Pakistan Journal Of Neurological Surgery
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Neurological Complications of Eclampsia
Get PDFObjective: Neurological complications contribute significantly to maternal mortality in eclampsia. We studied neurological and obstetric outcome of such patients.Material and Methods: A descriptive study was done at Gynaecology, Neurosurgery and Neurology Units of PGMI Lady Reading Hospital Peshawar, from January 2008 to December 2008. A total of 132 cases of eclampsia were included. Twenty seven cases of eclampsia with neurological complications were studied. We excluded cases with primary neurological abnormalities.Results: During this period one hundred and thirty two patients were admitted with eclampsia. Among 132 cases 27 had neurological abnormalities. One hundred and eight cases were antenatal and twenty four were postnatal. None of them had any antenatal care. Management included initial stabilization followed by early delivery in antenatal cases. Primary anticonvulsant was magnesium sulphate. Phenytoin controlled convulsions in all cases with recurrent seizures. Neurological complications were seen in twenty seven patients. Minor complications like transient impairment of consciousness (97%), blurred vision (22.22%), and Bell’s palsy (07.40%) were observed. Serious neurological complications like CVA (11.11%), recurrent seizures (37.03%) and deep coma occurred in (22.02%) of cases. The cesarean section rate was 18%. Fifty four perinatal deaths and five maternal deaths were recorded. Neurological recovery was complete in all survivors.Conclusion: Critical care backup is essential at tertiary referral centers for a large proportion of neurological abnormalities in eclampsia. High mean arterial pressure and accompanying coagulation defects may be key factors in cerebral pathology. CT scan is a simple and effective investigation in these cases. Phenytoin is an effective second line anticonvulsant. Early delivery prevents worsening of systemic status
Intracranial Hydatid Cyst: A Case Report of Three Cases
Get PDFA cerebral hydatid cyst is a less common condition as compared to hydatid diseases of liver and lungs. Surgical removal of the cyst without rupturing it should be the primary goal of surgery. We reported three cases of supratentorial cerebral hydatid cysts in this case-series. All of the cases belonged to three different age groups. One, 10 year old patient was previously operated at another hospital and presented with the recurrent disease. This patient was operated three times with a gap of six and nine months in-between surgeries. Currently, he is symptoms free for the last one year. Another, 40 year old patient was operated, 22 months back and is now disease free. Third case was of a 72 year old patient, who had a hepatic hydatid cyst as well. The relevant literature on the cerebral hydatid disease was reviewed and compared with our cases. The cerebral hydatid cyst should be included in the differential diagnosis of patients presenting with altered neurological status, especially in those who belongs to those regions where the disease is endemic. Total cyst removal without rupturing it should be the goal of surgery whenever possible. Postoperative treatment with Tablet Albendazole should be given in every case
Outcome of Traumatic Subarachnoid Hemorrhage in Patients Presenting to Neurosurgery Department Lady Reading Hospital Peshawar
Get PDFObjective: To know about outcome of Traumatic Subarachnoid Hemorrhage based on Glasgow outcome scale at the time of discharge from the hospital.Material and Methods: We conducted prospective observational study at Neurosurgery Department Lady Reading Hospital Peshawar from January 2016 to June 2016 with total 6 months' duration. All patients with traumatic subarachnoid hemorrhage having both genders and having age from 10 to 60 years were included. Patients with sub arachnoid hemorrhage due to aneurysm, AVM, brain tumors, neuroinfections, anticoagulants, sickle cell anemia and having other forms of traumatic brain injuries were excluded. SPSS version 20 was used for data analysis and showed in the form of tables and graphs.Results: 48% patients were in age group from 2nd to 4th decade while 19% had age< 2nd decade and remaining 33 % patients age > 40 years. 32 years ± 2.12SD was the mean age for all patients. 72% patients were male and 28% females. RTA (58.97%) was most common cause and majority of the patients initially at arrival were in the GCS range of 3 to 8 (74.74%). At the discharge from the hospital 60% patients had unfavorable traumatic subarachnoid hemorrhage while 40% patients had favorable traumatic subarachnoid hemorrhage.Conclusion: Our study concluded that the frequency of unfavorable traumatic subarachnoid hemorrhage is higher in KPK as compare to other international studies because of severity of the trauma, late presentation of the patients in the hospital, less community education about traumatic brain injuries, short time of follow up, Deficiency of neurosurgical icu,s in our set up
Occipital Condyle Fracture – A Diagnosis Requiring High Suspicion
Get PDFTraumatic injury causing occipital condyle fractures (OCF) are very rare. They are of critical clinical importance owing toimportant anatomical structures that need considerations of the occiput-atlantoaxial joint complex. Early diagnosis is of paramount importance since there may be associated lower cranial nerve palsies along with cervical spinal instability. Sometimes, this can be a diagnostic challenge in acute stage because of the inability to diagnose this injury with plain radiographs. To avoid this, high index of suspicion and relevant investigation of the craniocervical junction is indicated. Hence it helps in early recognition and diagnosis of OCF thus preventing possible neurological impairment. Here, we report a case of a 58 -year-old male who presented with complaints of neck pain and headache following physical assault
Surgical Management of Aneurysmal Subarachnoid Haemorrhage in the Punjab Institute of Neuroscience (PINS) Decade and Need of Shunt for Hydrocephalus
Get PDFObjective: Aneurysmal Subarachnoid Haemorrhage management is improving with the passage of time with the advancement of Microsurgery but still mortality is relatively high in the natural history of disease. The main stay of this gap is noted from the time of ictus to the time of presentation in the tertiary care centers. Management of Hydrocephalus was also studied in this study. Material and Methods: This is a prospective study conducted at PINS LGH Lahore. We studied a total of 50 cases in a period of July 2015 to July 2017. Results: Twenty nine (58.00%) were female and 21 (42.00%) male, the male to female ratio remained 1:1.5. The affected age group was mostly younger one in there productive years. Maximum patient were noted in 4th decade, equal incidence was seen in 5th and 6th decade of life. CT scan was done as initial investigation while CT angiogram and four vessels angiogram were used as definitive investigations. Grading of patient was done using the WFNS grade and 29 cases were found in good grades (58.00%). Maximum Aneurysm were founded at A.com artery 24 cases (45.00%) followed by 22 cases of middle cerebral artery (MCA) (41.00%).We predicted the vasospasm using the fisher grades and found 21 cases (42.00%) in Fisher Grade II, in grade III & IV there was 17 and 12 cases (24.00%) respectively. Surgical outcome of post clipping was analyzed by Glasgow outcome scale and 41 cases (82.00%) were present in Grade IV and V. We found in post-operative management that patent within older age had high chance to develop hydrocephalus and V-P shunt was required in 9 cases out of 28 in group of 55 – 65 years. While in younger group (52.00%) 20 – 49 years. 22 (19.00%) cases needed V-P shunt . relatively aggressive approach was used toward CSF diversion procedure in pre-clipping period 26% patient underwent ventriculoperitoneal V-P shunt (n+12). Triple therapy started in all the case post operatively to avoid vasospasm. Post-operative CT-scan was done on 1st post-operative day. Conclusion: Patients in Older Age group had higher tendency to be shunt dependent 32% vs. 19%; p-value = 0.04 (Chi Sq. test) (Table 3 & 4)
Chronic Subdural Hematoma, Review of 30 Cases Managed at DHQ Teaching Hospital, Sahiwal Medical College, Sahiwal
Get PDFChronic subdural hematoma (CSDH) most commonly occurs in elderly patients. Our aim was to examine the incidence, clinical presentation, causes (pathology), mode of surgical treatment and final results in patients with chronic subdural hematoma were identified. The chances of chronic subdural hematoma were always more in old age patients. Head trauma i.e. fall & road side accident was the cause in 76.66% and etiology was not known in 23.33% of patients. The common clinical presentation was headache, vomiting, altered conscious level (60%) and neurological deficits (50%). All the patients (100%) were operated while one patient died after surgery
Osteolytic Skull Lesions Rare but Important Pathology in Neurosurgical Department
Get PDFObjective: To present an overview of varied clinical presentations, investigations and treatment options for Osteolytic skull lesions. Study Design: It was a retrospective and prospective study. Materials and Methods: Between Jan 2011 __ Feb 2014 during a period of 3 years. Twelve patients presented in neurosurgical OPD Lahore General Hospital. All patients were thoroughly investigated with appropriate hematological and radiological investigations. All were followed regularly in OPD. Outcome was defined as Excellent, moderate and poor according to complete or partial remission and recurrence of disease. Results: Total 12 patients were included in the study. Amongst these 7 were male and 5 female. Age group of patients ranged from 6 months to 80 years. Majority of these were in younger age group. Of these 3 cases were each of Tuberculosis and malignancies, 2 midline benign lesions and 1 each of post traumatic, infection and metastasis. All underwent diagnostic / therapeutic procedures and referred for Radio or chemotherapy where indicated. Conclusion: All scalp / skull lesions need careful clinical correlation, appropriate radiological investigations to establish diagnosis and subject them to suitable treatment
Management of Intracranial Hydatid Cyst
Get PDFObjective: To know the clinical presentation and surgical complication of intracranial hydatid cyst.Materials and Methods: This retrospective study was done in neurosurgery department of Hayatabad Medical Complex, Peshawar, from 2nd February 1998 to 1st October 2012. A total of 37 patients with intracranial hydatid cyst, irrespective of gender discrimination were included in this study. Intracranial hydatid cyst was diagnosed on CT scan brain. The information regarding patient demographical details, clinical features, CT brain findings and post-operative complications was documented in patient’s Performa. The data was analyzed by SPSS version 16. Frequency and percentage was calculated for categorical variables. Mean ± SD was calculated for age. Results were presented as tables.Results: A total of 37 patients were included in the study. Out of 37 patients, there were 23 (62.8%) males and 14 (37.14%) females. The mean age was 12.4 years. Most of patients presented with increased intracranial pressure features like headache, vomiting and papilloedema. Majority of the patients had hydatid cyst in parietal region %. Post-operatively two patients having wound infection and no mortality.Conclusion: Hydatid disease should be kept in the differential diagnosis of cystic lesion of the brain. The pericystic hydraulic hydatid cyst excision is the safe procedure with minimal morbidity
Frequency of Early Complications of Trans-sphenoidal Surgery
Get PDFObjective: To determine the frequency of early complication of trans-nasal trans-sphenoidal surgery for pituitary adenoma.Material and Methods: This observational study was conducted at the department of Neurosurgery, Post-graduate medical institute, Lady Reading Hospital Peshawar from June 2009 to December 2010. A total of 63 consecutive patients who undergone Trans nasal trans-sphenoidal surgery for pituitary adenoma with age more than fourteen years were included in the study irrespective of their gender. These patients were followed up to 7 post op days for early complications and frequency of these complications was calculated.Results: Out of 63 patients, there were 52.4% males and 47.6% females. Majority (34.9%) of patients were in the age range of 31 – 40 years, followed by 28.6% patients in age group of 21 – 30 years. Among early post-operative complications diabetes Insipidus was noted in 7.9% cases, Postoperative CSF leak was recorded in 4.8% cases and meningitis was observed in 1.6% case.Conclusions: We conclude that most of our patients with pituitary adenoma were males in their 3rd or 4th decades of life. Diabetes Insipidus was the most common early post-operative complication followed by CSF leak and meningitis
Primary Soft Tissue Orbital Ewing’s Sarcoma Causing Unilateral Visual Loss: A Case Report
Get PDFA case of primary Ewing's sarcoma of right orbit causing unilateral visual loss in a 3 year old female child is reported. The child presented with 1 year history of painless unilateral proptosis and loss of vision. Loss of vision due to primary Ewing's sarcoma in orbit is extremely rare and it should be considered as one of the differential diagnoses while dealing the patient with these sorts of clinical presentation