1. Extra-cellular Matrix Molecule
Tenascin-C - Expression in Gliomas
PS Gaitonde, RS Dastur, JJ Nadkarni
Astrocytic gliomas constitute approximately 40% of all glial
tumours. Depending on the degree of cellularity, vascularity
and invasiveness, these are classified as Grade I to Grade IV
astrocytomas. One of the factors affecting the tumourogenecity
of gliomas is extracellular matrix glycoproteins. Tenascin-C
which is specific for brain parenchyma, is one of these glycoproteins
involved in cell-adhesion, cell migration and neovascularization.
Immunohistochemical expression of Tenascin-C, on different grades
of astrocytomas revealed a correlation between the intensity
of expression of Tenascin-C and angiogenesis in astrocytic gliomas.
2. Microsurgical Internal Decompression of Lumbar Spinal Stenosis
Nootan Kumar Sharma, Keki E Turel, Joy Varghese, Shashank
Two hundred consecutive cases of lumbar canal stenosis operated
by microsurgical internal decompression (MIDSS) by us were evaluated
over 8 years (1991-1998).
The commonest symptoms were backache (85%) root pain (76%)
and neurogenic claudication (72%). Other symptoms were paraesthesiae
(30%) and cauda equina syndrome (4%).
These patients underwent microsurgical decompression of the
central and/or lateral canal at single or multiple levels depending
upon clinical and imaging findings. In addition to stenosis
(68%), 32 cases also had significant disc protrusions.
The usual findings are: 1) hypertrophic facet joints, 2) extremely
reduced interlaminar space by telescoping of the superior edge
of the inferior laminar under the interior edge of the preceding
one, 3) reduced interpedicular distance (or “kissing”
joints), 4) hypertrophic ligamentum flavum, 5) engorged paraspinal
veins, 6) disc protrusion.
3. Microsurgery of AVMs in Eloquent Areas of Brain
Joy Verghese, Keki E Turel, Nootan Kumar Sharma,
Cranial AVMs have always challenged the skill and patience of
a microneurosurgeon, more so when the AVM is situated in an
eloquent area. In recent years, introduction and refinement
of endovascular techniques and gamma knife radiosurgery have
changed the surgical indication of AVMs significantly. More
and more eloquent area AVMs are subjected to these so called
minimally invasive treatment modalities. Endovascular embolisation,
at its best is only an adjuvant treatment modality, and results
of radiosurgery are still debatable. In such a scenario, direct
microsurgical removal (with or without prior embolisation) offers
the only hope of complete cure. These AVMs account for 4-5%
of the cranial AVMs.
In conclusion, microsurgical excision of eloquent area AVMs
in experienced hands offers a hope of permanent one stage ‘cure’
with minimal or no morbidity.
4. A Case of Motor Neuron Disease associated with Hashimoto’s
Ashish Bagdi, NE Bharucha
Hashimoto’s thyroiditis (HT) an autoimmune disorder occurs
in all age groups. It is more common in middle age and is much
more common in females than males. Amongst the neurological
manifestation of HT, encephalopathy was first described by Brain
et al in 1966, myelopathy by Tsutomu Azuma et al in 2000, ALS
by Appel SH.
We present a case of motor system disease (ALS) associated
with HT. A 53 year old housewife was admitted to Bombay Hospital.
She had history of stiffness in her right great toe for 2 years.
Subsequently, other toe, knee and thigh were affected and had
occasional falls. Stiffness was gradually increasing. EMG revealed
long standing widespread asymmetric motor axon degeneration
affecting the muscles of lower limbs and right upper limb. Site
of lesion most likely at the anterior horn cell level. She was
treated with Epitril and Baclofen, methylprednisolone (5 days).
There was marked improvement in stiffness and could walk with
support of two persons Her reflexes were +++ and plantars were
increased consistent with a combination of LMN and UMN involvement.
5. Cerebral Hemorrhage in Polycythaemia
Haresh Bharote, SV Khadilkar
We present a middle aged male presented with acute of aphasia
without limb deficit. The neuro-imaging showed cerebral haemorrhage
and haematology confirmed polycythaemia. We present this case
for the rarily and relevant literature is reviewed.
Polycythaemia is used to describe an increased red cell, count
packed cell volume or haemoglobin level. It is typically disorder
of middle aged and elderly patients. Disorders starts insidiously,
patient may present with an acute dramatic complication such
as cerebrovascular accident or major thrombotic episode.
Absolute polycythaemia are divided into primary polycythaemia
(polycythaemia vera) which is a myeloproliferative disorder
characterised by increased red cell mass and normal arterial
Secondary polycythaemia may occur in association with cerebral
haemangioblastoma, hepatoma, hypernephroma, uterine fibroid,
benign renal cyst, carbon monoxide exposure and administration
The majority of intracranial events are thrombotic in origin
occurring due to thrombocytosis, platelet disorder and hyperviscosity.
The larger cerebral arteries being most frequently involved,
cerebral haemorrhage also occurs and is fatal in 3% of patients.
Neurological presentation can be headache, dizziness, vertigo,
tinnitus, visual disturbance, carotid and vertebrobasilar TIAs,
chorea and fluctuating cognitive component.
6. Complications of Acute Stroke - A Prospective Study of 100
Sangamesh Bhagavati, BS Singhal
We studied 10 patients admitted with a history of acute stroke
to our hospital over a period of one year. We included 60th
cerebral infarction as well as primary intra cerebral haemorrhage.
We followed up these patients in the hospital till the time
of discharge or death for the development of any medical and/or
neurological complications particularly medical complications
were common after acute stroke (52%). Complications were highest
in the intracerebral haemorrhage group (95%) followed by in
the posterior circulation infarct group (57%) and partial anterior
circulation infarct group (47%) respectively. Constipation (36%)
and urinary retention (33%) were the common complications observed
in our study followed by urinary tract infection (14)% and chest
infection (9%) respectively. Frequency of neurological complications
was low. Patients with a low GCS score had an increased frequency
of complications. Four male patients died in the hospital and
all had a GCS score of less than seven. Out of these four patients,
three had an intracerebral bleed four, the remaining one had
a big left MCA territory infarct with haemorrhagic transformation.
The duration of stay in the hospital for the complicated stroke
group (10.354 ± 4.3831 days) was significantly higher
as compared to the uncomplicated stroke group (6.375 ±