Upendra Mohan Chowdhary

Anaesthetic-induced ventricular tachyarrhythmia in Jervell and Lange-Nielsen syndrome

A four-year-old deaf girl with a history of convulsions developed polymorphous ventricular tachycardia during induction of anaesthesia. The arrhythmia reverted to sinus rhythm spontaneously. Post-anaesthetic ECG showed marked prolongation of the QTc interval (570–690 msec). Deafness and prolonged QTc interval in association with microcytic-hypochromic anaemia confirmed the diagnosis of the Jervell and Lange-Nielsen syndrome. This case report highlights the potentially lethal complication ofhalothane anaesthesia in patients with long QTc interval syndrome.RésuméUne fillette âgée de quaire ans atteinte de surdité avec une histoire de convulsions a développé une tachycardie ventriculaire polymorphe lors de l’induction de l’anesthésie. L’arythmie s’est convertie spontanément à un rythme sinusal. L’ECG postanesthésique a démontré une prolongation marquée de l’intervalle QTc (570–690 msec). La surdité et la prolongation de l’intervalle QTc en association avec l’anémie hypochromiquemicrocytaire a confirmé le diagnostic du syndrome de Jervell et Lange-Nielsen. Cette histoire de cas met l’emphase sur la complication potentiellement léthale de l’anesthésie a l’halothane chez les patients avec un syndrome d’intervalle QTc long.

Tecto-cerebellar dysraphia with occipital encephalocele

We report four cases with the rare syndrome of tecto-cerebellar dysraphia with occipital encephalocele. The clinical features seen in these patients included episodic tachypnea and irregular breathing, opsoclonus, ataxia, marked hypotonia of the limbs, coloboma, and polydactyly. All four patients had midline occipital encephalocele. The cranial computed tomography scan showed partial to total agenesis of the vermis with a large communication between cisterna magna and the fourth ventricle. The computed tomography scan also showed partial deficiency of the midbrain tectum. We discuss the clinical and radiological findings and review the literature.

Brain abscess in Saudi Arabia.

There are significant variations among countries in the incidence of brain abscess. We report here 26 cases of brain abscess treated at the Neurosurgery Department of King Faisal University and Dammam Central Hospital Saudi Arabia over a six year period (1982–1988). This is 2.3% of total admissions to the two neurosurgery departments serving a population of approximately 1.2 million in the same period.Young males were most often affected (M/F ratio 3.3:1; 31% were less than 15 years old, 46% aged between 15–39 years, and 23% older than 40 years). Streptococcus was found to be the most common microorganism (38.4%). Mixed infection was seen in 15.3%, and sterile abscesses were found in 11.5% of the patients after aerobic and anaerobic cultures of the pus. Chronic otitis media and paranasal sinusitis predisposed the patients to abscess formation in 57.6% of the cases. The temporo-parietal area was the commonest site. Epilepsy was a complication in 30.7% of our patients, and the mortality rate was 15.3%.

Brucella meningoencephalitis associated with cerebrospinal fluid shunt in a child: Case report

Brucella meningoencephalitis is rare in young children. We describe a patient who developed Brucella meningoencephalitis at the age of 20 months while he had a ventriculoperitoneal shunt in situ for treatment of hydrocephalus. This patient was treated with streptomycin and rifampicin. The shunt was left in situ, and all the clinical and laboratory test abnormalities subsided with this management. We propose that in a patient with Brucella meningoencephalitis, the cerebrospinal fluid shunt system can be left in situ and treatment with appropriate combination of antibiotics should prove to be successful.

Cavernous Angioma Presenting as Subarachnoid Hemorrhage in a Child—A Case Report

Cavernous angioma of the brain is a rare lesion. Only a small percentage occur in childhood and less than a quarter present with intracranial hemor rhage. A case of cavernous angioma presenting as subarachnoid hemorrhage in a child is reported here. The author describes the clinical picture and the pitfalls in the management of such cases and comments on the histologic criteria, the radiologic appearances, and the rationale behind the operative management.Cavernous angioma of the brain is a rare lesion. Only a small percentage occur in childhood and less than a quarter present with intracranial hemorrhage. A case of cavernous angioma presenting as subarachnoid hemorrhage in a child is reported here. The author describes the clinical picture and the pitfalls in the management of such cases and comments on the histologic criteria, the radiologic appearances, and the rationale behind the operative management.

Intradural lumbar disc protrusion. A case report.

We report a rare case of intradural lumbar disc protrusion describing a specific myelographic appearance that may help in preoperative diagnosis. Most of these patients present with acute sciatica and neurologic deficit. Preoperative awareness and diagnosis is of importance because the extruded disc protrusion lies intrathecally and must be specifically looked for and removed from its intradural position.

Prevention of Early Recurrence of Aneurysmal Subarchnoid Haemorrhage by Tranexamic Acid: A Controlled Clinical Trial

A controlled clinical trial of Tranexamic Acid (TEA) was underaken to as sess its effectiveness in reducing early recurrence of haemorrhage in patients with aneurysmal subarchnoid haemorrhge (SAH). The series of control patients and patients having TEA which were consecutive. Of the 65 patients treated with TEA recurrence occurred in six (9%) and five patients died from recur rence of haemorrhage. Of the 64 patients in the control group, 17 (26%) pa tients had recurrent haemorrhage and eight patients died from it. Administra tion of tranexamic acid is found to have significantly reduced the early recur rence of haemorrhage.

Traumatic Arteriovenous Fistula of the Scalp-Case Reports:

Traumatic arteriovenous (AV) fistulae of the scalp are very rare.’ Only three reports on this subject are available in the literature.’-3 Such fistulae in other parts of the body have been described , but these are also rare. In the region of the head and neck, these fistulae have been noted over the dura, supplied by the middle meningeal artery ; 1,6 over the face, supplied by branches of the external carotid artery; 7,8 and in the suboccipital area, supplied by the vertebral artery.9’’° We are reporting 2 cases of traumatic AV fistulae of the scalp and their successful surgical treatment.The author describes 2 cases of traumatic arteriovenous (AV) fistulae of the scalp. In both patients the appearance of the pulsatile swelling occurred some time after the initial scalp injury. In spite of intense vascularity of the scalp, such fistulae are rare. The author describes the angiographic appearance and the complete excision of both AV fistulae.