Appearance of tuberculoma during the course of TB meningitis.

A patient with tuberculous meningitis is described, who developed brainstem tuberculoma after 7 months of adequate drug therapy and while improving satisfactorily. The possible factors resulting in the development of tuberculoma are discussed. The tuberculoma responded to the medical therapy. Tuberculoma should be looked for if the condition of the patient worsens or if the patient develops new neurological signs during the course of TB meningitis.

Radiological evaluation of mucocoele of the paranasal sinuses.

Ten cases of mucocoele of the para-nasal sinuses are reported. Plain X-ray findings were suggestive of the diagnosis in all cases. CT revealed a well defined homogeneous mass, isodense with brain, with expansion of the para-nasal sinuses and extension of the mass into the orbit or parasellar area in eight cases. Surgical confirmation was obtained in all cases.

The influence of buscopan on adverse reactions to intravascular contrast media.

We have analysed the ability of prior intravenous Buscopan (hyoscine butylbromide) injection to influence the incidence and severity of adverse reactions to intravascularly administered, iodinated, ionic contrast medium in 258 consecutive digital subtraction angiographic (DSA) examinations. Adverse reactions were seen in 7.9% of the intravenous and 2.4% of the intra-arterial DSA examinations. The incidence of adverse reactions with and without prior Buscopan injection during intravenous DSA examinations was 8.2% and 7.1%, respectively and during intra-arterial DSA examinations was 5.6% and 1.5%, respectively. This difference is not statistically significant (chi 2-test). We conclude that prior intravenous injection of Buscopan has no influence on the incidence or severity of adverse reactions to intravascular contrast media.

Intracranial internal carotid artery aneurysm as a cause of Raeder's paratrigeminal syndrome.

A 26-year-old woman was first seen with severe facial pain, partial Horner's syndrome, and restriction of ocular movements on the right side--all features of Raeder's paratrigeminal syndrome. Right carotid angiogram revealed an aneurysm of the internal carotid artery. This is the second reported case of Raeder's syndrome due to an aneurysm of the intracranial portion of the internal carotid artery. The mechanism of facial pain and sympathetic involvement are discussed.

Optic nerve hypoplasia: clinical and ultrasonographic study.

The ocular and systemic features of 11 cases of optic nerve hypoplasia were analysed, with particular reference to visual function and associated anomalies of the central nervous system. Schizencephaly, noted in one of the cases, is reported for the first time in association with optic nerve hypoplasia. The role of ultrasonography in the diagnosis and qualitative evaluation of optic nerve hypoplasia is highlighted.

Nasopharyngeal angiofibroma: (a nine-year experience).

In a nine-year period 50 nasopharyngeal angiofibromas, of whom 13 had recurrent tumour, were treated surgically at the All India Institute of Medical Sciences, New Delhi. A new staging system according to the regions involved was used; 31 patients in whom the tumour was limited to the nasopharynx (Stage I) and those with superior spread into the ethmoid or sphenoid sinuses (Stage IIA) had their tumours removed by a transpalatal route, alone or in combination with other approaches. Tumours with lateral extensions into the pterygopalatine or infratemporal fossae or the cheek (Stage IIB), and those with simultaneous superior and lateral spread (Stage III) underwent a transmaxillary excision (19 cases). In two of the three cases with intracranial extension (Stage IV), the tumour was removed successfully from below. There was no mortality. The usefulness of the transmaxillary approach, especially in recurrent cases, is emphasized. No adjuvant modalities were employed in this series and blood loss was acceptable.

Transsynaptic neuronal degeneration of optic nerves associated with bilateral occipital lesions.

A case is reported of a 9-year old male who presented with abnormal behaviour and progressive diminution of vision. Pupils were middilated in both eyes but the pupillary reflexes were preserved. Fundus examination revealed a bilateral optic atrophy and radiological investigations showed a bilateral occipital calcification. We hereby document a case of retrograde transsynaptic neuronal degeneration of the visual system secondary to bilateral occipital lesions. Transsynapptic neuronal degeneration of optic nerves consequent to occipital lobe lesions is a rare phenomenon. Experimentally occipital lobe ablation in non-human primates has been shown to result in optic atrophy. Herein, we document a case of retrograde transsynaptic neuronal degeneration of the visual system secondary to bilateral occipital lesions.

POEMS syndrome.

A patient with peripheral polyneuropathy, hepatosplenomegaly, osteosclerotic myeloma in the ilium, hyperpigmentation and hypertrichosis is described. A diagnosis of POEMS syndrome was made. This is the first report of this syndrome from India.

A new technique for accurate placing of the tip of the atrial catheter in ventriculo-atrial shunt operations for hydrocephalus.

A new method for accurate positioning of the tip of the atrial catheter in the middle of the right atrium in ventriculoatrial shunt operations is described. The correct length of the catheter is obtained from a consideration of the surface anatomy of the heart in each patient. The position of the tip of the catheter was checked by postoperative chest radiographs in postero-anterior and lateral views. The technique was used in 50 cases of hydrocephalus in which ventriculoatrial shunts were performed. The approach is simple and reliable, and is useful not only for elective operations but also in emergency situations where specialized monitoring equipment is not readily available.

Pneumoencephalographic changes with intrasellar cisternal herniation (primary empty sella).

In a selected material of 47 cases of primary intrasellar cisternal herniation, analysis of pneumoencephalographic changes demonstrated the long axis of the anterior part of the third ventricle to point towards the center of the herniation. Transmitted CSF pulsations from the third ventricle probably determine the formation and location of intrasellar herniations. The distribution of air in the subarachnoid space indicated a disturbed CSF circulation in the majority of patients. Visual field defects were unrelated to the slight deformity of the optic nerves observed but rather to a high position of the third ventricle.

Disappearing CT lesions in epilepsy.

A striking but reversible computed tomographic (CT) lesion corresponding to seizure activity is reported in a series of 46 epileptic patients. None of these patients had evidence of tuberculosis or cysticercosis, and all were treated with antiepileptic drugs only. Maximal radiological changes occurred in the area of maximal epileptic discharge; however, multiple lesions were seen in three cases. The CT lesion reappeared with recurrence of the ictus in four cases during follow-up, and this, too, disappeared after complete arrest of the seizures. The clinical, CT scan, and other investigatory findings suggest that the seizures may occasionally cause a CT-demonstrable focal abnormality, probably cerebral edema, a consequence of abnormal vascular permeability. Awareness of this radiological entity should avoid misdiagnosis of cerebral tumor, infarction or tuberculoma in patients with seizure disorder.