Brain CT Scan Research Articles

Potential candidacy for thrombolysis among ischemic stroke patients presenting to Khyber Teaching Hospital, Peshawar.

To determine the number of ischemic stroke patients presenting to a tertiary care hospital that are potential candidates for thrombolysis. This need analysis study was conducted on one hundred consecutive ischemic stroke patients during the last quarter of 2022 at the Department of Medicine, Khyber Teaching Hospital, Peshawar. The Arrival National Institute of Health Stroke Scale (NIH Stroke Scale) was calculated for all suspected stroke patients after a detailed history and clinical examination. An urgent non-contrast-enhanced CT scan brain was carried out. Patients were included in the study group after intra-cranial bleed was excluded on imaging. The majority (43%) of the patients (male and female) fell in the age group 51-60 years. Fifty-nine (59%) patients had hypertension as a co-morbid condition; 49% had diabetes mellitus while the remaining percentages were constituted by other risk factors. Fifty-seven (57%) patients presented with NIH Stroke Scale between 5-15; 25% had NIH Stroke Scale greater than or equal to 21. Forty-one (41%) patients having daytime (8 am to 8 pm) strokes presented within 4.5 hours of stroke onset to the hospital while 31% of patients having nighttime strokes (8 pm to 8 am) presented within 4.5 hours of stroke onset to the hospital. The majority (72%) of ischemic stroke patients reached the hospital facility within 4.5 hours of stroke onset. These patients can be benefited from thrombolysis leading to improved outcomes if available in that particular health facility.

Clinical Insights into Internuclear Ophthalmoplegia: A Case Report

Background: Internuclear ophthalmoplegia (INO) is a rare neuro-ophthalmological disorder characterized by impaired horizontal eye movement coordination due to lesion in the medial longitudinal fasciculus. INO commonly results from demyelinating diseases, vascular lesions, or structural brain abnormalities.
 Case presentation: A 60-year-old male patient presented with diplopia for the past 4 days. He had history of hypertension and diabetes mellitus and “mild” stroke for past years. Clinical examination revealed normal primary gaze, limited medial movement of the left eye, and diplopia in all gaze positions. Hess screen examination demonstrated underaction of the left medial rectus muscle and overaction of the right lateral rectus muscle. The laboratory results an elevated blood sugar level. Brain CT scan revealed multiple infarcts in the right parietal and cerebellar lobes and left parieto-occipital lobe, with evidence of brain atrophy. The patient was diagnosed with INO. Management involved addressing the underlying systemic diseases, namely diabetes and hypertension, in collaboration with internist and neurologist. The patient also received citicoline therapy and underwent regular follow-up. In the third-month follow-up, the patient demonstrated significant improvement, with reduction in diplopia and enhancement in left eye medial movement.
 Conclusion: This case report highlights the importance of considering INO in patients presenting with diplopia and a history of vascular risk factors. Timely diagnosis and comprehensive management with regular follow-up is crucial to monitor the progress and enhance the patient's quality of life.

A Review of the Clinical Significance of Lumbar Puncture in the Diagnostic Approach of Aneurysmal Subarachnoid Hemorrhage (SAH): A Case Report of CT-Negative and Lumbar Puncture–Positive SAH

Headaches are a common presentation in the emergency department (ED). Even though not all are potentially serious, some such as subarachnoid hemorrhage (SAH) can be more dangerous than others. SAH is a medical emergency with an almost 50% mortality rate. It is crucial not to miss the diagnosis of SAH, as a missed or delayed diagnosis can be severely detrimental. It classically presents as thunderclap headache, a severe, sudden-onset headache. There are various approaches in diagnosing or excluding SAH, which is classically done by performing a computed tomography (CT) scan followed by a lumbar puncture (LP). But with the improved sensitivity of more modern diagnostic tools, more physicians are in support of changing this classical teaching. The aim of this case report is to review the advantages and disadvantages of LP in diagnosing SAH, along with other diagnostic tools commonly used. Keywords: subarachnoid hemorrhage, lumbar puncture, cerebrospinal fluid, aneurysmal subarachnoid hemorrhage, brain ct scan, brain ct angiography, brain mr angiography

PAEDIATRIC-09 DIAGNOSIS AND MANAGEMENT OF PEDIATRIC BRAIN TUMORS IN SUB-SAHARAN AFRICA; A CASE STUDY OF UGANDA

Abstract BACKGROUND Pediatric brain tumors are the commonest solid tumors in children and the 2nd commonest childhood cancer globally. In Sub-Saharan Africa, there is paucity of data on their diagnosis and management. OBJECTIVES To describe the presentation, investigations done, treatment modalities and outcome of pediatric patients with brain tumors seen at Mulago National Referral Hospital in Uganda from May 2019 to March 2023. METHODS A retrospective study was conducted in Mulago National Referral Hospital, pediatric oncology unit, in patients below 18 years of age, admitted with a radiological finding of a brain tumor from May 2019 to March 2023. RESULTS The total number of children treated for a brain tumor in this period was 121.Majority (69 /121 (57 %)) of patients were males. The commonest symptom at presentation was headache (42%). Brain Ct-Scans were done in all, and majority (52%) had infratentorial tumors. The commonest diagnosis was glioma (38%), craniopharyngioma (26%), medulloblastoma (11%). Fifty-two patients had surgical resection and a histological diagnosis. Ten percent of patients had no diagnosis. Only 24(20%) patients received radiotherapy. Twenty patients received chemotherapy. Sixty-six are still alive and attending clinical reviews. The overall one-year survival was 63% (95%CI (50.3.0-73.4). CONCLUSION Gliomas were the commonest diagnosed pediatric brain tumor at the Mulago National Referral Hospital, pediatric oncology unit.

Correlation Between the Degree of Midline Shift in Computed Tomography Scan of Brain and Level of Consciousness of the Patients with Acute Spontaneous Intracerebral Haemorrhage

Background: Intracerebral hemorrhage (ICH) is the second most common cause of stroke, following ischemic stroke, but accounts for a disproportionate amount of cerebrovascular mortality and morbidity. The extent of midline shift, observed on computed tomography (CT) scans, has been recognized as an important radiological finding associated with the severity of ICH. Objective: To evaluate correlation between the degree of midline shift in computed tomography scan of brain and level of consciousness of the patients with acute spontaneous intracerebral haemorrhage. Material and method: This cross-sectional study was carried out in 100 patients, out of this 50 had spontaneous intracerebral hemorrhage with mass effect and 50 had spontaneous intracerebral hemorrhage without mass effect taken as the control group, the age range from 30-75 years. These patients were purposively collected from the Department of Radiology and Imaging in collaboration with Department of Medicine, Neuromedicine and Neurosurgery of Dhaka Medical College Hospital, Dhaka. All the patients were evaluated by CT findings. On admission Glasgow Coma Scale (GCS) score were recorded from participant’s treatment sheet and reviewed by the senior Neurologist after taking permission of the authority. Results: This study shows there is significant inversely correlation of the GSC score with degree of midline shift measure using septum pellucidum shift (P<0.05). The GCS score of <10 mm of septum pellucidum shift compared to greater than 10 mm of septum pellucidum shift is significantly different (P<0.05). The GCS score of SICH with mass effect compared to the GCS score of SICH without mass effect is significantly different (P<0.05). Conclusion: Radiologist should carefully and elaborately interpret the spontaneous intracerebral hemorrhage with midline shift at CT-scan brain and help clinicians to evaluate the level of consciousness which is significant predictor of outcome of our valuable patients. Sir Salimullah Med Coll J 2023; 31: 94-99

OTHER-07 NEUROSURGICAL ONCOLOGY CAPACITY IN KENYA: RESULTS FROM A NATIONWIDE SURVEY OF CONSULTANTS AND RESIDENTS.

Abstract Neurosurgical oncology services (NOS) in Kenya have grown in tandem with resident training programs yet little is known objectively on current capacity and challenges. A 37-item electronic survey was distributed to neurosurgical consultants and residents practicing in Kenya. Among 49 respondents [27 consultants (69% national response rate), 22 residents; median age of 36 – 40; 51% practice < 5 years], 100% and 88% had access to CT scan and MRI brain respectively. 57% performed more than 40 cranial tumor surgeries annually and 48/49 (98%) perform oncology cases on a “regular basis”. Radiotherapy, chemotherapy, and pathology are performed within the respondents’ institutions in 63%, 65% and 61% of surveys, while the rest are sent out. 45 (96%) utilize an operating microscope, and 8 (17%) have an ultrasonic aspirator. Palliative care services are available for 45 (92%). 41 (84%) “agree” or “strongly agree” that delays in referrals between specialties are a major challenge to practice. 38 (78%) “agree” or “strongly agree” that treatment abandonment is also a major challenge. 49% participate in a tumor registry however major barriers to conducting research included lack of funding and protected research time. Having a mentor is perceived as the greatest facilitator for conducting research. No respondents enrolled any patient in a clinical oncology trial during the past year yet nearly every neurosurgeon performs oncology cases and 60% of Kenyan neurosurgeons carry a major tumor case load, in contrast to countries where elective spine surgery predominates neurosurgical practice. Clinical trial enrolment remains uncharted in Kenyan neurosurgery and more than 2/3 of Kenyan counties lack NOS. This survey highlights progress in availability of neurosurgical oncology services while identifying that containing treatment cost, reducing referral delays, and embedding clinical research in clinical practice through mentorship can be NOS growth catalysts.

To study clinical profile and correlation of EEG and CT findings in diagnosis of focal seizures in children at medical institution in mid – Karnataka region

Focal-onset seizures account for approximately 40% of seizures in children. Focal seizures are most commonly associated with underlying brain pathology in extreme age groups. Clinical correlation and localizing the site of the lesion play an important role in the early diagnosis and proper management of focal seizures in children. Objectives: To study the clinical profile and correlation of EEG and CT findings in children admitted to the paediatric ward of Medical College.A prospective study on the correlation of focal seizures, CT brain, and EEG studies was carried out in children in the age group of 1 month–14 years admitted to the Department of Pediatrics at Medical College & Hospital, Karnataka. Among the (n=50) study subjects, the majority of the children with focal seizures were in the age group of 6–10 years, with a slight male preponderance.(n=22) (44% of the children) presented with focal-aware seizures. The most common brain lesions detected were calcified disc lesions and cysticercosis ring lesions (52%).45% of children with focal seizures had epileptiform discharges. We also observed that complementary to CT brain scans in correlating with the clinical history. It was noted that44% of children with focal seizures had normal CT brain scans and normal EEG studies. A good clinical history is crucial in the diagnosis of focal seizures. Most focal seizures are associated with underlying organic brain lesions. A CT brain scan plays an important role in the detection of brain lesions in children with focal seizures. The EEG study complements history and CT scan of the brain in defining and correlating the lesions precisely.

Idiopathic Normal Pressure Hydrocephalus: The Real Social and Economic Burden of a Possibly Enormous Underdiagnosis Problem.

Normal Pressure Hydrocephalus (iNPH) typically affects the elderly and can cause cognitive decline, resulting in its differential diagnosis with other neurodegenerative conditions. Moreover, it is probably underdiagnosed; such under- and misdiagnosis prevents the patient from receiving the right treatment and significantly affects the quality of life and life expectancy. This investigation is an in-depth analysis of the actual incidence of iNPH in the population of the province served by our hospital (circa 580,000 individuals). The first phase of this study was conducted by visualizing a total of 1232 brain CT scans performed in the Emergency Departments of the four hospitals of our network on patients who were admitted for different complaints yet screened as suspicious for iNPH. Subsequently, corresponding Emergency Department medical records were investigated to understand the medical history of each patient in search of elements attributable to an alteration of CSF dynamics. The cohort of positive CT scans, according to the radiological and clinical inclusion criteria, included 192 patients. Among the reasons to require acute medical care, "Fall" was the most common. The cumulative incidence of CT scans suggestive of iNPH among the patients undergoing CT scans was as high as 15.58%, and the period prevalence calculated for the total amount of patients accessing the Emergency Departments was 1.084%. The real incidence of iNPH in the population may be underestimated, and the social burden linked to the assistance of patients suffering from such untreated conditions could be significantly relieved.

Cardiac angiosarcoma: Clinical image

A 45-year-old male patient was admitted to hospital for a reported episode of tachycardia and chest pain followed by loss of consciousness. History of COPD in active smoking, drug abuse. Upon admission, a brain CT scan was performed resulting negative and a chest x-ray showed the presence of bilateral basal micronodules, for which a chest CT scan with contrast medium was performed. This examination showed “gross endoluminal thrombotic protrusion originating from the lateral wall of the right atrium with nonhomogenous peripheral impregnation of the contrast medium infiltrating the myocardium and adjacent pericardium” as well as multiple pulmonary nodular lesions with random distribution, angiocentric.

CT imaging of ventriculitis: Lessons learned

This concerns a 12-year-old female patient with a history of spina bifida for which she underwent a ventriculoperitoneal shunt at the age of 4 months. She presented to the emergency department with febrile altered consciousness associated with neck stiffness. A brain CT scan was ordered which revealed:

Prenatal features of aneurysm of the posterior cerebral artery: a case report

BackgroundFetal cerebral aneurysm other than aneurysm of vein of Galen aneurysmal malformation (VGAM) is extremely rare. This report describes prenatal features of aneurysm of the posterior cerebral artery (APCA) with rapid progression and its natural intrauterine course of the disease, which has never been reported.Case presentationThis is the first report of prenatal features of APCA, detected at 34–36 weeks of gestation, simulating choroid plexus cyst or arachnoid cyst. The diagnosis was based on color flow ultrasound with tracing along the course of cerebral arteries. Also, rendered 3D color flow ultrasound was helpful in demonstrating course of the vessels feeding the aneurysm and supporting the diagnosis. The aneurysm showed nature of rapidly progressive changes, leading to leakage resulting in intracerebral and intraventricular hemorrhage as well as high output state associated with anemia. Prenatal diagnosis and management are very challenging. This case ended up with planned delivery at 37 weeks, giving birth to a surviving male newborn, weighing 2600 g. The neonatal CT brain scans and CTA confirmed the prenatal findings. The prognosis was relatively poor because of extensive intracerebral hemorrhage with severe hydrocephalus and brain midline shift. The couple opted for neonatal palliative care without neurosurgical correction.ConclusionThis study demonstrate that the most important tool for prenatal diagnosis is color Doppler ultrasound, which will demonstrate turbulent blood flow. Three-dimension color Doppler ultrasound is helpful in supporting the diagnosis. The case presented here suggests that the disease has a natural course of rapid progression and massive brain destruction or high output congestive heart failure can be expected.

Satisfactory Improvement in Lifestyle of a Spastic Quadriplegic Cerebral Palsy Patient through Cranial Surgery

Several treatment options may help improve daily functioning in children with cerebral palsy (CP). However, these treatments cannot prevent early death or enable them to lead independent life without support. CP is a progressive disease, and even in its milder form, conditions such as Parkinson's disease, epilepsy, and stroke may develop even after 25 years. A new era of curable treatment has emerged for CP, utilizing bilateral cranioplasty and duraplasty (Tanfarid Procedure). This case report describes a successful case where this procedure was employed. During the surgery, after the removal of cranial bones through craniotomy, the absence of dural pulsation was observed, indicating elevated intracranial pressure. After duraplasty, normal brain pulsation was observed, indicating that intracranial pressure had normalized. In patients with CP, premature closure of sutures and thickening of skull bones lead to a reduced intracranial volume, which hinders proper brain growth and eventually results in brain atrophy, widened Sylvian issures, and widened sulci accompanied by the loss of brain parenchymal tissue. These findings were also evident in the patient's brain CT scan. In this case, cranioplasty and duraplasty provided adequate space for the brain to grow . The treatment of CP patients typically involves a multidisciplinary approach, which can be expensive. However, the procedure utilized in this case is affordable for economically disadvantaged individuals in this country. While a second cranial surgery may be required in some cases, the expenses associated with it are significantly lower compared to a lifetime of physiotherapy and other supportive treatments. Additionally, the outcomes are very promising.KYAMC Journal Vol. 14, No. 02, July 2023: 105-108.

Vascular Hemiballismus Due to Extraluysian Lesions

Hemiballismus represents a rare variety of hyperkinetic movement disorders that can complicate early-stage stroke. It is classically seen in contralateral Luysian lesions. We present the case of a 63-year-old hypertensive patient consulted for the sudden onset of involuntary movements. The neurological examination revealed right hemiballismus. Brain CT scan showed lacunar images of the internal capsule and left subthalamic muscles. The integrity of the subthalamic nucleus (STN) was confirmed by brain magnetic resonance image. The etiological assessment concluded that it was paroxysmal atrial fibrillation. The evolution was favorable after treatment with haloperidol. Hemiballismus represents less than 7% of movement disorders. It is usually linked to a vascular lesion of the contralateral STN. Extraluysian involvement remains rare.

Analisis Nilai CTDIvol Dan DLP Pada Pemeriksaan CT Scan Brain Non Kontras Dewasa Untuk Periode Januari – Desember 2022 Di Instalasi Radiologi Rumah Sakit X Jakarta Pusat

Background: CT scans are used for various types of examinations such as examinations of the head, thorax, abdomen and so on. The most frequently performed CT scan is a CT scan of the head. However, in the medical field, especially radiology, CT scans have the highest dose compared to other radiation equipment. Efforts to reduce radiation doses and radiation effects are by estimating the correct dose given to CT Scan patients using an optimization index called DRL (Diagnostic Level Reference), namely by evaluating the values ​​of CTDIvol and DLP on CT scans of the head, which have been determined in accordance with BAPETEN/I-DRL 2021 standards.
 Method: This research is a descriptive quantitative study with an observational approach which aims to analyze CTDIvol and DLP values ​​based on retrospective data on non-contrast brain CT scans at the Radiology Installation at Hospital X, Central Jakarta.
 Results: Calculation of the 2nd quartile (50th percentile) value of CTDIvol and DLP in Adult Non-Contrast Brain CT Scan examinations for the January-December 2022 Period at the Radiology Installation at X Hospital, Central Jakarta is CTDIvol 55.51 mGy and DLP 867.00 mGy* cm.
 Conclusion: The 50 percentile value of CTDIvol and DLP in the Adult Non-Contrast Brain CT Scan examination for the January-December 2022 period at the Radiology Installation at X Hospital, Central Jakarta is in accordance with the standards set by BAPETEN/I-DRL 2021. Where is the value for CT Non-Contrast Head Scan, namely a CTDIvol value of 60 mGy and a DLP value of 1275 mGy*cm.

Assessment of Evan’s Index in North-Western Nigeria using Computerised Tomography

Aim: To determine the Evan’s Index of Nigerians using computerized tomography in Sokoto North-Western Nigeria.
 Study Design: Retrospective cross- sectional.
 Place and duration of study: Department of Anatomy Usmanu Danfodiyo University Sokoto and Department of Radiology Usmanu Danfodiyo University Teaching Hospital Sokoto, between January, 2020 and January, 2022.
 Methodology: Normal brain CT scans of one hundred and seventy-eight subjects from the Radiology Department of the Usmanu Danfodiyo University Teaching Hospital, whose ages ranged from 1 to 70 year. The Evans index was determined by the ratio of the measured distance between the tips of the frontal horns of lateral ventricles and the inner skull tables at the midpoint of the cranium in axial plane.
 Results: The Evan’s indexes were larger in male than the females and these differences were not statically significant except in the age group 51-60years where statistically significant difference was observed between male and female (p=0.042). The minimum Evan’s index was 0.02cm in male and 0.01 females and the maximum bi-frontal index was 0.40cm in male and 0.38cm in females.
 Conclusion: The Evan’s indexes and it relation with sex and age in our environment was determined.

THU234 An Adolescent Patient With Asymptomatic Hypocalcemia And Extensive Cerebral Calcification Due To Pseudohypoparathyroidism Type 1B: A Care Report

Abstract Disclosure: R. Alemzadeh: None. J.D. Ross: None. D. Guillen-Mendoza: None. Background: Pseudohypoparathyroidism (PHP) is a heterogeneous group of disorders due to renal resistance to parathyroid hormone (PTH) resulting in biochemical hypoparathyroidism but with skeletal sensitivity to PTH. Case Presentation: A 15-year-old African American male was incidentally found to have biochemical evidence of severe hypocalcemia during routine evaluation of his bilateral slipped capital-femoral epiphyses. The patient was at age-appropriate stage of puberty with normal height and without any features of hereditary osteodystrophy. However, he had history of mild developmental delay requiring school accommodations. On physical exam, there was some mild dyscoordination with finger and toe-tapping and a Myerson’s sign, negative tetany signs. The biochemical screening revealed markedly low serum calcium (4.9 mg/dL) with elevated phosphorus (7.8 mg/dL) and PTH (1314 pg/mL) levels. His hypocalcemia was accentuated by the presence of severe 25 hydroxy-vitamin D deficiency (7.5 ng/mL) with mild hypomagnesemia (1.4 mg/dL). He had normal renal and thyroid function tests with normal growth factors. There were minimal plasma cyclic AMP responses to a single dose of intravenous teriparatide (Ellsworth-Howard test) consistent with diagnosis of pseudohypoparathyroidism. The skeletal survey showed bowing and under-tubulation of the radius, ulna, tibia, and fibula as well as slipped capital femoral epiphysis bilaterally. His brain CT scan showed symmetrical severe dense calcifications in the basal ganglia, bilateral frontal, parietal and temporal subcortical white matter, pons and right dentate nucleus. Genetic testing did not reveal any GNAS mutations. The patient was initially treated with parenteral calcium followed by high-dose oral calcium supplements and calcitriol. His coexisting hypovitaminosis D and hypomagnesemia were corrected with oral high-dose cholecalciferol and magnesium sulfate, respectively. Conclusions: An incidental finding of severe asymptomatic hypocalcemia and elevated PTH without hereditary osteodystrophy phenotype raised the clinical suspicion of pseudohypoparathyroidism type 1B. This was associated with cerebral calcifications with increasing risk of worsening learning disabilities and minimal neurological findings. Presentation: Thursday, June 15, 2023

Association of Serum Homocysteine Level with Acute Ischaemic Stroke among Young Adult Patients: Experience at a Largest Medical College Hospital in Bangladesh

Background: Hyperhomocysteinemia is emerging as a possible risk factor for stroke, possibly because of accelerated atherosclerosis. Objectives: This study was conducted to evaluate the association between the serum homocysteine level and ischemic stroke in young Bangladeshi patients. Methodology: This cross-sectional study was carried out among patients 18 to 40 years of either gender with sign and symptoms of acute focal neurological deficit, in the Department of Medicine of Dhaka Medical College Hospital, Dhaka, from January 2015 to December 2015. History taking and physical examination were done in a predesigned data collection sheet. Then required investigations like CT-scan of brain, fasting serum homocysteine, fasting blood sugar, 2 hours ABF blood glucose, HbA1c and fasting lipid profile were done. Results: Out of 96 patients after completing brain imaging 61(65.0%) patients were found suffering from ischemic stroke. Among the patients 74 had normal homocysteine level, 17 patients had moderate hyperhomocysteinemia and 5 patients had intermediate hyperhomocysteinemia. Mean levels of fasting serum homocysteine were significantly higher in patients those had ischemic stroke (16.02 μmol/L, 95% CI: 12.87 to 19.87) compared with those who did not have ischemic stroke (10.47 μmol/L, 95% CI: 9.16 to 11.95, P<0.001). Logistic regression showed fasting homocysteine as an important independent risk factor, with an adjusted OR of 1.1 (95% CI: 1.1 to 1.2; p=0.04966) for every 1 μmol/L increase in homocysteine. Conclusion: The relationship between increasing homocysteine and ischemic stroke risk is strong, graded, and significant. Journal of National Institute of Neurosciences Bangladesh, January 2023;9(1):24-29

End to end vision transformer architecture for brain stroke assessment based on multi-slice classification and localization using computed tomography.

Brain stroke is a leading cause of disability and death worldwide, and early diagnosis and treatment are critical to improving patient outcomes. Current stroke diagnosis methods are subjective and prone to errors, as radiologists rely on manual selection of the most important CT slice. This highlights the need for more accurate and reliable automated brain stroke diagnosis and localization methods to improve patient outcomes. In this study, we aimed to enhance the vision transformer architecture for the multi-slice classification of CT scans of each patient into three categories, including Normal, Infarction, Hemorrhage, and patient-wise stroke localization, based on end-to-end vision transformer architecture. This framework can provide an automated, objective, and consistent approach to stroke diagnosis and localization, enabling personalized treatment plans based on the location and extent of the stroke. We modified the Vision Transformer (ViT) in combination with neural network layers for the multi-slice classification of brain CT scans of each patient into normal, infarction, and hemorrhage classes. For stroke localization, we used the ViT architecture and convolutional neural network layers to detect stroke and localize it by bounding boxes for infarction and hemorrhage regions in a patient-wise manner based on multi slices. Our proposed framework achieved an overall accuracy of 87.51% in classifying brain CT scan slices and showed high precision in localizing the stroke patient-wise. Our results demonstrate the potential of our method for accurate and reliable stroke diagnosis and localization. Our study enhanced ViT architecture for automated stroke diagnosis and localization using brain CT scans, which could have significant implications for stroke management and treatment. The use of deep learning algorithms can provide a more objective and consistent approach to stroke diagnosis and potentially enable personalized treatment plans based on the location and extent of the stroke. Further studies are needed to validate our method on larger and more diverse datasets and to explore its clinical utility in real-world settings.

Frequency and Outcome of Traumatic Subarachnoid Hemorrhage in patients presenting with Traumatic Brain Injury at Tertiary Care Hospital, Karachi

Aim: To determine the frequency and outcome of traumatic subarachnoid hemorrhage (tSAH) in patients presenting with traumatic brain injury. Method: A cross-sectional study was conducted at the Department of Neurosurgery, JPMC, Karachi from August 2021 to July 2022. Patients presenting with traumatic brain injury at the Department of Neurosurgery, JPMC, Karachi were enrolled in this study. A brief history of demographic information, duration, and mode of head injury was taken at the time of admission. CT scan brain was performed and interpreted.The findings of quantitative and qualitative variables (gender, smoking status, diabetes mellitus (DM) type II, hypertension, associated brain injuries, mode of head injury, tSAH, and good outcome) were recorded in the performance. Results: A total of 267 patients were enrolled in the study. The majority of the patients were aged between 21-48 years. Around 197(73.8%) patients were male and 75(28.1%) were female. The cause of traumatic brain injury was found to be road traffic accidents in 157(58.8%) individuals. The Glasgow coma scale (GCS) at presentation was 3-8 in (33.70%) of patients, 9 -13 in (43.07%) of patients, and 14-15 in (23.22%) of patients. At the time of discharge, GCS was 14-15 in (40.07%), 9-13 in (25.09%) patients, 3-8 in 23.59%, and 11.23% of patients died. It was found that both age (p=0.003), gender (p=0.002), and other brain injuries (p=0.0001) were significantly associated with the outcome. Conclusion: The present study revealed the outcome of traumatic subarachnoid hemorrhage (tSAH) in the majority of the patients was unfavorable. Age, diabetes mellitus, smoking, and other associated brain injuries were significantly related to unfavorable outcomes in the study. Keywords: Traumatic subarachnoid hemorrhage, traumatic brain injury, GCS, neurosurgery

Frequency of Atrial Fibrillation in Patients of Ischemic Stroke Presenting in Emergency

Background: Stroke also known as cerebrovascular accident is sudden onset of neurological deficit due to vascular injury. About 87% of strokes are ischemic, the rest being hemorrhagic. Atrial fibrillation is an arrhythmia in which there is irregularly irregular heart beat which can lead to thrombus formation and then cardioembolic stroke. Objective: The study objective was to determine the frequency of atrial fibrillation in patients of ischemic stroke presenting in Emergency Department of the Hospital and its associations. Study Design: Retrospective observational study. Settings: Department of ???, DHQ Hospital Narowal Pakistan. Duration: Record of patients presented at DHQ Hospital Narowal form 03-03-2022 to 03-03-2023 reviewed. Methods: After taking ethical approval from head of the institution (Ref No. 451/PA-MS, dated 03-03-2023) medical record of patients presented with focal neurological deficit at DHQ Hospital Narowal during this period was reviewed.134 patients who fulfilled the inclusion criteria were included in the study. Information regarding their demographic data was noted in the performa. Record of CT Scan brain plain or report of CT brain and ECG findings were noted. Results: Amongst 134 participants, the mean age of participants was noted to be 52.93 ± 16.82 years. There were 44.8% male patients while remaining were females. Hypertension was present in 67.2% patients while 51.5% of patients were smoker. Atrial fibrillation was present in 37.3% patients. By using chi-square test, significant association was observed between presence of atrial fibrillation and gender, different age groups and smoking with p-value < 0.005. There was no significant association observed between atrial fibrillation and hypertension having p-value >0.05. Conclusion: Atrial fibrillation was present in 37.3% patients of ischemic stroke presenting in Emergency Department of the Hospital. Effect modifiers have significant effect except hypertension on the presence of atrial fibrillation.