Browsing by Author "Kannoth, Sudheeran"

Now showing 1 - 3 of 3
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    Intracranial infectious aneurysm: Presentation, management and outcome
    (JOURNAL OF THE NEUROLOGICAL SCIENCES, 2007)
    Background: Intracranial infectious aneurysms (IA) are infrequent, but can be fatal.Objectives: To compare the clinical profile of IAs associated with intravascular/systemic infection like infective endocarditis with that associated with local infections like meningitis, orbital cellulitis and cavernous sinus thrombosis.Methods: We analysed all cases of IA, treated in this Institute from 1976 to 2003, in order to identify prognostic factors.Results: There were 25 persons (mean age 24.8 +/- 17.3 years, males 17) with 29 IA (carotid circulation 19, vertebrobasilar circulation 10). Headache (83%) and fever (67%) were the most common presenting symptoms. In contrast to noninfectious aneurysms, intracerebral haemorrhage (60%) and focal signs were more common than subarachnoid haemorrhage (7%) with [A. Sources of infection were cardiac (10), meningitis (12), orbital cellulitis (2) or uncertain (I). Infective agents included bacteria (18), fungi (4), and tubercle bacilli (3). Fifteen]A were distal and 14 were proximal. IAs associated with meningitis were proximal (75%) while those associated with cardiac diseases preferentially involved carotid territory and were distal (p=0.013). The overall mortality was 32%. Survivors were younger than those who expired (p=0.015). Of the sixteen patients treated medically, seven recovered (44%), others (56%)) had treatment failure (three died and six required surgery later). Another five patients underwent early Surgery (one died). Mortality of IA was significantly higher with meningitis, fungal aetiology and vertebrobasilar location.Conclusions: IAs associated with local infections like meningitis had different clinical profile as compared to IAs associated with intravascular/systemic infections like infective endocarditis. (C) 2007 Elsevier B.V. All rights reserved.
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    Intracranial Microbial Aneurysm (Infectious Aneurysm): Current Options for Diagnosis and Management
    (NEUROCRITICAL CARE, 2009)
    The histopathological characteristic of intracranial microbial aneurysm (MA)-infectious aneurysm is the presence of infection and destruction of the walls of the vessels. It can occur in the setting of predisposing infections that spread by endovascular mechanism (e.g., infective endocarditis) or extravascular mechanism (e.g., meningitis). MA is probably a better term than mycotic, infectious, or infective aneurysm as a wide variety of bacteria, fungi, mycobacteria, and virus can cause MA. Typically MAs are multiple, distal, and fusiform aneurysms, but the angiographic and clinical presentations can vary widely. The most common presentation of MA is intracranial bleed. CT angiography, MR angiography, or Digital subtraction angiography can be deployed to detect MA. By combining the clinical findings, imaging, and angiographic findings, it is possible to arrive at a correct diagnosis in most instances. MAs carry higher risk of rupture and fatal bleed when compared to other aneurysms. The treatment options include antimicrobial therapy, surgery, and endovascular therapy. The management strategy is based on large case series rather than controlled trials. All MA should receive appropriate antibiotic therapy. Ruptured MA with mass effect would require surgery in most situations, while those without mass effect and in non-eloquent locations could also be managed by endovascular therapy. Unruptured MA could be managed according to the size, location, and risk of bleeding-by antibiotic therapy, surgery, or endovascular therapy. Monitoring the resolution of the MA under antibiotic therapy by serial CT angiography is another option, but it carries higher risk of bleeding. Treatment of the underlying predisposing infection is an important component of therapy.
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    Risk factors for epilepsy: A population-based case-control study in Kerala, southern India
    (EPILEPSY & BEHAVIOR, 2009)
    We undertook a community-based case-control study on persons with active epilepsy residing in Kerala, southern India. Using a standardized questionnaire, we collected information from 362 cases and 362 controls. In the final multivariate model, family history of epilepsy (odds ratio = 7.8, 95% confidence interval = 3.2-18.8, P = 0.000), antecedent history of febrile seizures (7.7, 4.3-14.0, 0.000), birth by complicated delivery (6.8, 2.1-21.8. 0.001), and neonatal seizures (7.8, 1.7-35.4, 008) emerged as strong independent predictors of epilepsy, followed in decreasing order by mental retardation, prematurity, maternal age >= 30, perinatal distress, and incomplete immunization. There were more similarities than differences in the distribution of risk factors between generalized and localization-related epilepsy syndromes. Our findings suggest interplay between genetic and acquired factors in the pathogenesis of epilepsies, and underscore the need for improvement in obstetric and neonatal care to minimize the epilepsy burden in low-income countries. (c) 2009 Elsevier Inc. All rights reserved.