Browsing by Author "Kapilamoorthy, TR"

Now showing 1 - 20 of 59
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    Advanced MRI in Rosai-Dorfman disease: Correlation with histopathology
    (JOURNAL OF NEURORADIOLOGY, 2011) Hingwala, D; Neelima, R; Kesavadas, C; Thomas, B; Kapilamoorthy, TR; Radhakrishnan, VV
    Rosai-Dorfman disease is an idiopathic benign lymphoproliferative disorder that can, on rare occasions, cause intracranial or intraspinal lesions with non-specific features on conventional imaging. For this reason, its diagnosis is based on the classical pathological findings of histiocyte proliferation and emperipolesis. In this case report, we describe the imaging features of Rosai-Dorfman disease as visualized by newer types of MRI sequences, such as diffusion tensor imaging (DTI), susceptibility-weighted imaging (SWI) and perfusion-weighted imaging (PWI). In fact, combining the findings of conventional cross-sectional imaging with high fractional anisotropy (FA), a low apparent diffusion coefficient (ADC), mild blooming on SWI and decreased perfusion can help to make the diagnosis of Rosai-Dorfman disease. These newer tools can also be used to clarify the pathology of Rosai-Dorfman disease. (C) 2010 Elsevier Masson SAS. All rights reserved.
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    An incidental persistent falcine sinus with dominant straight sinus and hypoplastic distal superior sagittal sinus
    (PEDIATRIC RADIOLOGY, 2006) Manoj, KS; Krishnamoorthy, T; Thomas, B; Kapilamoorthy, TR
    An incidental persistent falcine sinus was detected in an otherwise normal brain on MRI in a 12-year-old girl who underwent imaging after clinical suspicion of acute disseminated encephalomyelitis. The falcine sinus was associated with a hypoplastic posterior third of the superior sagittal sinus and a dominant straight sinus. Generally, atresia or hypoplasia of the straight sinus is associated with a persistent falcine sinus in postnatal life; otherwise, the falcine sinus disappears before birth. We discuss the embryological basis for such an association in this case.
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    Aneurysmal bone cyst of skull - A report of two cases
    (RIVISTA DI NEURORADIOLOGIA, 2005) Purkayastha, S; Gupta, AK; Kapilamoorthy, TR; Bodhey, NK; Thomas, B
    An aneurysmal bone cyst is a benign lesion usually involving the long bones, vertebrae including odontoid, hypoid and mandible. Skull is a rare site for aneurysmal bone cyst. Only 3% occur in the cranium and sites of involvement include temporal, occipital, orbital, frontal, parietal, ethmoids and sphenoid bones in order of frequency. We report two cases of aneurysmal bone cysts in occipital bone and maxilla. We discuss the radiological features, surgical findings and emphasize the role of endovascular management in these lesions.
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    Bilateral perisylvian infarct: a rare cause and a rare occurrence
    (SINGAPORE MEDICAL JOURNAL, 2011) Singh, A; Kate, MP; Nair, MD; Kesavadas, C; Kapilamoorthy, TR
    Foix-Chavany-Marie opercular syndrome is a severe form of pseudobulbar palsy occurring due to bilateral anterior opercular lesions. We report a case of a 51-year-old man with sudden onset of inability to speak and dysphagia, and a history of synovial sarcoma of the right hand. Detailed language evaluation was normal. The patient had right upper motor neuron facial paresis and absent gag reflex bilaterally. Magnetic resonance (MR) imaging revealed acute and subacute infarcts involving the bilateral insular cortex. Two-dimensional echocardiography and cardiac MR imaging showed a mobile mass in the left atrium attached to the interatrial septum, which was likely a myxoma. Chest radiograph and computed tomography imaging of the chest revealed multiple cannonball shadows that were suggestive of secondaries in the lung. The probable cause of the cerebral lesions was the mass lesion in the heart or metastatic lesions from the synovial sarcoma. The cardiac surgeon and surgical oncologist recommended palliative care.
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    Carotid artery stenting - An Indian experience
    (RIVISTA DI NEURORADIOLOGIA, 2003)
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    Carotid artery stenting: Results and long-term follow-up
    (NEUROLOGY INDIA, 2006)
    Background and Purpose: The role of carotid artery stenting (CAS) as an alternative to carotid endarterectomy in the treatment of for symptomatic carotid artery stenosis is investigated. Materials and Methods: Forty-seven patients underwent CAS over 10-year period. Forty-nine vessels were treated. Stenosis quantification was done using North American symptomatic carotid endarterectomy trial method. The mean follow-up period by clinical and Duplex examination ranged is 5.6 years. Results: The technical success rate was 100%. There were four deaths (8.1%) and two (4.1%) minor strokes within thirty days of procedure. There was no major strokes. All patients with minor stroke achieved complete recovery at 1-month follow up. Two deaths occurred probably due to hyperperfusion syndrome (HS) and two due to cardiac arrest. Conclusion: CAS is an effective treatment modality of symptomatic carotid artery disease but should be carefully done in high-risk groups having severe medical ailments and those having severe bilateral stenosis of the carotid arteries.
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    Case 186: Dysembrioplastic Neuroepithelial Tumor
    (RADIOLOGY, 2012) Raz, E; Kapilamoorthy, TR; Gupta, AK; Fiorelli, M
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    Cerebral dural arteriovenous fistulae - An Indian experience
    (RIVISTA DI NEURORADIOLOGIA, 2003) Gupta, AK; Joseph, S; Kapilamoorthy, TR; Bejoy, T; Kesavadas, C
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    Cerebrospinal fluid rhinorrhea and acquired anterior basal encephalocoele in a patient with colloid cyst of the third ventricle
    (NEUROLOGY INDIA, 2010) Deepak, KS; Kesavadas, C; Kapilamoorthy, TR; Menon, G
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    Cutting balloon angioplasty in type 1 aortoarteritis - A case report
    (RIVISTA DI NEURORADIOLOGIA, 2004)
    Percutaneous transluminal angioplasty (PTA) of steno-occlusive lesions in the supra-aortic arch vessels in aortoarteritis is associated with suboptimal results and higher restenosis rates, particularly in those with diffuse disease. We report a patient with aortoarteritis who presented with critical stenosis of the right common carotid artery, right subclavian artery and 50 percent stenosis of the brachiocephalic artery. Left common carotid and left subclavian arteries were occluded and were reforming via collaterals. Cutting balloon PTA of right subclavian, right common carotid and brachiocephalic arteries was done with good anatomic patency and clinical results on six month follow up.
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    Diffusion Tensor Imaging and Tractography of the Human Language Pathways: Moving Into the Clinical Realm
    (JOURNAL OF MAGNETIC RESONANCE IMAGING, 2014) Muthusami, P; James, J; Thomas, B; Kapilamoorthy, TR; Kesavadas, C
    The functional correlates of anatomical derangements are of interest to the neurological clinician. Diffusion tensor tractography (DTT) is a relatively new tool in the arsenal of functional neuroimaging, by which to assess white matter tracts in the brain. While much import has been given to tracking corticospinal tracts in neurological disease, studying language pathway interconnections using DTT has largely remained in the research realm. Hardware and software advances have allowed this tool to ease into clinical practice, with several radiologists, neurologists, and neurosurgeons now familiar with its applications. DTT images, although visually appealing, are founded in mathematical equations and assumptions, and require a more than basic understanding of principles and limitations before they can be integrated into routine clinical practice. Cognitive pathways like that of language, that are normally hard to assess and especially more so when pathologically affected, have been at the receiving end of several opposing and often controversial hypotheses, and the past decade has seen the clarification, validation or rejection of several of these by the in vivo charting of functional connectivity using DTT. The focus of this review is to illustrate DTT of the language pathways with emphasis on practical considerations, clinical applications, and limitations.
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    Direct puncture embolization of head and neck tumors
    (RIVISTA DI NEURORADIOLOGIA, 2003) Gupta, AK; Joseph, S; Kapilamoorthy, TR; Kesavadas, C; Thomas, B
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    Endovascular treatment of carotido-cavernous fistula
    (RIVISTA DI NEURORADIOLOGIA, 2003) Gupta, AK; Rao, VRK; Kapilamoorthy, TR; Bhattacharya, RN; Joseph, S; Krishnamoorthy, T
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    Evaluation, management, and long-term follow up of vein of Galen malformations
    (JOURNAL OF NEUROSURGERY, 2006) Gupta, AK; Rao, VRK; Varma, DR; Kapilamoorthy, TR; Kesavadas, C; Krishnamoorthy, T; Thomas, B; Bodhey, NK; Purkayastha, S
    Object. Vein of Galen malformations (VGMs) are extremely rare intracranial lesions. Clinical presentation and management strategies vary significantly in different areas of the world. The authors report their experience in evaluation, management, and long-term follow up of these lesions in India. Methods. Between October 1983 and June 2003, 25 patients with VGMs were referred to the authors' institution for evaluation and management. Ten children younger than 2 years of age presented with rapidly increasing head size as the chief complaint. Among 11 children 2 years of age or older, the most common presenting symptom was chronic headache. Four patients who presented during adulthood had chronic headache for many years before presentation. Angiographic evaluation of the lesion was performed in 21 patients. Fifteen patients were treated using endovascular techniques. Injection of the embolic material was performed after induction of systemic hypotension when the flow in the fistula was high. Complete occlusion of the arteriovenous shunt could be achieved in two patients with vein of Galen aneurysmal dilation (100% of patients with this type of malformation) and in five of the six patients with the mural type of malformation (83%). Among patients with the choroidal type of malformation, complete obliteration of the shunt could be achieved in three patients. In three patients with high-flow choroidal malformations, embolization carried out in a single sitting resulted in shunt reduction of nearly 90%. These patients received clinical follow up. Conclusions. The authors' experience in evaluation and management of VGMs reveals that in areas of the world where access to dedicated specialist care is limited, the clinical presentation of VGMs can differ appreciably from the classic descriptions in the literature. Endovascular management of these lesions results in excellent angiographic and clinical results.
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    Experiences with carotid endarterectomy at Sree Chitra Tirunal Institute
    (ANNALS OF INDIAN ACADEMY OF NEUROLOGY, 2008) Unnikrishnan, M; Siddappa, S; Anto, R; Babu, V; Paul, B; Kapilamoorthy, TR; Sivasankaran, S; Sandhyamani, S; Sreedhar, R; Radhakrishanan, K
    Background: Atherosclerotic carotid artery disease poses a grave threat to cerebral circulation, leading to a stroke with its devastating sequelae, if left untreated. Carotid endarterectomy has a proven track record with compelling evidence in stroke prevention. Objectives: a)To confirm that carotid endarterectomy (CEA) is safe and effective in preventing stroke at both short and long term. b) to demonstrate long term patency of internal carotid artery when arteriotomy repair is performed using autologous saphenous vein patch. Materials and Methods: During ten years, from September 1997 to February 2008, thirty nine patients who underwent consecutive carotid endarterectomy at our institute, form the basis of this report. Their age ranged from thirty to seventy eight years, with a mean age of 56. There were four women in this cohort. Thirty seven patients were symptomatic with >70% stenosis and two were asymptomatic with >80% stenosis, incidentally detected. Imaging included Duplex scan and MRA for carotid territory and brain, and non-invasive cardiac assessment. Co-morbidities included smoking, hypertension, diabetes, and coronary artery disease. Carotid Endarterectomy was performed under general anaesthesia, using carotid shunt and vein patch arteriotomy repair. Results: All the patients made satisfactory recovery, without major adverse cerebral events in this series. Morbidities included Transient Ischemic Attack (TIA) in two, needing only medications in one, and carotid stenting in the other. Minor morbidities included neck hematoma in two and transient hypoglossal paresis in three patients. Yearly follow-up included duplex scan assessment for all the patients. Two patients died of contralateral stroke, two of myocardial events and two were lost to follow up. Thirty three patients are well and free of the disease during the follow up of three to 120 months. Conclusion: Carotid endarterectomy provided near total freedom from adverse cerebral events and its catastrophic sequelae, leading to excellent outcome, both short as well as long term.
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    Glioma grading: sensitivity, specificity, positive and negative predictive values of diffusion and perfusion imaging (Retracted article. See vol. 114, pg. 255, 2013)
    (JOURNAL OF NEURO-ONCOLOGY, 2009) Arvinda, HR; Kesavadas, C; Sarma, PS; Thomas, B; Radhakrishnan, VV; Gupta, AK; Kapilamoorthy, TR; Nair, S
    Purpose The purpose of our study was to determine the statistical significance of thresholds of relative cerebral blood volume (rCBV), apparent diffusion coefficient (ADC) and ADC ratios in grading cerebral gliomas. Materials and methods In this retrospective study, 51 patients with histopathologically confirmed primary cerebral gliomas who had undergone conventional MR imaging, dynamic contrast-enhanced T2*-weighted perfusion MR imaging and diffusion MR imaging were included. A retrospective blinded analysis of the imaging findings including the perfusion and diffusion parameters was done. The rCBV measurements were obtained from regions of maximum perfusion. Minimum ADC values were obtained from the region of maximum hypointensity within the tumor and from the corresponding opposite white matter. Tumor grade determined with the two methods were then compared with the histopathologic grade. Mann-Whitney tests were performed to compare the DWI and PWI between tumor types. Receiver operating characteristic analyses were performed to determine optimum thresholds for tumor grading and also to calculate the sensitivity, specificity, PPV, and NPV for identifying high-grade gliomas. Results Statistical analysis demonstrated a threshold value of 2.91 for rCBV to provide sensitivity, specificity, PPV, and NPV of 94.7, 93.75, 90.0, and 96.8%, respectively, in determining high-grade gliomas. An ADC value of 98.50 mm(2)/s was defined as a threshold below which tumors were classified as high-grade gliomas and a sensitivity, specificity, PPV, and NPV of 90, 87.1, 81.81 and 93.10% respectively, were obtained. Significant differences were noted in the rCBV ratios, ADC and ADC ratios between low- and high-grade gliomas (P < 0.0001). Conclusion Combining PWI and DWI with conventional MR imaging increases the accuracy of pre-operative imaging grading of glial neoplasms. The rCBV measurements had the most superior diagnostic performance in predicting glioma grade. Absolute ADC values or ADC ratios were also helpful in preoperative grading of gliomas. Threshold values can be used in a clinical setting to evaluate tumors preoperatively for histologic grade and provide a means for guiding treatment and predicting postoperative patient outcome.
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    Glioma grading: sensitivity, specificity, positive and negative predictive values of diffusion and perfusion imaging (Retraction of vol 94, pg 87, 2009)
    (JOURNAL OF NEURO-ONCOLOGY, 2013) Arvinda, HR; Kesavadas, C; Sarma, PS; Thomas, B; Radhakrishnan, VV; Gupta, AK; Kapilamoorthy, TR; Nair, S
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    Glioma progression as revealed by diffusion tensor metrics
    (NEUROLOGY INDIA, 2012) Muthusami, P; Basti, RS; Thomas, B; Kapilamoorthy, TR; Kesavadas, C
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    High-flow traumatic carotico-jugular fistula manifesting as venous hypertensive encephalopathy - A case report
    (INTERVENTIONAL NEURORADIOLOGY, 2005)
    We report the clinical and angiographic findings in a patient who presented with venous hypertensive encephalopathy secondary to a traumatic carotico-jugular fistula. Endovascular entrapment of the fistula by occluding the common carotid artery and internal jugular vein at the base of the skull resulted in near total improvement of the patient's neurological status.
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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.