Role of magnetic resonance venogram, diffusion and susceptibility weighted imaging in diagnosis of cerebral venous thrombosis

Background: Cerebral venous thrombosis (CVT) is an uncommon and sometimes critical disease, especially in untreated patients. CVT is an elusive diagnosis because of its nonspecific presentation and its numerous predisposing causes. Accurate diagnosis is difficult but important because effective therapies, including anticoagulants and intrasinus thrombolysis are available. Patients with cerebral venous thrombosis often make dramatic recoveries after anticoagulation. For this reason, accurate diagnosis is important and critical. The aim was to study the extent of venous sinus involvement and associated cerebral parenchymal changes on magnetic resonance venogram (MRV); to study the pattern of diffusion weighted images and ADC (apparent diffusion coefficient) mapping in patients with cerebral venous thrombosis; to study the role of susceptibility weighted images in patients with cerebral venous thrombosis.Methods: Study was conducted on 34 patients diagnosed to have cerebral venous thrombosis on imaging.Results: Imaging analyses of 34 patients (19 females, 15 males, and age range 19-75 years) were done. Thrombus on MRV was seen as loss of high flow signal from the sinus in cases of complete occlusion of the sinus and frayed or patchy flow signal in the cases of non-occlusive thrombus. 16 patients with hemorrhagic infarct showed heterogeneous signal intensity on DWI (diffusion weighted imaging) and blooming on SWI (suseptibility weighted imaging) sequence. 13 patients with non-hemorrhagic infarct showed multifocal high signal intensities in DWI with variable ADC values and no blooming on SWI. 5 patients with intracerebral hematoma showed areas of heterogeneous signals on DWI with blooming on SWI, corresponding ADC values were variable.Conclusions: MRV, diffusion and susceptibility weighted imaging can be used to evaluate the extent of thrombus, discriminate between different types of edema, detect intracerebral hematoma, hemorrhagic and non-hemorrhagic infarcts, and deliver time-saving information for early diagnosis of CVT.

Correlation between optic nerve sheath diameter and Rotterdam computed tomography scoring in traumatic brain injury

Background: In India and other developing nations, traumatic brain injuries (TBIs) are main cause of disability, socioeconomic loss, morbidity, and mortality. In patients with TBI, Rotterdam CT score (RCTS) and diameter of optic nerve sheath (ONSD) have both been reliable independent predictors of prognosis. ONSD measurement has become a substitute non-invasive technique for keeping track of intracranial pressure (ICP). Aims and Objectives: The aims of this study were to study correlation between ONSD and RCTS in predicting outcome and prognosis in patients with traumatic brain injury. Materials and Methods: Total 90 patients with TBI were included in study. All patients meeting inclusion criteria were included and CT scan was performed. RTCS was done based, on which patients were divided into two groups (mild and severe head injury). According to standard protocol, ONSD was measured. Results: Among 90 cases included that most common cause of injury was motor vehicle accident (72.2%). Mean ONSD in the present study was 4.37±0.84 mm. About 57 (63.3%) patients had RCTS score of 1, 2, and 3 (mild head injury) and 33 (36.7%) had RCTS score of 4, 5, and 6 (severe head injury). Cutoff value of ONSD for predicting severity of TBI derived from receiver operating characteristic curve was >4.4 mm. There is a positive correlation between ONSD and RCTS. Conclusion: CT ONSD is a useful radiological tool to identify elevated ICP and it should be noted in every CT report in TBI cases

Evaluation of the Evan’s and Bicaudate index for South Karnataka Population using computed tomography

Background: Radiological markers that are useful in the diagnosis of normal pressure hydrocephalus include the Bicaudate index (BCI) and the Evans index (EI), which are practical indicators of ventricular volume. Worldwide, variation exists in normative studies for both these indices. The majority of research for EI and BCI is based on data from the Western population. The study has been performed on the South Karnataka population. Aims and Objectives: This study’s goal is to derive age and gender specific cutoff values on normative data of Evans and BCI. Materials and Methods: This was a prospective and observational study.Patients referred to “RL Jalappa Hospital” for computed tomography (CT) scan of the brain who meet the inclusion criteria will be included in this study. CT brain of all the patients will be performed in Siemens Somatom emotion 16 slice CT scanner. Ninety-seven were selected for this study, and EI and BCI were calculated for them. Results: The mean value of EI and BCI in our study was 0.26±0.02 and 0.1167±0.02, respectively. The difference in EI and BCI between males and females shown significant statistical difference between males and females but the values increased as increase in age. Conclusion: Our study for South Indian population concludes that EI and BCI have a significant statistical difference between males and females. Both EI and BCI values increase with age. Hence cutoff values of EI and BCI index according to age and gender are important for evaluation of hydrocephalus

Determination of fetal weight by ultrasonographic evaluation of fetal mid-thigh soft-tissue thickness in late third trimester

Background: Estimation of fetal weight is of utmost importance in the planning and management of uneventful labor. This study was done to compare the estimated fetal weight determined by Hadlock’s method and Scioscia’s formula (using femur length and mid-thigh soft-tissue thickness [MTSTT]) to the actual birth weight (ABW). Aims and Objectives: The objectives of this study were as follows: (1) To estimate fetal weight by Hadlock’s method and ultrasonographic evaluation of fetal MTSTT in late third trimester. (2) To correlate fetal weight derived by Hadlock’s method and ultrasonographic evaluation of fetal MTSTT with ABW. Materials and Methods: The study was conducted during the period November 2022–January 2023, at Sri Devaraj Urs Medical College, Tamaka, Kolar. Seventy-six pregnant ladies at term (between 37 and 40 weeks) were included in the study. Results: This study assessed validity of Hadlock formulae and Scioscia’s formulae for detecting fetal weight. For detection of fetal weight by Hadlock’s method, area under curve (AUC) was 0.961 and according to Scioscia’s formulae, AUC was 0.965. This study showed good agreement between fetal weight derived by Hadlock formulae and actual fetal weight (Kappa value – 0.725). There was also good agreement between fetal weight derived by Scioscia’s formulae and actual fetal weight (Kappa value – 0.745). Conclusion: The fetal weight derived by Scioscia’s formula was comparable to the actual fetal weight allowing us to rely on Scioscia’s formulae to detect fetal weight. Calculating fetal weight by measurement of fetal MTSTT serves as an additional tool for estimation of fetal weight along with the existing parameters, thereby increasing the likelihood for accurate fetal weight estimation

Post-COVID-19 Invasive Fungal Sinusitis: A Case Series from Southern India

Acute Invasive Fungal Rhinosinusitis (AIFR) is a serious condition with aggressive course and high mortality rates. There is an upsurge in the incidence of invasive fungal rhinosinusitis in post COVID-19 patients. We have come across 20 AIFR cases in post COVID-19 patients. On retrospective exploration of the patient’s records, we found that 30% patients had received steroids and 90% had diabetes. All the patients were managed by administration of IV amphotericin B and local debridement of infected tissues. The mortality rate was as low as 15 %. We conclude that combined approach of Antifungal therapy with debridement of infected tissues improves the prognosis and survival of AIFR patients

Role of magnetic resonance venogram, diffusion and susceptibility weighted imaging in diagnosis of cerebral venous thrombosis

Background: Cerebral venous thrombosis (CVT) is an uncommon and sometimes critical disease, especially in untreated patients. CVT is an elusive diagnosis because of its nonspecific presentation and its numerous predisposing causes. Accurate diagnosis is difficult but important because effective therapies, including anticoagulants and intrasinus thrombolysis are available. Patients with cerebral venous thrombosis often make dramatic recoveries after anticoagulation. For this reason, accurate diagnosis is important and critical. The aim was to study the extent of venous sinus involvement and associated cerebral parenchymal changes on magnetic resonance venogram (MRV); to study the pattern of diffusion weighted images and ADC (apparent diffusion coefficient) mapping in patients with cerebral venous thrombosis; to study the role of susceptibility weighted images in patients with cerebral venous thrombosis.Methods: Study was conducted on 34 patients diagnosed to have cerebral venous thrombosis on imaging.Results: Imaging analyses of 34 patients (19 females, 15 males, and age range 19-75 years) were done. Thrombus on MRV was seen as loss of high flow signal from the sinus in cases of complete occlusion of the sinus and frayed or patchy flow signal in the cases of non-occlusive thrombus. 16 patients with hemorrhagic infarct showed heterogeneous signal intensity on DWI (diffusion weighted imaging) and blooming on SWI (suseptibility weighted imaging) sequence. 13 patients with non-hemorrhagic infarct showed multifocal high signal intensities in DWI with variable ADC values and no blooming on SWI. 5 patients with intracerebral hematoma showed areas of heterogeneous signals on DWI with blooming on SWI, corresponding ADC values were variable.Conclusions: MRV, diffusion and susceptibility weighted imaging can be used to evaluate the extent of thrombus, discriminate between different types of edema, detect intracerebral hematoma, hemorrhagic and non-hemorrhagic infarcts, and deliver time-saving information for early diagnosis of CVT.