Neurology India
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Granulomatous amoebic encephalitis (GAE) caused by certain species belonging to the genus Acanthamoeba, Balamuthia, or Naegleria presents as a subacute or chronic illness. Amoebic encephalitis caused by Acanthamoeba is seen more often in immunosuppressed individuals. Thus, it may often be associated with human immunodeficiency virus infection and acquired immune deficiency syndrome (HIV/AIDS), organ transplantation, administration of steroids and systemic lupus erythematosus (SLE). ⋯ We describe a case of fatal granulomatous amoebic encephalitis in a patient recently diagnosed to be having SLE, who was receiving corticosteroids, cyclophosphamide, methotrexate, and hydroxychloroquine. The patient presented in an altered sensorium and expired after being hospitalized for 6 days. Postmortem examination of the brain showed extensive areas of necrosis and neutrophilic infiltrate with trophozoites and cysts of Acanthamoeba.
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Surgical clipping is the most definite treatment for intracranial aneurysms. Its aim is to achieve complete aneurysmal occlusion without compromising the lumen of a parent vessel or perforators, and with minimal brain tissue trauma. ⋯ Endoscopic keyhole approach for intracranial aneurysms combines the advantages of both keyhole approach and endoscopy. Endoscopic visualization can help to reduce chances of an incompletely clipped aneurysms/residual neck and the risk of parent vessel/perforator occlusion. However, the use of an endoscope in narrow corridors with space constraints has a learning curve that can be overcome by practicing on cadavers and initially performing several simple endoscopic procedures.
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Moya Moya disease (MMD) is one of the most common cerebro-vascular diseases in children resulting in stroke. Surgical revascularization aims at improving the perfusion to the 'at-risk' ischemic brain. Several factors including peri-operative anesthetic related ones, affect the outcome in these children. This study was performed with the aim to explore the role of anesthetic techniques, pharmacological agents and perioperative management strategies on the neurological outcome following an indirect revascularization procedure for the treatment of MMD. ⋯ In this study, anesthetic techniques or medications did not influence the occurrence of postoperative neurological deficits or prolonged hospital stay after an indirect revascularization procedure in children with MMD.