations.

Animals↗
PubMed2003

Taenia solium taeniosis/cysticercosis in Asia: epidemiology, impact and issues.

Several reports of patients with cysticercosis from many countries in Asia such as India, China, Indonesia, Thailand, Korea, Taiwan and Nepal are a clear indicator of the wide prevalence of Taenia solium cysticercosis and taeniosis in these and other Asian countries. However, epidemiological data from community based studies are sparse and available only for a few countries in Asia. Cysticercosis is the cause of epilepsy in up to 50% of Indian patients presenting with partial seizures. It is also a major cause of epilepsy in Bali (Indonesia), Vietnam and possibly China and Nepal. Seroprevalence studies indicate high rates of exposure to the parasite in several countries (Vietnam, China, Korea and Bali (Indonesia)) with rates ranging from 0.02 to 12.6%. Rates of taeniosis, as determined by stool examination for ova, have also been reported to range between 0.1 and 6% in the community in India, Vietnam, China, and Bali (Indonesia). An astonishingly high rate of taeniosis of 50% was reported from an area in Nepal populated by pig rearing farmers. In addition to poor sanitation, unhealthy pig rearing practices, low hygienic standards, unusual customs such as consumption of raw pork is an additional factor contributing to the spread of the disease in some communities of Asia. Undoubtedly, cysticercosis is a major public health problem in several Asian countries effecting several million people by not only causing neurological morbidity but also imposing economic hardship on impoverished populations. However, there are wide variations in the prevalence rates in different regions and different socio-economic groups in the same country. It is important to press for the recognition of cysticercosis as one of the major public health problems in Asia that needs to be tackled vigorously by the governments and public health authorities of the region.

Animals↗
PubMed2003

Benign metastasizing leiomyoma causing spinal cord compression.

BACKGROUND: Leiomyoma as a cause of cord compression is extremely rare. To our knowledge this is the first report of a dural-based leiomyoma and second report of a leiomyoma causing cord compression. CASE DESCRIPTION: A 38-year-old female renal transplant recipient presented with features of cervical cord compression. On imaging and at surgery, the tumor was mistaken for a neurofibroma. A cervical laminectomy and near total excision of the tumor was done. She did well in the postoperative period but presented 5 months later with thoracic empyema leading to septicemia and her demise. Ultrasound examination and autopsy showed leiomyomas in many other sites including the uterus. CONCLUSIONS: The presence of extrauterine and uterine leiomyomas is a curious condition termed as "benign metastasizing leiomyoma." As our patient was on immunosuppressant therapy following a renal transplant, it might have predisposed her to this rare condition with multifocal tumors.

Adult↗
PubMed2003

Cost-effective initial screening for vestibular schwannoma: auditory brainstem response or magnetic resonance imaging?

OBJECTIVE: Our goal was to determine the cost-effectiveness of including auditory brainstem response (ABR) testing in a screening protocol for the diagnosis of vestibular schwannoma (VS) in patients with asymmetric auditory symptoms at the Christian Medical College and Hospital, Vellore, India, where, commonly, patients with VS have tumors greater than 2 cm at the time of diagnosis. METHODS: Ninety patients with asymmetric audiovestibular symptoms were investigated prospectively with both ABR and gadolinum-enhanced magnetic resonance imaging (GdMRI). RESULTS: Of these 90 patients, 6 were diagnosed with VS on GdMRI. On ABR testing, 4 patients with VS had retrocochlear pathology and 2 with profound sensorineural hearing loss had no responses. ABR was found to have a sensitivity of 100% and specificity of 61.9%. A protocol involving screening of all patients with asymmetric audiovestibular symptoms using ABR and only subjecting those patients with no responses or retrocochlear pathology to GdMRI would effect a savings of $1200 for every patient detected to have a VS. CONCLUSIONS: In our hospital setting, including ABR as the preliminary screen for patients with asymmetric audiovestibular symptoms is a cost-effective strategy.

Adolescent↗
PubMed2003

Changes in cervical spine curvature after uninstrumented one- and two-level corpectomy in patients with spondylotic myelopathy.

OBJECTIVE: We studied changes in the cervical spine curvature in patients with cervical spondylotic myelopathy who underwent one- or two-level central corpectomy and iliac bone grafting without the use of instrumentation. METHODS: Curvature of the fused segment and of the whole cervical spine was evaluated on preoperative and follow-up x-rays in 93 patients (30 underwent one-level corpectomy, and 63 underwent two-level corpectomy). In 59 patients, the changes in the cervical spine curvature were studied using one follow-up x-ray; in the other 34 patients, the changes were studied on x-rays obtained at two or more follow-up visits. The sagittal alignment of the fused segment was categorized as lordotic (>+5 degrees), straight (+5 to -5 degrees) or kyphotic (>-5 degrees). The whole spine curvature also was recorded as lordotic, straight, or kyphotic. RESULTS: At a mean follow-up of 22.2 months (range, 6-71 mo), there was a mean change of -10.4 degrees in the segmental curvature (P < 0.001). The fused segment sagittal alignment also worsened (lordotic angles becoming straight or kyphotic and straight angles becoming kyphotic) in 44 patients (47%)(P < 0.001). However, serial studies in 34 patients (mean first and last follow-ups, 11.9 and 30.8 mo, respectively) did not demonstrate significant worsening of the kyphotic angle or the sagittal alignment over time (P = 0.9). Whole spine curvature worsened in 33 (35%) of the 93 patients (P < 0.001); serial studies did not reveal a significant change (P = 0.9). Patients improved in their functional status from a preoperative mean Nurick grade of 2.9 (range, 1-5) to a follow-up mean Nurick grade of 1.5 (range, 0-4) (P < 0.001). Patients with a kyphotic change in their whole spine curvature (n = 33) and those without such change (n = 60) had a similar functional outcome (mean change in Nurick grade, 1.5 and 1.4, respectively). CONCLUSION: Cervical spine curvature tended to undergo a kyphotic change at the fused segment in 47% of patients and a kyphotic change of the whole spine curvature in 35% of patients who underwent one- or two-level uninstrumented central corpectomy. This kyphotic change in the cervical spine, which stabilizes within 1 year after surgery, is not progressive, and it does not affect neurological outcome in these patients.

Adult↗
PubMed2003

Rate of resolution of histologically verified intracranial tuberculomas.

OBJECTIVE: The goal of this study was to determine the rate of radiological resolution of histopathologically proven tuberculomas treated with antituberculous therapy (ATT). The effects of the size of the tuberculomas, the number of tuberculomas, and the addition of corticosteroid therapy on the rate of resolution of the tuberculomas were also studied. METHODS: Twenty-eight patients (age range, 5-48 yr; 14 male and 14 female patients) with histologically proven intracranial tuberculomas were prospectively monitored with contrast-enhanced computed tomographic scans. The patients received ATT consisting of rifampicin and isoniazid for a period of 18 months, with ethambutol and/or pyrazinamide for a minimum of 3 months. Fifteen patients also received corticosteroid therapy for 1 to 6 weeks. Of the 28 patients, 17 patients underwent partial excision, 6 underwent open biopsy, and 5 underwent stereotactic biopsy of their tuberculomas. RESULTS: Kaplan-Meier analysis revealed that, after 9 months of ATT, only 18.2% of the patients demonstrated complete resolution of their tuberculomas; even after 18 months of ATT, 69.2% of the patients had residual lesions. By 24 months, 54% of the patients demonstrated complete resolution of their tuberculomas. Although the number of tuberculomas, corticosteroid administration, prior treatment with ATT, and the duration of symptoms before presentation (<6 mo versus >6 mo) did not influence the rate of resolution, larger tuberculomas (maximal size, >4 cm) were observed to resolve more slowly than smaller tuberculomas (<4 cm) (P = 0.02). CONCLUSION: More than two-thirds of patients with partially excised or biopsied intracranial tuberculomas exhibited persistent lesions on computed tomographic scans, even after 18 months of ATT. Therefore, the duration of ATT for patients with intracranial tuberculomas should be based on the radiological responses of the tuberculomas. Our data suggest that some patients with intracranial tuberculomas might require prolonged periods of ATT.

Adolescent↗
PubMed2002

Management of hydrocephalus associated with occipital encephalocoele using endoscopic third ventriculostomy: report of two cases.

BACKGROUND: Occipital encephalocoele is the most common cranial dysraphism in the western hemisphere and is often complicated by hydrocephalus. Management of hydrocephalus and reducing the CSF pressure is crucial in preventing dehiscence at the site of the encephalocoele repair. METHODS: Two female patients had presented with occipital encephalocoeles. The first patient (aged 42 days) had undergone repair of the occipital encephalocoele and then developed hydrocephalus with recurrence of the encephalocoele. The second patient (aged 12 months) had hydrocephalus associated with an occipital encephalocoele at initial presentation.Both the patients underwent endoscopic third ventriculostomy (ETV) through a right frontal burr hole. In the first patient, ETV was performed after shunt dysfunction at the age of 9 months. Because she presented with recurrence of the encephalocoele 15 months later, a repeat endoscopic third ventriculostomy was performed. She required a ventriculoperitoneal shunt during the same admission because of the early failure of the ventriculostomy. In the second patient, it was performed before the encephalocoele repair, both ETV and the repair being conducted under the same anesthesia. ETV was performed using a rigid scope and the perforation in the third ventricular floor was enlarged using a No. 4 Fogarty catheter. RESULTS: The first patient had no recurrence of encephalocoele at follow-up of 10 months but she presented with recurrence of the occipital encephalocoele after 15 months. The second patient had no evidence of recurrence at follow-up after 16 months. The lateral and third ventricular volumes had decreased in both the patients at initial follow-up. CONCLUSION: ETV can be an effective treatment option for encephalocoele-associated hydrocephalus, even in children under the age of 1 year. It may obviate the need for placement of CSF shunts that have a risk of infection and dysfunction. However, delayed failure of ETV may occur as seen in our first patient, indicating the need for careful and long-term follow-up.

Encephalocele↗
PubMed2002

Current consensus guidelines for treatment of neurocysticercosis.

Taenia solium neurocysticercosis is a common cause of epileptic seizures and other neurological morbidity in most developing countries. It is also an increasingly common diagnosis in industrialized countries because of immigration from areas where it is endemic. Its clinical manifestations are highly variable and depend on the number, stage, and size of the lesions and the host's immune response. In part due to this variability, major discrepancies exist in the treatment of neurocysticercosis. A panel of experts in taeniasis/cysticercosis discussed the evidence on treatment of neurocysticercosis for each clinical presentation, and we present the panel's consensus and areas of disagreement. Overall, four general recommendations were made: (i) individualize therapeutic decisions, including whether to use antiparasitic drugs, based on the number, location, and viability of the parasites within the nervous system; (ii) actively manage growing cysticerci either with antiparasitic drugs or surgical excision; (iii) prioritize the management of intracranial hypertension secondary to neurocysticercosis before considering any other form of therapy; and (iv) manage seizures as done for seizures due to other causes of secondary seizures (remote symptomatic seizures) because they are due to an organic focus that has been present for a long time.

Animals↗
PubMed2002

Outcome in neurologically impaired patients with craniovertebral junction tuberculosis: results of combined anteroposterior surgery.

OBJECT: The authors studied the immediate and long-term outcome after transoral decompression, occipitocervical fusion, and antituberculous therapy (ATT) in patients who had neurological deficits due to craniovertebral junction (CVJ) tuberculosis. METHODS: In this retrospective study, the authors reviewed the management and outcome in nine consecutive patients in whom features of spinal cord compression were observed and CVJ tuberculosis was diagnosed between 1993 and 1999. They ranged in age from 9 to 55 years. Onset of symptoms was acute or subacute and rapidly progressive (median 4 months, range 1-12 months). Patients presented with neck pain (89%), progressive limb weakness (89%), sensory symptoms (22%), and urinary dysfunction (33%). The mean preoperative functional grade based on the Nurick Scale was 3.4 (range 1-5). The disease caused reducible atlantoaxial dislocation (AAD) in three patients (33%), irreducible AAD in two (22%), basilar impression (BI) in one (11%), AAD with BI in one (11%), and C-2 vertebral body (VB) destruction without dislocation in two (22%). Surgery was performed in all cases. Five patients (56%) underwent transoral odontoidectomy, two (22%) transoral decompression of retropharyngeal abscess and granulation tissue, and two (22%) transoral decompression of abscess and diseased parts of the C-2 VB. All patients then underwent occipitocervical (occiput-C3) fusion in which a contoured Steinmann pin and iliac bone grafts were used. Postoperatively, A17 was prescribed for 18 months. In the immediate postoperative period, function in these patients improved from a mean Nurick grade of 3.4 to 2.3 (p < 0.01). At long-term follow-up examination (median 18.8 months, range 7-46 months) function improved from a mean Nurick grade of 3.4 to 0.3 (range 0-2) (p < 0.001). CONCLUSIONS: Patients with CVJ tuberculosis with features of cervical myelopathy are ideally managed with transoral decompressive procedures followed by occipitocervical fusion because this therapy provides immediate neurological improvement, stability, and allows early mobilization. The long-term prognosis in patients with this disease is excellent provided it is treated with appropriate surgical intervention(s) and with adequate duration of ATT.

Adolescent↗