Dengue virus NS4B interacts with NS3 and dissociates it from single-stranded RNA.

Dengue virus, a member of the family Flaviviridae of positive-strand RNA viruses, has seven non-structural proteins: NS1, NS2A, NS2B, NS3, NS4A, NS4B and NS5. Except for enzymic activities contained within NS3 and NS5, the roles of the other proteins in virus replication and pathogenesis are not well defined. In this study, a physical interaction between NS4B and the helicase domain of NS3 was identified by using a yeast two-hybrid assay. This interaction was further confirmed by biochemical pull-down and immunoprecipitation assays, both with purified proteins and with dengue virus-infected cell lysates. NS4B co-localized with NS3 in the perinuclear region of infected human cells. Furthermore, NS4B dissociated NS3 from single-stranded RNA and consequently enhanced the helicase activity of NS3 in an in vitro unwinding assay. These results suggest that NS4B modulates dengue virus replication via its interaction with NS3

Role of citicoline in the management of mild head injury

Mild head injuries can cause functional disabilities resulting in economic loss. Post concussion syndrome is seen in 15-45% of these patients. Cytidine-5‘-diphosphocholine (citicoline) is known to improve cognitive dysfunction. This study was undertaken to evaluate the effect of citicoline on the number of working days lost and on post concussion symptoms following mild head injury in adults, in a randomized, prospective, single blind study. Following informed consent, adults with mild head injury (Glasgow coma score of 13-15, <24 hours) were randomized, using a computer generated randomization table, to receive either citicoline (1 gram/day) or placebo for one month. The parameters evaluated at one month were number of working days lost, Glasgow outcome score, presence of post concussion symptoms and the Rivermead head injury follow up questionnaire (RHFQ) scores. The groups were compared using Pearson chi-square test and fisher’s exact test. The groups were well matched with respect to age, gender, GCS and mode of injury. There was no difference in the number of working days lost between the groups (P=0.061), Glasgow outcome score (P=0.281), Rivermead head injury follow up questionnaire scores (P=0.667) and the post concussion symptoms (P=0.3) between the groups. Compared to placebo, one gram/ day of citicoline for one month in patients with mild head injury did not reduce either the number of working days lost, or the post concussion symptoms. There was no difference in the quality of life between patients taking citicoline and placebo

Malignant nodular hidradenoma of scalp

Malignant nodular hidradenoma (MNH) is a rare tumor of sweat gland known by many names in the literature. Scalp is a known and yet uncommon site of occurrence. We describe two patients with scalp MNH with brain parenchymal invasion. Both tumors recurred in spite of total excision and radiotherapy

Multicompartmental Trigeminal Schwannomas: Management Strategies and Outcome

Trigeminal schwannomas (TS), though the second most common intracranial schwannomas, represent only 0.8 to 8% of all Schwannomas. Advancement in imaging and microsurgical techniques has led to a remarkable improvement in the outcome of these benign tumors. Multicompartmental TS, though extensive, have an excellent outcome after surgery. In this article, we present our experience in the management of multicompartmental TS (types middle/posterior [MP], middle/extracranial [ME], and middle/posterior and extracranial [MPE]) and outcome in this rather uncommon group of tumors. This retrospective study included all the cases of multicompartmental TS operated at our institute from 1999 to 2009. The medical data were analyzed retrospectively. The demographic profile, clinical features, radiological findings, management strategies, postoperative complications, length of hospitalization, and outcome were noted. Follow-up data were collected from outpatient department records. The range and average duration of follow-up were noted. There were a total of 43 patients with TS operated over this period. Among them, 4 were type B, 5 type C, 11 type D, 18 type E, and 5 type F. The study included 26 patients (4 type B, 18 type E, and 4 type B). A variety of approaches were used to approach the tumor. Of 26, 23 patients had a gross total or near-total excision while 2 patients were lost to follow-up. Among the three patients who had a near-total excision and follow-up magnetic resonance imaging showed a small residual tumor, two are on close follow-up with no increase in the size of the tumor over a follow-up period of 3 years, the other patient is a 5-year-old boy who is too young for radiosurgery and is on follow-up. There was no mortality while four patients have had fresh permanent postoperative deficits. Multicompartmental TS are a rare, complex but eminently treatable group of tumors. A variety of surgical approaches can be used to excise the tumor. The choice of approach needs to be individualized with total excision providing excellent results

Interhemispheric epidermoids - An uncommon lesion in an uncommon location: A report of 15 cases

Of the intracranial epidermoids, interhemispheric epidermoids are extremely rare and only about 19 cases have been reported. This is a retrospective study of 15 patients with interhemispheric epidermoids surgically treated over a 13-year period. The age at the time of presentation varied between 17 and 45 years and there were 9 males. The presenting feature was seizures (focal with secondary generalization) in 12 patients, hemiparesis in 5 and features of raised intracranial pressure in 3. On computerized tomography scan the lesions were hypodense in the interhemispheric region. On magnetic resonance imaging, the lesions were located in the interhemispheric region with heterogenous signal intensities. Restricted diffusion was evident on diffusion-weighted images and apparent diffusion co-efficient images. All the lesions were predominantly located in the anterior interhemispheric region, with either basal or parietal extension along the interhemispheric fissure. Eleven patients underwent frontal or fronto-parietal craniotomies, 3 underwent bifrontal craniotomies and 1 patient underwent supra-orbital craniotomy and endoscopic procedure. Total excision could be achieved in 11 patients; near-total, in 3; and partial excision, in 1 patient. Follow-up was available in 10 patients. Three patients had recurrence of lesion at 5½, 8 and 10 years, respectively

Domestic animal‑related neuro‑trauma: An account, from a tertiary institute

Context: Experience of animal‑related neurotrauma at an apex institute, National Institute of Mental Health and Neurosciences, Bangalore, India. Aims: The aim of this study is to review epidemiology, clinical findings, and outcome of animal‑related traumatic brain injury (TBI) evaluated and treated at our institute. Settings and Design: A retrospective study consisting of demographic data, clinical findings, radiological details, and outcomes. Materials and Methods: The clinical and imaging records of 30 patients treated for animal‑related TBI at the emergency services, from January to July 2010. Outcome was assessed by Glasgow outcome scale (GOS). Statistical Analysis Used: SPSS 15.0 version, descriptive statistics. Results: A total of 6190 neurotrauma cases were evaluated and treated during the study period. Among them, 30 (0.48%) were animal‑inflicted injuries. Of these cases, animal‑vehicle collision and directly animal‑inflicted injuries were 15 (50%) each. The mean age of patients were 39.46 (6-71 years). Twenty‑nine (96.66%) cases were from rural areas. Twenty‑three (76.6%) had mild, 6 (20%) had moderate, and 1 (3.3%) had severe head injury (Glasgow coma scale). Four (13.3%) patients had abnormal pupillary reaction. Associated injuries were found in 25 (83.3%) patients. CT scan was abnormal in 50% (15/30), common finding was contusion in 8 (26.6%) patients, followed by edema in 6 (20%). There were 3 (10%) spine injuries, 1 (3.3%) internal carotid artery (ICA) dissection, and 2 (6.6%) brachial plexuses injuries. Three (10%) required surgery, and 1 (3.3%) patient expired. As per the GOS, good recovery was seen in 8 (80%) patients, moderate disability in 1 (10%), and vegetative state in 1 (10%) patient

Hydrocephalus Associated with Large Vestibular Schwannoma: Management Options and Factors Predicting Requirement of Cerebrospinal Fluid Diversion after Primary Surgery

Objective: Obstructive hydrocephalus (HCP) related to vestibular schwannoma occurs in large tumors compressing the fourth ventricle. Symptoms related to HCP are expected to alleviate after resection of the tumor and decompression of the cerebrospinal fluid (CSF) pathways. However, some patients may require permanent cerebrospinal diversion even after surgery due to persistent HCP. In this study, the authors try to find out the factors associated with the requirement of CSF diversion after vestibular schwannoma surgery in cases of persistent HCP. Materials and Methods: This was a retrospective study involving 193 cases of vestibular schwannoma operated between 2010 and 2013 in our institute. Cases that underwent ventriculoperitoneal (VP) shunts before surgery were compared to cases which were operated directly. In cases where vestibular schwannomas were operated without prior VP shunts, factors which were associated with persistent postoperative HCP were analyzed. Results: Comparing the group who underwent direct surgery to the group who underwent VP shunt before definitive vestibular schwannoma surgery, the facial nerve preservation rates and surgical morbidity rates were comparable. In cases who underwent direct surgery, 10 out of 75 patients required postoperative permanent CSF diversion. Older age, male gender, duration of symptoms, larger tumor size, solid lesions, severe HCP, and clinical features of HCP were associated with postoperative requirement of CSF diversion but were not statistically significant. The most significant factor that correlated with the need for additional HCP treatment was the presence of postoperative hematoma of volume >10cc. Conclusions: Primary tumor removal is the optimal treatment for vestibular schwannoma associated with HCP. Postoperative hematoma may warrant close observation as these patients are at an increased risk of persistence of HCP

Intracranial Germ Cell Tumors: Spectrum of Disease in an Indian Cohort and Management Strategies

Background: Germ cell tumors (GCTs) represent approximately 3% of primary pediatric brain tumors in the West, whereas in Asia, they constitute between 8% and 15% of pediatric brain tumors. Methods: We retrospectively studied all patients with intracranial GCT managed at our institute from January 1998 to December 2013. The clinical data and radiological data were analyzed. Results: Forty-eight patients with intracranial GCT including 36 males and 16 females formed the cohort. The proportion of GCT in our study was 0.29%. The mean age was 16.5 ± 2.5 years. Germinomas constituted 56.3% and nongerminomatous GCTs constituted 43.7% of all the tumors. The most common location was posterior third ventricle (58.3%) followed by suprasellar (22.9%). Histopathological diagnosis was obtained in almost all patients (96%). Surgical procedures included tumor decompression (71.7%), stereotactic biopsy (13%), and endoscopic third ventriculostomy and biopsy (15%). Patient's age, location of the tumor, and histology did not influence the survival. Women with GCTs had poorer survival when compared to men. Conclusions: The present study documented a lower hospital-based incidence of GCT in Indian cohort. A multidisciplinary approach including surgical strategy based on location, appropriate radiation planning, and chemotherapy is needed for effective treatment and improved outcomes

Is there a need to diagnose Rathke's cleft cyst pre operatively?

Rathke′s cleft cyst is a rare benign sellar lesion. The exact preoperative diagnosis of this lesion by clinical and radiological features is difficult. Hence it is often misdiagnosed as craniopharyngioma. This paper aims at identify the radiological pointers for pre operative diagnosis of Rathke′s cleft cyst. This study presents the details of nine patients who were operated in our institution between 1998 and 2008. The possibility of Rathke′s cleft cyst was considered pre operatively in one patient only. Radiological and histopathological variations were studied. On reviewing the images, characteristic imaging findings were observed in a few cases. As minimally invasive trans sphenoidal approach is sufficient for treating these lesions, pre operative diagnosis is important

Central nervous system cladosporiosis: An account of ten culture-proven cases

Background : Central nervous system (CNS) cladosporiosis is a rare infection caused by Cladophialophora bantiana. It has varied presentation and poor outcome. Most of the available data in the literature are reviews of individual case reports. Objective : To describe the clinical, radiological and mycological features of 10 cases of C. bantiana managed at a single tertiary center. To analyze the various treatment options, factors associated with outcome, and to review the relevant literature. Materials and Methods: This is a retrospective study of 10 patients with CNS cladosporiosis managed at National Institute of Mental Health and Neurosciences from 1979 to 2006. It is a descriptive study. The case records were reviewed for clinical presentation, radiological features, management and outcome. Only those patients in whom the fungus could be isolated on culture were included in the study. Results : The age of the patients ranged from three to 42 years. Nine patients presented with features of space-occupying lesion and one patient with chronic meningitis. There were no specific clinical or radiological features. None of patients had impaired immune status. This infection presented as two pathomorphological forms - diffuse meningoencephalitis and focal abscesses. Burr hole tapping and excision are the surgical options. Both patients with burr hole tapping required excision of abscess subsequently. Two out of seven patients with abscess expired compared to all three patients with diffuse meningoencephalitis who expired. Recurrences occurred in four of the five patients following excision of the abscess. Combination antifungal treatment had better result than monotherapy. The outcome was poor with survival of only 50%. Conclusions : Thorough microbiological examination is required to diagnose CNS infection caused by C. bantiana . The outcome is better in patients with abscess. Excision of the abscess followed by combination antifungal therapy results in better outcome. Close follow-up is required due to high risk of recurrence