Nayil K Malik

Head Injury Caused by Tear Gas Cartridge in Teenage Population

Objectives: The aim of this study was to assess the head injury in children caused by an unusual projectile, a tear gas cartridge. The study is the only one on this subject which has been done in a teenage population. Method: This was a prospective study conducted over a period of 4 years in which all the patients aged less than or equal to 18 years and who had a head injury due to a tear gas cartridge were included. Results: We had 5 patients in our study group. All the patients were males. Commonest CT scan finding was brain contusion with skull fracture. One of our patients died. One patient continues to be in vegetative state whereas 3 had a good outcome. Conclusion: Tear gas cartridge, though considered as one of the benign modalities of controlling agitated crowds, is not really benign. It can cause serious injuries and mortality. The personnel using them might be trained in a better way so that the people do not receive direct hits. In addition some changes in the design of tear gas cartridge can be done to decrease the impact to the skull.

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.

Decompressive craniectomy in head injury

Decompressive craniectomy has been used to treat severe intracranial hypertension secondary to various causes like trauma, cerebral infarction, subarachnoid hemorrhage, and spontaneous hemorrhage, refractory to medical treatment. There are many different approaches grouped under the term ‘decompressive craniectomy’ with all of them aiming at reduction of raised intracranial pressure. We have reviewed the literature and tried to describe the mechanism, various types, indications and complications of this procedure.

Subdural hydatid cyst presenting as recurrent subdural hygroma.

Intracranial hydatid disease is an uncommon entity that usually is parenchymal in location. Presence of hydatid cyst in subdural location is being reported for the first time in the literature. A 13-year-old female child with the diagnosis of hydatid disease of brain was operated. She was advised to take albendazole which she did not take. In postoperative period she developed recurrent subdural hygroma for which multiple surgical interventions were done and finally cause of recurrent subdural hygroma was found to be hydatid cyst in the subdural space. The patient had initially undergone craniotomy for the excision of hydatid cyst. Later on she developed subdural hygroma for which the burr hole drainage was done twice. At time of third recurrence subduro-peritoneal (SDP) shunt was done. When she had recurrence again along with hydrocephalus, than VP shunt and revision of the SDP shunt was planned. While doing revision of SDP shunt, hydatid cyst was seen emerging from the burr hole site. A craniotomy was done to remove the hydatid cyst from the subdural space. Since then there has been no recurrent collection. Complete surgical excision is the best treatment modality to treat hydatid cyst of brain. Accidental spillage of the contents can have lead to recurrence, so every effort must be taken to prevent spillage of contents. Postoperatively all the patients must be put on antihelminthics.

Combination of needle aspiration and core needle biopsy: A new technique of stereotactic biopsy.

Aim: The study aims at describing the results of using a new technique to acquire the tissue sample in stereotactic biopsy of brain lesions. Materials and Methods: The study was performed in 19 patients over a period of 5 years in which we used the new technique, i.e., Abrar and Afzal technique (AT) of obtaining tissue biopsy. It is a combination of core tissue biopsy and needle aspiration techniques. The technique was devised to acquire greater amount of tissue for pathologic study. Results: While we could give pathologic diagnosis in 18 patients out of 19 (94.7%), in one patient, the tissue sample revealed only inflammatory cells and definitive diagnosis could not be reached. There was no significant morbidity or any mortality in the series. Conclusion: Abrar and Afzal technique is a reasonably accurate technique of acquiring larger tissue sample in stereotactic brain biopsy without any additional risks. It can be done with little modification of the conventional equipment available with the stereotactic system.

Brain abscess complicating hemorrhagic contusion in a case of closed head injury: Case report

Brain contusions commonly are identified in patients with traumatic brain injury (TBI) and represent regions of primary neuronal and vascular injury. These edematous lesions contain punctate parenchymal hemorrhages, which are termed micro-hemorrhages. These hemorrhages rarely get infected by hematogenous spread of microorganisms causing a brain abscess. Delayed brain abscess formation in the contusion is a very rare entity. We report a one year old patient who had traumatic right parietal hemorrhagic contusion with no external wound. She was managed conservatively. Two weeks after injury he deteriorated in neurological status and was found to have developed brain abscess. Patient underwent immediate craniotomy with drainage of abscess and excision of abscess wall; she was discharged home after one week. Infective complication can occur rarely even after closed head injury and should be kept as a differential diagnosis in a patient with delayed deterioration.

Controversy in use of mannitol in head injury

Abstract The most commonly used drug in the patients of severe head injury is mannitol. The drug is classified pharmacologically as osmotic-diuretic but its mechanism of action in decreasing intracranial pressure is multi-factorial. Despite having dramatic results in the management of head injury patients the drug is still facing many controversies ranging from mechanism of action to the efficacy, especially is the light of evidence based medicine.

Bilateral sequentially developed asynchronous extradural haematomas

Bilateral epidural haematomas are rare but sequentially developed asynchronous bilateral extradural haematoma (EDH) is even rarer. We report a case of 30 year-old-male who was operated for EDH on one side and postoperative CT scan was done which revealed EDH on contralateral side which was evacuated.

Idiopathic Spinal Extradural Hematoma—a Rare Entity

Spontaneous spinal epidural hematoma is a relatively rare entity but a neurological emergency. The source of bleeding can be arterial or from epidural venous plexus. The most common symptom can be neck or back pain followed by rapid neurological deterioration. It can present in all ages, but is more common in the fourth and fifth decade of life. MRI is the investigation of choice. Prompt surgical intervention is indicated. We report a case of 70-year-old male who had spontaneous spinal extradural hematoma in dorso-lumbar region with flaccid paraplegia. Patient was operated and laminectomy with evacuation of hematoma was done. There was significant neurological improvement in the postoperative period.