Publications by authors named "Sameer Vyas"

148 Publications

Neuroimaging Spectrum of Severe Hypernatremia in Infants with Neurological Manifestations.

Neuropediatrics 2021 08 30;52(4):316-325. Epub 2021 Jun 30.

Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh, India.

Background: Variable neurological manifestations and imaging findings have been described in children with severe hypernatremia. We aimed to describe the spectrum of neuroimaging changes in infants with severe hypernatremia.

Methods: This retrospective study included infants with severe hypernatremia (serum sodium >160 mEq/L), abnormal neurological examination, and an abnormal magnetic resonance imaging (MRI) of the brain over a period of 2 years in a tertiary care hospital. Relevant clinical data, including the feeding practices, clinical features, complications, and biochemical and radiological parameters, were entered in a structured pro forma. MRI findings were classified as vascular (hemorrhages and cerebral sinus venous thrombosis), osmotic demyelination syndrome (pontine and extrapontine myelinolyses), and white matter changes.

Results: The common clinical features in the neonates were poor feeding ( = 4) and decreased urine output ( = 4); the older infants presented with gastrointestinal losses ( = 5). All cases had dehydration with encephalopathy. The patterns of radiological injury were vascular (hemorrhages,  = 5 and venous thrombosis,  = 3), osmotic demyelination ( = 8), and white matter changes ( = 7). Coagulopathy was correlated with the vascular complications ( = 0.8,  < 0.0001); the degree of dehydration was correlated with the venous thrombosis ( = 0.7,  < 0.04) and acute kidney injury ( = 0.8,  < 0.001). Neurological sequelae were seen in four cases and correlated with hypernatremia ( = 0.6,  = 0.03) and hyperosmolarity ( = 0.6,  = 0.03).

Conclusion: Characteristic neuroimaging findings are vascular changes in the form of venous thrombosis and hemorrhages, osmotic demyelination and white matter tract injury, and/or mostly combinations of these findings. Severe hypernatremia and resulting hyperosmolarity frequently cause neurological sequelae in neonates and infants.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1055/s-0041-1730938DOI Listing
August 2021

Whole brain atlas-based diffusion kurtosis imaging parameters for evaluation of minimal hepatic encephalopathy.

Neuroradiol J 2021 Jun 29:19714009211026924. Epub 2021 Jun 29.

Department of Radiology, University of Miami, USA.

Background And Purposes: Minimal hepatic encephalopathy (MHE) has no recognizable clinical symptoms, but patients have cognitive and psychomotor deficits. Hyperammonemia along with neuroinflammation lead to microstructural changes in cerebral parenchyma. Changes at conventional imaging are detected usually at the overt clinical stage, but microstructural alterations by advanced magnetic resonance imaging techniques can be detected at an early stage.

Materials And Methods: Whole brain diffusion kurtosis imaging (DKI) data acquired at 3T was analyzed to investigate microstructural parenchymal changes in 15 patients with MHE and compared with 15 age- and sex-matched controls. DKI parametric maps, namely kurtosis fractional anisotropy (kFA), mean kurtosis (MK), axial kurtosis (AK) and radial kurtosis (RK), were evaluated at 64 white matter (WM) and gray matter (GM) regions of interest (ROIs) in the whole brain and correlated with the psychometric hepatic encephalopathy score (PHES).

Results: The MHE group showed a decrease in kFA and AK across the whole brain, whereas MK and RK decreased in WM ROIs but increased in several cortical and deep GM ROIs. These alterations were consistent with brain regions involved in cognitive function. Significant moderate to strong correlations (-0.52 to -0.66; 0.56) between RK, MK and kFA kurtosis metrics and PHES were observed.

Conclusion: DKI parameters show extensive microstructural brain abnormalities in MHE with minor correlation between the severity of tissue damage and psychometric scores.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1177/19714009211026924DOI Listing
June 2021

Severe microcephaly, intellectual disability and epilepsy: the ravages of congenital syphilis.

BMJ Case Rep 2021 Jun 15;14(6). Epub 2021 Jun 15.

Department of Radiodiagnosis, Post Graduate Institute of Medical Education and Research, Chandigarh, Chandigarh, India.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1136/bcr-2021-244203DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8207996PMC
June 2021

Letter: First in Man Pilot Feasibility Study in Extracranial Carotid Robotic-Assisted Endovascular Intervention.

Neurosurgery 2021 Jul;89(2):E139

Division of Neuroradiology Department of Radiodiagnosis and Imaging Post Graduate Institute of Medical Education and Research (PGIMER) Chandigarh, India.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1093/neuros/nyab159DOI Listing
July 2021

Long-term epilepsy control, motor function, cognition, sleep and quality of life in children with West syndrome.

Epilepsy Res 2021 Jul 2;173:106629. Epub 2021 Apr 2.

Pediatric Neurology Unit, Department of Pediatrics, Postgraduate Institute of Medical Education & Research (PGIMER), Chandigarh, India. Electronic address:

Purpose: To assess epilepsy, motor function, cognitive, sleep, and quality of life outcomes and their predictors in a follow-up cohort with West syndrome (WS) at ≥5 years of age.

Methods: Cross-sectional evaluation in a follow-up cohort of WS (aged 5-14 years), between July 2018 and December 2019, was performed at a tertiary-care referral center in Northern India. 164 children were assessed in-person for epilepsy severity, functional status (gross motor and hand function), social quotient, behavioral comorbidities, sleep problems, and quality of life (QoL) using Early Childhood Epilepsy Severity Scale, Gross Motor Function Classification System, Manual Ability Classification System, Vineland Social Maturity Scale, Diagnostic and Statistical Manual of Mental disorders-5 criteria, Children's Sleep Habits Questionnaire, and PedsQL-Epilepsy module respectively. Furthermore, 238 children with the inability to visit the hospital were assessed through telephonic interview along with retrospective case record review for epilepsy control, gross and fine motor measures.

Results: 402 children with WS (75 % boys) with regular follow-up were studied and the majority (80 %) had underlying structural etiology. The median age (interquartile range) of the cohort was 92 (78-107) months. Of these, 60 % had evolved to Lennox-Gastaut syndrome (LGS). The following long-term outcomes were observed: ongoing epilepsy (261/402), unfavorable motor status (130/402), moderate to profound intellectual disability (111/164), autistic spectrum disorder (42/164), attention-deficit hyperactivity disorder (18/164), poor sleep (135/164), and impaired QoL (115/164). Non-structural etiology (odds ratio [OR] = 3.8, 95 % confidence interval [CI]: 2.1-5.5, p=<0·0001) and older age (>5 months) at the onset of epileptic spasms (OR = 2·9, 95 % CI: 1.5-5.0, p=<0·0001) were associated with enduring seizure freedom for more than two years.

Conclusion: The present study revealed a preponderance of structural etiology and a high rate of transition to LGS. Early age at onset of spasms (before five months) and structural etiology were the predictors of unfavorable long-term epilepsy outcome. QoL was impaired in more than two-thirds of patients and it correlated significantly with cognitive, sleep, motor, and behavioral outcomes. However, the results of our study should be interpreted in the context of significant attrition of the original cohort.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.eplepsyres.2021.106629DOI Listing
July 2021

Unusual Cause of Encephalopathy and Seizures in a Child.

Neurol India 2021 Jan-Feb;69(1):167-169

Department of Radiodiagnosis and Pediatric Neurology, PGIMER, Chandigarh, Punjab, India.

Toxic encephalopathy is an important differential diagnosis in a child with encephalopathy and seizures. Subtle circumstantial evidence and apt neuroimaging features can significantly contribute to management, especially in a case of accidental exposure. 2, 4-D (ethyl ester) poisoning is a rare diagnosis, despite the common usage of this toxic compound as weedicide in northern India. The clinical similarity to the anticholinesterase poisoning, especially in the setting of agrochemical exposure is the main cause of under-diagnosis with usually fatal outcomes. We present an interesting case of accidental 2, 4-D (ethyl ester) poisoning in a child with typical neuroimaging features. A review of the literature regarding neuroimaging patterns of bilaterally symmetrical signal abnormalities involving basal ganglia in brain magnetic resonance imaging (MRI) from the point of view of clinical significance, is also discussed.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.4103/0028-3886.310065DOI Listing
June 2021

MR vessel wall imaging in tubercular meningitis.

Neuroradiology 2021 Feb 27. Epub 2021 Feb 27.

Department of Radiodiagnosis and Imaging, Post Graduate Institute of Medical Education & Research (PGIMER), Chandigarh, India.

Purpose: Tubercular meningitis (TBM) has the propensity to cause secondary vasculitis through various mechanisms leading to development of cerebrovascular complications. These vascular involvements can be detected by vessel wall imaging (VWI). In this study, we aimed to study detailed findings of vessel wall imaging in cases of tubercular meningitis.

Methods: All consecutive patients of suspected tubercular meningitis in whom diagnosis of TBM could be made according to diagnostic criteria given by Ahuja et al. were included in the study. High-resolution MR VWI and time of flight (TOF) magnetic resonance angiography (MRA) were done along with routine MRI sequences. Arteries up to second-order branches were studied, and statistical analyses were done with respect to stage of tubercular meningitis, infarctions and TOF MRA findings.

Results: Out of all 101 cases of TBM, infarctions were found in 49 cases (48.5%), and vessel wall enhancement was seen in 67 cases (66.3%). With increasing severity of disease, more severe vascular involvement was seen on VWI. There was significant association between enhancement of individual arteries and infarctions in their territories. VWI had better sensitivity than the MRA, while MRA had better specificity than VWI for detection of vascular complications.

Conclusion: Tubercular vasculitis can be detected by VWI in the form of nodular or smooth segmental enhancement of vessel wall with or without stenosis. Incorporation of VWI in routine MR imaging can play a greater role in early detection and management of cerebrovascular complications which can help to improve prognosis of the disease.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00234-021-02678-yDOI Listing
February 2021

Brain MRI in Epstein-Barr Virus Meningoencephalitis in Children.

Ann Indian Acad Neurol 2020 Sep-Oct;23(5):621-624. Epub 2020 Feb 7.

Department of Pediatrics, Medanta, The Medicity, Gurugram, Haryana, India.

Background And Purpose: Epstein-Barr virus (EBV) meningoencephalitis can have variable and nonspecific brain magnetic resonance imaging (MRI) findings in children. This study was done with the purpose of describing brain MRI findings in children with EBV meningoencephalitis.

Materials And Methods: The study included 45 pediatric patients that presented with variable neurological symptoms and were found to have EBV meningoencephalitis based on positive EBV deoxyribonucleic acid (DNA) in the cerebrospinal fluid. All these patients had undergone brain MRI. Clinical and radiological features were evaluated.

Results: Fever was a presenting feature in all cases. Signs of meningitis and raised intracranial pressure (ICP) were seen in 24 (53.3%) cases, encephalopathy in 15 (33.3%), and seizures were present in 33 (73.3%). MRI was abnormal in 29 (64.4%) patients. The cortical/subcortical pattern was diagnosed in 9 (20%) cases, white matter involvement in 7 (15.5%), basal ganglia in 5 (11.1%), thalamic involvement in 4 (8.8%), brain stem involvement in 2 (6.2%), substantia nigra involvement in 2 (4.4%), and cerebellar involvement in 2 (4.4%). Diffusion restriction was present in 11 (24.4%) cases and susceptibility changes in 7 (15.5%). Meningeal enhancement was present in 10 (22.2%) cases. In addition, brain abscess and subdural effusion/empyema were present in 1 (2.2%) case each.

Conclusion: Pediatric EBV meningoencephalitis has varied clinicoradiological spectrum and there is no specific MRI pattern to characterize the meningoencephalitis on imaging. Common MRI findings include cortical-subcortical involvement, white matter changes, basal ganglia, and thalamic involvement.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.4103/aian.AIAN_537_19DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7887499PMC
February 2020

MRI Spectrum of Meningoencephalitis in Children.

Ann Indian Acad Neurol 2020 Sep-Oct;23(5):616-620. Epub 2019 Dec 24.

Department of Pediatrics, Medanta, The Medicity, Gurugram, NCR, Haryana, India.

Background And Purpose: type b (Hib) infection occurs mostly in children and is transmitted from person to person through the respiratory pathway. Hib strain is associated with meningitis or encephalitis. It is not an uncommon infection, particularly, in the developing world. This prospective cohort study was done with the aim of describing imaging findings in patients with Hib meningoencephalitis.

Materials And Methods: In a prospective cohort study, consecutive children admitted in the pediatric emergency unit with acute febrile encephalopathy were enrolled. The clinical details, CSF analysis, and microbiological and serological investigations were recorded on a case record proforma. Children with confirmed Hib meningoencephalitis were included in this study. Clinicoradiological features were assessed.

Results: A total of 16 patients with acute febrile encephalopathy, in whom CSF latex agglutination, CSF culture, or CSF multiplex PCR were positive for were included in this study. All these children were investigated with magnetic resonance imaging (MRI) brain. Important imaging findings were meningitis, predominantly around frontoparietal lobes (43%), cerebritis (28%), ventriculitis (14%), and subdural collections (21.5%). One patient had features consistent with acute disseminated encephalomyelitis (ADEM) while four patients had normal MRI scan.

Conclusions: is still a common cause of meningitis in infants and children in the developing world. We have tried to study the most common MRI features associated with Hib infection to help radiologists alert the treating clinicians to further investigate these patients for appropriate prognostication.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.4103/aian.AIAN_500_19DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7887487PMC
December 2019

Etiologic Profile of Childhood Stroke from North India: Is It Different from Developed World?

J Child Neurol 2021 Jul 23;36(8):655-663. Epub 2021 Feb 23.

Pediatric Neurology Unit, Department of Pediatrics, 29751Post Graduate Institute of Medical Education and Research, Chandigarh, India.

Objective: To describe the etiology of childhood arterial-ischemic stroke from a developing country and assess short-term neurologic outcome.

Methods: Prospective observational study. Consecutive children between the age of >28 days to <12 years, admitted with the diagnosis of arterial-ischemic stroke were enrolled during the study period from January 2017 to December 2018. Short-term neurologic outcome was assessed with Pediatric Cerebral Performance Category (PCPC) scale and Pediatric Stroke Outcome Measure (PSOM).

Results: We enrolled 76 children with arterial-ischemic stroke, with a median age of 24 months (interquartile range 12-69), and 43 (57%) were boys. The most common risk factor for childhood arterial-ischemic stroke was arteriopathy in 59 (77%), followed by cardiovascular disorder in 12 (16%) children. Among 59 children with arteriopathy, 32 (42%) had infection-associated arteriopathies, 10 (13%) had mineralizing angiopathy, 10 (13%) had moyamoya disease. Pediatric stroke risk factors were classified according to Pediatric Stroke Classification and CASCADE primary classification. Short-term neurologic outcome was assessed at 3 months in 62 (82%) survivors. Among stroke survivors, 33 (61%) had sensory-motor deficits, and 24 (39%) had severe neurologic disability (PCPC ≥ 4). The presence of fever, encephalopathy, low Glasgow coma score at presentation, seizures, and infection-associated arteriopathy predicted severe neurologic disability at follow-up.

Conclusion: The risk factors for pediatric arterial-ischemic stroke are different from developed countries in our cohort. Infection-associated arteriopathies, mineralizing angiopathy, and moyamoya disease are the most common risk factors in our cohort. Two-thirds of pediatric stroke survivors have neurologic disability at short-term follow-up.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1177/0883073821991291DOI Listing
July 2021

Comparative Evaluation of Diffusion Kurtosis Imaging and Diffusion Tensor Imaging in Detecting Cerebral Microstructural Changes in Alzheimer Disease.

Acad Radiol 2021 Feb 18. Epub 2021 Feb 18.

Department of Radiology, University of Miami, Miami, Florida.

Objective: Comparative evaluation of diffusion kurtosis imaging (DKI) and diffusion tensor imaging (DTI) using a whole-brain atlas to comprehensively evaluate microstructural changes in the brain of Alzheimer disease (AzD) patients.

Methods: Twenty-seven AzD patients and 25 age-matched controls were included. MRI data was analyzed using a whole-brain atlas with inclusion of 98 region of interests. White matter (WM) microstructural changes were assessed by Fractional anisotropy (FA), mean diffusivity (MD), axial diffusivity (AD), radial diffusivity (RD), Kurtosis fractional anisotropy (KFA), mean kurtosis (MK), axial kurtosis (AK) and radial kurtosis (RK). Gray matter (GM) integrity was evaluated using KFA, MK, RK, AK and MD. Comparison of the DKI and DTI metrics were done using student t-test (p ≤ 0.001).

Results: In AzD patients widespread increase in MD, AD and RD were found in various WM and GM region of interests. The extent of abnormality for DKI parameters was more limited in both GM and WM regions and revealed reduced kurtosis values except in lentiform nuclei. Both DKI and DTI parameters were sensitive to detect abnormality in WM areas with coherent and complex fiber arrangement. Receiver operating characteristic curve analysis for hippocampal values revealed the highest specificity of 88% for AK <0.6965 and highest sensitivity of 95.2% for MD >1.2659.

Conclusion: AzD patients have microstructural changes in both WM and GM and are well-depicted by both DKI and DTI. The alterations in kurtosis parameters, however, are more limited and correlate with areas in the brain primarily involved in cognition.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.acra.2021.01.018DOI Listing
February 2021

Neurocognitive Functions and Brain Volume in Patients with Endogenous Cushing's Syndrome Before and After Curative Surgery.

Indian J Endocrinol Metab 2020 Sep-Oct;24(5):396-401. Epub 2020 Nov 9.

Department of Endocrinology, Post Graduate Institute of Medical Education and Research, Chandigarh, India.

Introduction: Cushing's syndrome (CS) leads to various neuropsychiatric manifestations due to structural and functional changes of the brain and contributes significantly in the impairment of health-related quality of life.

Aim And Objective: This study is conducted with aims to evaluate neurocognitive functions and brain volume in patients with endogenous Cushing's syndrome before and after curative surgery.

Methods: The diagnosis of CS was made by clinical features, abnormal cortisol dynamics, ACTH levels, and imaging studies. Neuropsychiatric tests (Beck depression Index, Spatial span test, PGI memory scale, Color trail test, Verbal fluency test), and Brain volume (Bi-caudate and third ventricular diameter) were done before and after curative surgery.

Results: Fifteen patients of CS were included for the study; all patients underwent curative surgery, neuropsychiatric assessment, and brain volume measurements. Nine patients were followed successfully till remission and repeat evaluation of these patients was done. Depression was the most common neuropsychiatric illness. Severity of depression positively correlated with 0800 h plasma cortisol and ACTH. Patients with higher severity of depression had maximum improvement after curative surgery. Significant decrease in the third ventricular, as well as bicaudate diameter, was observed after curative surgery ( < 0.01).

Conclusion: Neuropsychiatric functions and structural brain changes reverse after curative surgery in patients with endogenous CS, however, long term follow-up is required to know whether these changes reverse completely or not.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.4103/ijem.IJEM_162_20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7810051PMC
November 2020

"Calcified Clot March" after Intravenous Thrombolysis.

Ann Indian Acad Neurol 2020 Jul-Aug;23(4):568-570. Epub 2020 Jun 29.

Department of Neurology, PGIMER, Chandigarh, India.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.4103/aian.AIAN_532_19DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7657272PMC
June 2020

Pattern Recognition Approach to Brain MRI Findings in Patients with Dengue Fever with Neurological Complications.

Neurol India 2020 Sep-Oct;68(5):1038-1047

Department of Pediatrics, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.

Background And Purpose: Dengue can present with variable neurological complications including encephalitis, encephalopathy, acute disseminated encephalomyelitis (ADEM), and ischemic and hemorrhagic stroke. Our study describes a pattern-based approach to recognize different brain MRI findings in dengue-seropositive patients with neurological symptoms.

Materials And Methods: Thirty-six serologically proven dengue patients with neurological symptoms and undergoing brain MRI over a 6-month period were included in this study. The diagnosis of dengue encephalopathy or encephalitis was established by presence of signs/symptoms of acute encephalitic syndrome with the presence of Immunoglobin M (IgM) antibody against dengue antibody in the serum and/or presence of dengue antigen (NS1) in serum. The MRI brain along with diffusion weighted imaging and susceptibility weighted imaging sequences were evaluated by an experienced neuroradiologist.

Results: Eleven patients had normal MRI finding. In the rest 25 patients, 12 were found to have encephalitic pattern, 4 had encephalopathic (seizure related/metabolic) pattern, 3 had features of ADEM, and isolated micro- or macro-hemorrhages were found in 6 patients. In the encephalitis group, eight had concomitant involvement of brainstem, cerebellum, and ganglio-thalamic complexes with additional involvement of cortex and subcortical white matter (WM) found in three. Isolated brainstem and cerebellar involvement were seen in three in this group, whereas one had isolated cerebellar involvement. Interspersed hemorrhage was noted in the structures involved in eight patients in encephalitis group.

Conclusion: Radiologists should be aware of various MRI brain findings in dengue and a pattern recognition approach often helps in reaching the correct diagnosis albeit after exclusion of other differentials based on laboratory studies.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.4103/0028-3886.294556DOI Listing
May 2021

Meier-Gorlin syndrome presenting as early infantile epileptic encephalopathy.

BMJ Case Rep 2020 Aug 24;13(8). Epub 2020 Aug 24.

Radiodiagnosis, Post Graduate Institute of Medical Education and Research, Chandigarh, India.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1136/bcr-2020-235468DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7449299PMC
August 2020

Delayed Myelination Pattern and an Abnormal Thyroid Profile Caused by a Novel Mutation in the SLC16A2 Gene.

Indian J Pediatr 2020 09 6;87(9):764-765. Epub 2020 Aug 6.

Department of Radiodiagnosis and Imaging, Post Graduate Institute of Medical Education and Research, Chandigarh, India.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s12098-020-03459-wDOI Listing
September 2020

Teaching Video NeuroImages: Epileptic spasms and characteristic ophthalmologic findings: A diagnostic conundrum.

Neurology 2020 11 20;95(18):e2602-e2604. Epub 2020 Jul 20.

From the Pediatric Neurology Unit (C.R., P.M., L.S., J.K.S.) and Department of Pediatrics (M.B.), Advanced Pediatrics Centre, Department of Radiodiagnosis and Imaging (section of Neuroimaging and Interventional Radiology) (S.V.), and Advanced Eye Centre (S.R.S., D.K.), PGIMER, Chandigarh, India.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1212/WNL.0000000000010424DOI Listing
November 2020

[Tc]-Bis-Methionine-DTPA Single-Photon Emission Computed Tomography Impacting Glioma Management: A Sensitive Indicator for Postsurgical/Chemoradiotherapy Response Assessment.

Cancer Biother Radiopharm 2020 Jul 9. Epub 2020 Jul 9.

Division of Cyclotron and Radiopharmaceutical Sciences, Institute of Nuclear Medicine and Allied Science, DRDO, New Delhi, India.

The present study evaluated the prognostic value of [Tc]MDM (bis-methionine-DTPA) follow-up single-photon emission computed tomography (SPECT) imaging for response assessment to chemoradiotherapy in glioma postoperatively. One hundred fourteen glioma patients (80 M:34 F) were followed postoperatively by sequential [Tc]MDM SPECT, dynamic susceptibility contrast-enhanced (DSCE)-MRI, and magnetic resonance spectroscopy (MRS) at baseline, 6, 12, and 22.5 months postchemoradiotherapy. The quantitative imaging results and the clinical outcome were used for response assessment and for the final diagnosis. The quantitative parameter of [Tc]MDM SPECT were also used for survival analysis. A significantly ( = 0.001) lower target to nontarget (T/NT) ratio was observed in responders than in nonresponders. The sensitivity and specificity of [Tc]MDM-SPECT for identifying tumor recurrence from radiation necrosis at a cutoff ratio of 1.90 were estimated at 97.9% and 92%. Whereas, the sensitivity and specificity of DSCE-MRI with the normalized cerebral blood volume (nCBV) cutoff of 3.32 for this differentiation was found to be 84.6% and 93.0%. MRS intensity ratios of Cho/NAA and Cho/Cr provided comparatively lower sensitivity of 81.0% and 85.3% and specificity of 73.0% and 73.7%. T/NT ratios correlated with nCBV ( = 0.775,  < 0.001) and to a moderate extent with Cho/NAA ratios ( = 0.467,  = 0.001). [Tc]MDM SPECT and DSCE-MRI provided comparable results for predicting response assessment to chemoradiotherapy. There was a final diagnosis in 72 patients, of which 47 cases were tumor recurrence and 25 were radiation necrosis. The Kaplan-Meier analysis indicated that patients with T/NT ratio <1.9 showed prolonged survival (53.8 months) as compared (37.2 months) with those who demonstrated T/NT ratio >1.9 ( = 0.0001). Thus, this low-cost SPECT technique in combination with DSCE-MRI can be used accurately for mapping the disease activity, response assessment, and survival in glioma. [Tc]MDM SPECT and DSCE-MRI had the same diagnostic efficacy to detect recurrent/residual tumor and radiation necrosis while MRS was inferior to both the techniques.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1089/cbr.2020.3696DOI Listing
July 2020

Mystery Case: An infant with developmental delay, epileptic spasms, and acrocyanosis.

Neurology 2020 05 4;94(21):939-942. Epub 2020 May 4.

From the Pediatric Neurology Unit (P.M., L.S., J.K.S.) and Department of Pediatrics (S.V.A.), Advanced Pediatrics Centre, and Department of Radiodiagnosis and Imaging, Section of Neuroimaging and Interventional Radiology (S.V.), Postgraduate Institute of Medical Education and Research, Chandigarh; and Council of Scientific and Industrial Research (P.M.), New Delhi, India.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1212/WNL.0000000000009479DOI Listing
May 2020

Choroid metastasis from carcinoma of the tonsil.

Jpn J Clin Oncol 2020 10;50(11):1342-1343

Department of Radiotherapy and Oncology, Postgraduate Institute of Medical Education and Research, Chandigarh.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1093/jjco/hyaa048DOI Listing
October 2020

Epilepsy and Hydrocephalus: Should Pyridoxine-Dependent Epilepsy Cross Our Minds?

Ann Indian Acad Neurol 2020 Mar-Apr;23(2):239-241. Epub 2020 Feb 11.

Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh, India.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.4103/aian.AIAN_328_19DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7061514PMC
February 2020

Evaluation of cerebral microstructural changes in adult patients with obstructive sleep apnea by MR diffusion kurtosis imaging using a whole-brain atlas.

Indian J Radiol Imaging 2019 Oct-Dec;29(4):356-363. Epub 2019 Dec 31.

Department of Neurosurgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India.

Purpose: The association between obstructive sleep apnea (OSA) and cognitive impairment is well-recognized, but little is known about neural derangements that underlie this phenomenon. The purpose of this study was to evaluate the utility of diffusion kurtosis imaging (DKI) using a whole-brain atlas to comprehensively assess microstructural tissue changes in the brain of patients with OSA.

Methods: This prospective study was conducted in 20 patients with moderate-to-severe OSA and 20 age- and gender-matched controls. MRI data acquisition was performed with 3 Tesla and data was analyzed using a whole-brain atlas. DKI data were processed and transformed into a brain template space to obtain various kurtosis parameters including axial kurtosis (AK), radial kurtosis (RK), mean kurtosis (MK), and kurtosis fractional anisotropy (KFA) using a 189-region brain atlas in the same template space. These kurtosis measurements were further analyzed using a student -test in order to determine kurtosis measurements that present significant differences between the OSA patient set and the control set.

Results: Significant differences ( < 0.05) were found in AK (54 regions), RK (10 regions), MK (6 regions) and KFA (41 regions) values in patients with OSA as compared to controls. DKI indices, using an atlas-based whole-brain analysis approach used in our study, showed widespread involvement of the anatomical regions in patients with OSA.

Conclusion: The kurtosis parameters are more sensitive in demonstrating abnormalities in brain tissue structural organization at the microstructural level before any detectable changes appear in conventional MRI or other imaging modalities.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.4103/ijri.IJRI_326_19DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6958883PMC
December 2019

18FDG-PET is sensitive tool for detection of extracranial tuberculous foci in central nervous system tuberculosis - Preliminary observations from a tertiary care center in northern India.

J Neurol Sci 2020 Feb 27;409:116585. Epub 2019 Nov 27.

Department of Neurology, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India.

Purpose: To study the role of 18FDG- PET (Flourodeoxyglucose positron emission tomography) in a) determining the extent of cranial and extra-cranial disease and b) diagnosis as well as prognosis of CNS TB (central nervous system tuberculosis) including TBM (tuberculous meningitis).

Patients And Methods: This prospective observational study (n = 70) was carried out at a tertiary care institute in Northern India from 1.1.2017 to 30.6.2018. Diagnosis of TBM was made according to modified Ahuja's criteria. All patients were evaluated in detail and treated as per standard guidelines. All patients underwent 18FDG-PET scanning of brain and whole body at baseline.

Results: Mean age was 35.2 ± 14.8 years. There were 37 men. Majority of patients (n = 47; 67.1%) were below 40 years of age. 43 (61.4%) patients were in stage II TBM. The mean duration of illness was 77 ± 101.9 days. Majority of patients presented with fever (94.3%), headache (90%) and vomiting (84.3%). MRI was abnormal at baseline in 67 (95.7%) of patients, most common abnormalities being meningeal enhancement (68.6%) and tuberculomas (57.1%). PET was abnormal in 66 (95.7%) of patients. All these patients had either lung lesions (n = 62, 88.6%) or lymphadenopathy (n = 61; 87.1%). 18FDG-PET revealed evidence of brain lesions in 52 (74.3%) patients. It revealed vertebral involvement in 19 (27.1%) and genitourinary lesions in 9 (12.9%) patients. PET evidence of lymphadenopathy correlated significantly (p = .04) with good outcome in CNS TB. Conclusion 18FDG-PET does seem to have a promising role in initial evaluation of patients with CNS TB.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jns.2019.116585DOI Listing
February 2020

Reversible Basal Ganglia Changes and Metabolic Crisis in Infantile Tremor Syndrome.

Indian J Pediatr 2020 06 28;87(6):464-465. Epub 2019 Nov 28.

Pediatric Neurology Unit, Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s12098-019-03111-2DOI Listing
June 2020

Teaching NeuroImages: When MRI is a clue in episodic ataxia.

Neurology 2019 11;93(22):e2074-e2075

From the Pediatric Neurology Unit, Department of Pediatrics (S.R.D., A.G.S., S.V.A.), and Department of Radiodiagnosis (S.V.), Post Graduate Institute of Medical Education and Research, Chandigarh, India.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1212/WNL.0000000000008563DOI Listing
November 2019

Subacute Myelopathy: Think Beyond Neuromyelitis Optica Spectrum Disorder.

Ann Indian Acad Neurol 2019 Oct-Dec;22(4):541-542. Epub 2019 Oct 25.

Pediatric Biochemistry Unit, Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.4103/aian.AIAN_4_19DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6839321PMC
October 2019

Functional MRI in epilepsy - Comparison of Lateralization index and language scoring.

Indian J Radiol Imaging 2019 Apr-Jun;29(2):168-176

Department of Neurosurgery, Post Graduate Institute of Medical Imaging and Research, Chandigarh, India.

Aims: To evaluate the role of functional magnetic resonance imaging (fMRI) in epilepsy management and to ascertain whether laterality index (LI) derived from fMRI data, using routinely utilized paradigms, can serve as an adjunct to/or replace preoperative neuropsychological testing for evaluation of language lateralization and impairment.

Materials And Methods: This was a prospective study which included 20 consecutive patients with a clinical diagnosis of temporal lobe epilepsy over a period of 1 year. Neuropsychological assessment included oral word association test and animal names test. The scores of both tests were compared with normographic data provided in the NIMHANS neuropsychology battery. Three fMRI paradigms were used, namely, picture naming, word generation, and sentence completion. Processing and statistical analysis were performed subsequently.

Results And Conclusion: Right temporal lobe epilepsy (RTLE) was seen in 12 patients and left temporal lobe epilepsy (LTLE) in 8 patients. All patients were right handed. The activation pattern was predominantly left lateralized. Language lateralization varied with the type of paradigm. The overall percentage of patients showing left lateralization ranged from 44.00% for the picture naming task to 75% for the sentence completion. Reduced left lateralization was noted in both LTLE and RTLE patients. A negative correlation was observed in LTLE patients between performance in the verbal fluency and the lateralization index in the temporal and parietal regions of interest (ROI) in the word generation paradigm, suggesting that increased left lateralization was associated with a poorer score on neuropsychological tests. In RTLE patients, however, there was no significant correlation between performance in neuropsychological tests and LI. In conclusion, language lateralization using LI can serve as an adjunct during preoperative evaluation. However, it cannot replace neuropsychological testing.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.4103/ijri.IJRI_281_18DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6639858PMC
August 2019

Macroscopic and Microscopic Perfusion Changes in Hemispheric Status Epilepticus with Crossed Cerebellar Diaschisis.

J Pediatr Neurosci 2019 Jan-Mar;14(1):55-56

Department of Paediatric Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.

Hemispheric status epilepticus showing both macroscopic (MR angiography) and microscopic (arterial spin labelling) perfusion abnormalities with crossed cerebellar diachisis is an unusual and interesting phenomenon, which occurs following sequelae of various insults.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.4103/jpn.JPN_65_18DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6601123PMC
July 2019

Cerebellar Cysts and Dysplasias: More Diagnoses to Consider.

Pediatr Neurol 2019 09 11;98:91-92. Epub 2019 Mar 11.

Pediatric Neurology Unit, Department of Pediatrics, Post Graduate Institute of Medical Education and Research, Chandigarh, India. Electronic address:

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.pediatrneurol.2019.02.021DOI Listing
September 2019