Browsing by Author "Kesavadas, Chandrasekhar"

Now showing 1 - 3 of 3
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    Cost-effective utilization of single photon emission computed tomography (SPECT) in decision making for epilepsy surgery
    (SEIZURE-EUROPEAN JOURNAL OF EPILEPSY, 2011)
    Purpose: To investigate the utility of single photon emission computed tomography (SPECT) without subtraction and MRI co-registration in decision making for epilepsy surgeryMethods: Patients with refractory epilepsy and nonlocalizing or discordant non-invasive data (clinical, long-term VEEG, and MRI) were subjected to interictal and ictal SPECT studies before planning invasive or surgical strategy. Final localization was based upon the preoperative information and seizure freedom after surgery. SPECT was considered to be useful for decision-making if it obviated the need for intracranial monitoring or influenced its planning.Results: 61 patients (mean age, 25.1 +/- 8.3 years) underwent SPECT studies between January 2004 and December 2008. Twenty-two patients had mesial temporal lobe epilepsy (MTLE), 13 had neocortical temporal lobe epilepsy (NTLE), and 26 had extratemporal lobe epilepsy (ETLE). As compared to ETLE, SPECT provided more localizing information (77.3% vs 46.2%, p = 0.006) and influenced the final decision-making (45.4% vs 11.53%, p = 0.005) in a significantly higher number of patients with MTLE. SPECT was particularly useful in patients with lesional TLE and nonlocalizing ictal data and in those with dual pathologies. SPECT did not provide any additional information in patients having either TLE or ETLE with normal MRI.Conclusions: SPECT is useful in a selected group of patients and unlikely to provide additional information in others. By restricting its use in patients who are likely to be benefited, a cost-effective utilization strategy can be employed in countries with limited resources. Due to the small number, these findings need to be validated in a larger group of patients. (C) 2010 British Epilepsy Association. Published by Elsevier Ltd. All rights reserved.
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    Fungal infections of the central nervous system in HIV-negative patients: Experience from a tertiary referral center of South India
    (ANNALS OF INDIAN ACADEMY OF NEUROLOGY, 2010)
    Objective: To describe the clinical, radiological, and cerebrovascular fluid (CSF) findings and the outcome of microbiologically or histopathologically proven fungal infections of the central nervous system (CNS) in HIV-negative patients. Methodology and Results: We identified definite cases of CNS mycosis by screening the medical records of our institute for the period 2000-2008. The clinical and imaging details and the outcome were abstracted from the medical records and entered in a structured proforma. There were 12 patients with CNS mycosis (i.e., 2.7% of all CNS infections treated in this hospital); six (50%) had cryptococcal infection, three (25%) had mucormycosis, and two had unclassified fungal infection. Four (33%) of them had diabetes as a predisposing factor. The common presentations were meningoencephalitis (58%) and polycranial neuritis (41%). Magnetic resonance imaging revealed hydrocephalus in 41% and meningeal enhancement in 25%, as well as some unusual findings such as subdural hematoma in the bulbocervical region, carpeting lesion of the base of the skull, and enhancing lesion in the cerebellopontine angle. The CSF showed pleocytosis (66%), hypoglycorrhachia (83%), and elevated protein levels (100%). The diagnosis was confirmed by meningocortical biopsy (in three cases), paranasal sinus biopsy (in four cases), CSF culture (in three cases), India ink preparation (in four cases), or by cryptococcal polysaccharide antigen test (in three cases). Out of the ten patients for whom follow-up details were available, six patients recovered with antifungal medications (amphotericin B, 1 mg/kg/day for the minimum period of 6 weeks) and/or surgical treatment. Four patients expired (only one of them had received antifungal therapy). Conclusions: Most patients with CNS mycosis recover with appropriate therapy, but the diagnosis and management of these rare infections remains a challenge to clinicians.
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    Susceptibility-weighted imaging in differentiating bilateral medial thalamic venous and arterial infarcts
    (NEUROLOGY INDIA, 2010)
    Bilateral medial thalamic infarcts may be due to thrombosis of internal cerebral veins or occlusion of artery of Percheron. Conventional MR imaging is often not helpful in differentiating the two. We discuss two cases in whom susceptibility-weighted imaging, including phase images contributed in demonstrating the thrombosed or patent internal cerebral veins.