Browsing by Author "Ramesha, KN"

Now showing 1 - 9 of 9
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    Cerebrospinal fluid hypovolemia syndrome with benign course
    (ANNALS OF INDIAN ACADEMY OF NEUROLOGY, 2010) Ramesha, KN; Chandrashekaran, K; Thomas, SV
    Background: The cerebrospinal fluid hypovolemia syndrome (CHS) is an under recognized cause of headache. This study was designed to highlight the clinico-radiological and cerebrospinal fluid (CSF) picture of CHS and their long-term outcome from a tertiary referral center. Materials and Methods: The CHS was diagnosed on the basis of the criteria proposed by Chung et al. Cases with CSF rhinorrhoea or other CSF leak or head trauma were excluded from the study. Results: The study included eight consecutive cases of CHS diagnosed over the past 7 years from 2001. The mean age at diagnosis was 40.7 years (range, 34-56 years) and male-to-female ratio was 1:3. All patients presented with orthostatic headache of subacute onset and normal neurological examination. Magnetic resonance imaging studies of all patients showed hyperintensity of pachymeninges in T2W sequences, venous distension sign, and diffuse pachymeningeal gadolinium enhancement. The descent of the brainstem and subdural effusion were noted in two each (25%). CSF study (n = 5) showed low opening pressure in three (60%), and mild pleocytosis with elevated protein in two each (40%). The mean time to complete recovery with conservative treatment alone was 25.6 days. All radiological signs disappeared with clinical improvement in three patients where follow-up imaging was done. On mean follow-up period of 3.6 years, all were asymptomatic without any recurrence of CHS. Conclusion: CHS can resolve completely with conservative management and intervention with subdural blood patch or surgical repair would be required only if symptoms persist for more than 1 month.
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    Clinical, electrophysiologic, and histopathologic profile, and outcome in idiopathic inflammatory myositis: An analysis of 68 cases
    (ANNALS OF INDIAN ACADEMY OF NEUROLOGY, 2010) Ramesha, KN; Kuruvilla, A; Sarma, PS; Radhakrishnan, VV
    Objectives: To study the electroclinical and histopathologic profile of idiopathic inflammatory myositis (IIM) with reference to prognosis and survival rate. Materials and Methods: Diagnosis of IIM was based on the Bohan and Peter criteria. Patients who improved and those whose condition worsened or who expired due to IIM per se at last follow-up were classified to have favorable and poor outcomes, respectively. Fishers exact test was used for univariate analysis of prognostic factors. Results: The study cohort consisted of consecutive 68 patients with IIM. The mean age at diagnosis was 36.5 years and females constituted 71%. Of these patients, 62% had definite IIM, 49% had polymyositis, 20% had dermatomyositis, and 29% had overlap syndrome. The mean follow-up period was 5.4 years. Prednisolone alone was used in 55 (80%), and azathioprine (1-3 mg/kg/day) alone in 12 (17.6%) as the initial treatment. Relapse of IIM with drug withdrawal was seen in 15 patients (22%); 70% had favorable outcome and 16% had expired. The treatment delay of %6 months (P = 0.001), absence of cardiac or lung involvement (P < 0.001), and positive biopsy (P = 0.033) were predictive of a favorable prognosis in the univariate analysis. In multivariate analysis, only the duration of illness of %6 months (P = 0.008) and the absence of cardiac or lung involvement (P = 0.001) predicted the favorable outcome at last follow-up. Cumulative survival rate was 95% at 1 year, 86% at the 5th year, and 80% at the 10th year. Conclusions: Approximately, two-thirds of the patients showed good electroclinical and histopathologic correlations and an equal number improved with treatment. The treatment delay (>= 6 months), presence of cardiac or pulmonary involvements, and negative muscle biopsy are bad prognostic factors.
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    Clinical, electrophysiologic, and histopathologic profile, and outcome in idiopathic inflammatory myositis: An analysis of 68 cases.
    (Annals of Indian Academy of Neurology, 2010)
    OBJECTIVES: To study the electroclinical and histopathologic profile of idiopathic inflammatory myositis (IIM) with reference to prognosis and survival rate.MATERIALS AND METHODS: Diagnosis of IIM was based on the Bohan and Peter criteria. Patients who improved and those whose condition worsened or who expired due to IIM per se at last follow-up were classified to have favorable and poor outcomes, respectively. Fisher's exact test was used for univariate analysis of prognostic factors.RESULTS: The study cohort consisted of consecutive 68 patients with IIM. The mean age at diagnosis was 36.5 years and females constituted 71%. Of these patients, 62% had definite IIM, 49% had polymyositis, 20% had dermatomyositis, and 29% had overlap syndrome. The mean follow-up period was 5.4 years. Prednisolone alone was used in 55 (80%), and azathioprine (1-3 mg/kg/day) alone in 12 (17.6%) as the initial treatment. Relapse of IIM with drug withdrawal was seen in 15 patients (22%); 70% had favorable outcome and 16% had expired. The treatment delay of ?6 months (P = 0.001), absence of cardiac or lung involvement (P < 0.001), and positive biopsy (P = 0.033) were predictive of a favorable prognosis in the univariate analysis. In multivariate analysis, only the duration of illness of ?6 months (P = 0.008) and the absence of cardiac or lung involvement (P = 0.001) predicted the favorable outcome at last follow-up. Cumulative survival rate was 95% at 1 year, 86% at the 5th year, and 80% at the 10th year.CONCLUSIONS: Approximately, two-thirds of the patients showed good electroclinical and histopathologic correlations and an equal number improved with treatment. The treatment delay (?6 months), presence of cardiac or pulmonary involvements, and negative muscle biopsy are bad prognostic factors.
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    Functional and clinical outcome and its predictors in osmotic demyelination syndrome in 25 patients
    (JOURNAL OF THE NEUROLOGICAL SCIENCES, 2009) Ramesha, KN; Ashalatha, R; Fayaz, RK; Unnikrishnan, JP; Sankara, PS
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    Knowledge and practice profile of obstetricians regarding epilepsy in women in Kerala state, India
    (ANNALS OF INDIAN ACADEMY OF NEUROLOGY, 2011) Bhat, M; Ramesha, KN; Nirmala, C; Sarma, PS; Thomas, SV
    Purpose: To assess the knowledge of obstetricians about concerns of women with epilepsy. Materials and Methods: We surveyed 97 obstetricians (teaching hospitals-43, private hospitals-32, and community health centers-21) using knowledge of women's issues and epilepsy (KOWIE) questionnaire II with additional questions. Results: The mean duration of practice of the surveyed obstetricians was 12.4 +/- 10.7 years and 94% were female doctors. Most of them were well informed about the teratogenic effects of AEDs (91%), need to continue antiepileptic drugs (AEDs) during pregnancy (95%), and the role of folic acid and vitamin K during pregnancy (95%). They agreed AEDs decrease the efficacy of oral contraception and it was safe for the woman to breast-feed the baby while on AEDs. Only 1/3(rd) of them knew that steroid hormones could alter seizure threshold or that AEDs could predispose to osteomalacia. Fewer doctors knew that WWE could have increased sexual dysfunction (29.9%) or infertility (26.8%). The knowledge did not vary according to years of practice or practice settings. Conclusions: Obstetricians were well informed about the fetal complications of antenatal AED exposure, but were under informed of other complications such as osteomalacia, sexual dysfunction, and infertility.
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    Long term outcome, survival rate and prognosis of idiopathic inflammatory myositis
    (EUROPEAN JOURNAL OF NEUROLOGY, 2009) Ramesha, KN; Kuruvilla, A; Sarma, P
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    Neoplastic meningitis: clinico-radiological features, outcome and prognostic factors
    (NEUROLOGY ASIA, 2010) Ramesha, KN; Kate, MP; Kesavadas, C; Radhakrishnan, VV; Sarma, SP; Thomas, SV
    Objective: This retrospective hospital based study aimed to describe clinico-radiological features and outcome of neoplastic meningitis (NM) and to evaluate the significance of the presence of malignant cells in CSF and identifiable primary in NM. Methods: The diagnosis of NM was based on the presence of malignant cells in CSF cytology, meningeal biopsy, post mortem examination or compatible clinico-radiological features in patients with known primary malignancy. For subgroup comparisons, Mann Whitney test and Fisher's exact test were used for continuous and categorical variables respectively. Relative risk of survival in positive CSF cytology for malignant cells and known primary versus negative were calculated. Results: There were 25 patients (mean age 44.5 +/- 17.6 years) of NM during the study period (2000-2008). They presented with raised ICP headache (72%), cauda equina syndrome (28%), or hemiparesis (12%). Meningeal enhancement and hydrocephalus were seen in 60% and 21% respectively. CSF analysis revealed hypoglychorrachia (64%), raised protein (68%) and pleocytosis (48%). CSF cytology for malignant cells was positive in 76% and cumulative positivity increased by 31% from 1(st) to 3(rd) lumbar punctures. A primary could be identified in 56% cases. At last follow up, 16 out of 18 had died. Hypoglychorrachia was the only variable analyzed, which predicted the cytology positivity (p=0.01). The mean duration of survival from the onset was significantly less in cytology positive group (p=0.001). The relative risk of survival at 90 days, 120 and 150 days were significantly higher in cytology and primary negative group compared to positive group. Conclusion: NM with positive cytology or with an identifiable primary tumor has a more aggressive course when compared to the negative groups and former have shorter lifespan. The possibility of positive cytology is high with hypoglychorrachia.
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    Sexual desire and satisfaction after resective surgery in patients with mesial temporal lobe epilepsy with hippocampal sclerosis
    (Epilepsy & Behavior, 2012-11) Ramesha, KN; Radhakrishnan, A; Jiayaspathi, A; Padickaparambal, S; Alexander, A; Unnikrishnan, JP; Sarma, PS; Radhakrishnan, K
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    Sexual desire and satisfaction after resective surgery in patients with mesial temporal lobe epilepsy with hippocampal sclerosis
    (EPILEPSY & BEHAVIOR, 2012) Ramesha, KN; Radhakrishnan, A; Jiayaspathi, A; Padickaparambal, S; Alexander, A; Unnikrishnan, JP; Sarma, PS; Radhakrishnan, K
    Utilizing a questionnaire, we inquired about the self-perceived sexual behavior of 50 married males with mesial temporal lobe epilepsy with hippocampal sclerosis (MTLE-HS) before and after anterior temporal lobectomy (ATL) and compared the results with those of 50 age-matched healthy married males. The sexual desire and satisfaction of the patients were poor when compared to the controls. Although a majority of the sexual domains improved following ATL, even after a median duration of five years, the sexual status of the patients did not match with that of the controls. Those who, after ATL, were seizure free, had one or no antiepileptic drug (AED) and had an EEG without epileptiform abnormalities achieved a better sexual outcome. We conclude that sexual dysfunction is frequent in male patients with MTLE-HS. They require preoperative assessment to identify their sexual inadequacies as well as counseling about the expected post-ATL sexual outcome. Discontinuation of enzyme-inducing AEDs facilitates post-ATL improvement in sexual function. (C) 2012 Elsevier Inc. All rights reserved.