Basant Pant

Intrathecal baclofen therapy in severe head injury, first time in Nepal, a technique suitable for underdeveloped countries

Intrathecal baclofen (ITB) has been found to be helpful not only for spasticity but also for unconsciousness in a vegetative patient. This is the first case of ITB in Nepal, and here we discuss the effectiveness of ITB for spasticity in a patient in vegetative state. We also discuss about a simple technique for ITB used in Nepal where baclofen pump is not available. Here, we present a case of a 40-year-old male patient who had severe head injury with diffuse axonal injury treated conservatively. He went on to a vegetative state and subsequently developed severe spasticity of all the limbs. ITB was started under the guidance of one of the authors , Prof. Taira. Baclofen was injected to the spinal intrathecal space through a catheter which is used for spinal anesthesia. Spasticity improved significantly and his higher mental function also showed signs of improvement. He finally became fully conscious and well oriented. ITB is very useful in cases of severe spasticity and vegetative condition, a state of unconsciousness lasting longer than a few weeks. Even with a simple technique in the absence of baclofen pump, ITB can be used with its optimum effect.

Transient Cortical Blindness after Digital Subtraction Angiography of Cerebral Vessels

Received, 9 July, 2017 Accepted, 20 July, 2017 Transient blindness following cerebral angiography is a rare but known entity. We report a case of transient cortical blindness after cerebral angiography. The patient presented with ischemic stroke and the angiography was performed to rule out carotid artery stenosis. The patient, however, gradually regained his vision over a period of 3 days. This article is to understand one of the most unusual complications that may occur while performing angiography.

Propofol, An Alternative to Amobarbital in Wadas Test in Electro corticography Based Epilepsy Surgery for Determining Dominance of Brain

Annapurna Neurological Institute and Allied Sciences (ANIAS) has been performing ECOG based epilepsy surgery for many years with good results. The semiology of the patient should be concordant with Electro Encephalography (EEG) reading and Magnetic Resonance Imaging (MRI) fi ndings. Determination of dominant hemisphere in terms of language and memory function is important and is done by the WADA test. This test is usually done by short-acting barbiturate (amobarbital) pushed into an internal carotid artery.2,3,7,10,13,14 However Amobarbital is not available in Nepal, so Propofol an anesthetic agent acting on the central nervous system is used.1,6 Its chemical structure is 2,6 diisopropil fenol, it is insoluble in water and is delivered diluting it with equal proportion with normal saline (10 mg/1 ml of solution).

Management of brain tumor in Nepal

Abstract Management of brain tumors in developing countries displays a different perspective compared to developed nations. The difference starts from the presentation, which is always grossly advanced before the patient seeks treatment. Also, the surgeons must diagnose and plan surgery with the minimum number of diagnostic tools, while the majority of the time operating on the information gained from CT alone. Since cerebral angiography is rarely done, there is chance of vascular damage leading to profound bleeding or brain swelling. Due to the lack of medical insurance, the patient has to pay his/her own bill, a major deciding factor for surgery. Lack of social security is a further concern when morbidity is involved since postoperative disability can lead to further family suffering. Despite these constraints, we provide neurosurgical care to brain tumor patients with modification of surgical indications along with techniques meeting our socio-economic need. Here we present our experience in dealing with brain tumors in Nepal. We discuss the presentation, mode of investigation, the surgical tools and techniques adapted to meet these goals. We also discuss some peculiar differences in the presentation of brain tumors. Such differences in the biological nature of the tumor could be a subject of future study.