A Study on Clinical Spectrum of Cerebral Venous Thrombosis

INTRODUCTION: Cerebral venous thrombosis (CVT)—ie, thrombosis of the intracranial veins and sinuses—is a rare type of cerebrovascular disease that affects about 5 people per million and accounts for 0•5 % of all stroke. CVT was first recognised at the beginning of the 19th century1 and it was long thought to be an infective disorder that commonly affected the superior sagittal sinus and resulted in bilateral or alternating focal deficits, seizures, and coma, which usually led to death1. At that time, CVT was commonly diagnosed at autopsy and usually showed haemorrhagic lesions, which, by analogy with arterial stroke, was thought to contraindicate the use of heparin. In the past 25 years, the widespread use of neuroimaging has aided early diagnosis of CVT and has thus completely modified the current information we have on this disorder. CVT is now typically recognised as a disorder with various clinical presentations and a usually favourable outcome, with mortality well below 10%. MRI and magnetic resonance angiography are the best diagnostic methods for diagnosis and heparin is the first-line treatment. However, the diagnosis of CVT is still commonly overlooked or delayed because of the remarkable diversity of its clinical symptoms, mode of onset, and neuroimaging signs; furthermore, a cause cannot be found in about 15-30% of cases, the individual outcome may still be dfficult to predict, and the disorder may occasionally worsen despite anticoagulation. CVT thus remains a diagnostic and therapeutic challenge. AIM OF THE STUDY: To study the clinical spectrum of cerebral venous thrombosis patients admitted at Government Stanley Medical College and Hospital and to assess short term outcome. MATERIALS AND METHODS: The study design was prospective observational study involving patients admitted in Medicine and Neuromedicine wards at Government Stanley Hospital, Chennai. Patients admitted and diagnosed to have cerebral venous sinus thrombosis based on CT/ MRI & MRV above the age of 12 years were included in study group. METHODOLOGY: 1. Various clinical features of the patients in a predesigned proforma one allotted for each patient. 2. Detailed history about risk factors for CVT was obtained from patients or their relatives. 3. Detailed general examination and neurological examination including, Fundus examination was also done and were recorded in the individual proforma. 4. CT / MRI & MRV findings were also recorded. 5. All the patients were done Fasting Serum Homocysteine and analysed. 6. Patients were asked to come for followup after one month and their functional and neurological status were recorded and analysed. RESULTS: A total of 50 patients of cerebral venous sinus thrombosis were admitted during our study period and analysed. Of these Males were 27(54%) and Females were 23(46%) ranging from 18 to 68 years. Majority of the cases affected were in the age range of 21-40 years, constituting a total of 44 of 50 cases (88%), 2cases (4%) were aged <20 years,3 cases (6%) were between 41-60 years and 1 case (2%)was found aged >60 years. Median age of occurrence of cerebral venous sinus thrombosis was 28 years. Among the age group distribution in 21-40 years, 22 cases (56%) were males and 22(44%) females. CONCLUSION: 1. A total of 50 cases of CVT were studied.CVT is a disease of young adults.About 44 (88%) of patients were in the age group of 21-40 years.CVT has to be considered in differential diagnosis of young stroke as it affects often people in the age group of 21-40 years.56% of them were males and 44% were females. 2. Mean age of affected patients was 28 years. 3. CVT is more common in females in postpartum period when they have associated anaemia, and hypertension. 3. CVT has to be suspected in any patient with symptoms such as headache, seizures and focal neurological deficit as they are the most common clinical feature. 4. CVT can also present only with isolated intracranial hypertension 5. CT Brain is normal in upto 9(21%) of patients. Normal CT Brain doesnot ruleout CVT. So to confirm the diagnosis of CVT, MRI has to be done in all suspected cases. 6. Among the sinuses Superior Saggital Sinus is most commonly involved in 80% of patients followed by Transverse Sinus in 64% and Sigmoid sinus in 40% of cases. 7. Risk factors for CVT found are recent diarrhea in two(4%) patients, recent chicken pox in one (2%) patient, previous DVT one 2(%) patient, hyperhomocysteinemia in about 11(22%) of patients and CNS infection in one (2%) patient. 8. Initiation of heparin therapy followed by oral anticoagulants favours early recovery of neurological deficit and prevents further complications. 9. Followup at one month one patient has died with a mortality rate of 2%.One had permanent blindness and two patients had residual deficit. 10. CVT generally has a favourable prognosis

An interesting clinical association of short neck with an unusual laryngeal anomaly

An elongated high-rising epiglottis can represent a normal variation of the larynx in a majority of pediatric patients. However, there are virtually no reports available for visible or high-rising epiglottis on routine oral examination in adult patients without upper respiratory tract inflammation. We report an unusual case with prominently visible epiglottis on oral examination. We diagnosed him with a rare congenital disorder based on associated physical examination and imaging evidence of short neck, low hair line, Sprengel′s anomaly, left digital hypoplasia, restricted neck movements, cervical vertebra fusion, and mirror movements (synkinesia)

Genetics of Whole Plant Morphology and Architecture

Plant architectural features directly impact plant fitness and adaptation, and traits related to plant morphology and development represent important targets for crop breeding. Decades of mutagenesis research have provided a wealth of mutant resources, making barley (Hordeum vulgare L.) an interesting model for genetic dissection of grass morphology and architecture. Recent advances in genomics have propelled the identification of barley genes controlling different aspects of shoot and root development. In addition to gene discovery, it is important to understand the interplay between different developmental processes in order to support breeding of improved ideotypes for sustainable barley production under different climatic conditions. The purpose of the present chapter is to: (i) provide an overview of the morphology and development of shoot and root structures in barley; (ii) discuss novel insights into the genetic, molecular and hormonal mechanisms regulating root and shoot development and architecture; and (iii) highlight the genetic and physiological interactions among organs and traits with special focus on correlations between leaf and tiller development, flowering and tillering, as well as row-type and tillering