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Papers by MANMEET CHHABRA

Research paper thumbnail of Simultaneous (Near Simultaneous) bilateral basal ganglial bleed – A rarity

IP Indian Journal of Neurosciences, 2019

Intra-cerebral hemorrhages are a known cause of significant mortality and morbidity, among all th... more Intra-cerebral hemorrhages are a known cause of significant mortality and morbidity, among all the different forms of stroke. Primary multiple simultaneous intra-cerebral hemorrhages (MSICHs) are not common and has been reported in association with other diseases. There are only around 105 cases reported. The diseases most commonly associated are thrombophilia and hematologic disorders, vasculitis, neoplasms, arterio-venous malformation, anticoagulant therapy, illicit drug use, or multiple infarction with hemorrhagic transformation. Though the outcome is not much different, probably marginally worse compared to a regular stroke. Herein we describe a middle age male with hypertension who was referred to us with basal ganglial bleed.

Research paper thumbnail of Stereotactic guide for posterior approach to lateral ventricle

Egyptian Journal of Neurosurgery, 2021

Background Free-hand tapping of the lateral ventricle through the posterior approach is a standar... more Background Free-hand tapping of the lateral ventricle through the posterior approach is a standard procedure. There are occasions, however, when more than one pass is needed. One way to make it easy and safe is to use a neuro-navigation approach. This requires extra setup. Therefore, the authors in this paper describe the use of a simple device to accurately place the catheter tip in the frontal horn. Main body The device is rectangular with two open arms with co-linear free ends. Based on axial CT or MR images, a trajectory that travels within the ventricle from the posterior to the anterior horn is chosen. The anterior and posterior points of the trajectory are marked on the scalp. A burr hole is placed at the posterior point. The anterior free end is then attached to the anterior trajectory point on the scalp using an EKG pad and to the posterior to a plug placed in the burr hole. The ventricle is tapped through a central hole in the burr hole plug. All 12 patients had accurate c...

Research paper thumbnail of SDH with Bleeding Diathesis—a Management Protocol

Indian Journal of Surgery, 2015

Chronic subdural hematoma (SDH) is one of the leading causes of morbidity and mortality in elderl... more Chronic subdural hematoma (SDH) is one of the leading causes of morbidity and mortality in elderly. Patients taking antiplatelets and/or anticoagulants have increased risk of bleeding during the perioperative period. Precise dose blood products and specific surgical technique have been effective in preventing hemorrhagic complications perioperatively. From Jan 2010 to Dec 2012, 25 patients who were on antiplatelets and/or oral anticoagulants underwent emergency surgery for chronic or acute on chronic SDH. Patients were divided into three groups: group I-patients on antiplatelets, group II-patients on oral anticoagulants, and group III-patients taking both. Of these, 21 patients underwent minicraniotomy with microsurgical membranectomy and 4 patients underwent burr hole craniostomy. Random donor platelet concentrate (RDPC) and fresh frozen plasma (FFP) were used depending on whether patient was on antiplatelets or oral anticoagulants. Results were evaluated on the basis of ease of intraoperative hemostasis, incidence of rebleeding in postoperative period, postoperative imaging, and reversal of neurological deficits. Group I, group II, and group III had 16, 4, and 5 patients, respectively. Group I received a mean of 7 units of RDPC. Group II received a mean of 4 units of FFP. Group III received a mean of 7 units of RDPC and 4 units FFPs. There was no problem with intraoperative hemostasis and no incidence of rebleeding. We suggest specific dose protocol for reversal of antiplatelet and anticoagulant effect and specific surgical procedure in preventing intraoperative bleeding and postoperative rebleeding in the above group of patients.

Research paper thumbnail of Cerebral Coenurosis Masquerading as Malignancy: A Rare Case Report from India

Journal of Neurosciences in Rural Practice, 2019

ABSTRACTHuman coenurosis is a rare zoonotic disease caused by the larvae of Tinea multiceps seen ... more ABSTRACTHuman coenurosis is a rare zoonotic disease caused by the larvae of Tinea multiceps seen in sheep-rearing countries. We report the case of a 63-year-old male who was referred to our hospital with a working diagnosis of skull base chondrosarcoma. Histopathological examination after surgical excision revealed characteristic feature of coenurus with multiple scolices invaginating from the outer cuticular layer. Coenuri are often mistaken for giant cysticercal cysts and hydatid cysts. Despite its wide prevalence in cattle, only two cases of human coenurosis are reported from India till date. We report the third case from India.

Research paper thumbnail of Paraplegia due to Extramedullary Hematopoietic Tissue Compression of Thoracic Thecal Sac in a Patient with Thalassemia Treated Successfully with Surgical Decompression: A Case Report

Indian Journal of Neurosurgery, 2016

Research paper thumbnail of SDH with Bleeding Diathesis—a Management Protocol

Indian Journal of Surgery, 2015

Chronic subdural hematoma (SDH) is one of the leading causes of morbidity and mortality in elderl... more Chronic subdural hematoma (SDH) is one of the leading causes of morbidity and mortality in elderly. Patients taking antiplatelets and/or anticoagulants have increased risk of bleeding during the perioperative period. Precise dose blood products and specific surgical technique have been effective in preventing hemorrhagic complications perioperatively. From Jan 2010 to Dec 2012, 25 patients who were on antiplatelets and/or oral anticoagulants underwent emergency surgery for chronic or acute on chronic SDH. Patients were divided into three groups: group I-patients on antiplatelets, group II-patients on oral anticoagulants, and group III-patients taking both. Of these, 21 patients underwent minicraniotomy with microsurgical membranectomy and 4 patients underwent burr hole craniostomy. Random donor platelet concentrate (RDPC) and fresh frozen plasma (FFP) were used depending on whether patient was on antiplatelets or oral anticoagulants. Results were evaluated on the basis of ease of intraoperative hemostasis, incidence of rebleeding in postoperative period, postoperative imaging, and reversal of neurological deficits. Group I, group II, and group III had 16, 4, and 5 patients, respectively. Group I received a mean of 7 units of RDPC. Group II received a mean of 4 units of FFP. Group III received a mean of 7 units of RDPC and 4 units FFPs. There was no problem with intraoperative hemostasis and no incidence of rebleeding. We suggest specific dose protocol for reversal of antiplatelet and anticoagulant effect and specific surgical procedure in preventing intraoperative bleeding and postoperative rebleeding in the above group of patients.

Research paper thumbnail of Tuberculosis of Spine with Spastic Paraparesis in Pregnancy: A Case Report and Review of the Literature

The Journal of Spinal Surgery, 2014

Stress is found to be a predictive factor of periodontal disease. Among proposed mechanisms that ... more Stress is found to be a predictive factor of periodontal disease. Among proposed mechanisms that mediate possible association between psychosocial factors and periodontitis status, immunological pathways are of great importance. Depressed immune responsiveness, as a result of physical or mental stress, influences stress-released hormones (gluco corticoids), which are present in the gingival crevicular fluid and may provide a source of nutrients that promote subgingival growth of periodontal pathogens, thus, leading to periodontal destruction. The purpose of this review article is to provide the progression of evidence present in the field of stress and periodontal disease for better understanding of the link.

Research paper thumbnail of Simultaneous (Near Simultaneous) bilateral basal ganglial bleed – A rarity

IP Indian Journal of Neurosciences, 2019

Intra-cerebral hemorrhages are a known cause of significant mortality and morbidity, among all th... more Intra-cerebral hemorrhages are a known cause of significant mortality and morbidity, among all the different forms of stroke. Primary multiple simultaneous intra-cerebral hemorrhages (MSICHs) are not common and has been reported in association with other diseases. There are only around 105 cases reported. The diseases most commonly associated are thrombophilia and hematologic disorders, vasculitis, neoplasms, arterio-venous malformation, anticoagulant therapy, illicit drug use, or multiple infarction with hemorrhagic transformation. Though the outcome is not much different, probably marginally worse compared to a regular stroke. Herein we describe a middle age male with hypertension who was referred to us with basal ganglial bleed.

Research paper thumbnail of Stereotactic guide for posterior approach to lateral ventricle

Egyptian Journal of Neurosurgery, 2021

Background Free-hand tapping of the lateral ventricle through the posterior approach is a standar... more Background Free-hand tapping of the lateral ventricle through the posterior approach is a standard procedure. There are occasions, however, when more than one pass is needed. One way to make it easy and safe is to use a neuro-navigation approach. This requires extra setup. Therefore, the authors in this paper describe the use of a simple device to accurately place the catheter tip in the frontal horn. Main body The device is rectangular with two open arms with co-linear free ends. Based on axial CT or MR images, a trajectory that travels within the ventricle from the posterior to the anterior horn is chosen. The anterior and posterior points of the trajectory are marked on the scalp. A burr hole is placed at the posterior point. The anterior free end is then attached to the anterior trajectory point on the scalp using an EKG pad and to the posterior to a plug placed in the burr hole. The ventricle is tapped through a central hole in the burr hole plug. All 12 patients had accurate c...

Research paper thumbnail of SDH with Bleeding Diathesis—a Management Protocol

Indian Journal of Surgery, 2015

Chronic subdural hematoma (SDH) is one of the leading causes of morbidity and mortality in elderl... more Chronic subdural hematoma (SDH) is one of the leading causes of morbidity and mortality in elderly. Patients taking antiplatelets and/or anticoagulants have increased risk of bleeding during the perioperative period. Precise dose blood products and specific surgical technique have been effective in preventing hemorrhagic complications perioperatively. From Jan 2010 to Dec 2012, 25 patients who were on antiplatelets and/or oral anticoagulants underwent emergency surgery for chronic or acute on chronic SDH. Patients were divided into three groups: group I-patients on antiplatelets, group II-patients on oral anticoagulants, and group III-patients taking both. Of these, 21 patients underwent minicraniotomy with microsurgical membranectomy and 4 patients underwent burr hole craniostomy. Random donor platelet concentrate (RDPC) and fresh frozen plasma (FFP) were used depending on whether patient was on antiplatelets or oral anticoagulants. Results were evaluated on the basis of ease of intraoperative hemostasis, incidence of rebleeding in postoperative period, postoperative imaging, and reversal of neurological deficits. Group I, group II, and group III had 16, 4, and 5 patients, respectively. Group I received a mean of 7 units of RDPC. Group II received a mean of 4 units of FFP. Group III received a mean of 7 units of RDPC and 4 units FFPs. There was no problem with intraoperative hemostasis and no incidence of rebleeding. We suggest specific dose protocol for reversal of antiplatelet and anticoagulant effect and specific surgical procedure in preventing intraoperative bleeding and postoperative rebleeding in the above group of patients.

Research paper thumbnail of Cerebral Coenurosis Masquerading as Malignancy: A Rare Case Report from India

Journal of Neurosciences in Rural Practice, 2019

ABSTRACTHuman coenurosis is a rare zoonotic disease caused by the larvae of Tinea multiceps seen ... more ABSTRACTHuman coenurosis is a rare zoonotic disease caused by the larvae of Tinea multiceps seen in sheep-rearing countries. We report the case of a 63-year-old male who was referred to our hospital with a working diagnosis of skull base chondrosarcoma. Histopathological examination after surgical excision revealed characteristic feature of coenurus with multiple scolices invaginating from the outer cuticular layer. Coenuri are often mistaken for giant cysticercal cysts and hydatid cysts. Despite its wide prevalence in cattle, only two cases of human coenurosis are reported from India till date. We report the third case from India.

Research paper thumbnail of Paraplegia due to Extramedullary Hematopoietic Tissue Compression of Thoracic Thecal Sac in a Patient with Thalassemia Treated Successfully with Surgical Decompression: A Case Report

Indian Journal of Neurosurgery, 2016

Research paper thumbnail of SDH with Bleeding Diathesis—a Management Protocol

Indian Journal of Surgery, 2015

Chronic subdural hematoma (SDH) is one of the leading causes of morbidity and mortality in elderl... more Chronic subdural hematoma (SDH) is one of the leading causes of morbidity and mortality in elderly. Patients taking antiplatelets and/or anticoagulants have increased risk of bleeding during the perioperative period. Precise dose blood products and specific surgical technique have been effective in preventing hemorrhagic complications perioperatively. From Jan 2010 to Dec 2012, 25 patients who were on antiplatelets and/or oral anticoagulants underwent emergency surgery for chronic or acute on chronic SDH. Patients were divided into three groups: group I-patients on antiplatelets, group II-patients on oral anticoagulants, and group III-patients taking both. Of these, 21 patients underwent minicraniotomy with microsurgical membranectomy and 4 patients underwent burr hole craniostomy. Random donor platelet concentrate (RDPC) and fresh frozen plasma (FFP) were used depending on whether patient was on antiplatelets or oral anticoagulants. Results were evaluated on the basis of ease of intraoperative hemostasis, incidence of rebleeding in postoperative period, postoperative imaging, and reversal of neurological deficits. Group I, group II, and group III had 16, 4, and 5 patients, respectively. Group I received a mean of 7 units of RDPC. Group II received a mean of 4 units of FFP. Group III received a mean of 7 units of RDPC and 4 units FFPs. There was no problem with intraoperative hemostasis and no incidence of rebleeding. We suggest specific dose protocol for reversal of antiplatelet and anticoagulant effect and specific surgical procedure in preventing intraoperative bleeding and postoperative rebleeding in the above group of patients.

Research paper thumbnail of Tuberculosis of Spine with Spastic Paraparesis in Pregnancy: A Case Report and Review of the Literature

The Journal of Spinal Surgery, 2014

Stress is found to be a predictive factor of periodontal disease. Among proposed mechanisms that ... more Stress is found to be a predictive factor of periodontal disease. Among proposed mechanisms that mediate possible association between psychosocial factors and periodontitis status, immunological pathways are of great importance. Depressed immune responsiveness, as a result of physical or mental stress, influences stress-released hormones (gluco corticoids), which are present in the gingival crevicular fluid and may provide a source of nutrients that promote subgingival growth of periodontal pathogens, thus, leading to periodontal destruction. The purpose of this review article is to provide the progression of evidence present in the field of stress and periodontal disease for better understanding of the link.