Pakistan Journal Of Neurological Surgery
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Meningitis in Closed Head Injury 2 Years Experience at Lahore General Hospital
Get PDFDuring the time period of January 2006 till December 2007 there were 114300 patients with closed head injuries admitted at The Department of Neurosurgery Lahore General Hospital Lahore. The patients with closed head injury who developed meningitis were 17 and presented with headache, vomiting and neck stiffness. Headache was the commonest symptom. Diagnosis was made with the help of post contrast CT scan brain and CSF examination. Majority of patients admitted with head injury were adults while among patients who developed meningitis predominantly were children. Road traffic accident was the commonest cause of trauma. Majority developed meningitis within 6 weeks of trauma. There was no patient who developed meningitis after 12 weeks. Glasgow coma score at admission was above 8 in most of the patients. All patients were treated with combination of antibiotics for 6 to 12 weeks. Clinically outcome was moderate disability and good recovery in most of the cases.
Conclusion: Meningitis may occur following closed head injury. Its incidence is more in children than in adults. Responsible organism is not commonly identified on CSF examination. Outcome is reasonably good after proper management. Prophylactic antibiotics to all patients with closed head injury are not required
Five years Review of Failed Back Surgery Syndrome (FBSS) at Dept of Neurosurgery Unit-I, Lahore General Hospital Lahore
Get PDFObjective: To report our data of cases of failed back surgery syndrome (FBSS) and surgical and non surgical etiologies.
Materials and Methods: A review of cases of Failed back surgery Syndrome (FBSS), from 2003 to 2008 man-aged at The Neurosurgery Department Lahore General Hospital Lahore/PGMI, was conducted. The inclusion criterion was Re-admission within one year of their previous lumbar disk surgery at our department or other teaching institutes. 39 patients were found and included in the review. Two groups of patients were created on the basis of whether patient managed conservatively or re-explored. Important Data was recorded, analyzed and is presented.
Results: Out of the total 39 patients 15 (38.46%), were managed conservatively and included in group A. Twenty four 61.5% patients who were managed surgically with re-exploration and were grouped as B. 26 patients were male and 13 were female.
Group A: In this group 15 (38.46%), were included. These patients did not have a radicular element in their history of recurrent backache, and symptoms were vague.
Group B: In group B, 24 (61.5%) patients were included. All these patients presented at re-admission with backache and radiculopathy. The time since previous surgery was not more than One year in all these patients.
Conclusion: The failure of back surgery remains a challenge for the surgeons. There is a constant search for the causes and the pathogenesis of this syndrome and the best method of treatment. Recurrent disc is the commonest cause of failed back syndrome which responded well with reexporotive
Presentation and Surgical Outcome of Carpal Tunnel Syndrome
Get PDFObjective: The authors present their experience in evaluation of Clinical features and the surgical outcome of carpal tunnel syndrome.
Material and Methods: This descriptive study was conducted in Neurosurgery Department Hayatabad Medical Complex (HMC), Peshawar from 31march 2008 to 30 march 2010. Thirty one patients from both sexes were included. There was no gender discrimination in patient selection. However age limit was from twenty to sixty years. Cases with multiple nerve compression abnormalities, cervical radiculopathy, ulnar nerve compression, diabetic polyneuropathy or those who had Long-term exposure to vibrating tools were excluded. Diagnosis were made on positive clinical history, clinical examinations and Confirmed by nerve conduction studies. Open carpal tunnel release was done and then followed for 3 months for relief of symptoms and complications.
Results: Thirty one patients were included. The youngest patient was 22 years while the oldest one was 56 years with mean age 34 years ± 29.3. Female to male ratio was 6:1.Commonest presentation was pain and paresthesia in the affected hand. Open surgical release was performed for all patients. One patient (3%) developed super-ficial surgical site infection. The results of surgical treatment were excellent with 90% patients being completely relieved of symptoms after three months fallow up.
Conclusion: Carpal tunnel syndrome is common in female and manual workers. Pain is the predominant symptoms. Some patients may present with complications. Open carpal tunnel release is still preferable because of minimum complications and quick recovery.
Key Words: Presentation. Surgical outcome. Carpal tunnel syndrome.
Abbreviations: CTS: Carpal tunnel syndrome
Modifiable Factors Associated with Intracerbral Hemorrhage
Get PDFBackground and Purpose: The purpose of the study was to evaluate modifiable factors causing intracerebral hemorrhage in our set up.
Material and Method: This prospective descriptive study was done at King Edward Medical University/ Mayo Hospital, Lahore from January 2009 to August 2010. Patients of spontaneous intracerebral hemorrhage admitted through emergency department were included. After history and examination, diagnosis of ICH was made on CT brain without contrast in all cases. Further evaluation was done by platelet count, INR, LFTs, renal function tests and CT angiogram brain. Modifiable factors studied were hypertension, coagulopathy and drugs. Only patients of negative CT angiogram were included in the study.
Results: Age range of patients was 11 to 85 years. Male were more than female i.e. 24 (54.5%). Maximum patients i.e. 10 (22.5%) had ICH in 7th decade. Maximum patient had uncontrolled hypertension as the cause of intracerebral hemorrhage i.e. 31 (70.5%). It was followed by coagulopathy and smoking i.e. 4(9.9%). Dengue fever was present 2 (4.5%) cases and both had low platelet count.
Conclusion: Hypertension is the commonest modifiable risk factor for ICH, affecting middle aged and elderly persons. All modifiable factors especially hypertension needs extensive public awareness programs to decrease mortality and morbidity related to ICH
Management and Outcome of Compound Depressed Skull Fracture
Get PDFObjectives: To determine the clinical presentation, management and outcome of patients presenting with compound depressed skull fracture.
Study Design: Descriptive study.
Place and Duration of Study: Bolan Medical Complex Hospital Duration from May 2003 to March 2006.
Materials and Methods: Study conducted on sixty patients with compound depressed skull fracture. Patients of both gender and all age group were included in the study, those with major life threatening injuries to other organs were excluded.
Results: Out of total of 60 patients, 42 (70%) patients were male and 18 (30%) were female. Majority were in the first (33%) second (25%) decade of life (child and young patients). Most of patients were injured as a result of road traffic accidents 32 (53%), fall from height in 16 patients (27%) and assault in 12 (20%). Seventy percent of patients in fall group fell from roof while 30% from electric pool. Patients presented with various signs and symptoms like headache, vomiting (70%), loss of consciousness (33%), ear, nose and throat bleed (40%), CSF rhinorrhea (17%) and fits. Seventy percent of patients in this study presented with sings of raised intracranial pressure. Temporal region was the most frequently affected area in 30 (50%) cases.
Conclusion: Children and yuoung adults and males are most commonly affected. Road traffic accidents and falls from height are the most common modes of head injury. If treated properly most cases of compound depressed fracture will reveal good results.
 
Cranioplasty following decompressive craniectomy-analysis of Neurological outcome and complication rate: A single Centre Study
No full textObjective: To analyze the pattern of head injuries along with characteristics and outcomes among pediatric age group presenting in The Children hospital Lahore, Pakistan.
Material and Methods: A cross-sectional study was conducted and a total of 384 children of both genders aged up to 12 years presenting with head injuries were included. After initial review and resuscitation by the trauma unit or neurosurgery unit, children were evaluated clinically and radiologically and the plan was decided for further treatment. Gender, age, place of injury occurrence, etiology of injury, Glasgow coma score (GCS) at the time of enrollment, the interval between injury and admission, management, outcome, and total duration of hospital stay were recorded on a predesigned proforma.
Results: In a total of 384 children, 249 (64.8%) were boys. Overall, the mean age was 5.8 ± 3.3 years. Falls were the commonest etiology in 210 (54.7%) children while motor vehicle accidents were the cause of head trauma among 78 (20.3%) children. The mean interval between injury and presentation was noted to be 3.2 ± 2.1 hours. Mortality was reported in 56 (14.6%) children and it was observed that a significant association was noted between outcome and GCS at the time of presentation (p < 0.0001).
Conclusion: The majority of the pediatric head injury cases were male and aged above 5 years. The most common etiology of head injuries was falls followed by motor vehicle accidents. GCS ? 8 at the time of presentation was significantly linked with poor outcomes
Anosmia in Parkinson’s Disease in Pakistan: A Matched Case – Control Study
Get PDFObjective: To assess olfactory dysfunction in Parkinson's disease (PD) patients in Pakistan utilizing an autochthonous smell test.
Setting: Tertiary care center, single-center study.
Materials and Methods: Eighty-seven non-demented patients with PD, who fulfilled Queen Square Brain Bank Criteria were enrolled at the Movement Disorder Clinic, Lahore General Hospital (LGH), Lahore. Fifty-eight controls matched by gender, age, and place of residence were enrolled among patients and visitors attending other hospital clinics. Both groups underwent olfactory testing using the Pakistani Smell Identification test (PKSIT). The participants were required to identify the smell from a set of choices and were scored out of 10.
Results: Among patients in the study group, the mean duration of disease was 4.7 years (range 6 months to 19 years). The PD onset mean age was 52.15 ± 13.02 years among patients. The mean number of smell test items accurately recognized by the PD patients was 4.55 ± 2.4. A multiple linear regression demonstrated that age (P < 0.05) but not disease duration (P = 0.899) was a significant determinant of the smell test result in PD and control groups. The mean number of smell test items appropriately recognized by the controls was 7.33 ± 1.69. Logistic regression showed that the PKSIT had 73.2% sensitivity and 84.3% specificity to distinguish PD from control.
Conclusion: PKSIT being easily available, cheap, and more convenient to use in the Pakistani population, can be used in the evaluation of olfactory dysfunction in PD subjects
The outcome of Titanium Mesh Cranioplasty
Get PDFObjective: The purpose of this study was to report on the result and complications of titanium mesh cranioplasty in patients with trauma.
Materials and Methods: The patients who underwent craniectomy previously for acute subdural hematomas (20 cases) or depressed fractures (40 cases) following RTA (road traffic accidents) were included in the study. Titanium mesh was placed on the skull defect 3 – 6 months later in the private hospitals of Quetta. The resulting complications were reported.
Results: There were 50 male and 10 female patients. The majority (66.66%) of patients were from the age group 15 – 40 years. The majority of patients (83.33%) did not develop any complications. 8.3% of patients had wound infections, 3.3%had mesh exposures, 1.6% developed loosening screws and 1.6% had mesh indentation due to external pressure.
Conclusion: This study concludes that there are few patients (< 20%) who develop complications after cranioplasty. The study’s findings will assist neurosurgeons in the clinical decision-making process.
Keywords: Titanium Mesh Cranioplasty, Acute Subdural Hematoma, Road Traffic Accident, Depressed Fractures
Increment of High-Grade Gliomas Among Pediatric and Young Adult Population
Get PDFBackground/Objective: Glioblastomas are among the commonest primary brain cancers. This study aimed to assess the trend shift of high-grade glioma in our setting among the young and pediatric population.
Materials and Methods: This is a descriptive and cross-sectional study; it was carried out at the Department of Neurosurgery, Liaquat University of Medical and Health Sciences, between duration. All cases with suspected brain tumors, irrespective of age or gender were assessed for glioblastoma. Once a solid tumor was identified on imaging with consistent features of glioblastoma, a provisional diagnosis was established. After that, the patient underwent a brain biopsy. Patients' gender, demographics, clinical presentation, radiologic records, etc. were collected in a predefined proforma.
Results: 22 patients were diagnosed with glioblastoma with a high frequency of patients between the age range of 20 to 30 years. The most common location of the tumor was subcortical near the midline. There was slight male predominance. 8 patients had levels of KPS at presentation < 70 and among those two were infants, four were in a vegetative state, and two had a loss of consciousness secondary to increased intracranial pressure. The recurrence rate among those who came back for follow-ups was 27.2%.
Conclusion: Though it is a short study with short follow-up results were astonishing due to perhaps trend shift among Glioblastoma patients, a further detailed workup is needed in different dimensions especially molecular level and genetics to know exactly about the disease and the national registry should be carried and alarmed to identify the problem at once, counter effectively and make a future strategy
Incidence, Pattern, and Outcome of Stray Bullet Injuries: Three Years’ Experience in a Teaching Institute
Get PDFObjectives: The purpose of this study is to better define the incidence, pattern, and outcome of a stray bullet.
Materials & Methods: The current study summarizes the data on stray bullet injuries presented to the Emergency Department (ED) Hayatabad Medical Complex, Peshawar. A total of 24 subjects were included for three years. We enrolled all patients who had head or spine injuries caused by a stray bullet. Data were extracted on demographic profile, site of injury, operative procedure, complication, and mortality, and were recorded on prescribed proforma.
Results: A total of 24 subjects were included for 3 years. 17 (70%) were male patients and 7 (30%) were females. Male to female ratio was 2:1. out of 24 cases, 9 (37.5%) were from District Peshawar, 3 (12.5%) cases were from Mardan and Charsadda District, and 2 (8.3%) cases were from Swat. 12 cases had a bullet in the Head and face. out of which 7 were supratentorial 3 cases had a bullet in the posterior fossa. Out of 24 cases, 13 (54.1%) were operated for the removal of bullets. 5 (20.8%) developed focal or generalized fits. 13 (54.1%) developed a neuro deficit. 4 (16.6%) of cases remain in a vegetative state, and the overall mortality rate is 20%.
Conclusion: Morbidity and mortality due to stray bullets is an increasing problem in our society. This study aims to bring awareness among the concerned authorities to try and bring an end to this menace resulting in deaths and misery