Pakistan Journal Of Neurological Surgery
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Giant Tuberculoma Resembling Brain Tumor in a Child
Get PDF13 years old child from tribal area of Khyber Pakhtunkhwa presented to us with chief complaints of headache and vomiting for last 3 months with recent onset of aggressive behavior. Patient had normal neu-rological examination except that he had frontal lobe release signs and bilateral papilledema. MRI scan of brain showed a large ring enhancing lesion measuring 5x6x5 cm in the frontal lobe with surrounding edema (Figures 1 – 3). Because of Short history and relevant MRI picture diagnosis of high grade glioma was made. Though there was history of tuberculosis in the family but because of large size of the lesion with short his-tory with no fever or cough the differential of tubercu-loma was not considered before surgery. Routine in-vestigations were unremarkable. Patient was prepared and put on elective list for craniotomy and excision of the lesion. During surgery patient brain was edematous so patient was hyperventilated and mannitol was given before opening the dura. Per operatively the lesion was fibrous, firm and not easily removable as is the case with high grade glioma and gross total resection was not possible because of brain edema and respiratory distress. Biopsy was taken and subtotal resection was performed. Patient was put on ATT and metastastic work up also advised started. Histopathology report showed a caseating granulomatous lesion (Figure 4)
Epidemiology of Traumatic Brain Injury (TBI_ in UAE – A Review
Get PDFObjective: To evaluate the causes and pattern of Traumatic Brain Injury (TBI) in Dubai, UAE.Material and Methods: This descriptive study was carried out at Rashid Hospital, Dubai UAE from June 1, 2008 to August 27, 2008. All the patients admitted to neurosurgical unit referred from A&E were included and the total no. was 96 patients in this short study. Demographic data, causes and pattern of injury and presentation with clinical and radiological findings were recorded.Results: Most of the patients were young males (7.7:1) in the age range of 21 – 30 years. RTA being the most common (45%) cause in non-Arab expatriate population and 49 patients had minor injuries only with the rest included in moderate to severe category. The results were consistent with the international studies.Conclusion: Traumatic Brain Injury (TBI) is a potentially preventable cause of mortality and morbidity in young population world over and still there is a need for formulating new strategies to avoid it
Variables that Predict Significant Intracranial Damage in Mild Head Injury
Get PDFObjective: To identify patients, at risk of intracranial complications, after mild head injury.Study Design: It was an observational study.Place and Duration: Patients received at the emergency department or OPD or referred to Pakistan institute of Medical Sciences, Islamabad were included in the study. Pakistan institute of Medical Sciences is a tertiary care hospital that recruits patients from Punjab and northern areas. The data was collected over a period of six mon-ths from 1st August 2008 till 31st January 2009. A total of 206 patients were included in our study.Methodology: Data were analyzed relating to a consecutive series of 206 patients who presented to the emer-gency department of Pakistan Institute of Medical Sciences, Islamabad. Data was collected through non-pro-bability convenience sampling. Characteristics studied, were age, gender, mode of trauma, level of consciousness and CT scan brain findings.Result: Our study included 206 patients with mild head injury. Their age ranged from 1 to 90 years with a mean age of 32.06 ? 19.86 years. Maximum patients (59 patients 28.6%) were in the age range of 21 – 30 years. Only 34 (16.5%) patients were above 50 years of age and 26 (12.6%) were below the age of 10 years.163 (79%) were males and remaining 43 (21%) were females. 124 (60.2%) were due to road traffic accidents, 62 (30.1%) were due to falls, 18 (8.7%) were assault injuries and 2 (0.9%) were sports injuries. All patients had a GCS score of 13 – 15; with a mean score of 14.35 ? 0.902. Majority of the patients (132 patient, 64%) had a GCS of 15, 14 (6.8%) had a GCS of 14 and 60 (29%) had a GCS of 13. 127 (61.7%) patients presented with vomiting after head injury and 79 (38.3%) patients did not vomit. 49 (23.8%) vomited once and 78 (37.9%) vomited on multiple occasions. CT scan was done without contrast in all patients. It was reported as normal in 68 (33%) patients, 39 (18%) had extradural hematoma, 15 (7.3%) had subdural hematoma, 4 (1.9%) showed intracerebral hemor-rhage, 30 (14.6%) had cerebral contusion, 6 (2.9%) had subarachnoid hemorrhage, 20 (9.7%) had diffuse axonal injury and 9 (11.7%) patients had skull fracture.Conclusion: Our study was conducted to derive and validate a set of criteria that could be used to identify patients with minor head injury in whom CT could be forgone. It concluded that men, in their twenties, suffered from mild head injury, most commonly from a road traffic accident and were more likely to have an intracranial surgical lesion, such as an extra dural haematom
Result of Endoscopic Dissectomies for Treatment of Symptomatic Prolapse Lumber Disc Herniation
Get PDFIntroduction: Lumber disc prolapsed is a common problem and causes pain or weakness. There are multiple treatment options in which open surgical dissectomy is considered gold standard, but in this era trend is changed toward minimal invasive surgery i.e. endoscopic procedure. This study was carried out to determine the outcome of endoscopic dissectomy in our setup.Objective: To determine the outcome of endoscopic dissectomy for the treatment of symptomatic lumber disc herniation.Study Design: Descriptive case study.Setting: This study was carried out in Department of Neurosurgery Lahore General Hospital Lahore.Duration: Six months from 20-4-11 to 21-10-11.Methods: Thirty patients were included in this study. All patients were treated with endoscopic dissectomy. The outcome were determined at 3 months follow-up based on MacNab’s classification system.Results: According to MacNab’s classification system 26 (88.6) patients had successful outcome including excellent and good outcome.Conclusion: Endoscopic dissectomy is a safe and effective treatment for patients with lumber disc herniatio
SAARC Neurosurgery March 28th – April 1st 2018/Need of Neurosurgery Institutes in the Country
No full textDear ReadersForeign trans scholarshipsPJNS upgraded, now all submission of articles will be via online our email [email protected] then it is processed for plagiarism, peer review etc. it is online now. We hope our readers will benefit from its online serial website theDuring the Neurotrauma Conference at Peshawar, PSN had meeting with Mr. Franco Servadei President WFNS. He agreed to provide short term training/visits of PGRs or young Neurosurgeons to the well established centers of the world. PSN is in contact with International Societies and many short term Visits 2/3 Months are available. All young Neurosurgeons/Senior PGRs should avail these opportunities. The International Candidates should apply to PSN Executive Committee VIA Dr. Muhammad Usman Publication. Secretary PSN or President PSN Prof. Mumtaz Ali
Recurrence of CSHD after Single Burr-Hole Evacuation and Closed Drainage System Versus Double Burr Hole Evacuation and Closed Drainage System
Get PDFObjective: The recurrence rate was compared after single burr hole evacuation and closed drainage system versus double burr hole evacuation and closed drainage system of CSHD.Material and Methods: Sixty cases were included and randomized into two equal groups. Patient fulfilling the inclusion criteria were enrolled through the emergency and outdoor. CT scan brain was done and site, size and thickness of CSDH were evaluated. Patient were treated in exactly the same way as per standard ward routine practice except that the treatment option (whether to use the single or double burr hole) was decided through randomization by using random tables, Group A with single burr hole and Group B with double burr hole with closed drain used in both cases. Patients were kept admitted in the hospital till they were fit go home. Each patient was followed for recurrence at the 15th day, 1 month, 2 months and finally at 03 months.Results: Total 60 patients of chronic subdural hematoma were included. Total cases were divided into two equal groups with 30 cases in group A (single burr hole) and 30 cases in group B (two burr holes). The mean age of all patients was 59 yrs with SD ± 12 with minimum age 40 yrs and maximum age 80 yrs. Conclusion: Most of the patients (82%) had recovered after burr-hole craniostomy. However, some patients (18%) suffer recurrence of hematoma. No significant difference in recurrence of CSDH with one burr hole or two burr holes and was found and also noticed that the rate of recurrence is to some extent lower with double burr hole than with one burr hole evacuation of chronic subdural hematoma
Chronic Subdural Hematoma in Elderly Patients after Trivial Head Injury
Get PDFBackground: Chronic subdural hematoma is a benign disease but its behavior is more than a malignant space occupying lesion intra-cranially and it kills patient, if diagnosis delayed. Chronic subdural hematoma is frequently associated with underlying co-morbidities like diabetes mellitus, hypertension, ischemic heart diseases and atrial fibrillation in elderly patient. Early recognition of chronic subdural hematoma is important for early management.Objective: To identify the factors for causing chronic sub-dural haematoma following minor head injury.Materials and Methods: This observational descriptive study was conducted in the Department of Neurosurgery “A” Unit, Lady Reading Hospital Peshawar from 1st January 2016 to 31st July 2018. All patients with history of minor head injury resulting in unilateral or bilateral chronic subdural hematoma diagnosed clinically and radiologically by CT scan/MRI brain, Age greater than 60 years & operated for chronic subdural hematoma were included in this study. Exclusion criteria was all chronic subdural hematoma patients with age less than 60 years and previous operated. Medical records of patients were revised and searched for associated risk factors. A proforma was designed for collection of data. The data was analyzed through SPSS Version17.Results: Total number of patients were (46) with male to female ratio (3:1). Clinical presentations were decreased level of consciousness in 11 patients (23.9%), Headache in 10 patients (21.7%), Memory loss in 5 (10.8%), Personality changes in 10 patients (21.7%), Motor deficits in 5 patients (10.8%), Aphasia in 5 patients (10.8). The risk factors found were Diabetes Mellitus 8 cases (17%), Hypertension 16 cases (35%), Rheumatic heart disease 1 case (3%), Ischemic heart disease 15 cases (32%) and atrial fibrillation 6 cases (13%).Conclusion: The common risk factors for chronic subdural hematoma was ischemic heart disease, hypertension, diabetes mellitus and atrial fibrillation. Early management results in favorable prognosis in terms of morbidity and mortality
Spectrum of Head Trauma at Tertiary Care Military Hospital CMH Quetta, Pakistan
Get PDFObjective: The objective of this study was to determine the etiological spectrum, injury patterns and outcome of head injured patients at tertiary care military hospital CMH Quetta.Materials and Methods: This descriptive study includes all patients of head trauma coming to trauma centre at CMH Quetta, Pakistan. Patients with associated injuries of other organs were excluded from the study. We noted the detailed clinical history and examination, demographics, mechanism of injury, treatment offered (operative / non operative) and analyzed the details of operative procedure (craniotomy, craniectomy, elevation of compound depressed fracture, scalp suturing), morbidity and outcome (according to Glasgow outcome scale). Data was analyzed using SPSS version 16.Results: There were 1026 patients (856 males and 170 females) eligible to be included in the study. The mean age of the patient was 28.9 ± 19.2 years SD. Majority of the patients belonged to the age group 21 – 40 years. The commonest cause of head injury was Road traffic accident 507 (49.41%), fall 273 (26.6%), gunshot wound 97 (9.45%), bomb blast injury 76 (7.41%), sports related 35 (3.41%), mine blast 25 (2.44%) and splinter injury 13 (1.27%) of patients. CT Brain findings were contusions in 116 (11.3%), isolated fractures in 45 (4.38%), SDH in 44 (4.28%), EDH in 43 (4.19%), DAI (diffuse axonal injury) in 36 (3.51%), compound depressed fractures in 16 (1.55%), frontal sinus fractures in 14 (1.36%), combined EDH / SDH in 6 (0.58%) and normal CT brain findings in 706 (68.81%) patients. 662 (64.52%%) patients were managed conservatively and 364 (35.47%) underwent operative management. Major operations (craniotomy / craniectomy / elevation of compound depressed skull fracture) were performed in 138 (13.45%) and minor operations (suturing of scalp laceration) were performed in 226 (22.03%). Good recovery was seen in 894 (87.13%), moderate disability in 26 (2.53%) and severe disability in 12 (1.16%) whereas 16 (1.56 %) patients remained vegetative. The mortality was 78 (7.6%).Conclusion: In Pakistan, head injury contributes significantly to mortality and morbidity. Road traffic accident, history of fall and gunshot are the commonest causes of head injury. Appropriate medical care facilities needs to be established at district and tehsil level to provide prompt and adequate care to head injured patients
Fire Arm Injury to the Head: A One Year Experience at Department of Neurosurgery Lady Reading Hospital, Peshawar
Get PDFObjective: To determine the outcome of head injury due to fire arm in Lady Reading Hospital, Peshawar.Material and Methods: This observational study was conducted in Neurosurgery Department of PGMI, Lady Reading Hospital Peshawar from January 2010 to December 2010. Patients of all ages with either sex were included in this study, while those patients of firearm having associated thoracic, abdominal or pelvic injuries were excluded. All the data was collected by using a Performa. Data was analyzed by descriptive statistics using SPSS software version 17.Results: Out of total 46 head injury patients due to firearm 37 (80.43%) were males and 9 (19.56%) were females. Most of the patients (73.91%) were in the age range of 16 – 45 years. At the time of initial presentation majority of the patients (65.21%) presented with mild to moderate head injury. Major radiological findings were intraparenchymal bleed / contusions (69.56%) followed by brain edema (58.69%). Most of the patients (76.08%) needed surgical intervention and were treated accordingly. The mortality rate was 15.22%. Seventeen patients had satisfactory condition at discharge, while 22 were referred to local hospitals for neuro-rehabilitation.Conclusion: Majority of our patients was young males and the most common presenting age range was 16-45 years. Most of our patients (91.30%) sustained firearm due to homicide. At the time of initial presentation majo-rity of the patients (65.21%) presented with mild to moderate head injury. Thirty five patients (76.08%) needed surgical intervention and were treated accordingly. Mortality rate was 15.22%
Analysis of 200 Cases of Hydrocephalus Managed at DHQ Teaching Hospital Sahiwal
Get PDFObjective: Hydrocephalus is a common disease in children management and complications were standard in this study.Study Design: Prospective study.Results: 200 consecutive patients of all age groups and with all types of hydrocephalus were included. This study showed that 70% of patients with hydrocephalus were of congenital variety and 30% were of acquired variety. The incidence of associated congenital anomalies in congenital hydrocephalus was 50% and amongst them spinal dysraphysm was on the top i.e. 40%. In patients with acquired hydrocephalus, the majority of patients (20%) were post meningitic, 5% with brain tumors and 3% were post-traumatic. Postoperative complications were also noted.Complications: Common complications were infections (10%), shunt obstruction (24%) and intracranial hemorrhage (0.5%).Conclusion: We conclude that hydrocephalus is the commonest problem amongst the pediatric neurosurgical patients. Seventy percent of patients were of congenital variety while 30% of acquired variety. Amongst the neoplastic group, 80% patients had posterior fossa tumors causing obstructive hydrocephalus. 24% patients developed shunt obstruction and 10% had shunt infection