A journey !

I have been a student of the Magnetic Resonance Image studies of the brain for the last thirty three years.

As a medical student I had an opportunity to learn about x-ray imaging of different part of the body.

The MRI facility was introduced in Chennai in 1986 at two hospitals around the same time. It was the KJ Hospital in Egmore which had the unique distinction of having the first CT machine in south India  in the late seventies. But it was the Apollo hospital, Chennai which acquired the MRI first. 

I had moved on at that time to full time practice of Developmental Paediatrics. I was volitionally averse to neurology from my post graduate training days. So anything with neurology was distant to my thinking. But when Anna and I sensed a calling to pursue this specialty, I had discovered a growing desire to learn the essentials of EEG and MRI brain.

The stimulus for this came from Professor Ken Holte, professor of Child Neurology and Developmental Paediatrics at Wolfson Centre, Children's Hospital, Great Ormond Street, while undergoing child Development training at the Institute of Child Health in 1986. His views on EEG and MRI brain were fascinating: Look for clinical signs and locate the sites in the brain which can cause these signs.  

Dr Raju Abraham, a neurologist at Hammersmith Hospital, London gifted me a book on Epilepsy. That prompted me to develop the habit of reading. He even arranged for me to be a visitor-observer at the Electro-physiology lab at the great Ormond Street children's Hospital.  

Dr K.N.Nambudiripad, a neuro-surgeon at CMC Ludhiana spent his latter years in neuro-imaging department to help the radiologists to develop this integrated thinking: 'Look for sites of lesions in the brain responsible for clinical signs'. Later, while undergoing neurology training at the Institute of Neurology, Madras Medical College, Chennai for three years from 1992, Professor Sayed Ahmed, an Electro-physiologist by training as his neurology sub-speciality took an exceptional interest in helping me to build foundations in neuro-imaging and electrophysiology. 

Now, after thirty three years, when I look at at least two MRI of brain and about five EEG tracings of children each day, I have an immense sense of gratitude to these eminent mentors who set me on a self directed journey in this science of interpretation of clinical signs by locating the pathology with the help of the two valuable diagnostic tools.  

The MRI of the brain in this blog is of a child who had perinatal risk factors. The images reveal likely pathology of ventriculitis, vascular insult, periventricular white matter volume loss, and the associated adverse effects on the visual pathway to the occipital cortex on the left side, compromise to the pyramidal tracts affecting muscle tone, power and co-ordination of functions on the right side of the body, perhaps affecting the right lower limb more. The language areas and motor cortex are probably spared. The increased ventricular volume of CSF in the posterior horn of the left lateral ventricle would need to be monitored. The pathology of anoxia, infection and vascular insult had a cascading effect on the brain.

This information was decisive to plan for the developmental prospects of this child and prognosticate the academic skills and neuro-motor outcome.   

I am awed by the clarity of thought which corresponds with clinical signs in such situations. This defines the content of the neuro-developmental support and helps the psychologists and therapists to be precise and area-centric while planning for activation of the the neural functions.

Science is largely observations leading to evidences.

I feel grateful for having been on this journey! It continues.

M.C.Mathew(text and photo)