Sarvpreet Singh Grewal

Incidence, short-term outcome, and spatial distribution of stroke patients in Ludhiana, India

Objective: To estimate the incidence, short-term outcome, and spatial distribution of stroke patients and to evaluate the completeness of case ascertainment in Ludhiana. Methods: This population-based prospective cohort study was conducted in Ludhiana, Punjab, Northwest India. All first-ever stroke patients (≥18 years) were included between March 2010 and March 2013 using WHO Stepwise Approach Surveillance methodology from the city. Stroke patient data were obtained from hospitals, scan centers, and general practitioners, and details of deaths from the Municipal Corporation. Results: Out of 7,199 stroke patients recruited, 3,441 were included in final analysis. The mean age was 59 ± 15 years. The annual incidence rate was 140/100,000 (95% confidence interval [CI] 133–147) and age-adjusted incidence rate was 130/100,000 (95% CI 123–137). The annual incidence rate for stroke in the young (18–49 years) was 46/100,000 (95% CI 41–51). The case fatality at 28 days was 22%. Patients above 60 years of age (p = 0.03) and patients who were managed in public hospitals had poor survival (p = 0.01). Hot spots for cumulative incidence were seen in central and southern parts of the city, and hot spots for poor outcome were seen in the outskirts of the city. Conclusions: The incidence rates are similar to other studies from India. Stroke patient survival is poor in public hospitals. The finding of spatial analysis is of public health significance for stroke prevention and strengthening of stroke services.

Traumatic bilateral basal ganglia hematoma: A report of two cases

Traumatic Basal ganglia hemorrhage is relatively uncommon. Bilateral basal ganglia hematoma after trauma is extremely rare and is limited to case reports. We report two cases of traumatic bilateral basal ganglia hemorrhage, and review the literature in brief. Both cases were managed conservatively.

Do they hear what we speak? Assessing the effectiveness of communication to families of critically ill neurosurgical patients

Background and Aims: Clinician-family communication must be effective for medical decision making in any Intensive Care Unit (ICU) setting. We performed a prospective study to assess the effectiveness of communication to families of critically ill neurosurgical patients based on the two criteria of comprehension and satisfaction. Materials and Methods: The study was conducted on 75 patients in a 15 bedded neurosurgical ICU. An independent investigator assessed the comprehension and satisfaction of families between the 3rd and the 5th day of admission in ICU. Comprehension was tested using three components, that is, comprehension of diagnosis, prognosis and treatment. The satisfaction was measured using a modified version of the Critical Care Family Needs Inventory (CCFNI) (score of 56-extreme dissatisfaction and 14-extreme satisfaction). Results: Poor comprehension was noted in 52 representatives (71.2%). The mean satisfaction score as measured by the CCFNI score was 28. Factors associated with poor comprehension included increasing age of patient representative (P = 0.024), higher simplified acute physiology score (P = 0.26), nonoperated patients (P = 0.0087) and clinician estimation of poor prognosis (P = 0.01). Operated patients had significantly better satisfaction score (P = 0.04). Conclusion: Families of patients were reasonably satisfied, but had poor comprehension levels of the patients illness. The severity of the patients illness, poor prognosis as estimated by the physician and nonoperated patients were independent predictors of poor comprehension. Extra effort to communicate with patient representatives at risk of poor comprehension and provision of a family information leaflet could possibly remedy this situation.

Spinal epidural abscess following epidural cannulation for flail chest analgesia: a case report

Epidural abscess after epidural catheterization is a rare complication. Neurological manifestations vary and the patient described here presented with complete paraplegia. He was managed by surgical decompression and did well postope-ratively. We present a case report and review of the literature of thoracic epidural abscess following catheterization for epidural analgesia with near total neurological recovery.

Prospective randomized comparative study to evaluate epidural fibrosis and surgical outcome in patients undergoing lumbar laminectomy with epidural autologous free fat graft or gelfoam: A preliminary study

Introduction: Epidural fibrosis (EF) contributes to unsatisfactory relief of symptoms and failed back syndrome after spine surgery. EF around the nerve root can be more refractory to treatment than the original disc herniation itself. Reoperation on the scar can produce more scarring. Few studies have been conducted regarding the type of material to be used for decreasing EF. Materials and Methods: The prospective randomized comparative study was conducted in the Department of Neurosurgery and Radiodiagnosis, of a tertiary care hospital. Informed and written consent was obtained. Patients previously unoperated with symptoms and radiological features of lumbar spinal canal stenosis were included in the study. Fifteen patients were assigned to Group A (free fat graft) and 15 patients in Group B (Gelfoam group). Postoperatively, at 3 and 6 months, clinical outcome was evaluated and EF was assessed on CE-MRI. Results: Age and sex were comparable in both groups. The pain relief at 3 and 6 months was more in Group A as compared to Group B. In Group A, on CEMRI at 3 months, 87% of patients had none to mild fibrosis, with none had extensive fibrosis. The CEMRI at 6 months showed no increase in fibrosis. In Group B, 80% of patients had none to mild fibrosis at the end of 3 months. At 6 months, 13.3% patients had extensive fibrosis. The extent of EF was found to be statistically significant at 6 months postsurgery. Conclusion: Use of free fat graft at laminectomy site helps in reducing EF.

Variegated colors of pediatric glioblastoma multiforme: what to expect?

Malignant gliomas account for 35-45% of primary brain tumors; among these glioblastoma multiforme (GBM) is the most common adult brain tumor constituting approximately 85%. Its incidence is quite less in the pediatric population and treatment of these patients is particularly challenging. Exposure to ionizing radiation is the only environmental factor found to have any significant association with GBM. Several genetic alterations associated with GBM in adults have been well documented such as epidermal growth factor receptor amplification, overexpression of mouse double minute 2 homolog also known as E3 ubiquitin-protein ligase, Phosphatase and tensin homolog gene mutation, loss of heterozygosity of chromosome 10p and isocitrate dehydrogenase-1 mutation. However, data on genetic mutations in pediatric GBM is still lacking. Exophytic brain stem gliomas are rare tumors and are usually associated with a poor prognosis. The most effective treatment in achieving long-term survival in such patients, is surgical excision of the tumor and then chemoradiotherapy followed by adjuvant chemotherapy by temozolomide. This schedule is the standard treatment for GBM patients. In view of the rarity of pediatric GBM, we report here a case of pontine GBM in a 5-year-old girl.

Silent bowel perforation with per anal protrusion of ventriculoperitoneal shunt

Ventriculoperitoneal (VP) shunt used in the treatment for hydrocephalus is associated with several complications. Visceral/bowel perforation is an unusual but serious complication of VP shunt. A silent protrusion of distal end of VP shunt per anus is reported in an 8-month-old male child. Patient underwent right VP shunt at the age of 6 months for congenital hydrocephalous. Patient was afebrile and had no signs of peritonitis or meningitis. Exploratory laparotomy was done where shunt was found to penetrate antimesenteric border of sigmoid colon. Shunt was removed and patient is doing well at 6 months follow-up without revision of VP shunt. Etiopathogenesis and management issues are discussed with relevant review of literature.

Fat in the cerebellum: An unusual complication of occipitocervical fixation

Injuries to neural and vascular structures of the posterior fossa are the most dreaded complications of occipitocervical fi xation. We report an unusual complication of occipitocervical fi xation in a 38-year-old man, presenting with type III odontoid fracture, atlantoaxial instability, and quadriparesis; following a road traffic accident. Inadvertent dural tear occurred while drilling holes in the occipital bone for anchoring the implant. Postoperative imaging showed contusion and fat deposition in the cerebellum. Patient was managed with extraventricular drainage for the hydrocephalus and conservatively for the cerebellar lesion. Thorough search of literature showed no previous reports of such iatrogenic fat deposition within the cerebellum.