R Venkataramanan

R Venkataramanan

R Venkat's Blog

R Venkat's Blog
"To be an Inspiring Teacher,one should be a Disciplined Student throughout Life" - Venkataramanan Ramasethu



Sunday, March 21, 2010

The Bong Connection

Typically,people would think,this is being written by a Bengali about his deep rooted attachment to his roots and Calcutta.But this story has a different twist,this is about a tamil iyer guy born somewhere in the byelanes of triplicane,Chennai,who later shifted to Bangalore for a few years and then landed back in triplicane to get his nursery education at a small nursery school,in a lane called swami pillai street or something like that….then one fine day got shifted to a village somewhere in thanjavur district and did his schooling in a village school,cycling 4 to 5 kilometers in a cycle with hair neatly combed with plenty of oil dripping from forehead in hot sun,reached school always late,finished the tiffin box as the first assignment as soon as reaching the school,then eagerly wait for the first break at 11 am in the morning,slowly slip away to angu achi ice factory somewhere in a remote lane of that extended village and quickly sip two canes of kuchi ice,read stick ice,have some dry mangoe pieces cut and treated well with chilli and salt powder and then run back to class to get a blow on the back from haran sir!!

Lunch times were very eagerly awaited as it gave one full hour to roam about freely looking at tamil cinema posters in the two famous theatres….velu cinema kotta & mala cinema kotta….times spent there were better than inox as there was no need to take tickets, since I had this bit of innocent, charming face (paal vadium mugam), which also helped me to impress and make a bengali girl fall in love with and marry me. I try very strongly to bring back the same face today…only to fail repeatedly.

The person in the ticket counter at the village theatre was rather amused to have a reasonably fair skinned iyer boy from one of the well known land lords house in that village area, to come to his theatre to watch a matinee show, leaving the school once in a while.Not only was the ticket free but also the kuchi mittai and color (read cool drink)….

Evening back at home,roam around in kollai (a term referring to backyard in village houses) dreaming to become a singer like SPB,a writer like balakumaran,an actor like kamalhassan and much more….only to be woken up from the dream with a welcome blow on the back from chittappa (read kaku in bengali….)days used to fly fast in this manner.Little did I realize one day I would get married to a Bengali girl and parent a child and settle in Calcutta and pursue a career in health care….Surprisingly hardly did I find it difficult to adjust or adapt to the culture of this beautiful city kolkata….may it be waking to water bearing baris bell rings,crowded metro trains,trams,pvt buses,shuttle cars & pool cars.Masala Dosas & Idlies in the lanes and byelanes of Kolkata were as tasty as those that were ate in the tiny lanes of that remote village in tanjore district….eating luchis,putchkas,singaras,misti dohi,shokto,alu bhaja,aloo posto were as easy as eating sambar and rasam.Of course having born a tamil iyer,having non veg was a little difficult to the hardware!!!!

I wonder how was it possible to adapt in this way….I just heard rani mukerjee saying in an interview that her mother had to fight with the hospital authorities when she was born, before she was to be exchanged with a punjabi kid….I wonder may be my mother did not fight when I was born in that byelane of triplicane….and maybe I was a bengali boy who got exchanged in to a tamil iyer family……

So now I know the secret behind my Bong Connection & my love for this beautiful city….aamar Kolkata!!

Monday, March 1, 2010

Sixth Nerve Palsy

Sixth nerve palsy, or abducens nerve palsy, is a disorder associated with dysfunction of cranial nerve VI (the abducens nerve), which is responsible for contracting the lateral rectus muscle to abduct (i.e., turn out) the eye. The inability of an eye to turn outward results in a convergent strabismus or esotropia of which the primary symptom is double vision or diplopia in which the two images appear side-by-side. The condition is commonly unilateral but can also occur bilaterally.

The unilateral abducens nerve palsy is the most common of the isolated ocular motor nerve palsies [1].

Alternative names

VIth nerve palsy

Lateral rectus palsy

Cranial mononeuropathy VI


The affected individual will have an esotropia or convergent squint on distance fixation. On near fixation the affected indiviual may have only a latent deviation and be able to maintain binocularity or have an esotropia of a smaller size. Patients sometimes adopt a face turn towards the side of the affected eye, moving the eye away from the field of action of the affected lateral rectus muscle, with the aim of controlling diplopia and maintaining binocular vision.

Diplopia is typically experienced by adults with VI nerve palsies, but children with the condition may not experience diplopia due to suppression. The neural plasticity present in childhood allows the child to 'switch off' the information coming from one eye, thus relieving any diplopic symptoms. Whilst this is a positive adaptation in the short term, in the long term it can lead to a lack of appropriate development of the visual cortex giving rise to permanent visual loss in the suppressed eye; a condition known as amblyopia.


Because the nerve emerges near the bottom of the brain, it is often the first nerve compressed when there is any rise in intracranial pressure. Different presentations of the condition, or associations with other conditions, can help to localize the site of the lesion along the VIth cranial nerve pathway.

Differential diagnoses

Mobius syndrome - a rare congenital disorder in which both VIth and VIIth nerves are bilaterally affected giving rise to a typically 'expressionless' face.

Duane's syndrome - A condition in which both abduction and adduction are affected arising as a result of partial innervation of the lateral rectus by branches from the IIIrd oculomotor cranial nerve.

Cross fixation which develops in the presence of infantile esotropia or nystagmus blockage syndrome and results in habitual weakness of lateral rectii.


The first aims of management should be to identify and treat the cause of the condition, where this is possible, and to relieve the patients symptoms, where present. In children, who rarely appreciate diplopia, the aim will be to maintain binocular vision and, thus, promote proper visual development.

Thereafter, a period of observation of around 9 to 12 months is appropriate before any further intervention, as some palsies will recover without the need for surgery.

Symptom relief and/or binocular vision maintenance

This is most commonly achieved through the use of fresnel prisms. These slim flexible plastic prisms can be attached to the patient's glasses, or to plano glasses if the patient has no refractive error, and serve to compensate for the inward misalignment of the affected eye. Unfortunately, the prism only correct for a fixed degree of misalignment and, because the affected individual's degree of misalignment will vary depending upon their direction of gaze, they may still experience diplopia when looking to the affected side.

The prisms are available in different strengths and the most appropriate one can be selected for each patient. However, in patients with large deviations, the thickness of the prism required may reduce vision so much that binocularity is not achievable. In such cases it may be more appropriate simply to occlude one eye temporarily. Occlusion would never be used in infants though both because of the risk of inducing stimulus deprivation amblyopia and because they do not experience diplopia.

Longer term management

Conservative management

Where the residual esotropia is small and there is a risk of surgical overcorrection, or where the patient is unfit or unwilling to have surgery, prisms can be incorporated into their glasses to provide more permanent symptom relief. Where the deviation is too large for prismatic correction to be effective, permanent occlusion may be the only option for those unfit or unwilling to have surgery