Background: Non-traumatic spinal subdural hematoma is a rare condition that may present as a chronic subdural hematoma in rare instances and subsequently progress to an organized form. Here, we report the case of a 68-year-old woman with a history of atrial fibrillation who was receiving non-vitamin K antagonist oral anticoagulant therapy. Case Description: The patient presented with sudden-onset left-sided hemiparesis and was transferred to a local hospital. There was no evidence of ischaemic stroke on brain magnetic resonance imaging (MRI); however, intravenous tissue plasminogen activator therapy was initiated 1 h 30 min after symptom onset. The patient’s symptoms persisted despite the treatment. Subsequently, she developed persistent high-grade fever (>39°C) of unknown origin despite extensive investigations and empirical antibiotic therapy. Spinal MRI revealed an intradural lesion compressing the spinal cord at the C6–T2 level on day 22, which was a suspected spinal subdural abscess. Consequently, she was referred to our hospital, where imaging findings led to the diagnosis of a subdural hematoma. Conservative management was initially commenced; however, the persistent unexplained fever and absent neurological improvement necessitated surgical intervention on day 57. Intraoperatively, we observed thickened arachnoid membranes and organized yellowish hematomas in the subdural space, confirming the diagnosis of organized spinal chronic subdural hematoma. Postoperatively, the left-sided hemiparesis gradually improved. Therefore, she was transferred for rehabilitation 21 days post-surgery. Conclusion: In this case report, we highlighted spinal subdural hematomas, which are rare and occasionally progress to an organized chronic form. Surgical treatment is crucial to reverse neurological deficits.

Introduction: The use of synthetic materials for duraplasty has been a topic of considerable interest in neurosurgery. Synthetic grafts offer several advantages over autologous tissue, including reduced operative time, decreased morbidity, and consistent availability. Methods: This is a retrospective study and analyzed data from patients who underwent duraplasty with G-Patch at a single institute. All the patients under inclusion criteria, data were collected from the hospital records, digital and hardcopies. Inclusion Criteria were all patients who underwent surgery and dura were closed using Gpatch and availability of complete medical records and follow-up data. Results: A total of 48 patients were included in this study. Most of the patient were males 68.75% (33) and 31.25%(15) females. The mean (SD) age of the population was 32.48 (20.05) years. Almost 69% (33) had traumatic brain injury where 31% (15) had non traumatic indications for surgery. Three patients 6.25% had post operative complications. Two patients had post operative wound infection, and one patient had wound infection along dehiscence. None of the patients had seizure, bleeding seroma, CSF leak or any signs of foreign body reactions. Conclusion: G-Patch appears to be safe and biocompatible, efficient, and practical option for dural closure in both traumatic and non-traumatic neurosurgical cases.

Introduction: Childbirth poses significant physical and psychological challenges like increasing the risk of postpartum psychiatric disorders, including postpartum depression (PPD), anxiety and psychosis. Epidural analgesia (EA) is widely recognized for its efficacy in managing labor pain,its impact on maternal mental health and neonatal neurodevelopment remains uncertain. This meta-analysis evaluates the effects of EA on maternal psychiatric outcomes, including PPD, anxiety, mother-infant bonding, and autism spectrum disorder (ASD) in offspring. Methods: A systematic review of PubMed, Cochrane Library, and Scopus databases was conducted. Studies providing quantitative data on psychiatric outcomes, including odds ratios (ORs) were included. Data were analyzed using the DerSimonian and Laird random-effects model. Heterogeneity was assessed with Cochran’s Q and I² statistics, and publication bias was evaluated using funnel plots and Egger’s test. Sensitivity analyses ensured robustness. Results: This Meta-analysis included fifteen studies (n = 42,342 participants) which showed that using EA during labour reduced the risk of PPD (pooled OR: 0.56; I² = 42%) and Maternal Anxiety (pooled OR: 0.62; I² = 48%) and it also improved Mother-Infant Bonding (pooled OR: 1.45; I² = 38%). However, there was no significant association found between EA and ASD (pooled OR: 1.04; I² = 21%). Conclusion: Epidural analgesia offers notable benefits for maternal mental health, reducing PPD and anxiety while enhancing mother-infant bonding. These findings reinforce its value in labor management but highlight the need for further research on long-term effects and specific anesthetic agents.

Introduction: Spontaneous brainstem haemorrhage (SBH) is a rare but life-threatening subtype of intracerebral haemorrhage (ICH) that carries high mortality and morbidity rates. Given the brainstem's critical role in vital functions, rapid diagnosis and appropriate management are essential for improving outcomes. Objective: This systemic review aims to comprehensively analyse the definition, diagnostic modalities, and management options for spontaneous brainstem haemorrhage using evidence from studies published over the past 25 years. Methods: A systematic search of PubMed, Scopus, and Cochrane Library databases was conducted for studies published between 1999 and 2024. Inclusion criteria encompassed studies focusing on spontaneous brainstem haemorrhage, its diagnosis, and management strategies. Data were extracted, analysed, and synthesized into tables summarizing diagnostic modalities and treatment outcomes. A meta-analysis was performed where applicable. Results: Advances in neuroimaging, particularly computed tomography (CT) and magnetic resonance imaging (MRI), have significantly improved the early diagnosis of SBH. Management primarily focuses on controlling blood pressure, optimizing neurocritical care, and addressing anticoagulation. While surgical options are limited due to the brainstem's sensitive anatomy, emerging minimally invasive procedures show promise. Mortality rates remain high, ranging from 30% to 70%, with functional recovery being poor in a significant proportion of patients. Conclusion: Spontaneous brainstem haemorrhage remains a challenging neurological emergency with high mortality and poor functional outcomes. While medical management remains the cornerstone, ongoing advancements in neuroimaging and minimally invasive techniques offer hope for improved outcomes. Further research is needed to develop standardized treatment protocols and assess the efficacy of emerging therapies

After Lumbar spine surgery many of the patients improve but few develop post-operative lumbar giant pseudomeningocele causing symptomatic trouble in rare cases. In our case a 21-year-old male who was operated in other hospital for symptomatic Prolapsed lumber intervertebral Disc where microdiscectomy was done. After 5 months he developed symptomatic pseudomeningocele over the operative scar area, confirmed by clinical examination and Imaging. Due to headache and annoyable swelling in the lower back, L3-L4 Laminectomy with duroplasty with dural sealant fibrin glue with Lumbar drain was performed. His post operative period was uneventful, His giant pseudomeningocele resolved and he was discharged on 11th post-operative day.

Introduction: Dystonia is a movement disorder characterized by involuntary, sustained, and patterned muscle contractions, which cause twisting and repetitive movements. Dystonia includes various types of movement disorders such as cervical, generalized and task specific focal hand dystonia. Several potential stereotactic targets have been suggested for the treatment of dystonia such as GPi ( Globus pallidus internus) and PTT (Pallidothalamic tract) for generalized and cervical dystonia and Thalamotomy for task specific focal hand dystonia. Materials and Methods: All the patients of cervical dystonia who underwent surgical interventions in Annapurna Neurological Institute and Allied Sciences since January 2015 till December 2023 were included in our study. We performed unilateral pallidotomy or pallidothalamic tractotomy for cervical dystonia. We used ZD Fishers frame and the thermal lesioning machine of Cosman Radiofrequency (RF) generator with the lesioning electrode of 0.75 mm internal diameter and 2 mm exposed tip was used. Results: There were altogether 42 cases of cervical dystonia. Twenty nine cases had unilateral Pallidotmy and thirteen cases had unilateral pallidothalamic tract (PTT) lesioning. The mean age was 41.49 years±12 years. The male: female ratio was 3:1. The mean percentage change in BFMDRS was 70 percent (p value<0.05) in pallidotomy group and 75% (p value<0.05) in PTT lesioning group in postoperative period. Similarly there was 60 % improvement in TWSTRSs score in pallidotomy group (p value<0.05) and 70% improvement in PTT group (p value<0.05). One case had hemiparesis, three cases had transient dysarthria and one case had hypophonia. Conclusion: Lesioning surgery is rewarding for cervical dystonia. It is less time consuming and cheaper and it should not be abandoned. Both unilateral PTT lesioning or unilateral pallidotomy is equally effective in cervical dystonia. Though some recurrent cases may benefit from Deep brain stimulation (DBS) surgery we believe lesioning surgery is effective with good outcome. Conclusion:

Tremors are involuntary, rhythmic movements of one limb or a part of the human body produced by irregularly synchronous contractions of reciprocally innervated muscles. Tremors affect significantly on individual’s capability to perform tasks of daily routine and reduce their independence and quality of life. It may also affect mood, sleep, ways of thinking, and fundamental motor functions.The research team of Gwangju Institute of Science and Technology (GIST), Korea took the responsibility and crowned themselves as the pioneer in the world of modern medical sciences by inventing the SPINDLE therapy technique. Their research was published in IEEE Transactions on Neural Systems and Rehabilitation in which the Spherical Parallel Instrument for Daily Living Emulation (SPINDLE) was introduced. SPINDLE is a robotic rehabilitation device that provides resistive forces in 3-dimensional rotations. It is incorporated with a 6-axis force or torque sensor and a Virtual Reality (VR) System to enable an interactive ADL rehabilitation experience. SPINDLE sessions may also contribute valuable insights into neuroplasticity and motor learning, which could refine treatments for various neurological disorders. The promising outcomes endorse that SPINDLE can emerge as a preferred device in tremor rehabilitation programs. It is quite important to introduce new and interesting features in SPINDLE-based therapy that could be more effective and enjoyable for patients of tremors whose life is already frustrated by tremors.

Medulloblastoma is a common infratentorial malignant tumour in children. This case was previously diagnosed with infratentorial medulloblastoma and was operated and completed chemo-radiotherapy and was regular follow up. On follow up scan he had tumour in sellar and suprasellar space and he underwent surgery. Histopathological examination showed medulloblastoma.

Viral encephalitis is the infection of brain parenchyma caused by severalgroups of viruses. It can involve any age group and usually presents with the general symptoms of fever, headache, seizure, neurological deficit, or altered sensorium. However; few viruses can produce a specific group of systemic symptoms that can help to distinguish them from other causes. The two most important tools for determining the etiology of a disease are CSF examination and polymerase chain reaction (PCR). Furthermore, neuroimaging plays a critical role in diagnosing encephalitis, the direction and pattern of spread of the causative organism and the complications. In this pictorial essay, the various types of viral encephalitis are discussed along with their imaging pattern.

Introduction: Traumatic Brain Injury (TBI) is a major cause of death and disability globally affecting millions of people each year. The clinical presentation and prognosis of TBI vary widely, depending on factors such as the severity of the injury, the location of brain damage and patient’s overall health. This study is aimed for learning the clinical profile and outcome of traumatic brain injuries in our setting. Materials and Methods: This is a hospital based observational descriptive cross-sectional study conducted for a period of 18 month at Neurosurgical unit of Universal College of medical science teaching hospital, Bhairahawa. All the patients presenting in the Emergency department with TBI were enrolled in the study. Results: There were total 278 cases mostly male (76.6%) and of age group 21 to 40 yrs. Most cases were mild head injury (60 %) and 48 cases (18.2%) had some pupillary abnormalities. The most common mode of injuries were RTA followed by fall injuries and physical assault. Most of the cases underwent conservative management and 44 cases (15.8%) had undergone surgeries. Outcome of TBI at discharge in terms of GOS was 1.88 for severe TBI, 4.67 for moderate TBI and 5 for mild TBI. Mean GOS after 3 months follow up was 5 for mild, 5 for moderate TBI and 3.69 for severe TBI. Conclusion: The study provides insightful data on patients with head injuries, revealing several key trends. Functional outcome of severe head injuries according to GOS was poor at time of discharge but improved after 3 months.