Abrar Ahad Wani

Subdural Hematomas: An Analysis of 1181 Kashmiri Patients

BACKGROUND We endeavored to analyze patients of subacute and chronic subdural hematomas studied in a 4-year period at the Sher-i-Kashmir Institute of Medical Sciences, Kashmir, India. METHODS The study was a retrospective analysis of 1181 patients of subdural hematomas. Demographic characteristics, clinico-radiologic features, operative modalities, and outcome were studied. Acute subdural hematomas were excluded from the study. RESULTS The mean age was 60.4 ± 12.4 and males outnumbered females. Chronic subdural collections were more common than subacute subdural hematomas and left side predominated. Two burr holes with closed-system drainage was used in most patients. Incidence of postoperative seizures is very low. Overall recurrence rates were low; however, multilocular hematomas had the highest incidence of recurrence. Morbidity and mortality were 7.53% and 2.96%, respectively. Preoperative neurologic grade correlated with outcome. CONCLUSIONS Subdural hematomas are common in elderly males. Preoperative neurologic grade dictates the outcome. Multilocular hematomas have a higher chance of recurrence. Craniotomy should be reserved for recurrent hematomas, and there may be a scope of craniotomy for multilocular chronic subdural hematomas at the outset. Antiepileptic prophylaxis is not routinely recommended.

Protrusion of a peritoneal catheter through the umblicus: an unusual complication of a ventriculoperitoneal shunt

Abstract Protrusion of a ventriculoperitoneal (VP) shunt through the umblicus is one of the rarecomplications of shunt insertion reported in the medical literature. One such case is presented here in a child in whom a VP shunt had been placed for congenital hydrocephalus.

Extraventricular neurocytoma of the vermis in a child

Neurocytomas are rare neoplasms, composed of uniform round cells with neuronal differentiation. We report a rare extraventricular neurocytoma (EVN) in a 5-year-old boy who presented with headache and vomiting. His MRI brain showed a vermian mass. The histopathological examination and immunohistochemistry revealed it to be an EVN. We report this patient for the rarity of the condition and the EVN mimicking a medulloblastoma on imaging. This tumor needs to be differentiated from a medulloblastoma as the former has a better prognosis.

Intradiploic epidermoid causing spontaneous extradural hematoma: case report.

OBJECTIVEA case of an intradiploic epidermoid tumor leading to spontaneous extradural hematoma is reported. Intradiploic epidermoids are not common intracranial tumors. This is the first reported case of intradiploic epidermoid presenting as a spontaneous extradural hematoma. CLINICAL PRESENTATIONThe patient presented with sudden onset of headache and deterioration in the sensorium. A computed tomographic scan revealed a lesion causing erosion of both tables of the calvarium and a mixed intensity extradural hematoma. INTERVENTIONThe patient underwent immediate operation, and evacuation of the hematoma and excision of the tumor were performed. CONCLUSIONIntradiploic epidermoid tumors so rarely present with extradural hemorrhage that prophylactic removal cannot be recommended in all such cases. However, in view of the seriousness of the hemorrhage, prophylactic removal may be recommended, especially if the patient, such as a sportsman, child, or elderly person, is prone to injuries.

Childhood Tubercular Meningitis: An Institutional Experience and Analysis of Predictors of Outcome

Tubercular meningitis constitutes an important cause of morbidity and mortality in developing countries, and various factors determine its outcome. We studied demographic and clinical profiles of childhood tubercular meningitis, and identified predictors of outcome. This prospective study was performed in 65 children aged ≤ 18 years, hospitalized with a diagnosis of tubercular meningitis. Boys outnumbered girls. Most patients presented with a poor clinical grade. Headache and vomiting comprised common features. Cerebrospinal fluid was characterized by predominant lymphocytosis. Many patients were diagnosed for Mycobacterium tuberculosis via polymerase chain reaction. Hydrocephalus comprises a common finding via computed tomography. Low Glasgow Coma Scores, seizures, basal exudates, and infarcts predict outcomes. Children with headaches, fevers, and altered sensorium should be investigated promptly for tubercular meningitis. Timely intervention may lead to early diagnoses and reductions in morbidity and mortality.

Apoplexy in sellar metastasis: a case report and review of literature.

Apoplexy in sellar metastasis is very rare with only a few case reports in literature. A case of apoplexy in sellar metastasis from follicular thyroid carcinoma is reported and the literature is briefly reviewed. The patient presented with sudden onset headache and bi-lateral loss of vision following thyroidectomy in a case of follicular carcinoma thyroid with proven sellar metastasis. CT scan showed hyperdense blood in sellar mass suggestive of apoplexy in sellar metastasis. The patient underwent early trans-sphenoidal decompression. Apoplexy in sellar metastasis, although very rare, can be clinico-radiologically indistinguishable from pituitary apoplexy and should be especially considered in the differential diagnosis of patients with known primary neoplastic disease. In view of similar patho-physiological mechanism, sellar metastasis with apoplexy should be managed in a similar manner as pituitary apoplexy.

Sellar-suprasellar tuberculomas in children: 2 cases and literature review.

Sellar and suprasellar tuberculomas are rare. Patients with these lesions usually experience headache, vomiting, and hypofunction of pituitary gland; imaging reveals an enhancing sellar-suprasellar mass. We report 2 rare cases of sellar-suprasellar tuberculomas in children aged 8 and 6 years. One child presented with features of headache and vomiting, and the other presented with posterior pituitary dysfunction. In both cases, imaging revealed sellar-suprasellar masses. Both cases were multidrug-resistant tuberculomas. We discuss sellar-suprasellar tuberculomas, a rare form of neurotuberculosis in the background of an overall increase in multidrug-resistant tuberculosis, especially in children.

A prospective, randomized, double blind study to compare the effects of equiosmolar solutions of 3% hypertonic saline and 20% mannitol on reduction of brain-bulk during elective craniotomy for supratentorial brain tumor resection

Aims: The aim of the study was to compare the effect of mannitol (M) and hypertonic saline (HTS) on brain relaxation and electrolyte balance. Settings and Design: Prospective, randomized, double-blind study. Subjects and Methods: A total of 114 patients with American Society of Anesthesiologists status II and III, scheduled to undergo craniotomy for supratentorial brain tumor resection were enrolled. Patients received 5 ml/kg 20% mannitol (n = 56) or 3% HTS (n = 58) at the start of scalp incision. Hemodynamics, fluid balance and electrolytes, were measured at 0, 15, 30, and 60 min and 6 h after infusion. Intensive Care Unit (ICU) stay between the two groups was also recorded. The surgeon assessed brain relaxation on a four-point scale (1 = Relaxed, 2 = Satisfactory, 3 = Firm, 4 = Bulging). Appropriate statistical tests were used for comparison; P < 0.05 was considered significant. Results: Brain relaxation conditions in the HTS group (relaxed/satisfactory/firm/bulging, n = 28/20/5/3) were better than those observed in the M group (relaxed/satisfactory/firm/bulging, n = 17/21/11/9). The levels of serum sodium were higher in the HTS group (P < 0.001). The average urine output was higher in the M group (5.50 ± 0.75 L) than in the HTS group (4.38 ± 0.72 L) (P < 0.005). There was no significant difference in fluid input, ICU stay, and hospital days between the two groups. Conclusion: We concluded that HTS provided better brain relaxation than mannitol during elective supratentorial brain tumor surgery, without affecting ICU and hospital stay.

Missile injury to the pediatric brain in conflict zones.

OBJECT This study was conducted both prospectively and retrospectively at one center over a period of 8 years. The population consisted of all patients with both an age 18 years or younger and a diagnosed penetrating missile injury (PMI) during the study interval. The authors analyzed factors determining outcome and demographic trends in this population, and they compared them with those in the more developed world. METHODS Fifty-one patients were the victims of armed conflict, although no one was directly a party to any battle. This mechanism of injury is in strong opposition to data in the literature from developed countries, in which most missile injuries are the result of suicide or homicide or are even sports related. Moreover, all previous studies on the pediatric population have considered only injuries from gunshots, but authors of the current study have included injuries from other penetrating missiles as well. RESULTS On cross tabulation analysis using the chi-square test, the factors shown to correlate with outcome included the Glasgow Coma Scale (GCS) score, pupillary abnormalities, patient age, hemodynamic status, and bihemispheric damage. On multinomial regression analysis, the two strongest predictors of death were GCS score and pupillary abnormalities. The GCS score and hemodynamic status were the strongest predictors of disability. CONCLUSIONS There was no difference in the prognostic factors for PMI between developing or more developed countries. Glasgow Coma Scale score, pupillary abnormalities, and hemodynamic status were the strongest predictors of outcome. In conflict zones in developing countries the victims were mostly innocent bystanders, whereas in the more developed countries homicides and suicides were the leading etiological factors.

Isolated enchondroma of atlas.

Compression at the craniovertebral junction because of tumors is not a very common entity. The commonest tumors present here are neurofibroma and meningioma. Any vertebral tumour can be present at this location. Benign bony tumors are very uncommon at this location and amongst these enchondromas are exceptionally rare. Enchondromas are rare bony tumours of chondrogenic origin. These are benign tumours with a propensity for malignant transformation. There are four histological types: osteochondromas, enchondromas, chondroblastoma and chondromyxoid fibroma. Enchondromas are often asymptomatic because of their slow growth but may have varied presentation. An enchondroma may occur as an individual tumor or as several tumors together. We here report a case of enchondroma arising from the atlas and causing myelopathy. The best treatment is complete excision which we could achieve in our case.