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Neurosurgery in India.

This is a brief account of Neurosurgery in India. Prior to 1949, Neurosurgery was being practised by General Surgeons. With the return of Professor Jacob Chandy to the Christian Medical College, Vellore in 1949 modern neurosurgery was born and progressed, and today there are more than 180 neurosurgeons in India. Even so, the ratio works out to one neurosurgeon for every 3,600,000 individuals! Conditions commonly encountered such as hydrocephalus, craniovertebral anomalies, pyogenic, fungal and tuberculous infections of the central nervous system, and fluorosis are being discussed. Stereotaxic surgery for pain, epilepsy, behaviour disorders and involuntary movements is being practised at several centres especially at Madras. Following the workshops conducted by Professor Pia and his co-worker Professor Grote , enthusiasm for microneurosurgery has waxed.

Brain Injuries↗

The Kayser-Fleischer ring during long-term treatment in Wilson's disease (hepatolenticular degeneration). A follow-up study.

The role of Kayser-Fleischer rings is described in 67 patients with Wilson's disease, both in the asymptomatic and symptomatic stage of the disease during life-long therapy, which lasted up to 22 years. The rings were missing in 60% of patients in the presymptomatic stage and in 2% of those in the symptomatic stage at the time of diagnosis. The Kayser-Fleischer rings disappeared in 81% of the patients (completely in 41% and incompletely in 59%). In 2 of the 6 asymptomatic patients the rings did not reabsorb even after therapy of more than 10 years. The fading of Kayser-Fleischer rings seems to be independent not only of the stage of the disease but also of the effectiveness of the decopperizing treatment.

Basal Ganglia Diseases↗

Myoadenylate deaminase deficiency in twins with recessive olivopontocerebellar atrophy.

Two adult non-identical twins with autosomal recessive olivopontocerebellar degeneration (OPCA) had markedly deficient adenylate deaminase in skeletal muscle homogenates. Ischemic exercise failed to increase the blood ammonia, while lactate increased normally. Glutamate dehydrogenase and NADP-dependent malic enzyme activities in muscle mitochondria of both patients were normal. The significance of adenylate deaminase deficiency in these twins with OPCA is discussed.

AMP Deaminase↗

Trace eyeblink conditioning in human subjects with cerebellar lesions.

Trace eyeblink conditioning was investigated in 31 patients with focal cerebellar lesions and 19 age-matched controls. Twelve patients presented with lesions including the territory of the superior cerebellar artery (SCA). In 19 patients lesions were restricted to the territory of the posterior inferior cerebellar artery (PICA). A 3D magnetic resonance imaging was used to determine the extent of the cortical lesion and possible involvement of cerebellar nuclei. Eyeblink conditioning was performed using a 40 ms tone as conditioned stimulus (CS) followed by a stimulus free trace-interval of 400 ms and a 100 ms air-puff as unconditioned stimulus (US). In SCA patients with lesions including parts of the cerebellar interposed nucleus trace eyeblink conditioning was significantly impaired. Pure cortical lesions of the superior cerebellum were not sufficient to reduce acquisition of trace conditioned eyeblink responses. PICA patients were not impaired in trace eyeblink conditioning. Consistent with animal studies the findings of the present human lesion study suggest that, in addition to forebrain areas, the interposed nucleus is of importance in trace eyeblink conditioning. Although cortical cerebellar areas appear less important in trace compared with delay eyeblink conditioning, the present data strengthen the view that cerebellar structures contribute to different forms of eyeblink conditioning paradigms.

Adult↗

The cerebral intravascular enhancement sign is not specific: a contrast-enhanced MRI study.

The intravascular enhancement (IVE) sign, also known as the "arterial enhancement sign", is an abnormal finding in the brain on contrast-enhanced MRI studies. IVE has been described in arterial cerebrovascular disorders, most commonly in acute or subacute arterial ischemic infarcts. However, the specificity of this sign has not been established. We describe four patients with disorders other than arterial strokes in whom gadolinium-enhanced high-field (1.5 T) MRI suggested IVE. The conditions were herpes simplex viral encephalitis, idiopathic cerebellitis, pneumococcal meningitis, and superior sagittal sinus thrombosis with venous infarction. IVE in these cases may be due to multiple factors, including arterial, venous, perivascular, and leptomeningeal or sulcal contrast medium accumulation. Our observations suggest that arterial ischemia, previously described as the cardinal cause of IVE, probably does not explain all instances, and urge caution in interpreting this sign as a specific MRI manifestation of acute arterial infarction or ischemia.

Adult↗

Posterior fossa tension pneumocephalus.

Posterior fossa tension pneumocephalus (PFTP) is a very rare clinical entity--OFF few case reports available prove how rare. Five patients with PFTP are presented. All were operated on for posterior fossa lesions. One was operated on in the lateral position and the rest in a sitting position. All the patients had postoperative (early) neurological deterioration, and computed tomography (CT) scans revealed PFTP in the left cerebellopontine angle in one case and in the IV ventricle in the rest. Air was aspirated from the posterior fossa in one case. All the cases were electively ventilated for 48-72 h. All the patients had an immediate onset of progressive neurological recovery after early intervention and elective ventilation. One patient died 10 days later because of a recurrence of empyema and the development of meningitis. PFTP is a rare but important complication of posterior fossa surgery. Early intervention and elective ventilation can produce a good recovery.

Adolescent↗

Vision and vertigo: some visual aspects of vestibular disorders.

This review deals with two syndromes, oscillopsia and visual vertigo. Oscillopsia is the illusion of oscillation of the visual surroundings. For diagnosis purposes one should ask, when does the oscillopsia occur? If oscillopsia is only present during head (or whole body) movements, the likely underlying cause is a bilateral defect in the vestibulo-ocular reflex (VOR). The more common causes are post meningitic vestibular damage, gentamicin ototoxicity or bilateral idiopathic vestibular failure. When oscillopsia develops after specific head positions, it is usually due to a positional nystagmus, usually the result of brainstem-cerebellar disease. When the oscillopsia is largely unrelated to head movements, one should ask, is it fairly constant or is it in attacks (paroxysmal)? If the oscillopsia is constant it is usually due to the presence of a clinically observable nystagmus; the most common is downbeat nystagmus but the most visually disabling is pendular nystagmus. If the oscillopsia comes in brief attacks it is usually due to a paroxysmal nystagmus as observed in irritative VIII nerve and brainstem lesions. However, the most common cause of paroxysmal oscillopsia is a non organic condition called voluntary nystagmus. Treatment of oscillopsia is often pharmacological but disappointing; the best chance of success is carbamazepine for paroxysmal disorders secondary to structural vestibular nerve/nuclear lesions.Visual vertigo should not be confused with oscillopsia. It can be defined as dizziness provoked by visual environments with large size (full field) repetitive or moving visual patterns. Patients with visual vertigo report discomfort in supermarkets and when viewing movement of large visual objects, eg crowds, traffic, clouds or foliage. Visual vertigo is present in many patients with a history of a peripheral vestibular disorder, particularly those who are visually dependent (ie subjects who use vision preferentially for postural and space orientation control). Patients with visual vertigo benefit from the addition to their standard vestibular rehabilitation of optic flow (optokinetic) stimuli and exercises involving visuo-vestibular conflict.

Head Movements↗

Hippocampal EEG changes in rats following cerebellar lesions.

In the rat, there is a close relation between hippocampal theta rhythm and voluntary movements. The purpose of the present study was to investigate whether motor deficits and subsequent recovery following cerebellar lesions may be accompanied by changes in hippocampal EEG. The results show that rats with severe motor dysfunctions displayed increased frequency of hippocampal theta that lasted beyond the recovery of motor deficits. Hippocampal theta that appeared along with gross automatic movements disappeared about 50 days postoperatively. The findings are discussed in terms of recovery of function and potential compensatory neural mechanisms.

Animals↗

Intracerebellar hemorrhage due to cerebellar hemangioblastoma.

A rare case of a bleeding from a cerebellar hemangioblastoma is described. The tumor was diagnosed preoperatively with a computed tomography scan and a vertebral angiogram. The characteristic computed tomography scan findings and probable mechanism of bleeding are discussed.

Cerebellar Diseases↗

Perception and production of tone in aphasia.

An acoustical and perceptual study of lexical tone was conducted to evaluate the extent and nature of tonal disruption in aphasia. The language under investigation was Thai, a tone language which has five lexical tones--mid, low, falling, high, and rising. Subjects included six left brain-damaged aphasics (two Broca's, one transcortical motor, one global, one conduction, one Wernicke), one right brain-damaged nonaphasic, one cerebellar dysarthric, and five normals. High-quality tape recordings of each subject's productions of a minimal set of five, monosyllabic Thai words were presented to 10 adult Thai listeners for identification. Results from the phonemic identification tests indicated that tone production is relatively spared in aphasic patients with unilateral left hemisphere lesions. The performance of the global aphasic, however, was considerably below normal. Patterns of tonal confusions further revealed that the performance of all aphasics, except the global, differed from that of normal speakers primarily in degree rather than in kind. Tonal contrasts were signaled at a high level of proficiency by the right brain-damaged and dysarthric patients. Acoustical analysis revealed that F0 contours associated with the five tones for all aphasics, except the global, were similar in overall shape as well as position in the tone space to those of normals. F0 contours for the right brain-damaged patient and the dysarthric also generally agreed with those of normals in terms of shape and position. F0 ranges of both aphasic and nonaphasic brain-damaged speakers were generally larger than those of normals for all five tones. The relationship between tone and vowel duration was generally similar to that of normals for all brain-damaged speakers. A comparison of aphasics' performance on tone perception (J. Gandour & R. Dardarananda, 1983, Brain and Language, 18, 94-114) and tone production indicated that, for the normal and right brain-damaged subjects, performance on the perception task was higher than on production, whereas the opposite was true for the aphasics. These data are brought to bear on issues related to tone production in aphasia, consonant and vowel production in aphasia, hemispheric specialization for tone production, intonation production in aphasia, relationship between speech perception and speech production, and tone production in dysarthria with cerebellar disease.

Adult↗