V Lal

Publications (38)31.52 Total impact

• Article: Idiopathic CD4 lymphocytopenia presenting as refractory cryptococcal meningitis.

  A Sharma, V Lal, M Modi, D Khurana, S Bal, S Prabhakar
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  ABSTRACT: Idiopathic CD4 T-lymphocytopenia (ICL) is a syndrome characterized by depletion of CD4 T-cells without evidence of human immunodeficiency virus (HIV) infection. There are a few reported cases of ICL associated with different diseases and clinical conditions, most commonly the opportunistic infections like Tuberculosis, fungal and parasitic diseases which are also seen in HIV-positive patients. We report a case without risk factors or laboratory evidence of HIV infection who presented with refractory cryptococcal meningitis and was found to have ICL.
  Annals of Indian Academy of Neurology 04/2010; 13(2):136-8. · 0.93 Impact Factor
• Article: To compare CSF adenosine deaminase levels and CSF-PCR for tuberculous meningitis.

  S V Rana, F Chacko, V Lal, S K Arora, S Parbhakar, Sanjeev K Sharma, K Singh
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  ABSTRACT: This study was planned to compare the adenosine deaminase (ADA) levels and polymerase chain reaction (PCR) in cerebrospinal fluid (CSF) as a rapid method to diagnose tuberculosis meningitis (TBM). Fifty-four adult patients with suspected TBM and 37 controls were included in this study. The median ADA level was 21U/L of most likely TBM, 14U/L of unconfirmed TBM and 5U/L of controls. PCR for Mycobacterium tuberculosis was positive in 12 out of 27 most likely TBM cases, 5 out of 27 unconfirmed TBM cases and 3 out of 37 controls. Using a cut off level of >10U/L, CSF-ADA had a sensitivity of 92.5% and specificity of 97% for the diagnosis of TBM. PCR for M. tuberculosis had a sensitivity of 44.5% and specificity 92% in the most likely TBM cases. This study shows that CSF-ADA is a more sensitive indicator than PCR for the diagnosis of M. tuberculosis.
  Clinical neurology and neurosurgery 03/2010; 112(5):424-30. · 1.30 Impact Factor
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  Article: Reversible delayed neuropsychiatric syndrome following acute carbon monoxide exposure.

  R Bhatia, F Chacko, V Lal, B R Mittal
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  ABSTRACT: A 40-year-old male presented with acutely oncoming neuropsychiatric symptoms in the form of extrapyramidal disturbances, personality change, behavior changes and urinary incontinence. One month prior to this symptomatology, he had been found unconscious in his closed room where a coal fire was burning overnight. He recovered completely in two days with supportive therapy. Magnetic resonance imaging during this presentation showed bilateral white matter changes suggestive of demyelination. Tc99m-ECD SPECT study revealed hypoperfusion in bilateral frontal region. He was managed conservatively and eventually made a nearly complete recovery. Repeat SPECT study revealed marked improvement in tracer uptake correlating with his improvement. Delayed neuropsychiatric syndrome after acute carbonmonoxide poisoning is a rare and distinct entity. This case report discusses the various aspects of this disease entity.
  Indian journal of occupational and environmental medicine 05/2007; 11(2):80-2.
• Article: Hyperhomocysteinemia as a risk factor for ischemic stroke: an Indian scenario.

  M Modi, S Prabhakar, S Majumdar, M Khullar, V Lal, C P Das
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  ABSTRACT: Hyperhomocysteinemia has been proposed as an important risk factor for ischemic stroke worldwide, but data available from the Indian subcontinent is scarce. To study homocysteine levels in patients with ischemic stroke and compare it with age- and sex-matched controls. Case-control prospective study. Fifty-seven patients with ischemic stroke and 30 controls were recruited for the study. They were subdivided into two subgroups (< 40 years and> 40 years of age) and plasma fasting total homocysteine (tHcy) levels were measured. Student's 't' test and chi-square test. The tHcy were significantly high in patients with stroke, compared to controls (9.91 +/- 2.25 vs 8.00 +/- 2.74 micromol/l; P vs 8.45 +/- 2.72 micromol/l; P = 0.01) and female patients compared to controls (9.08 +/- 1.81 vs 6.79 +/- 2.60 micromol/l; P = 0.04). The tHcy levels were significantly high in patients with hypertension compared to normotensive patients (10.96 vs 9.49 micromol/l; P = 0.01) and smokers compared to nonsmokers (11.17 vs 9.33 micromol/l; P = 0.01). Hyperhomo-cysteinemia emerged as an important independent risk factor for ischemic stroke. A strong positive correlation was also observed between hypertension, smoking, and high-tHcy levels in the present study.
  Neurology India 10/2005; 53(3):297-301; discussion 301-2. · 0.96 Impact Factor
• Article: Uncommon manifestations of neurosarcoidosis.

  M Modi, R Bhatia, R Jain, V Lal, B D Radotra, A Aggarwal
  Neurology India 07/2004; 52(2):280-1. · 0.96 Impact Factor
• Article: Acute onset paraneoplastic cerebellar degeneration in a patient with small cell lung cancer.

  R Bhatia, S Prabhakar, V Lal, D Khurana, C P Das
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  ABSTRACT: A patient with small cell lung cancer presented with a rare presentation of an acute onset pancerebellar dysfunction. His clinical condition markedly improved following the surgical removal of the tumor and chemo- and radiotherapy.
  Neurology India 06/2003; 51(2):244-5. · 0.96 Impact Factor
• Article: Ventilatory management of respiratory failure in patients with severe Guillain-Barre syndrome.

  A N Aggarwal, D Gupta, V Lal, D Behera, S K Jindal, S Prabhakar
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  ABSTRACT: Guillain-Barre syndrome (GBS) is the commonest peripheral neuropathy causing ventilatory failure, and 10-30% patients may require respiratory support. Records of 11 adult patients of GBS in respiratory failure, admitted to the Respiratory Intensive Care Unit (RICU) of our institute for mechanical ventilation over a four-year period, were studied. Six patients received intravenous immunoglobulin. The median duration of mechanical ventilation was 38 days. Seven patients underwent tracheostomy. Four patients were ventilated for less than 2 weeks and 3 for more than 2 months each. Seven developed ventilator-associated pneumonia and/or sepsis. Three patients died in, and two shortly after discharge from RICU; all had systemic problems or complications of hospitalization.
  Neurology India 06/2003; 51(2):203-5. · 0.96 Impact Factor
• Article: Authors' Reply

  A Aggarwal, D Gupta, V Lal, D Behera, S Jindal, S Prabhakar
  Neurology India. 01/2003;
• Article: Visual loss with papilledema in Guillain-Barre syndrome.

  P S Kharbanda, S Prabhakar, V Lal, C P Das
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  ABSTRACT: Papilledema and raised intracranial pressure have been reported in association with Guillain-Barre syndrome. Papilledema is usually asympotomatic or associated with mild visual field defects, without any visual loss. The cerebrospinal fluid protein is usually reported to be high. A case of a 35 year old lady is reported, who presented with headache, diplopia and progressive visual loss in both eyes and limb weakness with hyporeflexia. Optic fundus examination showed bilateral papilledema. She had features of pseudotumor cerebri. Nerve conduction studies were suggestive of polyradiculopathy. The unusual things in this case, were the profound visual loss normal cerebrospinal fluid profiles and the presentation of papilledema before the limb weakness.
  Neurology India 01/2003; 50(4):528-9. · 0.96 Impact Factor
• Article: Scleroderma, stroke, optic neuropathy: a rare association.

  C P Das, S Prabhakar, V Lal, P S Kharbanda
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  ABSTRACT: A known case of scleroderma presented with right hemiparesis, focal seizures, optic atrophy and gangrene of digits. There was no evidence of peripheral nerve or muscle involvement. MRI showed multifocal infarcts in both cerebral hemispheres. MR angiography revealed poor flow in bilateral carotid arteries with collateralization from posterior circulation. She improved with phenytoin, nifedipine, antibiotics and immunosuppressants. The rarity of central nervous system affliction in scleroderma and large vessel vasculitis is discussed along with review of literature.
  Neurology India 01/2003; 50(4):504-7. · 0.96 Impact Factor
• Article: Acute symptomatic seizures due to single CT lesions: how long to treat with antiepileptic drugs?

  A Thussu, A Arora, S Prabhakar, V Lal, I M S Sawhney
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  ABSTRACT: The duration of anti epileptic drug therapy for single small enhancing CT lesions (SSECTL) presents a major dilemma. We studied the efficacy of short duration (6 months) antiepileptic drug therapy as compared to long duration (2 years) drug therapy. Seventy three patients presenting with seizures and showing SSECTL on cranial CT scans (plain and contrast) were randomized into group A (6 months therapy) and group B (2 years therapy). There were 47 patients in group A and 26 patients in group B. Patients were followed up for one year after withdrawal of anti epileptic drugs. CT Head (plain and contrast) was repeated after 3 months, or earlier in cases of recurrence to rule out reinfection. 53.2% in group A and 53.8% in group B showed complete resolution and were seizure free on one year follow up. Punctate residual calcification was seen in 46.8% in group A and 46.2% in group B. Eight patients (17%) in group A and three (11.5%) in group B had a recurrence. The difference in recurrence of seizure between the two groups was not statistically significant (p<0.77) in the calcified lesion subset. Since none of the patients in total resolution subset showed recurrence, the difference between calcified and total resolution subset was highly significant. The study shows that a short duration (6 months) AED therapy in patients with total resolution of lesion on follow up scan, may be adequate in comparison to those who have calcific speck as a residue. However, a longer duration of therapy in case of calcific group probably does not alter their chances of recurrence.
  Neurology India 06/2002; 50(2):141-4. · 0.96 Impact Factor
• Article: Hypertrophic pachymeningitis: varied manifestations of a single disease entity.

  S Prabhakar, R Bhatia, V Lal, Paramjeet Singh
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  ABSTRACT: Hypertrophic pachymeningitis is a unique clinical entity characterised by fibrosis and thickening of the duramater with resulting neurological dysfunction. Three cases of this entity are described. Presenting features were headaches and cranial neuropathies in two patients and predominantly cerebellar dysfunction in the third. One of the patients also had evidence of spinal involvement. Lower cranial nerves were chiefly involved in two patients whereas optic nerve was the predominantly affected nerve in one. Except for the presence of rheumatoid arthritis in one of the patients, we could not document clinical or biochemical evidence of any predisposing infective, inflammatory or infiltrative condition in the other two. All three patients had characteristic changes on imaging suggestive of thickened and enhancing duramater. Although variable steroid responsiveness was seen in all the three patients, tendency towards steroid dependence was evident. The clinical presentations, causes, radiological features, management options and differential diagnosis of this unique clinical syndrome have been discussed.
  Neurology India 04/2002; 50(1):45-52. · 0.96 Impact Factor
• Article: Vertebral artery dissection due to indirect neck trauma : an underrecognised entity.

  S Prabhakar, R Bhatia, N Khandelwal, V Lal, C P Das
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  ABSTRACT: Vertebral artery dissection is an important cause of brain stem stroke, especially in the young. Dissections of carotid and vertebral arteries in neck account for about 20% of strokes in young compared with 2.5% in the elderly. Three patients of vertebral artery dissection related to indirect neck trauma are described. The first patient developed the symptoms while dancing, the second after a trivial fall and the third while he was on a dental chair. None of them had a direct severe neck trauma or concomitant risk factor like hypertension, connective tissue disease or migraine. Clinical symptomatology was similar in all the patients and included occipito-nuchal pain, headache and brain stem dysfunction chiefly in the posterior inferior cerebellar artery (PICA) territory. One of the patients also had associated ischaemic myelopathy. MRA and DSA confirmed dissection in all with a predominant steno-occlusive picture. Cases of so called trivial neck movement/torsion related dissection have been described previously but have not received any major importance. Usually classified as 'spontaneous' or 'traumatic', there is a possible ambiguity in literature about appropriate terminology. We emphasise that a history of such subtle precipitating events be taken while diagnosing young patients with brain stem strokes, to recognise this clinical entity. Although mechanisms are not absolutely clear, yet there seems to be an important relationship between arterial dissection and neck movements or minor trauma.
  Neurology India 01/2002; 49(4):384-90. · 0.96 Impact Factor
• Article: Acute symptomatic seizures due to single CT lesions : how long to treat with antiepileptic drugs?

  A Thussu, A Arora, S Prabhakar, V Lal, I Sawhney
  Neurology India. 01/2002;
• Article: Scleroderma, stroke, optic neuropathy : a rare association.

  C Das, S Prabhakar, V Lal, P Kharbanda
  [show abstract] [hide abstract]
  ABSTRACT: A known case of scleroderma presented with right hemiparesis, focal seizures, optic atrophy and gangrene of digits. There was no evidence of peripheral nerve or muscle involvement. MRI showed multifocal infarcts in both cerebral hemispheres. MR angiography revealed poor flow in bilateral carotid arteries with collateralization from posterior circulation. She improved with phenytoin, nifedipine, antibiotics and immunosuppressants. The rarity of central nervous system affliction in scleroderma and large vessel vasculitis is discussed along with review of literature.
  Neurology India. 01/2002;
• Article: Visual loss with papilledema in Guillain-Barre syndrome.

  P Kharbanda, S Prabhakar, V Lal, C Das
  [show abstract] [hide abstract]
  ABSTRACT: Papilledema and raised intracranial pressure have been reported in association with Guillain-Barre syndrome. Papilledema is usually asympotomatic or associated with mild visual field defects, without any visual loss. The cerebrospinal fluid protein is usually reported to be high. A case of a 35 year old lady is reported, who presented with headache, diplopia and progressive visual loss in both eyes and limb weakness with hyporeflexia. Optic fundus examination showed bilateral papilledema. She had features of pseudotumor cerebri. Nerve conduction studies were suggestive of polyradiculopathy. The unusual things in this case, were the profound visual loss normal cerebrospinal fluid profiles and the presentation of papilledema before the limb weakness.
  Neurology India. 01/2002;
• Article: Albendazole therapy for solitary persistent cysticercus granuloma.

  A Thussu, A Arora, V Lal, S Prabhakar, I M Sawhney
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  ABSTRACT: Use of Albendazole therapy for the treatment of patients having persisting intracranial solitary cysticercus granuloma is controversial. Most of the times these patients are treated empirically with variety of drugs for variable period. Some authors advocate biopsy before definitive treatment. 25 patients having radiologicaly persistent solitary cysticercus granuloma (>6 months) were given 15 days course of oral albendazole (15 mg/kg body wt). Cranial CT scan was repeated one month after the completion of albendazole therapy. It was evaluated for complete resolution, partial response (> 50% decrease in size of lesion) or no change as compared to previous scan. 12 patients (48%) showed complete resolution, 4 patients (16%) showed a partial response, while 9 patients (36%) did not show any change on follow up. Albendazole therapy may be useful for patients having persistent cysticercus granuloma.
  Neurology India 03/2001; 49(1):95-7. · 0.96 Impact Factor
• Article: Profile of intractable epilepsy in a tertiary referral center.

  J P Singhvi, I M Sawhney, V Lal, A Pathak, S Prabhakar
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  ABSTRACT: This study was undertaken to find out the profile of intractable epilepsy (IE) in a tertiary referral centre. 100 patients (males 67; females 33) with IE attending the epilepsy clinic were evaluated. Detailed history, examination, investigations like EEG and CT scan and details regarding pharmacotherapy were analysed. The age of the patients ranged from 5 to 70 yrs (mean=23.2 yrs). Mean duration of seizures was 11.44 years. Commonest seizure type was partial seizures (74%). Amongst patients with generalised seizures (26%), 14% had multiple seizure types. The seizure frequency was 12.39 +/- 21.57 (mean +/- SD) per month. Fifty seven patients were in the symptomatic group with CNS infections being the leading cause (19%) of epilepsy. Fifty patients had one or more abnormal predictors of IE. There was no difference in the severity of epilepsy in patients with no abnormal feature when compared with patients having abnormal features. EEG was abnormal in 69% cases with background abnormality in 20% and focal abnormality in 36% cases. CT scan was abnormal in 41% cases with commonest abnormality being neurocysticercosis (11%) followed by gliosis (9%) and chronic infarct (9%). Sixty patients were receiving a combination of two drugs, 32 patients 3 drugs and 8 patients were on 4 drugs. There was no difference in seizure control in patients who were on 2 drugs or more than 2 drugs. Partial seizures were the commonest seizure type leading to IE; CNS infection being the leading aetiological factor. The presence or absence of predictors of intractability does not predict severity of epilepsy. Addition of third primary drug to existing combination only increases adverse effects without better control of seizures.
  Neurology India 01/2001; 48(4):351-6. · 0.96 Impact Factor
• Article: Albendazole therapy for solitary persistent cysticercus granuloma.

  A Thussu, A Arora, V Lal, S Prabhakar, I Sawhney
  [show abstract] [hide abstract]
  ABSTRACT: Use of Albendazole therapy for the treatment of patients having persisting intracranial solitary cysticercus granuloma is controversial. Most of the times these patients are treated empirically with variety of drugs for variable period. Some authors advocate biopsy before definitive treatment. 25 patients having radiologicaly persistent solitary cysticercus granuloma (>6 months) were given 15 days course of oral albendazole (15 mg/kg body wt). Cranial CT scan was repeated one month after the completion of albendazole therapy. It was evaluated for complete resolution, partial response (> 50% decrease in size of lesion) or no change as compared to previous scan. 12 patients (48%) showed complete resolution, 4 patients (16%) showed a partial response, while 9 patients (36%) did not show any change on follow up. Albendazole therapy may be useful for patients having persistent cysticercus granuloma.
  Neurology India. 01/2001;
• Article: Risk of recurrence of seizures following single unprovoked idiopathic seizure.

  C P Das, I M Sawhney, V Lal, S Prabhakar
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  ABSTRACT: A prospective study was conducted to look for various factors that could predict the risk of recurrence of a single unprovoked idiopathic seizure. Seventy six patients with a history of single episode of seizure ultimately completed the study and the data regarding age, sex, duration of seizure, time of occurrence of the ictus, interval between onset and referral, family history of seizure and alcohol consumption were analysed. All patients of symptomatic epilepsy and those with an abnormal scan were excluded. The patients were randomized into two groups, one of which received anti epileptic medication and the other did not. All patients underwent electroencephalography (EEG). Twenty two (M=16, F=6) of the 76 patients (M=56, F=20) had a recurrence of seizure. The duration of seizure at initial presentation was 10.1 +/- 5.2 min. in the recurrence group and 6.5 +/- 4.1 min. in the non-recurrence group. Twelve of the 16 patients with an abnormal EEG had a recurrence whereas only 10 of the 60 patients with a normal EEG had a recurrence (p <0.001). Of the treated cases (n=36), only 4 had a recurrence compared to 18 of the untreated cases (n=40) (p <0.002). Eighteen of the 22 cases having a recurrence did so within three months. Six of the cases with family history of seizure (n=10) had a recurrence, whereas only 16 of the cases without family history of seizure (n=16) had a recurrence (p <0.05). Patients of a single unprovoked idiopathic seizure with a normal CT scan are less likely to have a recurrence if the duration of seizure at presentation is short, EEG is normal, more than 3 months have passed since the first seizure and if treatment has been started. Family history of seizures does have a moderately significant bearing, but alcohol intake does not increase the chances of seizure.
  Neurology India 12/2000; 48(4):357-60. · 0.96 Impact Factor