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Title: Case report of unilateral involvement of basal ganglia in case of hanging and poisoning

Authors: Dr.Sunilchowdary Minnekanti, Dr.Monika sai paida., Dr.Sushant ,Dr. Nerin , Dr.Snigdha, Dr. Varsha

Topic: Clinical Research

Abstract:

Abstract : Hypoxic injury of brain can occur at any age from an infant to an adult, also called as global hypoxic ischaemic  injury. The patients usually presents with a  history of  asphyxiation , drowning, cardiac arrest or respiratory arrest. Basalganglia , thalami , cerebral cortex (the sensorimotor and visual cortices are predominantly involved , though involvement is often diffuse) , cerebellum , hippocampi are the areas usually affected in the brain. Usually the involvement is bilateral in deep nuclei we here present a rare case of unilateral involvement of basal ganglia in a case of hypoxic brain injury.

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    COMMENT - 1

  • MLUNGISI PATRICK MSIBI (Viewer) 17th Nov 2015 - 12:04 PM
    Informative article Dr.Sunilchowdary Minnekanti, Dr.Monika sai paida., Dr.Sushant ,Dr. Nerin , Dr.Snigdha and Dr. Varsha.
    However if i may ask, is the deprivation of blood and oxygen supply localized in the brain or systemic in any part of body? If its in the brain, the cells will be necrotic but if systemic it can then result to hypoxia and ischaemia. Please help me connect the point of contact on the hanging and poisoning case as outlined.
    • Madhumati Varma (Viewer) 24th Nov 2015 - 11:28 PM
      Good topic on hypoxy and effect on brain
      There are many medical conditions and events that interrupt the flow of oxygen to your brain. Stroke, cardiac arrest, and an irregular heartbeat can prevent oxygen and nutrients from traveling to the brain.

      Other possible causes of oxygen depletion include:

      hypotension, which is extremely low blood pressure
      anesthesia complications during surgery
      choking
      carbon monoxide poisoning
      drowning
      breathing in carbon monoxide or smoke
      traveling to high altitudes (above 8,000 feet)
      brain injury
      strangulation
      medical conditions that make it difficult to breathe, such as extreme asthma attacks

  • COMMENT - 2

  • Sunil Chowdary (Author) 17th Nov 2015 - 12:24 PM
    hi.MLUNGISI PATRICK MSIBI .thanks for asking the question, theres is no specific location or part of body affected during ischaemia its the whole body which gets affected during the event, but the most important vital organs which require maximum amount of oxygen gets affected the most..the series of events occour during hypoxia the end stage of deprieved oxygen ststus permanently will lead to necrosis ischemia is partly reversible state if ischemea continues it will lead to necrosis..i think i answered ur doubt..and as of the history related thing the patient incidentally had two different types of episodes for his attempted suicide..usually in both the types it should have systemic effects..its just a coincidental thing...but usually there willl be bilateral involvement of basal ganglia in hanging as well as poisoning

  • COMMENT - 3

  • Kavita Gupta (Viewer) 19th Nov 2015 - 4:07 PM
    Dear Dr.Sunilchowdary Minnekanti, Dr.Monika sai paida., Dr.Sushant ,Dr. Nerin , Dr.Snigdha, Dr. Varsha,

    Quite informative article.
    1. However, I found several spelling mistakes while reading the article such as, brainstemand, imagingfindings, appearanceof, laminarnecrosis, doesnot, isprolonged, whichis, perioddiffers, Usg, Ct Scan, Mri.

    2. Full form of GTCS and ABG?

    3. Does immature brain relate to infant's brain?

    4. Please explain as how the severity of a hypoxic ischemic insult plays an important role in determining the distribution of injuries in the brain?

    Thanking you,

    Regards,
    Kavita.

  • COMMENT - 4

  • Sunil Chowdary (Author) 19th Nov 2015 - 4:54 PM
    Thanks for replying kavita..those are not spelling mistakes just got spacing mistake..the second question GTCS refers to generalised tonic clonic seizures, and ABG referes to arterial blood gases, the answer for third question ..immature brain is not the synonym of infants brain

    actually the answer is vice versa the distribution indicates the severity..the amount of area involved corresponds to clinical out come and the areas involved will rule the outcome as highly metabolic areas in brain when affected will have bad outcome as of this case and less metabolically active lesions will have a better outcome as compared to the highly metabolically affected organs . i think i answered ur questions..if u have any queries please feel forward to reply..with regards

  • COMMENT - 5

  • Dr Bashir Adam Yakasai (Viewer) 20th Nov 2015 - 4:34 AM
    Dear Sunil and Others,

    A very interesting study, however, it suprises me that you have not notice much change in the hippocampal gyrus despite the degree of hypoxia suffered by your patient. In our experience, even the mildest form of hypoxia tends to show changes in the hippocampus before changes occur in other part of the brain.

  • COMMENT - 6

  • Sunil Chowdary (Author) 24th Nov 2015 - 10:23 PM
    Dr bashir adam yakasai : Thanks for your valuable information, and sorry for late replying as have my practical xams in between, its really a very good point you brought up but we havnt noticed any change in hippocampi regions

  • COMMENT - 7

  • Madhumati Varma (Viewer) 24th Nov 2015 - 11:29 PM
    Good topic for effect of hypoxic brain
    There are many medical conditions and events that interrupt the flow of oxygen to your brain. Stroke, cardiac arrest, and an irregular heartbeat can prevent oxygen and nutrients from traveling to the brain.

    Other possible causes of oxygen depletion include:

    hypotension, which is extremely low blood pressure
    anesthesia complications during surgery
    choking
    carbon monoxide poisoning
    drowning
    breathing in carbon monoxide or smoke
    traveling to high altitudes (above 8,000 feet)
    brain injury
    strangulation
    medical conditions that make it difficult to breathe, such as extreme asthma attacks
    Dr Madhumati Varma