Browsing by Author "Purkayastha, S"

Now showing 1 - 20 of 34
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    Absence of the left common carotid artery with cervical origin of the right subclavian artery
    (AMERICAN JOURNAL OF NEURORADIOLOGY, 2006)
    We report the case of a 1(1)/(2)-year-old female child, who developed symptomatic hemorrhage from major aorto-pulmonary collaterals after surgery for Tetrology of Fallot. During the course of embolization of the aorto-pulmonary collaterals, we discovered the presence of direct origin of the left internal and external carotid arteries from the aortic arch. Further, there was cervical origin of right subclavian artery. We discuss the clinical significance and potential embryological mechanism in development of this anomaly.
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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 cerebral venous angioma associated with varices: A case report and review of the literature
    (AMERICAN JOURNAL OF NEURORADIOLOGY, 2005) Vattoth, S; Purkayastha, S; Er, J; Gupta, AK
    A varix occurring with a cerebral venous angioma is a rare combination of cerebral vascular malformations. The most common vascular anomaly associated with a venous angioma is a cavernous angioma. We report a case of bilateral supratentorial venous angioma with 2 varices involving the angioma situated on the right frontotemporal region. Multiple subependymal veins were seen in the right supratentorial region, which joined to form multiple collector veins, which, in turn, unified into a tortuous channel in the region of the sylvian fissure and continued into venous varices.
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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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    Cerebral arteriovenous malformation embolized through persistent primitive hypoglossal artery - A case report (vol 11, pg 241, 2005)
    (INTERVENTIONAL NEURORADIOLOGY, 2005)
    Carotid-vertebral anastomoses are commonly detected as incidental findings. But sometimes these channels are important for the clinical condition of the patient. Here a case of right thalamo-capsular arteriovenous malformation is described where a persistent primitive hypoglossal artery was the only route for embolization of the arteriovenous malformation.
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    Cerebral myxomatous angiopathy. Imaging features
    (RIVISTA DI NEURORADIOLOGIA, 2004) Sonwalkar, HA; Gupta, AK; Varma, DR; Purkayastha, S; Bodhey, N; Kesavadas, C
    Strokes due to embolization from a cardiac myxoma are rare. Myxomatous cerebral emboli can cause occlusion of intracranial vessels or oncotic aneurysm formation. We describe a case of cardiac myxoma presenting with stroke having bilateral cerebral infarct and oncotic aneurysm formation. Myxomatous emboli have characteristic CT, MR and angiography findings, which are well seen in this case. The pathogenesis, imaging features, clinical presentation and natural history are discussed.
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    Chordoid meningioma mimicking tuberculoma
    (RIVISTA DI NEURORADIOLOGIA, 2005) Purkayastha, S; Gupta, AK; Varma, DR; Radhakrishnan, V
    Meningiomas are common extra-axial brain tumors presenting a bewildering variety of histopathological patterns. The rare subtypes seldom demonstrate the imaging features classically described for meningiomas. Here we present the imaging features of rare histological varieties of meningiomas.
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    CT angiographic demonstration of agenesis of the internal carotid artery with transsellar cavernous collateral and PCA aneurysm
    (RIVISTA DI NEURORADIOLOGIA, 2004) Bodhey, NK; Gupta, AK; Varma, DR; Sonwalkar, HA; Purkayastha, S
    We report an unusual case of complete agenesis of the right internal carotid artery (ICA) with transsellar anastomosis from the cavernous segment of the contralateral ICA and presence of a posterior cerebral artery aneurysm and aberrant origin of the right subclavian artery.
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    CT cisternography of paradoxical cerebrospinal fluid rhinorrhea after operation for acoustic neuroma
    (RIVISTA DI NEURORADIOLOGIA, 2005) Thomas, B; Purkayastha, S; Vattoth, S; Gupta, AK
    Cerebrospinal fluid (CSF) rhinorrhea after acoustic neuroma surgery is a well-known complication. CT cisternography can be used to demonstrate the entry of CSF from cerebellopontine angle cistern into the mastoid air cells, middle ear and then into nasopharynx via Eustachian tube. We report a case of paradoxical CSF rhinorrhea after surgery for acoustic neuroma in which the path of CSF leak was accurately demonstrated using CT cisternography.
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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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    Duplicate origin of the right vertebral artery in a patient with stroke. Case report
    (RIVISTA DI NEURORADIOLOGIA, 2004) Purkayastha, S; Gupta, AK; Sonwalkar, H; Bodhey, NK
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    Effect of bromocriptine therapy in pituitary adenoma an empty sella' appearance
    (RIVISTA DI NEURORADIOLOGIA, 2005) Purkayastha, S; Bodhey, NK; Gupta, AK; Kesavdas, C; Pendharkar, HS
    Prolactin-secreting pituitary adenomas are the most common type of functional pituitary tumor. Bromocriptine therapy is an effective alternative to surgery in this group of patients. We report a case of prolactinoma where the patient was put on bromocriptine therapy and after 15 months of follow-up the tumor almost regressed giving an empty sella appearance.
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    Embolization of choroid plexus arteriovenous malformation. A case report
    (RIVISTA DI NEURORADIOLOGIA, 2005) Gupta, AK; Varma, DR; Bodhey, NK; Purkayastha, S
    Choroid plexus arteriovenous malformations are rare lesions that usually present with intraventricular hemorrhage. Management of these lesions is challenging as their deep location makes them relatively inaccessible for surgical excision. Recent advances in microcatheter technology have made it possible to access these lesions safely for embolization. We report a case of lateral ventricular choroid plexus arteriovenous malformation completely occluded by endovascular treatment.
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    Embolization of craniofacial vascular malformations
    (RIVISTA DI NEURORADIOLOGIA, 2005) Bodhey, NK; Gupta, AK; Purkayastha, S; Kesavadas, C; Krishnamoorthy, T; Kapilamoorthy, T; Thomas, B
    Craniofacial vascular malformation (CVM) is a major cosmetic concern and may present as catastrophic situations like bleeding apart from the functional impairment. The treatment of CVM has been very challenging. Till the recent past, surgery was the mainstay of treatment. However, because of the torrential intraoperative haemorrhage and frequent recurrences, embolization has evolved as a major adjunct in treating these lesions. This study evaluated the efficacy of various preoperative embolization techniques in the management of CVM. A total of 94 patients (54 males, 40 females) with an age range from three months to 68 years with a mean of 42.4 years having craniofacial AVM (forehead, face, neck and scalp lesions) were treated with the various embolization techniques: Arterial route with (a) hydrogel only (b) hydrogel and gelfoam (c) gel foam only (d) nbutyl cyanoacrylate (NBCA), Venous route and direct puncture injection of NBCA. The devascularisation achieved with the transarterial route was between 80-95% with particulate agents and 95-100% with NBCA. Direct puncture embolization also resulted in near total devascularisation of the lesion. This resulted in a significant decrease in blood loss at surgery. Cure was obtained in a few patients without the need for surgery. After embolization, almost all the patients had mild pain and subtle increase in the swelling with firmer consistency. The embolization of CVM is an essential adjunct to surgery in most cases and can be curative in a few patients. Hydrogel, PVA and gelfoam are good embolizing agents with NBCA being excellent when used with direct puncture.
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    Endovascular treatment of ruptured intracranial aneurysms: Immediate result and long term follow up - An Indian experience
    (JOURNAL OF NEURORADIOLOGY, 2006) Gupta, AK; Purkayastha, S; Bhattacharya, RN; Bodhey, NK
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    Endovascular treatment of ruptured posterior circulation dissecting aneurysms
    (JOURNAL OF NEURORADIOLOGY, 2006) Purkayastha, S; Gupta, K; Krishnamoorthy, AT; Bodhey, NK
    Background and aim: Dissecting aneurysms of the posterior circulation constitute a relatively uncommon subgroup of aneurysms. They account for 3-7% of cases of nontraumatic subarachnoid hemorrhage. Because of high risk, in most cases the patients require surgical or endovascular therapy. In this study we discuss the clinical efficacy of endovascular treatment with long-term follow-up in ruptured dissecting aneurysms of the posterior circulation. Materials and methods: This retrospective study was conducted at our institution between January 1995 and June 2005. Eight patients (4 male; 4 females) ranging in age from 24 to 65 years (mean, 46.75 years), were included. All presented with SAH. Endovascular treatment was based on the configuration of the dissecting aneurysm. Attempt was made to occlude the dissecting aneurysm. Result: A total of 8 ruptured dissecting aneurysms in the posterior circulation were treated. Out of them 5 were in the intradural vertebral artery, 2 in the basilar trunk and one in the proximal PCA. All the cases were technically successful. We have seen only two complications. The pre and post procedure (at the time of discharge) mean modified Rankin scores in the patients were 4.6 (SD 0.51) and 1.7 (SD 1.98). This improvement in Rankin score after endovascular treatment was statistically significant (Wilcoxon signed rank test, P=.017). Conclusion: Endovascular management of these lesions is safe and effective mode of treatment and gives adequate protection from rebleed.
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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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    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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    Hyperperfusion syndrome after supraaortic vessel interventions and bypass surgery
    (JOURNAL OF NEURORADIOLOGY, 2005)
    Cerebral hyperperfusion and hemorrhage is a recognized complication of endarterectomy, aortocarotid bypass surgery or angioplasty and stenting of the carotid or vertebral artery. We performed 87 balloon angioplasty, stenting and bypass surgery of arteries supplying the brain over the last 15 years. We have found 6 cases of hyperperfusion syndrome in a total of 87 procedures. So the incidence of hyperperfusion was noted as 6.89%. Two cases occurred after two combined procedures in a single sitting. Hyperperfusion syndrome is a well-known complication of craniocervical revascularisation procedures. gut with proper care, including strict post procedural control of blood pressure and staged procedure in case of multiples vessel stenosis, these complications can be largely avoided.