Browsing by Author "Harsha, KJ"

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    A clinician's dilemma: Sturge-Weber syndrome 'without facial nevus'!!
    (ANNALS OF INDIAN ACADEMY OF NEUROLOGY, 2013) Jagtap, SA; Srinivas, G; Radhakrishnan, A; Harsha, KJ
    Sturge-Weber syndrome (SWS) is a rare, sporadic neurocutaneous syndrome characterized by a classical triad of facial port wine nevus, ipsilateral leptomeningeal angiomatosis (LAM) and glaucoma. The incidence of SWS is 1/50,000 live births, although it is more often underreported. The incidence of SWS without facial nevus is not known, although very few patients without facial nevus have been reported. In these patients, the diagnosis of SWS is made by the findings of computed tomography, magnetic resonance imaging, and histopathology. Here, we report three patients with SWS from our cohort of 28 patients with SWS without facial nevus and discuss their clinical profile and outcome.
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    Adult onset moyamoya disease: Institutional experience
    (NEUROLOGY INDIA, 2011) Chinchure, SD; Pendharkar, HS; Gupta, AK; Bodhey, N; Harsha, KJ
    Moyamoya disease is a progressive steno-occlusive disease of bilateral carotid forks with the formation of fine collateral vascular network and is an angiographic diagnosis. We analyzed case records of 11 patients with "adult-onset moyamoya disease." Six patients presented with intracranial hemorrhage (intracerebral and/or intraventricular) and 5 with focal ischemia. Angiography revealed bilateral Internal carotid artery involvement in 8 patients and unilateral involvement in 3. Posterior cerebral artery involvement was seen in 3 patients. Saccular aneurysm involving posterior circulation was seen in only 1 patient. Although rare, adult-onset moyamoya disease should be considered as one of the causes for intracerebral and intraventricular hemorrhage in adults.
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    Imaging of vascular causes of trigeminal neuralgia
    (JOURNAL OF NEURORADIOLOGY, 2012) Harsha, KJ; Kesavadas, C; Chinchure, S; Thomas, B; Jagtap, S
    Trigeminal neuralgia (TN) is a neuropathic disorder associated with severe recurrent episodic facial pain affecting predominantly elderly people. Though medical management is effective in pain control in first 2 years of symptom onset, many patients eventually require surgical intervention. Preoperative magnetic resonance imaging (MRI) evaluation of posterior fossa helps to identify major etiologies for TN. Neurovascular conflict is a common cause of TN. MRI is unique in imaging entire course of the trigeminal nerve, cisternal segment in particular. Microvascular decompressive (MVD) surgery is a safe and effective method for relieving neuralgic pain in neurovascular conflicts. We described vascular causes of TN, MR sequences useful in imaging of trigeminal nerve, the various vascular etiological possibilities, factors to be mentioned in MRI report. (C) 2012 Elsevier Masson SAS. All rights reserved.
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    Implicating the long styloid process in cervical carotid artery dissection
    (Neuroradiology., 2013-06) Muthusami, P; Kesavadas, C; Sylaja, PN; Thomas, B; Harsha, KJ; Kapilamoorthy, TR
    INTRODUCTION: To look for the presence and strength of association of cervical carotid artery dissection (CCAD) with a long styloid process. METHODS: This case-control analysis included 35 patients with 37 affected carotid arteries. CT angiograms of these patients were analyzed by two raters blinded to clinical and radiological diagnosis. Parameters assessed were styloid process length, its proximity to the cervical internal carotid artery, and its medial and anterior angulations. The same parameters were assessed in 70 CT angiograms in age and sex matched controls. RESULTS: Interrater correlations were 0.87, 0.40, 0.71, and 0.79 for styloid process length, contact distance, medial angulation, and anterior angulation, respectively. The mean styloid process length on the affected side was significantly more than on the contralateral side (37.8 vs. 34.6 mm, p = 0.006). There were also significant length and contact distance differences between the styloid processes ipsilateral to dissection and ipsilateral styloid processes of controls (38.9 vs. 36.2 mm, p = 0.05 and 3.1 vs. 5.0 mm, p = 0.05, respectively). There were increasing odds ratios (OR) for dissection with increasing styloid process length, with OR of 4.36 (95 % CI = 1.04 to 18.4, p = 0.04) for length more than 50 mm. ORs for dissection increased with decreasing contact distance, with OR for distances less than 5 mm being 7.58 (95 % CI = 0.93 to 62.1, p = 0.06). There was no significant association of CCAD with angulation of the styloid process. CONCLUSION: Length and contact distance of the styloid process are risk factors for CCAD, suggesting mechanical impingement.
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    Sturge-Weber Syndrome: Clinical Spectrum, Disease Course, and Outcome of 30 Patients
    (JOURNAL OF CHILD NEUROLOGY, 2013) Jagtap, S; Srinivas, G; Harsha, KJ; Radhakrishnan, N; Radhakrishnan, A
    Sturge-Weber syndrome is a heterogeneous neurocutaneous syndrome with facial and leptomeningeal angiomas, glaucoma, seizures, stroke-like episodes, and mental retardation. The authors critically evaluated the clinical manifestations, outcome, and natural history in 30 patients with Sturge-Weber syndrome followed up from January 1985 to May 2010. Of the patients, 15 were males, age at diagnosis ranged from 1 month to 43 years. Typical port-wine stain nevus occurred in 26 (86%), it was bilateral in 2 (8%), and it was absent in 4 (4%). Nine patients had glaucoma (30%), 3 required surgery. Four had transient hemiparesis. All patients had seizures; they were well controlled in 22 (73.3%); in 8 they remained drug resistant. Three patients underwent surgery and became seizure-free. Of the 17 who had mental subnormality, 14 (82.4%) had seizure onset before 2 years. An early age at seizure onset and those with drug-resistant seizures had more severe degree of mental subnormality. Uncontrolled seizures, mental subnormality, visual handicap, and cosmetic disfiguration were the major impediments in life.
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    Susceptibility-Weighted Imaging in Carotido-Cavernous Fistulas A Case Control Study
    (INTERVENTIONAL NEURORADIOLOGY, 2013) Harsha, KJ; Basti, RS; Kesavadas, C; Thomas, B
    This study determined the utility and accuracy of susceptibility-weighted MRI (SWI) for the detection of carotid cavernous fistulas. We retrospectively compared SWI images in nine patients (Group 1, case group) of DSA-proved carotid cavernous fistula (CCF) and 19 DSA negative cases for CCF as a control group (Group 2). Group 1 was again sub-grouped into direct and indirect types. Using uniform region-of-interest measurements, signal intensity within the superior ophthalmic vein (SOV) and the superior sagittal sinus (SSS) were measured on magnitude images of SWL The SOV/SSS signal intensity ratio was calculated in each case and the mean values of the two groups were compared. Eleven SOV/SSS signal intensity ratios in Group 1 (7 unilateral and two bilateral CCF), 38 in Group 2 (both sides in 19 control subjects) were included. Median +/- interquartile range of SOV/SSS ratios for Group I, Group 2, indirect and direct type CCFs were 1.07 +/- 0.43, 0.39 +/- 0.23, 0.83 +/- 0.29, 1.4 +/- 0.38 respectively. Mann-Whitney test between Groups 1 and 2 was statistically significant with P<0.0001. All cases and controls were reliably distinguished with SOV/SSS signal intensity ratio of 0.64 as cut-off Direct CCF cases had consistently higher ratios than indirect CCE SWI was highly sensitive for detection and differentiation of both direct and indirect CCF. Only one case of corticovenous reflux was missed by SWI. SWI is useful for detection of CCF and to differentiate between direct and indirect CCE
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    Transient ventricular bigeminy during vertebral artery catheterization
    (NEUROLOGY INDIA, 2012) Harsha, KJ; Jayadevan, ER; Kannath, SK