Introduction: Cerebrospinal fluid evaluation is the single most important aspect of the laboratory diagnosis of meningitis. Analysis of the Cerebrospinal fluid abnormalities along with evaluation of biomarkers like Lactate dehydrogenase (LDH) and Adenosine deaminase (ADA) produced in bacterial, mycobacterial, and infections may greatly facilitate diagnosis and direct initial therapy. Methods: A prospective, descriptive cross-sectional study was done in a tertiary care hospital from 15th August-15th November, 2024 after obtaining ethical clearance. 65 patients who met the inclusion criteria and consented to participate were included in the study. Cerebrospinal fluid was collected aseptically and processed for biochemical analysis including estimation of LDH and ADA, cytology, Gram’s staining and culture using standard techniques. The data obtained were computed and analyzed using Statistical Package for Social Sciences 20.0 Version. Results: Total of 65 patients were enrolled and their Cerebrospinal fluid was analyzed, among which, 19 were diagnosed as bacterial meningitis, 7 as tubercular meningitis and 39 as viral meningitis. CSF ADA was 23.91±15.37 U/L (Mean±SD) in the tubercular meningitis group. p value of ADA was significant in tubercular meningitis when a cut off value of 10 U/L was taken. The mean LDH value in bacterial meningitis was 234.26±155.45 U/L (Mean±SD). p value of LDH in bacterial meningitis was significant. Conclusions: CSF biomarkers such as lactate dehydrogenase and adenosine deaminase are simple, rapid and effective diagnostic tools in differentiating the etiology of meningitis. Elevated CSF LDH levels are indicative of bacterial meningitis, whereas significantly increased CSF ADA levels are characteristic of tuberculous meningitis (TBM).

Introduction: This study aims to analyze the diagnostic yield of various brain biopsy techniques performed at the National Neurosurgical Referral Center (NNRC), National Academy of Medical Sciences (NAMS), Bir Hospital, Kathmandu, Nepal, to identify brain pathologies such as infections, tumors, inflammations, demyelinating diseases, and other conditions. Materials and Methods: This retrospective study reviewed 188 cases of brain biopsies conducted at NNRC over a specified period. Biopsies were performed using diverse techniques, including open free- hand biopsy, open biopsy, CT-guided biopsy, frame-based biopsy, frameless biopsy and endoscopic biopsy. Patient demographics, clinical presentations, imaging findings, biopsy techniques, and histopathological results were analyzed. Diagnostic yield was calculated as the percentage of cases where a definitive diagnosis was obtained. Results: Of the 188 cases, a diagnostic yield of 93% was achieved, highlighting the effectiveness of these biopsy techniques in diagnosing a wide range of brain pathologies. Tumors represented the most common pathology diagnosed, followed by infections, inflammatory conditions, and demyelinating diseases. The choice of biopsy technique depended on the lesion’s location, size, and clinical scenario. Advanced techniques like CT-guided and Frame-guided biopsies demonstrated high accuracy in sampling deep-seated or eloquent brain areas. Conclusion: Brain biopsy remains an invaluable tool for diagnosing diverse intracranial pathologies with a high diagnostic yield. The integration of advanced imaging and guided techniques has significantly enhanced the safety and accuracy of the procedure. This study emphasizes the need for tailored biopsy approaches based on individual clinical and radiological profiles to maximize diagnostic outcomes. Further research and technological advancements are recommended to improve diagnostic efficacy and reduce complications.

Lumbar radiculopathy is a common clinical pathology with a lifetime incidence ranging from 13% to 40% and is associated with significant morbidity and socioeconomic burden. In cases where conservative therapy fails, discectomy is the standard surgical care for prolapsed intervertebral disc. There are various methods to remove the disc materials viz open discectomy, microscopic discectomy, transforaminal endoscopic discectomy, Percutaneous Endoscopic Lumbar Discectomy (PLED) or Unilateral biportal endoscopic discectomy (UBED). Surgical techniques of most of these methods are abundant in literature. However, there are few technical details on UBE. In this paper, we outline key technical steps to guide surgeons in performing UBE effectively. The technique described here represents one possible method among many, rather than a definitive protocol.

Brain aneurysms incidence is rare in children. Out of all intracranial aneurysms, posterior cerebral artery aneurysms (PCA) represent approximately 1% of all intracranial aneurysms Pediatric cerebral aneurysms are associated with a variety of systemic and intracranial disorders. We have reported a rare case of a giant thrombosed aneurysm arising from the P-2 segment of the right PCA in a 30-month-old child who presented to us. This case report was undertaken to understand the clinical presentation and radiological features of the PCA segment aneurysm in a pediatric age group so that it be early diagnosed and can be early managed to prevent pediatric mortality.

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Analysis of spontaneous EEG activity is an essential method in evaluation of patients with impaired consciousness in both acute care and chronic settings. It continues to be the only method that allows the bedside monitoring of both immediate and longterm cortical functioning associated with the conscious or unconscious state.We report two cases of encephalopathy with periodic discharges in chronic kidney disease patients;

Introduction: Decompressive craniectomies are among the most common procedures in neurosurgery, performed for conditions such as stroke or trauma. Patients who survive the initial insult require cranioplasty to cover the defect initially created to decrease intra cranial pressure. This study explores the common indication, types and potential complications of cranioplasty. Methodology: A retrospective descriptive study was performed at a tertiary neurosurgical referral hospital. It included all patients who underwent cranioplasty over a five-year period. Data was collected on the demographics, type of cranioplasty, indication and complications. It was tabulated and studied using Microsoft excel. Results: Total of 162 patients (67.5%) underwent cranioplasty out of 240 decompressive craniectomies. The patients ranged in age from 12 to 72 years, with twice as many men undergoing cranioplasty compared to women. The most common indication were craniectomies for trauma, followed by ischemic stroke. Acrylic cranioplasty was performed in 110 patients, autologous in 39 and titanium in 4 patients. Infection was the most common complication, occurring in 2.5% of cases, followed by seizure in 1.2%. Conclusion: Cranioplasty is a common and generally safe procedure for patient who have undergone craniectomies for various conditions. The most frequent complications are infections and seizures.

Introduction: Post traumatic hydrocephalus is one of significant complication post DC.PTH has significant morbidity and mortality. In this study we study prognostic and etiologic factors of PTH with outcome analysis. Materials and Methods: This prospective study includes 103 patients who underwent DC after TBI between august 22 and November 22 2022 at UPUMS Saifai Hospital and were still alive at 6-month follow-up. It was prospective cohort study. Various etiological factors and demographic factors correlated with outcome. Results: In this study total 103 patients studied among them 21 devloped PTH who undergone vp shunt. Low Glasgow Coma Scale (GCS) score, post DC meningitis, and intraventricular hemorrhage (IVH)and SAH were significant predictors for the development of PTH after DC. PTH patients showed impeded recovery or low-pressure hydrocephalus symptoms, of whom 9 experienced subjective clinical improvement after shunt treatment. TWO DC patients received a shunt due to subdural hygromas of whom one improved following treatment. Four patients were vegetative with concurrent ventriculomegaly and these patients did not have any positive shunt response. Altogether, 11 PTH patients improved after shunt surgery. Conclusion: Post-traumatic ventriculomegaly was common, but few developed symptomatic PTH and received a VP-shunt. Patients with low-pressure hydrocephalus symptoms had the best shunt response, whereas patients with suspected vegetative state exhibited a minimal shunt response.

Evidence-based medicine (EBM) emphasizes the systematic and judicious use of the best available evidence in clinical decision-making aligning treatment options with individual patients’ values and circumstances. It integrates clinical expertise, patient preferences, and research evidence to optimize patient care. By adopting EBM principles, clinicians improve care quality, ensure ethical decision-making, and adapt to the evolving landscape of medical science. This dynamic paradigm advances patient outcomes while providing a compassionate and evidence-driven healthcare environment. However, challenges such as information overload, resource constraints, and variations in evidence quality necessitate continuous learning and systematic approaches. This article explores the historical evolution of EBM, its foundational principles, and the structured five-step process: Assess, Ask, Acquire, Appraise, and Apply.

Introduction Cervical spine injury is a common occurrence in trauma patients. Materials and Methods This is a descriptive cross sectional study performed over a period of 6 months in Province Hospital, Surkhet. This study describes the incidence, presentation, management of cervical spine injury in Province Hospital Surkhet over a 6 month period. Results A total of 29 patients with cervical spine injury were admitted in Province Hospital, Surkhet over a 6 month period. Most commonly injuries occurred in the second and third decades with male predominance. Diagnosis was done using computed tomography and magnetic resonance imaging. Ten cases underwent surgery and the other cases were managed conservatively. Conclusion Cervical spine injury is a common presentation after trauma. It can be dealt with efficiently if a protocol based management is done.