Amit Thapa

Pure Acute-on-Chronic Subdural Hematoma Due to Ruptured Posterior Communicating Artery Aneurysm: Unsuspecting Entity

BACKGROUND Even though rarely reported as a cause of pure subdural hematoma (SDH), aneurysmal rupture should be suspected in patients with spontaneous SDH without coagulopathy. CASE DESCRIPTION We report a case of acute-on-chronic SDH in a 55-year-old lady with cerebral herniation due to a ruptured posterior communicating artery aneurysm. She was managed with single-stage SDH evacuation along with clipping of the aneurysm. CONCLUSIONS Computed tomography angiography of the head is advisable in patients with spontaneous SDH without coagulopathy. Pure SDH as compared with SDH associated with subacute hemorrhage, intraventricular hemorrhage, or intracerebral hemorrhage due to aneurysmal rupture has a good outcome.

Change in perception to use of ultrasound in trauma and ICU: a questionnaire based survey

Introduction and Objective: We since 2012 have been routinely conducting KUTLS (KMCTH ultrasound trauma life support) courses. Unlike detailed examination of an organ with an ultrasound as performed by radiologist, we profess sonoscopic based problem solving approach for the clinician as he uses his stethoscope. The initial skepticism to use of sonoscope in a systematic methodical way has been seen to be fading. We conducted a survey to see the change in attitude of the clinicians with the training program. Materials and Methods: We study the questionnaire based feedback forms of the participants in the last 5 course of KUTLS workshop and analysed the change in scores of the post test. Results: 152 delegates actively participated in 5 sessions of KUTLS workshops during the last 3 years. The most common reasons to attend the workshop was to develop the skill with sonoscope with almost 95% participant not having any past experience of sonoscopy. Almost 98% scored more than 75% in the post test suggesting fast learning curve and interest among the learners. Almost 100% were convinced with the applicability of the USG and had wished to change their practice. Conclusion: A structured use of sonoscope would be helpful in clinical practice particularly in solving difficult questions in trauma and ICU. Workshops and seminars help change attitude and practice of the participants even with no prior formal training in ultrasound.

Aneurysmal bleed in traumatic SAH: are we missing something serious?

Introduction and Objective: Spontaneous Subarachnoid hemorrhage (SAH) is usually due to aneurysm rupture (85%) however SAH is far common in traumatic brain injury (TBI) (60%). We did an audit to see proportion of our patients with TBI with SAH and their outcome Materials and Methods: We did a retrospective study of patients admitted with Department of neurological surgery since April 2012 till Jan 2016. We included all patients with traumatic SAH and subjected patients with significant cisternal bleed or history of dizziness or headache prior to fall or injury to brain CT angiography. Patient who could not be properly evaluated despite suspicion were excluded. Endpoints studied were outcome, hospital stay and morbidity. Results: 112 patients were studied of which 63 were males and mean age was 48.2 years. Total of 5 cases (4.5%) had intracranial aneurysm. Of these, 3 were PCOM aneurysm and 2 from ACOM. These were successfully clipped and no significant difference in hospital stay or morbidity was seen. Of the other followed up patients, none had recurrent bleed. We discuss our approach and limitations of this study. Conclusion: 5% patients with traumatic SAH had aneurysm. A high index of suspicion and early clipping of aneurysm in such cases is associated with good outcome.