Browsing by Author "Raghavendra, S."

Now showing 1 - 7 of 7
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    Disseminated necrotizing leukoencephalopathy following low-dose oral methotrexate
    (EUROPEAN JOURNAL OF NEUROLOGY, 2007)
    Leukoencephalopathy is a recognized complication with intrathecal or intravenous methotrexate (MTX). We report a 59-year-old lady who developed MTX leukoencephalopathy with long-term low-dose oral MTX. She developed posterior leukoencephalopathy (PLE) that initially was reversible on discontinuation of oral MTX. Four months later, she developed disseminated necrotizing leukoencephalopathy (DNL), and was left with devastating neurological deficits. The sequential conventional magnetic resonance imaging (MRI), diffusion weighted imaging (DWI), MR perfusion (MRP) and MR spectroscopic (MRS) changes are highlighted in this report. MRP and MRS showed more wide spread abnormalities than DWI. Stereotactic biopsy from the lesion revealed demyelination with macrophagic infiltration, pericapillary lymphomononucear aggregation,fibrinoid changes in the capillaries and neovascularization. Of the two cases of PLE with oral MTX reported in literature, one reversed clinically and radiologically with the discontinuation of MTX. To the best of our knowledge, this is the first reported case of DNL following oral MTX in the world literature.
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    Focal neuronal loss, reversible subcortical focal T2 hypointensity in seizures with a nonketotic hyperglycemic hyperosmolar state
    (NEURORADIOLOGY, 2007)
    Introduction Neuroimaging in seizures associated with nonketotic hyperglycemia (NKH) is considered normal. We report magnetic resonance imaging (MRI) abnormalities in four patients with NKH and seizures.Methods We prospectively evaluated clinical and radiological abnormalities in four patients with NKH during the period March 2004 to December 2005.Results All patients presented with seizures, either simple or complex partial seizures or epilepsia partialis continua. Two of them had transient hemianopia. MRI showed subcortical T2 hypointensity in the occipital white matter and in or around the central sulcus (two patients each), T2 hyperintensity of the overlying cortex (two patients), focal overlying cortical enhancement (three patients) and bilateral striatal hyperintensity (one patient). Diffusion-weighted imaging (DWI) performed in three patients showed restricted diffusion. The ictal semiology and electroencephalographic (EEG) findings correlated with the MRI abnormalities. On clinical recovery, the subcortical T2 hypointensity and striatal hyperintensity reversed in all patients. The initial cortical change evolved to FLAIR hyperintensity suggestive of focal cortical gliosis. The radiological differential diagnosis considered initially included encephalitis, malignancy and hemorrhagic infarct rendering a diagnostic dilemma.Conclusion We identified subcortical T2 hypointensity rather than hyperintensity as a characteristic feature of seizures associated with NKH. Only very few similar reports exist in literature. Reversible bilateral striatal T2 hyperintensity in NKH has not been reported to the best of our knowledge.
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    Hemimegalencephalic appearance of normal hemisphere in unilateral heterotopia and absent corpus callosum
    (EPILEPSY & BEHAVIOR, 2006)
    We report two patients with medically refractory epilepsy who had MRI evidence of unilateral subcortical nodular heterotopia and agenesis of corpus callosum. The abnormal hemisphere was small, whereas the contralateral normal hemisphere appeared large and crossed the midline. Although the normal hemisphere was initially mistaken for hemimegalencephaly, there were no typical radiological features. Moreover, the electroencephalographic abnormalities lateralized to the hemisphere showing heterotopia. Because contralateral hemispheric abnormalities like heterotopia, hemimicrencephaly, and hemimegalencephaly can occur in patients with hemispheric heterotopias, we emphasize the importance of careful scrutiny of the contralateral hemisphere in patients with unilateral heterotopia. Absence of typical radiological features and appropriately lateralized electroencephalographic abnormalities will help differentiate the two. This is crucial when planning epilepsy surgery. (C) 2006 Elsevier Inc. All rights reserved.
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    Reversible periictal MRI abnormalities: Clinical correlates and long-term outcome in 12 patients
    (EPILEPSY RESEARCH, 2007)
    Although a wide spectrum of reversible periictal magnetic resonance imaging (MRI) abnormalities (RPMA) are being increasingly identified, the clinicians are often in a dilemma about their localization significance. This prompted us to analyze the clinical, MRI, electroencephalographic (EEG) and follow-up data of 12 patients with RPMA seen in a tertiary referral epilepsy center. RPMA occurred after a single or a cluster of focal seizures with or without secondary generalization. The interictal and ictal EEG abnormalities were localized to the site of RPMA in nine patients. RPMA involved areas remote from the site of EEG abnormalities in four patients. We have developed a comprehensive classification to account for the wide spectrum of RPMA involving gray matter, white matter and teptomeninges with or without contrast enhancement or mass effect. Follow-up MRIs showed complete resolution of RPMA in all, except in four patients, who developed residual focal atrophy. During median follow-up period of 3 years, recurrence of RPMA was observed in two patients. Diffusion weighted MRI in two patients and histopathological finding in one patient favored causal rote of hypoxia in the pathogenesis of RPMA. Our observations help to understand the electroclinical profile, radiological spectrum, localization significance and natural history of RPMA better. (c) 2006 Elsevier B.V. All rights reserved.
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    Spinal angiolipoma with acute subarachnoid hemorrhage
    (JOURNAL OF CLINICAL NEUROSCIENCE, 2007)
    Angiolipoma is a rare tumor of the spine commonly presenting with compressive myelopathy. We report a spinal angiolipoma in a 14-year-old patient with acute spinal subarachnoid hemorrhage (SAH). To our knowledge this is the first reported case of a spinal angiolipoma presenting with SAH, associated with post-subclavian coarctation with diffuse hypoplasia of the descending aorta. This association of coarctation of aorta, aortic hypoplasia and spinal angiolipoma has also not been reported previously. (c) 2006 Elsevier Ltd. All rights reserved.