Parthiban Bala | All India Institute of Medical Sciences, New Delhi (original) (raw)

Papers by Parthiban Bala

Journal of NeuroInterventional Surgery, Dec 8, 2023

Rivista Di Neuroradiologia, Sep 7, 2020

The ongoing COVID-19 pandemic has forced every radiology setup to evolve and formulate guidelines... more The ongoing COVID-19 pandemic has forced every radiology setup to evolve and formulate guidelines for day-today functioning. The sub-speciality of neuroradiology, both diagnostic and neuro-intervention, forms a very important part of any radiology or 'neuro-care' setup. The present document is a consensus statement of the Indian Society of Neuroradiology, prepared after reviewing the available data and working experience. It scientifically tries to answer many questions faced by neuroradiologists everyday in practice. It encompasses simple things such as which patients need to be imaged, what precautions are essential, the work-flows, cleaning of radiology equipment, how to carry out neuro-interventions in COVID-suspect patients, and what procedures/tests to avoid, or their alternatives, to minimise the spread of COVID infection both to the patients and health care personnel. As radiology setups can be large, every subspeciality may have certain precautions which will not be covered in general guidelines, and this document tries to answer those for neuroradiologists. Carefully evolved Standards of Operating Procedure (SOPs) and guidelines are the need of the hour to guide in providing uninterrupted and adequate services to the needy without compromising the safety of the specialised work force and facilities involved.

World Neurosurgery, May 1, 2019

BACKGROUND Arterial pseudoaneurysms of the neck are rarely reported in the pediatric population a... more BACKGROUND Arterial pseudoaneurysms of the neck are rarely reported in the pediatric population and no dedicated large series are available. Trauma and infection are the most common causes for these aneurysms, with congenital and collagen vascular disorders being the less common causes. These lesions can be life threatening, especially when they present with bleeding or airway compromise. METHODS We searched our radiology information system for all cases of pediatric neck aneurysm presented between June 2015 and May 2018. These cases were analyzed for clinicoepidemiologic variables, clinical presentation, imaging findings, management, and follow-up. RESULTS Six children were included in the study (male/female ratio, 5:1), with a mean age of 7.8 years (range, 2.5-15 years). Four presented acutely with either bleeding or rapidly enlarging neck swelling, whereas 2 presented with slowly increasing pulsatile swelling. One had a traumatic cause, 2 had infections, and 1 had infective cervical lymphadenitis complicated by iatrogenic injury whereas no definite causative mechanisms could be accounted for in 2 patients. Two of the children were managed by trapping of the aneurysm and 2 only by proximal parent vessel occlusion. The other 2 children were treated with stent graft deployment across the aneurysm neck to reconstruct the parent vessel. All the patients were doing well during the follow-up period (mean, 14.8 months). CONCLUSIONS Endovascular means of treatment for pediatric neck aneurysms is relatively simple and safe. Although parent vessel sacrifice is the gold-standard management, vessel-preserving strategies can be tried in select cases with favorable anatomy.

Clinical neuroradiology, Jun 28, 2023

Journal of Clinical Neuromuscular Disease, Dec 1, 2022

Background: Ulnar nerve is frequently involved in mononeuropathies of the upper limb. Ulnar neuro... more Background: Ulnar nerve is frequently involved in mononeuropathies of the upper limb. Ulnar neuropathies have been diagnosed conventionally using clinical and electrophysiological findings. Physicians opt for nerve imaging in patients with ambiguous electrophysiological tests to gain additional information, identify etiology and plan management. Objectives: The aim of this study was to describe the electrophysiological and the magnetic resonance neurography (MRN) findings in patients with nontraumatic ulnar neuropathy. Methods: All consecutive patients with suspected nontraumatic ulnar mononeuropathy were recruited; clinical assessment and electrophysiological studies (EPSs) were done in all. After EPS, patients with localization of lesion along the ulnar nerve underwent MRN. Results: All 39 patients recruited had clinical findings suggestive of ulnar neuropathy; Electrophysiological confirmation was possible in 36/39 (92.30%) patients. Localization of ulnar nerve lesion to elbow and wrist was possible in 27 (75%) and 9 (25%) patients, respectively. MRN was done in 22 patients; a lesion was identified in 19 of 22 (86.36%) ulnar nerves studied. Thickening and hyperintensity in T2 W/short TI inversion recovery images of ulnar nerve at the level of olecranon, suggesting ulnar neuropathy at elbow, was the commonest (8/22) imaging finding. Conclusions: MRN acts as a complimentary tool to EPS for evaluating nontraumatic ulnar neuropathy. By identifying the etiology, MRN is likely to modify the management decision.

Journal of Clinical Toxicology, 2018

T1W image of 60 yr old<br>

Clinical and Experimental Dermatology, 2018

Aicardi-Gouti eres syndrome (AGS) is a rare, genetically determined, neurological disease with cu... more Aicardi-Gouti eres syndrome (AGS) is a rare, genetically determined, neurological disease with cutaneous manifestations. AGS has a varied phenotypic spectrum, and a variant with a lesser degree of neurological deficits has been described. We report a case of AGS with a milder phenotypic variant in a young man. A 25-year-old man presented with a history of erythematous, mildly tender plaques on acral sites, ear helices and the tip of nose since early infancy. The disease was markedly worse during winter, and spontaneously healed with depigmentation, scarring and acral resorption in summer. The patient had delayed milestones since birth, mild mental retardation (intelligence quotient 50), limb spasticity, contracture and flexion deformity of 20 degrees in knee joints, and hyper-reflexia and sensory neuropathy in the legs, but no microcephaly or severe neurological deficit. There was no family history of consanguineous marriage but the patient's three siblings had died in early infancy from unidentifiable causes. Physical examination showed mildly erythematous atrophic scars on the interphalangeal and metacarpophalangeal joints (Fig. 1a) and a few minimally erythematous ulcerated plaques over the lateral malleoli and the plantar aspect of the right foot (Fig. 1b). The bilateral ear helices, all toes and the right index finger showed marked resorption (Fig. 1c,d).

Journal of Clinical Neuromuscular Disease

T1W image of 60 yr old<br>

BMJ Case Reports, 2019

A female patient, aged 61 years, presented to us with a 3-day history of fever and altered sensor... more A female patient, aged 61 years, presented to us with a 3-day history of fever and altered sensorium. She was discharged from another hospital 1 week back where she was admitted for community-acquired pneumonia. She was put on mechanical ventilation for threatened airway and her magnetic resonance brain imaging showed evidence of delayed posthypoxic leucoencephalopathy, also known as Grinker’s myelinopathy. She was discharged 1 month later, on room air with a tracheostomy tube in situ. On follow-up after 5 months, she was ambulating with support and carried out activities of daily living independently.

World Neurosurgery, 2019

BACKGROUND Arterial pseudoaneurysms of the neck are rarely reported in the pediatric population a... more BACKGROUND Arterial pseudoaneurysms of the neck are rarely reported in the pediatric population and no dedicated large series are available. Trauma and infection are the most common causes for these aneurysms, with congenital and collagen vascular disorders being the less common causes. These lesions can be life threatening, especially when they present with bleeding or airway compromise. METHODS We searched our radiology information system for all cases of pediatric neck aneurysm presented between June 2015 and May 2018. These cases were analyzed for clinicoepidemiologic variables, clinical presentation, imaging findings, management, and follow-up. RESULTS Six children were included in the study (male/female ratio, 5:1), with a mean age of 7.8 years (range, 2.5-15 years). Four presented acutely with either bleeding or rapidly enlarging neck swelling, whereas 2 presented with slowly increasing pulsatile swelling. One had a traumatic cause, 2 had infections, and 1 had infective cervical lymphadenitis complicated by iatrogenic injury whereas no definite causative mechanisms could be accounted for in 2 patients. Two of the children were managed by trapping of the aneurysm and 2 only by proximal parent vessel occlusion. The other 2 children were treated with stent graft deployment across the aneurysm neck to reconstruct the parent vessel. All the patients were doing well during the follow-up period (mean, 14.8 months). CONCLUSIONS Endovascular means of treatment for pediatric neck aneurysms is relatively simple and safe. Although parent vessel sacrifice is the gold-standard management, vessel-preserving strategies can be tried in select cases with favorable anatomy.

The Neuroradiology Journal, 2019

Intracranial dermoid and epidermoid cysts are usually considered to be two different entities in ... more Intracranial dermoid and epidermoid cysts are usually considered to be two different entities in the radiological and surgical literature. Epidermoid cysts are classically off midline in location, isointense to cerebrospinal fluid on T1 and T2-weighted images and have restricted diffusion, whereas dermoid cysts are classically midline in location, have T1-hyperintense regions due to the presence of fat and show facilitated diffusion. We report a case of radiological epidermoid cyst in baseline imaging, which evolved into a radiological dermoid cyst over time, and explain this unique occurrence with a review of the embryology and histopathogenesis of these cysts.

Journal of NeuroInterventional Surgery, Dec 8, 2023

Rivista Di Neuroradiologia, Sep 7, 2020

The ongoing COVID-19 pandemic has forced every radiology setup to evolve and formulate guidelines... more The ongoing COVID-19 pandemic has forced every radiology setup to evolve and formulate guidelines for day-today functioning. The sub-speciality of neuroradiology, both diagnostic and neuro-intervention, forms a very important part of any radiology or 'neuro-care' setup. The present document is a consensus statement of the Indian Society of Neuroradiology, prepared after reviewing the available data and working experience. It scientifically tries to answer many questions faced by neuroradiologists everyday in practice. It encompasses simple things such as which patients need to be imaged, what precautions are essential, the work-flows, cleaning of radiology equipment, how to carry out neuro-interventions in COVID-suspect patients, and what procedures/tests to avoid, or their alternatives, to minimise the spread of COVID infection both to the patients and health care personnel. As radiology setups can be large, every subspeciality may have certain precautions which will not be covered in general guidelines, and this document tries to answer those for neuroradiologists. Carefully evolved Standards of Operating Procedure (SOPs) and guidelines are the need of the hour to guide in providing uninterrupted and adequate services to the needy without compromising the safety of the specialised work force and facilities involved.

World Neurosurgery, May 1, 2019

BACKGROUND Arterial pseudoaneurysms of the neck are rarely reported in the pediatric population a... more BACKGROUND Arterial pseudoaneurysms of the neck are rarely reported in the pediatric population and no dedicated large series are available. Trauma and infection are the most common causes for these aneurysms, with congenital and collagen vascular disorders being the less common causes. These lesions can be life threatening, especially when they present with bleeding or airway compromise. METHODS We searched our radiology information system for all cases of pediatric neck aneurysm presented between June 2015 and May 2018. These cases were analyzed for clinicoepidemiologic variables, clinical presentation, imaging findings, management, and follow-up. RESULTS Six children were included in the study (male/female ratio, 5:1), with a mean age of 7.8 years (range, 2.5-15 years). Four presented acutely with either bleeding or rapidly enlarging neck swelling, whereas 2 presented with slowly increasing pulsatile swelling. One had a traumatic cause, 2 had infections, and 1 had infective cervical lymphadenitis complicated by iatrogenic injury whereas no definite causative mechanisms could be accounted for in 2 patients. Two of the children were managed by trapping of the aneurysm and 2 only by proximal parent vessel occlusion. The other 2 children were treated with stent graft deployment across the aneurysm neck to reconstruct the parent vessel. All the patients were doing well during the follow-up period (mean, 14.8 months). CONCLUSIONS Endovascular means of treatment for pediatric neck aneurysms is relatively simple and safe. Although parent vessel sacrifice is the gold-standard management, vessel-preserving strategies can be tried in select cases with favorable anatomy.

Clinical neuroradiology, Jun 28, 2023

Journal of Clinical Neuromuscular Disease, Dec 1, 2022

Background: Ulnar nerve is frequently involved in mononeuropathies of the upper limb. Ulnar neuro... more Background: Ulnar nerve is frequently involved in mononeuropathies of the upper limb. Ulnar neuropathies have been diagnosed conventionally using clinical and electrophysiological findings. Physicians opt for nerve imaging in patients with ambiguous electrophysiological tests to gain additional information, identify etiology and plan management. Objectives: The aim of this study was to describe the electrophysiological and the magnetic resonance neurography (MRN) findings in patients with nontraumatic ulnar neuropathy. Methods: All consecutive patients with suspected nontraumatic ulnar mononeuropathy were recruited; clinical assessment and electrophysiological studies (EPSs) were done in all. After EPS, patients with localization of lesion along the ulnar nerve underwent MRN. Results: All 39 patients recruited had clinical findings suggestive of ulnar neuropathy; Electrophysiological confirmation was possible in 36/39 (92.30%) patients. Localization of ulnar nerve lesion to elbow and wrist was possible in 27 (75%) and 9 (25%) patients, respectively. MRN was done in 22 patients; a lesion was identified in 19 of 22 (86.36%) ulnar nerves studied. Thickening and hyperintensity in T2 W/short TI inversion recovery images of ulnar nerve at the level of olecranon, suggesting ulnar neuropathy at elbow, was the commonest (8/22) imaging finding. Conclusions: MRN acts as a complimentary tool to EPS for evaluating nontraumatic ulnar neuropathy. By identifying the etiology, MRN is likely to modify the management decision.

Journal of Clinical Toxicology, 2018

T1W image of 60 yr old<br>

Clinical and Experimental Dermatology, 2018

Aicardi-Gouti eres syndrome (AGS) is a rare, genetically determined, neurological disease with cu... more Aicardi-Gouti eres syndrome (AGS) is a rare, genetically determined, neurological disease with cutaneous manifestations. AGS has a varied phenotypic spectrum, and a variant with a lesser degree of neurological deficits has been described. We report a case of AGS with a milder phenotypic variant in a young man. A 25-year-old man presented with a history of erythematous, mildly tender plaques on acral sites, ear helices and the tip of nose since early infancy. The disease was markedly worse during winter, and spontaneously healed with depigmentation, scarring and acral resorption in summer. The patient had delayed milestones since birth, mild mental retardation (intelligence quotient 50), limb spasticity, contracture and flexion deformity of 20 degrees in knee joints, and hyper-reflexia and sensory neuropathy in the legs, but no microcephaly or severe neurological deficit. There was no family history of consanguineous marriage but the patient's three siblings had died in early infancy from unidentifiable causes. Physical examination showed mildly erythematous atrophic scars on the interphalangeal and metacarpophalangeal joints (Fig. 1a) and a few minimally erythematous ulcerated plaques over the lateral malleoli and the plantar aspect of the right foot (Fig. 1b). The bilateral ear helices, all toes and the right index finger showed marked resorption (Fig. 1c,d).

Journal of Clinical Neuromuscular Disease

T1W image of 60 yr old<br>

BMJ Case Reports, 2019

A female patient, aged 61 years, presented to us with a 3-day history of fever and altered sensor... more A female patient, aged 61 years, presented to us with a 3-day history of fever and altered sensorium. She was discharged from another hospital 1 week back where she was admitted for community-acquired pneumonia. She was put on mechanical ventilation for threatened airway and her magnetic resonance brain imaging showed evidence of delayed posthypoxic leucoencephalopathy, also known as Grinker’s myelinopathy. She was discharged 1 month later, on room air with a tracheostomy tube in situ. On follow-up after 5 months, she was ambulating with support and carried out activities of daily living independently.

World Neurosurgery, 2019

BACKGROUND Arterial pseudoaneurysms of the neck are rarely reported in the pediatric population a... more BACKGROUND Arterial pseudoaneurysms of the neck are rarely reported in the pediatric population and no dedicated large series are available. Trauma and infection are the most common causes for these aneurysms, with congenital and collagen vascular disorders being the less common causes. These lesions can be life threatening, especially when they present with bleeding or airway compromise. METHODS We searched our radiology information system for all cases of pediatric neck aneurysm presented between June 2015 and May 2018. These cases were analyzed for clinicoepidemiologic variables, clinical presentation, imaging findings, management, and follow-up. RESULTS Six children were included in the study (male/female ratio, 5:1), with a mean age of 7.8 years (range, 2.5-15 years). Four presented acutely with either bleeding or rapidly enlarging neck swelling, whereas 2 presented with slowly increasing pulsatile swelling. One had a traumatic cause, 2 had infections, and 1 had infective cervical lymphadenitis complicated by iatrogenic injury whereas no definite causative mechanisms could be accounted for in 2 patients. Two of the children were managed by trapping of the aneurysm and 2 only by proximal parent vessel occlusion. The other 2 children were treated with stent graft deployment across the aneurysm neck to reconstruct the parent vessel. All the patients were doing well during the follow-up period (mean, 14.8 months). CONCLUSIONS Endovascular means of treatment for pediatric neck aneurysms is relatively simple and safe. Although parent vessel sacrifice is the gold-standard management, vessel-preserving strategies can be tried in select cases with favorable anatomy.

The Neuroradiology Journal, 2019

Intracranial dermoid and epidermoid cysts are usually considered to be two different entities in ... more Intracranial dermoid and epidermoid cysts are usually considered to be two different entities in the radiological and surgical literature. Epidermoid cysts are classically off midline in location, isointense to cerebrospinal fluid on T1 and T2-weighted images and have restricted diffusion, whereas dermoid cysts are classically midline in location, have T1-hyperintense regions due to the presence of fat and show facilitated diffusion. We report a case of radiological epidermoid cyst in baseline imaging, which evolved into a radiological dermoid cyst over time, and explain this unique occurrence with a review of the embryology and histopathogenesis of these cysts.