Pakistan Journal Of Neurological Surgery
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Impact of The Time Taken Before Surgery in Evaluating the Outcome of Extradural Hematoma
Get PDFObjective: To assess the impact of the time taken before surgery in evaluating the outcome of extradural hematoma.
Materials & Methods: A prospective observational study was done at the Department of Neurosurgery, Pakistan Institute of Medical Sciences (PIMS) Islamabad. Patients with extradural hematoma (>20ml) as per calculation by the scale on axial images of a CT scan brain and scheduled for surgical intervention, aged 18 years to 60 years of either gender were included. Patients underwent surgical treatment as per indications and were scheduled for surgery. Time was recorded for injury, diagnosis, and surgery and calculated from the time of injury to the time of surgery.
Results: Overall mean age was 34.09 years with a higher proportion of males (66.7%). Post-surgery, disability was observed in 11.8% of cases and the overall mortality rate was 15.7%. Considering the overall outcomes, 74.5% of the patients had favorable results, whereas 25.5% had unfavorable outcomes. The timing of surgery significantly influenced outcomes (p < 0.0001). Patients operated on within 1-6 hours post-trauma had no disability or mortality, with 70.6% favorable outcomes. In contrast, those operated on within 6-12 hours showed 11.8% disability, 11.8% mortality, and 23.5% unfavorable outcomes, with only 2.0% achieving favorable outcomes.
Conclusion: It is evident that a time interval of less than six hours between the traumatic incident and surgical intervention is strongly correlated with better results, including significantly lower rates of disability and mortality
Neuroscience in Acute Stroke Treatment: Current Strategies and Emerging Therapies in Pakistan
Get PDFObjective: To discuss the current strategies and emerging therapies in treating acute stroke in Pakistan. Explores how personal beliefs influence health behavior and decision-making.
Materials & Methods: The present qualitative study of neuroscience in acute stroke treatment was carried out at the Department of Neurology at Aziz Fatimah Medical and Dental College, Faisalabad. The theoretical concepts of the Health Belief Model (HBM) apply to explore how personal beliefs influence health behavior and decision-making in acute stroke treatment, strategies, and emerging therapies. All acute stroke patients of the Department of Neurology from June 2023 to June 2024 were interviewed for thematic analysis. Interviews were transcribed on MS Word, and then they were coded using software called QDA Miner Lite.
Results: The study found intravenous thrombolysis, mechanical thrombectomy, stroke units, and tele-stroke services, which could gradually be made a part of the healthcare infrastructure. Improvement in stroke management is expected with emerging therapies like neuroprotective agents and stem cell therapy also helpful for acute stroke treatment. The study found major problems in awareness and accessibility of acute stroke treatment, current strategies, and emerging therapies.
Conclusion: The study revealed that stroke care optimization in Pakistan reduces the burden of disabilities and mortality related to stroke. Although most significant urban centers offer advanced care for stroke patients, accessibility to their services is still not present for those residing in remote and rural areas
Bilateral Cerebral Ischemia after Epidural Hematoma Evacuation
Get PDFBackground: Unilateral Cerebral Ischemia after Epidural Hematoma (EDH) evacuation is well documented in the literature. We are reporting a case of Epidural Hematoma evacuation, resulting in cerebral ischemia bi-laterally.
Case Report: A 42-year-old male presented to the ER with a history of road traffic accidents. Arrival GCS was 7/15. A CT scan brain showed a huge left-side EDH involving frontal, parietal, and temporal regions. On the right side, there were contusions in the frontal area. EDH was evacuated surgically. The patient’s GCS improved after 2 days but deteriorated afterward. Repeat CT shows the expansion of contusions and developing ischemia on both sides involving MCA and PCA territories. Contusions were surgically removed and ischemia was treated conservatively. After a couple of weeks, the patient improved.
Conclusion: Cerebral Ischemia does develop after epidural hematoma evacuation, so the contusions on the conta-lateral side expand. Therefore close monitoring of such patients and timely surgical evacuation are necessary in preventing complications.
Keywords: Epidural hematoma, Cerebral Ischemia, Head Injury, Complications.
Demographic Profiling of Patients on Drug Dependence Admitted in Punjab Institute of Mental Health, Addiction Treatment Centre, Lahore
Get PDFObjective: Drug dependence is a global public health concern, affecting millions and contributing to widespread negative consequences. This research delves into the demographic characteristics of drug abuse patients at the Punjab Institute of Mental Health (PIMH) Addiction Treatment Center in Lahore, Pakistan.
Materials and Methods: Utilizing a cross-sectional research-based descriptive design, the study employs purposive sampling and a comprehensive questionnaire to collect data from 100 drug abusers. The analysis considered age, gender, socioeconomic status, residential area, occupation, education, marital status, and family system, shedding light on the diverse factors contributing to the drug dependence of the patients.
Results: The results revealed a diverse age range (18-80 years) among participants (M=33,4, SD=10.3), most of them belonging to lower (34%) and middle class (39%); 67 respondents residing in the urban region and 32 from the rural areas. Heroin (32.3%) was reported to be the most consumed substance while cannabis (25.8%) and crystal methamphetamine (16.4%) were the second and third respectively taken mostly through sniffing. Among the reasons for using drugs, peer pressure came out to be the most reported cause.
Conclusion: The findings underscored the complexity of drug dependence, necessitating targeted interventions that consider demographic variations that are crucial for effective treatment and prevention strategies. The study contributed valuable knowledge to the existing scientific understanding of drug dependence, paving the way for more informed public health initiatives
Intracranial Meningioma; Assessment of Tumor Size and Clinical Feature on First Presentation
Get PDFObjective: To assess the tumor size of intracranial meningioma on first presentation and their clinical features.
Materials & Methods: A prospective review of patients undergoing meningioma resection at the Neurosurgery department, Jinnah Postgraduate Medical Center, Karachi was performed. The clinical records and imaging studies of 43 patients with intracranial meningiomas were analyzed. The data was collected for tumor size, location, first symptom, and clinical features.
Results: There were 31 (72.1%) female and 12 (27.9%) male patients with a mean age of 45.6 years (std: 8.18 years). convexity and Parasagittal meningiomas had the highest frequency (32.6% and 30.2% respectively). The average tumor size was greater than 60mm (44.2%). Skull base tumors presented with a size of more than 60mm (60.0%), followed by convexity meningiomas (57.1%). The most common initial symptom was headache (46.5%) followed by seizures (11.6%). The patients presenting with a duration greater than 24 months (32.6%) had a size greater than 60mm (57.1%). Convexity and skull base meningiomas presented lately greater than 24 months of duration (50%), however, parasagittal meningioma generally presented earlier in less than 6 months of duration 53.8%.
Conclusion: Tumor size location, and clinical features at the first presentation are interlinked. Larger tumors were found on the first presentation, with headache and seizure being the most common clinical features. The location also contributed to the early or late presentation of meningioma patients. The association shown between the size and first symptom may be explained by a symptom's tolerance, location, and ongoing medical treatment.
Keywords: Meningioma, Excision, Space Occupying Lesion, Supratentorial, Clinical Feature
The Surgical Outcome of Intramedullary Spinal Cord Tumors
Get PDFObjective: This study focused on assessing the surgical outcome of the intramedullary spinal cord tumor.
Materials & Methods: A prospective study was conducted in the Department of Neurosurgery, Jinnah Postgraduate Medical Center, Karachi. The clinical records and imaging studies of 42 patients with intramedullary spinal cord tumors who underwent surgery, were analyzed and followed up. The data was collected for tumor location, histology, extent of resection, and pre and postoperative neurological status.
Results: Around 64.3% of patients were predominantly males while 35.7% were females. The mean age was found to be 43.3 years. The highest frequency (52.4%) of tumors was located in the thoracic region. Most patients presented with Frankel’s grade C (52.4%). In 54.8% (n:23) patients, subtotal excision or incomplete excision was done, in 12 patients (28.6%), complete resection was done. In histology, most patients had low-grade Ependymoma (40.5% n:17) and 7 patients (16.7%) had high-grade Ependymoma. Postoperatively, 33.3% (n:14) patients had grade D and were able to walk, followed by 28.6% (n:12) with grade B.
Conclusion: Progression-free survival is increased by adjuvant radiation combined with subtotal resection; complete resection is still the key to improved results. Thoracic-located tumors possess an increased risk of surgical morbidity. The preoperative neurological function is an important predictor of increased functional survival, including histology and the extent of resection. Long-term survival outcomes are achieved with an early and aggressive surgical treatment targeted at total tumor excision
Epidemiological and Therapeutic Aspects of Depressed Skull Fractures
Get PDFObjective: To describe the epidemiological, clinical, therapeutic, and evolutionary characteristics of depressed skull fractures in our hospital.
Materials and Methods: This was a 15-month prospective descriptive study involving all patients operated on for a depressed skull fracture. Recruitment was carried out after obtaining the consent of the patient or the person accompanying him/her. The clinical diagnosis was confirmed by a cerebral CT scan.
Results: During the study period, depressed skull fractures accounted for 16% of head injuries. The average age of the patients was 27 years. Males predominated (66.7%). Apprentice motorbike mechanics were the most affected with 20.4%, followed by students with 18.5%. Road traffic accidents and intentional assault and battery were the main causes of trauma, with 37.9% and 29.6% respectively. Headache was present in all patients admitted to emergency departments, followed by scalp wounds (63.5%) and hemiparesis (45.9%). Cerebral CT scans revealed an open embracing fracture in 63 patients (58.3%). Ping-Pong ball fractures were found in 11.1%. 42.6% of patients had associated intracranial lesions. Surgery was performed through a single trepan hole in 49% of patients. A craniotomy with bone flap replacement was performed in 34.3%. At 6 months, 77.3% of patients had a favorable outcome; 16.5% had a persistent motor deficit and 3.1% of patients were taking anti-epileptic drugs. Mortality was 2.06%.
Conclusion: Depressed skull fractures are pathologies that are sometimes considered trivial, even though they are responsible for significant disability. Emphasis must be placed on prevention to achieve better results
Exploring Gender Disparities in Carpal Tunnel Syndrome: A Comparative Analysis of Male-Female Ratios
Get PDFObjective: To know about the gender disparities in carpal tunnel syndrome in the Neurosurgery and Orthopedics departments of Naseer Teaching Hospital and Maqsood Medical Complex.
Materials and Methods: This descriptive cross-sectional study was conducted in the Neurosurgery and Orthopedics department of NTH and MMC from 1st January 2017 to 20th March 2024. We included a total of 525 patients, both male and female from the age range of 16 years to 70 years presenting with complaints of pain and tingling sensation in their hands. All the included patients were diagnosed with cases of CTS based on clinical signs and symptoms and NCS. All the patients who had a joint pathology or any previous trauma to the wrist joint or pregnancy were excluded. The data was analyzed using SPSS (v 23.0).
Results: In our study; we observed that the mean age was 34.21 ± 7.685 and male-to-female frequency was 19.2% to 80.8% in a ratio that can be written as 1:4.2. The most common age group affected in females is 30-39 while in males the most common affected one was 40-49.
Conclusion: Our study concludes that the male-to-female ratio of median nerve entrapment was 1:4.2
Coccydynia: Do Corticosteroid Injections Hit the Mark Over NSAIDs?
Get PDFObjective: Coccydynia is a medical ailment that causes discomfort at the coccyx, or tailbone, which can make it difficult for a person to go about their regular business. Nonsteroidal anti-inflammatory medications taken orally, and corticosteroid injections are two potential treatments for Coccydynia. However, the most effective and appropriate course of treatment for this condition must be identified. The study aimed to compare the effectiveness of Corticosteroid Injection vs. NSAID for pain relief in Coccydynia patients.
Materials & Methods: A total of 47 patients with idiopathic coccydynia were allocated to receive either oral NSAIDs plus a tailbone cushion (n=24) or fluoroscopic corticosteroid injection (n=23). Pain levels were measured by a visual analog scale at baseline and 2-, 3-, and 4-months post-treatment. Chi-square and t-tests were used to compare treatment efficacy.
Results: The two treatment groups showed no significant differences. Both groups demonstrated reduced pain over time, with no significant difference between injections and NSAIDs (p=0.209). While injections provided more relief for mild pain, NSAIDs showed better results for no-pain patients. Overall mean pain scores were similar between groups. The treatments differed in effectiveness for certain pain levels but exhibited comparable efficacy in reducing overall coccyx pain. The hypothesis of differing treatment efficacy was not supported.
Conclusion: As a result, it can be considered a viable alternative therapy for patients who have difficulty adhering to oral medication regimens due to its one-time administration and affordable cost. To achieve optimal therapeutic outcomes, it is critical to choose the appropriate patients