$472 Thursday, November 10, 2005 Poster Abstracts

Conclusion: Dengue patients may present with two major neurological syndromes-encephalopathy and acute motor weakness probably due to myositis. Presence of raised CPK in encephalopathy and EEG slowing in acute motor weakness group suggest a continumn of dengue virus infection; myositis representing a milder and encephalopathy a severe illness.

1466 Cerebral Venous Sinus Thrombosis (CVT): Clinieoradiologieal spectrum anti nmnageinenl dflenmlas

Modi, M:, Prabhakar, S:, Grewal, G a, Lal, V a, Pandey, A a, Ahluwalia, J:, Bhatia, R 2, Khurana, D a, Das, C:, Kharbanda, P:. 1Postgraduate Institute Of Medical Education and Research, All India Institute of Medical Sciences, Chandigarh, India

Objectives: The present study was designed to look for the clinical, etiological and imaging features of patients of CVT. Furthermore no comparative data is available on the efficacy of two types of heparin therapy in CVT i.e. Unfractionated and Low Molecular Weight Heparin (LMWH). Methods: 75 patients o f CVT admitted at PGIMER, Chandigarh, India were managed with either Unfractionated heparin or LMWH. 35 patients received Heparin therapy (Group-I) at the dose of 5000 IU stat followed by 800-1000 U/hr infusion and 40 patients received LMWH (Group-If) - 200 anti Xa units/kg/day in 2 divided doses for 7-10 days. Oral anticoagulants were given subsequently for a period of 3 months, maintaining an INR of 2-3. Procoagulant work up was done at the end of 4 months of therapy in 50 cases, one month after stopping therapy. Results: At 90 days, complete recovery was observed in 29 patients in Group I and 34 patients in Group II and partial recovery in 3 patients in Group I and 3 patients in Group II. 3 deaths were observed in Group I and 3 in group II. Subgroup analylsis revealed no difference in disability outcome in different age groups, patients with or without postpartum state and patients with or without hemorrhagic infarcts. Conclusion: Anticoagulation is safe in CVT and possibly hastens the recanalisation. The present study will reflect the clinico-radiologico- pathological spectrum of CVT and enable us to reach a consensus in management of CVT.

1467 Progress in JapaneSe Encephalitis in India

Pradhan, S 1. 1San jay Gandhi Postgraduate Institute of Medical Sciences, Lue]cnow, India

JE virus was discovered in India through a serological study conducted by National Institute of Virology, Pune in 1952. Early cases were recorded from Central and Southert: states Madhya Pradesh, Tanfflnadu and Andhra Pradesh. In 1978, JE outbreaks were reported from Northeastern states of Uttar Pradesh and Bihar from where GP78 strain was isolated. Common mode of transmission in India is pig-to-man through Culex vishnui and Culex tritaeniorhynchus mosquitoes which breed heavily in waterlogged paddy fields during the post-monsoon period. Clinical diagnosis is made when a case with features of encephalitis comes from an endemic area with predominant extra-pyramidal signs. MRI features of thalamic, basal ganglia and substantia nigra involvement as described by Misra et al. and Pradhan et al. fi'om Lucknow help in the diagnosis. These findings correlate with the staining of autopsied brain with anti-JEV anti-bodies as shown by Shanker et al. and Ravi et al. fi'om Bangalore. Their microscopic findings included peri-vascular inflammation, necrosis, glial proliferation and nodule formation. Complete gene sequencing by Vrati et al. from New Delhi for envelop glycoprotein (Egp) from different Indian strains revealed 4 distinct group with differences located in group specific domain-1 and flavi-virus cross reactive domain-3. Mathur et al. from Lucknow showed monocytes and macrophages to be the primary sites of viral replication with latency of

virus in mice leucocytes via suppressor T-cell mechanism. This viral- latency may cause bi-phasic illness (Pradhan et al.) or delayed relapse (Kumar et al.). For the recovery from encephalitis, Mathur showed that JEV induces Macrophage Derived Factor (MDF), which degrades phagocytosed virion via generation of superoxide radicals and nitric oxide. Severe movement disorders (Kalita et al.), parkinsonism (Pradhan et al.) and association with neurocysticercosis has also been described from India. Vaccination programme is yet to be implemented in endemic zones and prevention is primarily through fully covered clothing and use of mosqnito-nets.

1468 Neurobrucellosis at rise of present millenium

Saadah, M ~. 1Rashid Hospital, Neurology Department, Salmiya, Kuwait

Background and Objectives: Brucellosis is hyperendemic in most of Middle East countries. Neurobrucellosis range fi'om 1.7-10"/o. Although psychiatric manifestations are frequent mode of presenta- tion, they were scarcely reported in literature. We are reporting 32 cases over a 25 years period, psychiatric, manifestations were either a major mode of presentation or a prominent manifestation. Methods: Prospective study that involved three Middle East countries over the period of 1980-2004. Cases were drained from Kuwait, 2Mm:mn, Jordan and Dubai. Diagnostic laboratory and radiological techniques were used as needed. Brucella melitensis was cultured from bone marrow, blood or CSF (14). CSF showed lymphocytic pleocytosis (23), hypoglychorrhia (128), elevated protein (29), immunoglobulin G values (114) and positive oligoclonal bands (15). Results: Psychiatric manifestations were in form of confusional (15), depressive (11), Sctffzophreniform (14) and manic psychosis (2). Neurologic manifestations were in form of acute meningoencephalitis (18), lower motor neuron (115), cranial nerve (13), autonomic (13), pyramidal (8), speech (5), cerebellar (4), sensory (14), extrapyramJdal (12) and apractic (1) or cauda equine lesions (1). Contusions: Combined antibacterial therapy, at:tipsychotics and steroids resulted in full recovery of solely acute meningoencephalitic cases, others were left with either minor, moderate or severe disability. This should alert general practitioners, physicians, psychiatrists and neurologists about protean manifestations of neurobrucellosis. High index of suspicion is imperative particularly in endemic areas. Differential diagnostic window should not be prematurely closed. Blind psychotherapy may lead to undue delay in diaguosis and treatment, more neurological damage and chronic disability.

1469 Hmnoral Itmnune IgG Antibody response against PlllNulodiuln Fald- pc_nun in adult patients with Cerebral Malaria

Shigidi, M a'2, Sokrab, T :'2, Hastffm, R 3 Mukhtar, M 3, Idris, M:. 1Faculty of Medicine, University of Khartoum, Sudan; 2Harnad General Hospital, Doha, Qatar; 3Institute of Endemic Diseases, University of IUzartown, Sudan

Background: Although antibodies are essential mediators of immunity, high levels of lgG antibodies against a wide range of blood-stage antigens of P. falciparum are poor predictors of clinical protection. It is the qualitative and the functional specificity of the antibodies to malaria antigens that predict the development of a clinically potent protective inmmnity. In tiffs study we investigated the profile pattern of the total and sub-class IgG (IgG1, 2, 3 and 4) antibodies to the C-temfinal fiagment MSA- la9 of P. falciparurn in healthy and infected adult residents o f a malaria-endemic area in Sudan. Methods: Total plasma IgG and IgG subclasses against the C-terminal region of the MSA-la9 antigen of Plasmodium faleiparum were measured by a quantitative enzyme-linked immunosorbent assay (ELISA) in 30 adult patients presenting to the emergency department with cerebral malaria (CM). The levels of IgG antibody profile in CM patients were compared with those in patients with uncomplicated

Poster Abstracts Thursday, November 10, 2005 $473

acute malaria (n - 20) and in clinically healthy asymptomatic volunteers (in - 20). The control groups were age-and sex-matched and were residing in the same malaria endemic region. Results: Total plasma IgG level was significantly lffgher in CM patients. The level of the sub-class IgG1 antibody against MSA-I~9 was siguificantly lower in patients infected with P. falciparum; the lowest values being observed in CM patients and the highest values in the clinically healthy volunteers. Conclusion: It appears that low or defective IgG1 response may be associated with severe malaria in adults.

1470 Clinical and inagnefie resonance imaging features of Tuberculous Myelitis

Arif, H ~, Kheleani, B ], Ahsan, H ], Wasay, M 1. 1Department of Medicine, Neurology and Radiology, The Aga Khan University, Karachi, Pakistan

Background: Tuberculosis (TB) is an important cause of morbidity and mortality worldwide, and may involve multiple organ systems. However, TB myelitis is seen uncommonly, even in areas endemic for TB. Objective: This study aimed to describe the clinical and MRI features in patients with TB myelitis presenting to a tertiary care hospital in Pakistan. Methods: This study is a retrospective case-series reviewing all the patients diagnosed as having TB myelitis presenting to the Aga Khan University Hospital in Karachi, Pakistan, over a period of 10 years. Medical records of all these patients were retrospectively reviewed to record presenting ssanptoms, neurological examination findings, MRI/ CT findings, CSF analysis, treatment plans and outcomes at discharge as well as most recent follow-up. Results: The data of 10 patients (mean age 33.1 ± 16.26 years) with tuberculous myelitis is presented. The most common presenting symptoms were fever (70%), paraplegia (60%), neck stiffness (150%), altered mentation (50"/0). Crauial nerve involvement was uncommon (:30"/0). 90"/0 patients had compromised motor power on exanffnation (160"/o were hyperreflexic, 30?,5 hyporefiexic). Sensory symptoms were present in 60%, the dorsal column frequently being involved. No patient exhibited any spinal tenderness or deformity or reported a history of backache. 50?,'; patients had urinary retention, 30?,'; bowel incontinence and 20?,5 urinary incontinence. On MRI, involvement of the cervical/thoradc segment of the spinal cord was most commonly seen (:90"/0). The most consistent finding was hyperintense signals in all T2-weighted MRFs. Other findings were isointensities (15) and hypointensities (14) on Tl-weighted images, post-contrast enhancement (5), epidural enhancement (14) and cord swelling (12). A comparison of functional status assessed on adnffssion and discharge revealed that 5 patients had improved, 2 had expired, 2 were the same and 1 was worse. The mean duration of the 12-month course of antituberculous therapy (ATT) prescribed at discharge, as recorded on follow-up, was 4.1 ± 4.3 months. Conclusion: TB myelitis can present on MRI with a constellation of findings that signify infianmmtion/infection, and apart from T2WI- hyperintensities, none seem to be pathognomonic for tiffs disease. A high index of clinical suspicion, early detection with appropriate courses of ATT, stressing proper compliance is imperative to reduce the mortality and morbidity of this potentially life-threatening but treatable disease.

1471 Role of brain perfusion single-photon emission tomography in chronic coinplieafions of traumatic head injury

Saghari, M a, Eftekhari, M a, Assadi, M a, Akbarpour, S 1. ~Shariati Hospital, Tehran, Iran

Background: Anatomical imaging (AI; CT and MRI) is helpful in the diagnosis of acute traumatic complications however it is not efficient in the diagnosis o f disabling injury syndrome. In contrast, brain perfusion SPECT can be more useful due to evaluation of micro- vascular situations. To explain tiffs role we present brain perfusion SPECT and AI findings in 50 patients who have been suffering from traumatic, brain injury more than 1 year. Methods: fifty patients with mean age 32.32 ± 11.8 years and mean post-traumafic time 1.48 ± 0.65 years presenting with traumatic head injury, were enrolled. Brain SPECT and also AI was perforated for each patient with interval up to one month. Results: brain perfusion SPECT revealed remarkable abnormality in 76 lobes (19%) compared with AI in 38 lobes (9.5%). The correlation between SPEC~ and AI findings was 84%. SPECT was more sensitive than AI in demonstrating brain abnommlJty. There is no significant difference between before and after 30 years old cases; however, superiority of SPECT over AI is more obvious in the male group. Conclusion: The findings showed that reflected brain perfusion SPECT is more sensitive and valuable than AI in representing more lesions in patients espedally who had hypofrontalism signs and symptoms. Because of its availability, rather low costs, easy perfommnce, and objective quantitative information supplied, brain perfusion SPECT can be complementary to other diagnostic tedmiques in the evaluation of chronic complications of head trauma, while AI shows some abnormalities.

1472 How t?equent and severe are head injuries in amateur boxing?

Ghougassian, D.F 1. 1Prince of Wales, Sutherland Hospitals, NSW, Australia

Background: Most literature on boxing was done prior to availability of current diagnostic techniques. Previous reports often did not differentiate between professional and amateur boxers. The New South Wales Amateur Boxing Association (NSWABA) governs amateur boxing in NSW and enforces rigorous controls as per the Medical Commission of the IABA. Methods: An Injuries" Questionnaire was developed, field-tested and distributed to 1,486 boxers on lists compiled from information obtained from the NSWABA. It covered mid 1997-1999. Results: There were 291 responses received: 168 were "active" (registered) boxers and 108 retired. Of the retired boxers, 53 had bouts in the prior two years and were eligible for inclusion in the analyses. Respondents were young, had spent less than 4 years in the sport, smoked and consumed little alcohol. Most fought less than 5 bouts. 13"/o or more played other "fighting" sports wlffle 56"/0 played other contact sports. At least 65"/0 reported one injury; 61% of reported injuries occurred in non-boxing tournament environs. 42 (19%) reported at least one TKO. None had loss of consciousness greater than 5 minutes. In around 20% of TKOs, mandatory exclusion times were not applied. More head injuries occurred whilst pursuing other sports. Conclusions: There were less than 7"/0 of bouts related with TKOs. Of concern, not all wore mandatory helmets or had the time bans applied. More often, head injuries were reported during other sporting activities. The measurement o finjuries in sport is complex and multiple previously-unrealized factors need to be taken into account.

1473 Spinal Decumpression Sickness

Kiln MK 1, Ko SM 1, Bae JS 1, Park SS ]. ~Seoul Medical Center, Seoul, Korea

Background: Decompression sickness may involve the CNS; it is usually characterised by damage to the spinal cord. This investigation was conducted to determine M R imaging showed spinal damage in acute decompression sickness and clinical findings.