Browsing by Author "Hingwala, DR"

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    Imaging signs in idiopathic intracranial hypertension: Are these signs seen in secondary intracranial hypertension too
    (ANNALS OF INDIAN ACADEMY OF NEUROLOGY, 2013) Hingwala, DR; Kesavadas, C; Thomas, B; Kapilamoorthy, TR; Sarma, PS
    Background: The purpose of this study was to evaluate the difference in the occurrence of the various "traditional" imaging signs of intracranial hypertension (IIH) on magnetic resonance imaging (MRI) in patients with idiopathic (IIH) and secondary intracranial hypertension. Materials and Methods: In a retrospective analysis, the MRI findings of 21 patients with IIH and 60 patients with secondary intracranial hypertension (41 with tumors; 19 with intracranial venous hypertension) were evaluated for the presence or absence of various "traditional" imaging signs of IIH (perioptic nerve sheath distention, vertical buckling of optic nerve, globe flattening, optic nerve head protrusion and empty sella) using the Fishers exact test. Odds ratios were also calculated. Statistical Package for the Social Sciences version 17.0 was used for statistical analysis. Subgroup analysis of the IIH versus tumors and IIH versus venous hypertension were performed. Results: Optic nerve head protrusion and globe flattening were significantly associated with IIH. There was no statistically significant difference in the occurrence of rest of the findings. On subgroup analysis, globe flattening and optic nerve head protrusion occurred significantly more often in IIH than in tumors. However, there was no statistically significant difference in the occurrence of any of these findings in patients with IIH and venous hypertension. Conclusions: IIH is a diagnosis of exclusion. While secondary causes of raised intracranial pressure (ICP) have obvious clinical findings on MRI, some conditions like cerebral venous thrombosis may have subtle signs and differentiating between primary and secondary causes may be difficult. In the absence of any evident cause of raised ICP, presence of optic nerve head protrusion or globe flattening can suggest the diagnosis of IIH.
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    Imaging signs in idiopathic intracranial hypertension: Are these signs seen in secondary intracranical hypertension too?
    (Ann Indian Acad Neurol., 2013-05) Hingwala, DR; Kesavadas, C; Thomas, B; Kapilamoorthy, TR; Sarma, PS
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    maging signs in idiopathic intracranial hypertension: Are these signs seen in secondary intracranial hypertension too?
    (Ann Indian Acad Neurol., 2013-06) Hingwala, DR; Kesavadas, C; Thomas, B; Kapilamoorthy, TR; Sarma, PS
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    Non-functioning pituitary adenoma and concomitant Rathke's cleft cyst
    (INDIAN JOURNAL OF PATHOLOGY AND MICROBIOLOGY, 2011) Radhakrishnan, N; Menon, G; Hingwala, DR; Radhakrishnan, VV
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    Pediatric gliosarcoma of thalamus
    (NEUROLOGY INDIA, 2012) Neelima, R; Abraham, M; Kapilamoorthy, TR; Hingwala, DR; Radhakrishnan, VV
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    Spontaneous intracranial hypo and hypertensions:An imaging review
    (NEUROLOGY INDIA, 2011) Vaghela, V; Hingwala, DR; Kapilamoorthy, TR; Kesavadas, C; Thomas, B
    Cerebrospinal fluid (CSF) pressure changes can manifest as either intracranial hypertension or hypotension. The idiopathic forms are largely under or misdiagnosed. Spontaneous intracranial hypotension occurs due to reduced CSF pressure usually as a result of a spontaneous dural tear. Idiopathic intracranial hypertension (IIH) is a syndrome of elevated intracranial tension without hydrocephalus or mass lesions and with normal CSF composition. Neuroimaging plays an important role in excluding secondary causes of raised intracranial tension. As the clinical presentation is varied, imaging may also help the clinician in arriving at the diagnosis of IIH with the help of a few specific signs. In this review, we attempt to compile the salient magnetic resonance imaging findings in these two conditions. Careful observation of these findings may help in early accurate diagnosis and to provide appropriate early treatment.
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    Suboptimal Contrast Opacification of Dynamic Head and Neck MR Angiography due to Venous Stasis and Reflux: Technical Considerations for Optimization
    (AMERICAN JOURNAL OF NEURORADIOLOGY, 2011) Hingwala, DR; Thomas, B; Kesavadas, C; Kapilamoorthy, TR
    BACKGROUND AND PURPOSE: Contrast-enhanced head and neck MRA may be degraded by venous stasis and reflux of contrast into the jugular veins. The purpose of this study was to evaluate the relationship between venous stasis and reflux and the side of injection and other causal factors. MATERIALS AND METHODS: One hundred twenty-six consecutive patients (94 males and 32 females) who underwent contrast-enhanced MRA were evaluated for the side of contrast injection (left, n = 65; right, n = 61), hypertension, and cardiac disease. The retrosternal space was measured in all patients with left-arm injections. RESULTS: Eight patients (6.34%) had reflux into the jugular veins. The difference in the mean ages of patients with and without reflux was not significant (P = .069). There was a significant difference in the incidence of systemic hypertension in patients with (77.78%) and without reflux (23.73%; P = .007). There was no significant difference in the incidence of cardiac disease in patients with and without reflux (P = .323). The difference in the side of injection in patients with and without reflux (P = .005) and the difference in the mean retrosternal distance in the patients with left-arm injection with (7.2 mm) and without reflux (12.1 mm) were statistically significant (P < .001). CONCLUSIONS: Compression of the left brachiocephalic vein between the sternum and a tortuous aorta and proximal vessels may lead to venous reflux that can degrade the quality of contrast-enhanced MRA. Our study suggests that venous reflux can be avoided by routinely injecting right-sided veins.
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    Susceptibility weighted imaging in the evaluation of movement disorders
    (Clin Radiol., 2013-06) Hingwala, DR; Kesavadas, C; Thomas, B; Kapilamoorthy, TR
    Movement disorders are neurodegenerative disorders associated with abnormalities of brain iron deposition. In this presentation, we aim to describe the role of susceptibility weighted imaging (SWI) in the imaging of patients with movement disorders and differentiate between the various disorders. SWI is a high-resolution, fully velocity-encoded gradient-echo magnetic resonance imaging (MRI) sequence that consists of using both magnitude and phase information. We describe briefly the physics behind this sequence and the post-processing techniques used. The anatomy of the midbrain and basal ganglia in normal subjects on SWI is covered. A number of neurodegenerative disorders are associated with abnormal iron deposition, which can be detected due to the susceptibility effects.
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    Tanycytic ependymoma of filum terminale: A case report
    (CLINICAL NEUROLOGY AND NEUROSURGERY, 2012) Radhakrishnan, N; Nair, NS; Hingwala, DR; Kapilamoorthy, TR; Radhakrishnan, VV
    Tanycytic ependymoma is an uncommon but well-recognized variant of ependymoma. Here we report a case of tanycytic ependymoma occurring at the region of filum terminale in a 44-year male who presented with low backache, bilateral lower limb weakness and urinary incontinence. MR imaging in this patient showed a lesion that was composed of solid and cystic components and was suggestive of ependymoma. The filum terminale region is an extremely unusual location for the occurrence of tanycytic ependymoma. To the best of our knowledge this is the third case of tanycytic ependymoma occurring in the filum terminale region. (C) 2011 Elsevier B.V. All rights reserved.
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    Tumefactive demyelinating lesions: A Clinicopathological correlative study
    (INDIAN JOURNAL OF PATHOLOGY AND MICROBIOLOGY, 2012) Neelima, R; Krishnakumar, K; Nair, MD; Kesavadas, C; Hingwala, DR; Radhakrishnan, VV; Nair, SS
    Tumefactive demyelinating (TDL) lesions are focal zones of demyelination in the central nervous system and they often mimic the neuroimaging features of an intraxial neoplasm. In this report we describe the clinical, neuroimaging and neuropathological features of six cases of TDL. Only in two patients the neuroimaging features in MRI (magnetic resonance imaging) scans were suggestive of TDL while in the other four cases a diagnosis of glioma was suggested. In order to establish a confirmatory diagnosis neuronavigation/stereotactic biopsy was undertaken and the diagnosis of TDL was established in all six cases at histopathology. Two out of six patients did not respond to the conventional corticosteroid therapy and they were treated with plasma exchange. It is being concluded that neuronavigation biopsy, though provide only a small amount of tissue, and is extremely useful in making the diagnosis of TDL.