Brain CT Scan Research Articles

Prognostic Value of the Brain CT-Scan in Head Trauma in Yaounde Central Hospital

Prognostic Value of the Brain CT-Scan in Head Trauma in Yaounde Central Hospital

Outcome of Depressed Cranial Fracture: A single centre Experience of 490 Cases with short literature Review

Introduction: Depressed cranial fractures (DCFs) are one of the serious head injuries where road traffic accident (RTA) is the most common cause. So, we have assessed the outcome in surgically managed cases of depressed cranial fracture following head injury and study the factors which may affect the surgical outcome of patients. Materials and methods: A retrospective assessment of 490 consecutive cases was undertaken who went surgery for depressed cranial fracture (DCF) in Department of Neurosurgery, Neuro-Cardio and Multispecialty Hospital, Biratnagar, Nepal, from January 2011 to December 2021. All age groups (except< 1 year) were included in this study and diagnosis confirmed by CT scan of brain with bone window. Outcome was assessed by Glasgow outcome scale. Results: The incidence of depressed cranial fracture was highest in road traffic accident (RTA) and in the age group of 20-40 years. There was predominance of male over female with ratio 5.53:1. There was a significant correlation between age, mode of injury, fracture site, GCS at admission and intracranial bleed with outcome. Similarly, the complications such as CSF leakage, seizure were significant association with outcome. Of all 490 cases, most of them were operated within 5 hour with overall mortality rate of 0.40%. Conclusions: Our study concluded that patient who underwent surgery for DCFs, with GCS >13 at the time of admission, age <40 year and no hospital delay (<5hour) had better outcomes. Incidence of RTAs was noted comparatively higher rate in age 20-40 year, which can help us to find out best strategic management option.

A case-control study on the driving factors of childhood brain volume loss: What pediatricians must explore.

The brain volume loss also known as brain atrophy is increasingly observed among children in the course of performing neuroimaging using CT scan and MRI brains. While severe forms of brain volume loss are frequently associated with neurocognitive changes due to effects on thought processing speed, reasoning and memory of children that eventually alter their general personality, most clinicians embark themselves in managing the neurological manifestations of brain atrophy in childhood and less is known regarding the offending factors responsible for developing pre-senile brain atrophy. It was therefore the goal of this study to explore the factors that drive the occurrence of childhood brain volume under the guidance of brain CT scan quantitative evaluation. This study was a case-control study involving 168 subjects with brain atrophy who were compared with 168 age and gender matched control subjects with normal brains on CT scan under the age of 18 years. All the children with brain CT scan were subjected to an intense review of their birth and medical history including laboratory investigation reports. Results showed significant and influential risk factors for brain atrophy in varying trends among children including age between 14-17(OR = 1.1), male gender (OR = 1.9), birth outside facility (OR = 0.99), immaturity (OR = 1.04), malnutrition (OR = 0.97), head trauma (OR = 1.02), maternal alcoholism (OR = 1.0), antiepileptic drugs & convulsive disorders (OR = 1.0), radiation injury (OR = 1.06), space occupying lesions and ICP (OR = 1.01) and birth injury/asphyxia (OR = 1.02). Pathological reduction of brain volume in childhood exhibits a steady trend with the increase in pediatric age, with space occupying lesions & intracranial pressure being the most profound causes of brain atrophy.

Study of Relationship between Location of Ventricular Catheter Tip and Function of the Ventriculoperitoneal (VP) Shunt in Hydrocephalus in Children

Objective: To determine the relationship between location of the ventricular catheter tip and functional status of the ventriculo-peritoneal (VP) shunt in children. Methods: This prospective observational study was conducted in Faculty of Paediatric Surgery under the Department of Paediatric Neurosurgery in Bangladesh Shishu Hospital and Institute (BSH&I) from January 2017 to December 2021. The study included 140 patients who underwent ventriculo-peritoneal shunt using free hand technique. Data obtained for each patient included age, sex, diagnosis including site and side of ventricular catheter placement. Postoperative CT scan of brain were done in all cases and followed up over 2½ to 4½ years. Sixty-three patients were available for follow up. The relationship of location of ventricular catheter tip and function of the ventriculo-peritoneal shunt was analyzed in all 63 patients. Results: Number of the patients included in the study was 140. Accuracy of ventricular catheter tip placement were 55(39.28%) using freehand technique. VP shunts function well in 43(68.25%) patients. Among the 43 patients with well-functioning shunts, 19 were in accurate group, 7 were in suboptimal group and 17 were in inaccurate group. Twenty-six (41.27%) patients had good outcome with normal development. Conclusion: Mechanical malfunction and infection are the most significant problems associated with VP shunts for the treatment of hydrocephalus. A significant proportion of shunt failure is due to inaccurate placement of the ventricular catheter tip. Accurate placement of the catheter tip is highly important to reduce the incidence of shunt malfunction.

Text Analysis of Radiology Reports with Signs of Intracranial Hemorrhage on Brain CT Scans Using the Decision Tree Algorithm.

The initial data is a download from the Unified Radiological Information Service of the Unified Medical Information and Analytical System (URIS UMIAS) containing 34,188 studies obtained by a non-contrast CT of the brain in 56 inpatient medical settings. Data analysis and preprocessing were carried out using NLTK (Natural Language Toolkit, version 3.6.5), a library for symbolic and statistical processing of natural language, and scikit-learn, a machine learning library containing tools for classification tasks. According to 14 selected ICH-related key words, as well as 33 stop-phrases with key words denoting absence of ICH, an automatic selection of the CT investigations and their subsequent expert verification were carried out. Two classes of investigations were formed based on the sample from 3980 protocol descriptions: containing descriptions of ICH and without them. The problem of binary classification was solved using the decision tree algorithm as a model. To evaluate the performance of the model, the CT investigations were divided randomly into samples in the ratio of 7:3. Of 3980 protocols, 2786 were assigned to the training data set, 1194 - to the test one. According to the test results, the designed and trained algorithm in the binary classification of the CT reports "with signs of ICH" and "without signs of ICH" has shown sensitivity of 0.94, specificity of 0.88, F-score of 0.83. The developed and trained algorithm for the analysis of radiology reports has demonstrated high accuracy in relation to brain CT with signs of intracranial hemorrhage and can be used to solve binary classification problems and create appropriate data sets. However, it is limited by the need for manual revision of CT studies to ensure quality control.

Midline Shift as a Predictor of Outcome in Head Trauma Patients managed Conservatively

Objective: To evaluate the role of the degree of midline shift on CT scans in predicting clinical outcomes in traumatic brain injury (TBI).
 Materials and Methods: A prospective observational study was conducted at the Department of Neurosurgery of a tertiary care hospital. We included 148 patients. After fulfilling the inclusion criteria, the patient’s baseline data, including the patient's age, gender, and CT scan findings with the degree of midline shift, was noted. The patients were monitored for three months to evaluate the outcome. The collected data was analyzed using SPSS version 22.0.
 Results: Our study showed that 105 (70.9%) patients showed satisfactory outcomes while 43 (29.1%) showed unsatisfactory outcomes. Patients with no midline shift were 70, out of which 55 (78.6%) showed satisfactory outcomes. Similarly, patients with 1-2 mm midline shifts showed satisfactory outcomes in 39 (69.6%) while 3-5 mm midline shifts showed 11 (50%) satisfactory outcomes. In our study, the degree of brain midline shift on CT scan was a statistically significant outcome factor (p = 0.035).
 Conclusion: Patients with TBI who had an increasing degree of midline shift on brain CT scans had considerably worse clinical outcomes.
 Keywords: Midline shift, CT scan, Glasgow Coma Score, Head Injury.

Uremic Encephalopathy.

HomeRadiologyVol. 307, No. 1 PreviousNext Reviews and CommentaryFree AccessImages in RadiologyUremic EncephalopathyDavid A. Lizarazo , Jairo LizarazoDavid A. Lizarazo , Jairo LizarazoAuthor AffiliationsFrom the Department of Diagnostic Imaging, Fundación Santa Fe de Bogotá, Universidad El Bosque, Ave 116 No. 9-02, Bogotá 110246, Colombia (D.A.L.); and Department of Internal Medicine, Hospital Universitario Erasmo Meoz, Universidad de Pamplona, Cúcuta, Colombia (J.L.).Address correspondence to D.A.L. (email: [email protected]).David A. Lizarazo Jairo LizarazoPublished Online:Dec 20 2022https://doi.org/10.1148/radiol.221602MoreSectionsPDF ToolsImage ViewerAdd to favoritesCiteTrack CitationsPermissionsReprints ShareShare onFacebookTwitterLinked In A 54-year-old man was admitted for a 3-day history of dysarthria, hand tremors, hypokinesia, and generalized muscle rigidity. His past medical history included diabetes mellitus and end-stage renal disease on hemodialysis. On admission, there were elevated blood urea nitrogen and creatinine levels with a metabolic acidosis. Axial CT scan of the brain showed symmetrical hypoattenuation of both basal ganglia (Figure). Noncontrast brain T2-weighted MRI demonstrated symmetrical high signal intensity in the basal ganglia surrounded by a more hyperintense rim delineating the lentiform nucleus (Figure). This is the lentiform fork sign, wherein the internal and external capsules and the medullary laminae become hyperintense with axial T2-weighted images (Figure). After correction of the metabolic acidosis with prompt dialysis and glycemic control, the neurologic examination returned to normal, and his symptoms completely resolved. A follow-up MRI examination was not performed.Images in a 54-year-old man who presented with a 3-day evolution of dysarthria, hand tremors, hypokinesia, and generalized muscle rigidity. He had diabetes mellitus and end-stage renal disease and was undergoing hemodialysis. Laboratory tests showed azotemia and metabolic acidosis. (A) Axial CT scan of brain shows symmetrical hypoattenuation in the bilateral basal ganglia. (B) Axial T2-weighted fluid-attenuated inversion recovery noncontrast brain MRI scan demonstrates bilateral symmetrical swollen lentiform nuclei with a hyperintense rim delineating the lentiform nucleus with a typical fork-like appearance representing the “lentiform fork sign.” (C) Schematic drawing shows the “lentiform fork sign.” At follow-up after correction of metabolic acidosis with prompt dialysis and glycaemic control, the neurologic examination was normal, and symptoms completely resolved. Follow-up scan was not performed. EC = external capsule, IC = internal capsule, LME = external medullary lamina, LMI = internal medullary lamina, TS = the stem.Download as PowerPointOpen in Image Viewer Uremic encephalopathy is a neurologic complication resulting from endogenous uremic toxins in patients with severe renal failure. The pathogenesis is complex and unclear (1). The lentiform fork sign (Figure) is attributed to metabolic acidosis in patients with diabetes and renal failure with a history of incomplete dialysis leading to reversible basal ganglia and adjacent white matter injury (2). The edematous external capsule represents the lateral arm of the fork, with both the external and internal capsule joining to build the stem of the fork. Edema of the medial lentiform margin forms the medial arm, which splits into two along the medullary laminae to envelop the globus pallidus (3). The lentiform fork sign is nonspecific for uremic encephalopathy. Differential diagnosis of pathologic conditions manifesting with this sign includes severe metabolic acidosis, ketoacidosis, dialysis disequilibrium syndrome, and intoxication (ie, methanol, ethylene glycol); this can also be drug induced (ie, metformin) (4).Disclosures of conflicts of interest: D.A.L. No relevant relationships. J.L. No relevant relationships.

Diagnostic Accuracy of Recognition of Stroke in Emergency Room Score in Patients with Ischemic Stroke

To determine the diagnostic accuracy of ROSIER scale in patients with ischemic stroke taking non-enhanced CT scan brain as gold standard. Materials and Methods: Cross-sectional study conducted at tertiary care hospital in Gujrat from October 2019 to December 2020. Patients of both sex groups aged 30- 75 years presented in emergency within 24 hours of onset of focal neurological deficit which is objectively present and suspected of ischemic stroke. 289 patients were included. Patient history and neurological examination done calculating ROSIER scale and ischemic stroke diagnosed after CT scan brain done 24 hours after onset of symptoms. Sensitivity, specificity, PPV, NPV and diagnostic accuracy of ROSIER scale were calculated. Data analysis was done using SPSS 20.0. Results: In this study group 141(48.8%) were male while 148(51.2%) were female. Mean age was 62.1+11.02 years. 49(17%) patients were aged <50 years while 240(83%) were aged >50 years. 215(74.4%) presented within 12 hours while 74(25.6%) after 12 hours of symptoms onset. Sensitivity of ROSIER scale for diagnosing ischemic stroke was 98.86%(95%CI;95.96%-99.86%), specificity 5.31%(95%CI;1.97%-11.20%), PPV 61.92%(95% CI;60.82%-63.01%) and NPV was 75%(95%CI;38.13%-93.59%). LR+ was 1.04(95%CI; 1.00-1.09) while LR- was 0.21(95%CI; 0.04-1.04). Conclusion: ROSIER score can be used as initial screening test in patients with stroke. It has high sensitivity but low specificity and is a good test to rule in and rule out stroke patients.

Evaluation of image quality, organ doses, effective dose, and cancer risk from pediatric brain CT scans

purposeThe present study was conducted to assess organ doses, effective dose, and image quality, and to estimate the risk of exposure-induced cancer death (REID) in pediatric brain computed tomography examinations. MethodsThis investigation was performed on 179 pediatric patients (99 men and 80 women) under 12 years old who underwent non-contrast brain CT scans. Patients were classified into four age groups of ≤ 1, 2–5, 6–9, and 10–12 years old. Organ doses and effective doses were calculated using the ImpactDose program. Cancer risk models presented in the BEIR VII report were used to estimate REID values. Image quality assessment in this study was performed by measuring image quality parameters such as noise, signal-to-noise ratio (SNR), and contrast-to-noise ratio (CNR). ResultsThe highest organ dose in all age groups belonged to the brain. The mean REID values were 12.34 per 100,000 males and 16.77 per 100,000 females. REID values decreased with the increasing age of patients in both genders and were higher for female children than male children. The mean SNR of gray matter, SNR of white matter, and CNR were 11.04, 10.5, and 2.31, respectively. ConclusionsAccording to the results of this study, brain CT scans in children are associated with an increased potential risk of cancer. Therefore, minimizing unnecessary radiation exposure in pediatric patients and using alternative imaging modalities are of particular importance. Moreover, optimizing the radiation parameters while maintaining the diagnostic image quality in children should be considered.

285 BIVENTRICULAR TAKO-TSUBOSYNDROME ASSOCIATED WITH SYNCOPE AND UNCONSCIOUSNESS

Abstract A 58-years old woman came to the emergency department due to syncope; she had been found lying on the ground in her residence. At the admission the patient was unconscious but had preserved blood pressure 120/80 mmHg. CT brain scan was negative for hemorrhage. Admission ECG showed a 52 b/m sinus bradycardia, elevated antero-septal ST segment and prolonged QT interval. Diagnosis of antero-septal STEMI was made and a coronary angiogram performed via right femoral access showed mild atheromasia in the absence of angiographically significant lesions. Bedside echocardiogram showed severe left ventricular dysfunction (LVEF 35%) with akinesia of apical and mid-ventricular segments. The right ventricle presented a marked hypocontractility of the apical region and a preserved kinetics of the basal portion (TAPSE 22 mm). There was also a moderate mitral regurgitation and a mild tricuspid regurgitation with a sPAP of 50 mmHg (40+10). On blood sampling, high-sensitivity troponin was slightly elevated (3950 pg/ml) and marked hyponatriemia (117 mmol/l) and slight hypokalemia (3.1 mmol/l) were noted. The echocardiogram on the third day showed an improvement in global and segmental kinetics of left ventricle with an estimated EF of 45% and persistence of a mild hypocontractility of the apex of right ventricle. During her hospital stay, her cognitive state gradually improved and she remained asymptomatic without evidence of arrhythmic events on monitoring. The ECG evolved on days with normalization of the ST-T tract, negative T wave in the anterior region and prolonged QTc interval. The pre-discharge echocardiogram showed a recovery of biventricular kinetics with an estimated EF of 50%. The presence of a transient abnormality in biventricular wall motion beyond a single epicardial coronary artery perfusion territory with new electrocardiographic change met the diagnostic criteria of Tako-tsubo Syndrome defined by Mayo Clinic criteria. The electrocardiogram on the day of discharge showed a 55 b/m sinus bradycardia with a negative T wave from V1 to V4. Tako-tsubo syndrome (TTS) is an acute and reversible left ventricular dysfunction that improves spontaneously within days or weeks and is often preceded by emotional or physical stress. Biventricular involvement in TTS is typically identified on imaging studies such as echocardiography and MRI. TTS with RV involvement is associated with a higher rate of in-hospital mortality and long-term adverse clinical events than isolated LV TTS. In our clinical case, biventricular involvement was associated with a severe clinical presentation (syncope and unconsciousness). This case shows that biventricular Tako-tsubo is a clinical scenario that requires intensive care monitoring and strict cardiological evaluation.

MORPHOMETRIC STUDY OF THE FRONTAL HORN OF LATERAL VENTRICLES OF BRAIN BY IMAGING USING COMPUTERIZED TOMOGRAPHY

Introduction The cerebral ventricular system consists of a series of interconnecting spaces and channels which originate from the central lumen of the embryonic neural tube. The ventricular system lled with cerebrospinal uid, is an essential part of the brain. Understanding the normal anatomy and the variations of the ventricular system of brain is helpful for clinicians, neurosurgeons and radiologists in day-to-day clinical practice1. Aims And Objectives To determine the average dimensions and variations of the frontal horn of the normal lateral ventricles of brain by CT scan. Materials And Methods The study was conducted in individuals who attended the Department of Radiodiagnosis in Government Medical College, Thiruvananthapuram. Those patients whose brain CT scans were read as normal by the radiologist were taken up for the study. A total of 200 CT brain of individuals above 10 years of age were taken during the period from January 2017 to June 2018.100 males and 100 females were included in the study group. Results The length of the frontal horn of lateral ventricle of brain was found to be more on the left side and in male gender. It was also observed to be increasing with age. Conclusion The present study outlines the normal values of the length of frontal horn of the lateral ventricles of brain using Computerized tomography which would aid in the diagnosis and management of neurological disorders.

277 THE OLDEST CLINICAL SIGN IN ONE OF THE MOST RECENTLY DISCOVERED SYNDROMES: A CASE REPORT ON DIGITAL CLUBBING AND BRUGADA SYNDROME IN A YOUNG MALE

Abstract A 21-year-old male arrived by ambulance in the Emergency Department following a syncopal episode with head trauma to the ground. The patient denied similar episodes in the past. He only reported a history of myoclonus and tics in childhood, limited to involuntary eye movements, treated in the past with valproic acid. In the last period, he was not taking any drugs at home. Physical examination revealed no heart, lung, or abdominal alterations, but the presence of bilateral hand fingers clubbing. The electrocardiogram showed: sinus tachycardia (107 bpm), normal atrioventricular conduction, incomplete right bundle branch block, and ST-T segment elevation in the right precordial derivations. Routine blood samples showed mild neutrophilic leukocytosis, while the high sensitivity troponin was normal. Neurological examination revealed repetitive, stereotyped ocular movements indicative of tics without other alterations responsible for the syncopal episode. Subsequently, the patient underwent a brain CT scan with a contrast medium, which excluded acute brain hemorrhages. Therefore, a cardiological consultation was requested. The trans-thoracic echocardiogram showed regular chamber dimensions and preserved biventricular functions. Also, no valve alterations or pericardial effusion were present. Considering EKG alterations and no neurological disease explaining the actual clinical picture, the cardiologists decided to hospitalize the patient to the Cardiology ward for further assessments. Because of digital clubbing, a chest-X ray and global spirometry were performed to exclude a respiratory disease but resulted in the normal range. In addition, in the suspicion of Brugada syndrome, the patient underwent a test with the infusion of Ajmaline, a sodium-channel blocking, class-1A antiarrhythmic agent. The drug was infused into a vein in about 5 minutes, observing the EKG trace constantly up to 10 minutes after administration to highlight possible changes. Within a few minutes, a type-1 Brugada syndrome pattern appeared, characterized by the morphological alterations of the QRS in V1-V2, with an elevation of the J point and an ST-segment elevation with a negative T wave. According to the ESC Guidelines, in consideration of the syncopal episode and the type-1 induced Brugada pattern, the implantation of a subcutaneous implantable defibrillator for the primary prevention of arrhythmias was performed. Lastly, a genetic evaluation was performed before hospital discharge, to identify which genetic alteration was responsible for Brugada syndrome and obtain more information regarding the possible link with digital clubbing, still not available. In the patient described in the present case report, no cause of classical disease associated with digital clubbing was present. To the best of our knowledge, the present is the first case report describing the association between digital clubbing and Brugada syndrome. It is possible that signaling pathways, such as PDGF, VEGF and HPGD, often involved in the release of fibrogenic and growth cytokines in the pathogenesis of digital clubbing may be also present in Brugada syndrome. However, further observations are needed to understand better the possible association between these two conditions. In particular, it should be clarified if patients with digital clubbing need a proper screening for Brugada Syndrome and if the presence of digital clubbing in a patient with a diagnosis of Brugada syndrome represents a marker of a more severe disease.

Risk factors of intracerebral hemorrhage- a cross sectional study

BACKGROUND:
 Stroke is the most common cause of disability and a leading cause of mortality worldwide. Though the incidence is falling in West but probably rising in Asia. The burden of stroke risk factors in Pakistan is enormous. Data on stroke incidence and prevalence from Pakistan is scarce; however, there are several reported case series in literature highlighting significant differences in terms of stroke epidemiology, risk factors and stroke subtypes/patterns. METHODS: This descriptive cross sectional study was conducted from August 2019 to February 2020, on 109 patients from medical units of DHQ Teaching Hospital Abbottabad. Diagnosis of cerebrovascular accidents was made on focal neurological deficit lasting more than 24 hours. CT scan brain was done in all patients to detect intra cerebral bleed. Detailed history and medical records were carefully scrutinized in the patients of intracerebral bleed to detect factors leading to it like uncontrolled hypertension. Fasting blood glucose, fasting serum cholesterol and fasting triglycerides were done to detect uncontrolled diabetes and hyperlipidemia. Data was collected on a structured proforma and analysed using SPSS 20. RESULTS: Majority of the patients were 39.81%(n=41) >70 years of age, 71 (68.93%) were male and 32 (31.07%) female, frequency of intracerebral bleed among patients presenting with acute cerebrovascular accidents was recorded in 8.74%(n=9), among them 66.67%(n=6) had history of uncontrolled hypertension, 44.44%(n=4) had diabetes and 33.33%(n=3) had hyperlipidemia.
 CONCLUSIONS: Frequency of intracerebral bleed is higher among patients presenting with cerebrovascular accidents, hypertension is recorded the most common risk factor for this complication.

EVALUATION OF NORMAL VALUES OF EVANS INDEX IN SOUTH KERALA POPULATION USING COMPUTERIZED TOMOGRAPHY OF BRAIN

Introduction In the adult human brain, there are four connected ventricles - two lateral ventricles within the cerebrum, a midline third ventricle between the right and left thalami, and a midline fourth ventricle lying between the cerebellum posteriorly and the pons and medulla anteriorly1. Evans index is the ratio of the maximum width of the anterior horn of the lateral ventricle to the maximum transverse diameter of the inner table of the skull. A clear understanding of the normal values of Evans index and variations of the ventricular system of brain is useful for clinicians, radiologists and neurosurgeons in their daily clinical practice2. To determine Aims And Objectives the normal values of Evans index using Computerized tomography of brain in South Kerala population. The study was conducted in indi Materials And Methods viduals who attended the Department of Radiodiagnosis in Government Medical College, Thiruvananthapuram. Those patients whose brain CT scans were read as normal by the radiologist were taken up for the study, during the period from January 2019 to June 2020. A total of 200 CT brain of individuals above 10 years of age were taken.100 males and 100 females were included in the study group. Results The mean Evans index in the study was found to be 0.258±0.05 in males, 0.255±0.03 in females and an overall mean of 0.256±0.04 was calculated. Conclusion The present study shows that Evans index was more in individuals who were above 60 years in both males and females. Knowledge of Evans index will help in the diagnosis of idiopathic normal pressure hydrocephalus and in the assessment of outcome of patients with ventriculoperitoneal shunt placement.

Transient global amnesia associated with acute bacterial endocarditis; A case report

Introduction: Transient global amnesia (TGA) is a sudden loss of memory without definite etiology. Some cardiac conditions like myocardial infarction, mitral valve prolapse, takotsubo syndrome, and arrhythmias have been described in the literature as offenders. To our knowledge, there is no report of an association between TGA and endocarditis or even septicemia.Case presentation: The patient was a 52-year-old man with a history of hypertension and aortic valve surgery which was presented to the emergency department with TGA. On brain CT scan and MRI there was not any pathological finding and EEG revealed normal features without any epileptiform discharge. During evaluations, the diagnosis of acute bacterial endocarditis has been established by the presence of positive blood culture and vegetation on the aortic valve in trans-esophageal echocardiography. At 6 months follow-up, and after receiving appropriate antibiotic therapy and cardiac surgery, he was symptom-free.Conclusion: Association between TGA and cardiovascular disorders like myocardial infarction and takotsubo syndrome has been described. Neurological complications occur in about one-fourth of patients with infective endocarditis, but there is not any report of the association between TGA and acute bacterial endocarditis. Cardiovascular disorder studies are just limited to case reports without any clarification of mechanism and pathophysiology.

A COMPARATIVE STUDY OF LIPID PROFILE AND ECG CHANGES IN ISCHEMIC AND HAEMORRHAGIC STROKE

Objective The study was done to compare the risk factors, lipid prole, and ECG changes in patients of ischemic and haemorrhagic stroke. Methodology All patients clinically and radiologically diagnosed to be ischemic or haemorrhagic stroke, detailed history, clinical examination, ECG, CT scan brain and routine blood investigation was done on arrival.MRI brain was done when required. Repeat CT scan brain and clinical evaluationwas done after 24 hours to look for complications or improvements, as well as ECG was repeated to look for development of any further changes and comparison was made. Results Out of 80 patients, 34(42.5%) suffered from Haemorrhagic stroke and 46(57.5%) suffered from ischemic stroke. Out of 34 patients who suffered from haemorrhagic stroke 25 had history of hypertension, 22 had history of diabetes, 20 had history of smoking, 12 had history of stroke, 22 had history of alcohol intake, 8 was found to have obesity, and 12 had sedentary lifestyle. Out of 46 ischemic stroke patients, 44 had history of hypertension, 34 had history of diabetes, 24 had history of smoking, 18 had history of stroke, 22 had history of alcohol intake, 9 were obese, and 23 had sedentary lifestyle. Lipid prole was found to be elevated in both type of stroke, however, total cholesterol and LDL were more in ischemic comparatively, while HDL and triglyceride was higher in haemorrhagic. ECG changes were seen in 52.5% of the patients and were more common in haemorrhagic stroke. Conclusion It was seen that the risk factors such as older age, hypertension, diabetes, dyslipidemia, sedentary lifestyles favoured ischemic stroke and smoking, alcohol, obesity favoured haemorrhagic stroke. Higher cholesterol and LDLlevels favoured ischemic more than haemorrhagic stroke. ECG changes were more common in haemorrhagic stroke

Frequency Of Hydrocephalus In Preoperative Patients Of Myelomeningocele

Objective: To find out the frequency of hydrocephalus in preoperative patients of lumbosacral myelomeningocele.Place of study: Department of Pediatric Neurosurgery, The Children's Hospital, and the Institute of child health, Multan.Study design: Descriptive cross-sectional studyDuration of study: March 2020 to April 2021.Methodology: A total of 139 patients with lumbosacral myelomeningocele were included in the study. Myelomeningocele patients were diagnosed using MRI images which revealed herniation of a meningeal lined sac having a spinal cord and nerve roots through the defect and the herniated sac was filled with cerebrospinal fluid. (hyperintense on T2 weighed images) The pressure of neural tissue in myelomeningocele patients was assessed by ultrasonography and MRI of the Spine. Associated hydrocephalus was diagnosed with an MRI brain plain and CT scan. Data were analyzed using SPSS.21. Quantitative variables including age and gender were analyzed by mean and standard deviation. The presence or absence of hydrocephalus was analyzed by frequency and percentages.Results: The mean age of the patients was 6.392 + 3.517 months, the minimum age was 0.5 months and the maximum age limit was 12 months. Out of 139 patients, 76 (54.7%) were males while 63 (45.3%) were females. Out of 139 patients, 121 (87.5%) had hydrocephalus, while 18 (12.5%) did not have hydrocephalus.Conclusion: There is a high frequency of hydrocephalus in patients with myelomeningocele.

Convulsioni e gastroenterite: un caso che insegna

The article reports a case of convulsions with gastroenteritis (CWG) and briefly reviews the related literature. A 2-year-old girl presented with four short episodes of focal afebrile seizures within 12 hours. She had fever with vomiting in the previous 2 days and she developed diarrhoea during her hospital stay, after the fifth seizure. She had no significant past medical history and showed neither neurological signs nor signs of dehydration. Serum electrolytes were normal, cerebrospinal fluid examination was negative for meningoencephalitis and contrast-enhanced CT Brain scan showed no evidence of intracranial lesion. Stool investigation was positive for rotavirus. Therefore, the diagnosis of CWG was made. Repeated convulsions were handled with continuous intravenous infusion of midazolam. The main cause of CWGs in viral gastroenteritis is due to rotavirus or norovirus. The convulsions are usually focal seizure clusters, with secondary generalization. CWGs are associated with a benign prognosis.

Posterior fossa epidural hematoma: A 6-year management experience.

Through this study, we sought to evaluate the management of posterior fossa extradural hematoma (PFEDH). An observational study was conducted at the Neurosurgery Department of Lady Reading Hospital in Peshawar from January 2015 to December 2020. All patients who had a traumatic acute extradural hematoma (EDH) of the posterior fossa were included, irrespective of age and gender. The clinical predictors and outcomes were assessed, including the CT-scan findings and Glasgow Coma Scale (GCS) score. A total of 104 cases with posterior fossa extradural hematoma were identified from 1252 extradural hematoma patients admitted during the study period. The mean age of the enrolled patients was 18.17 ± 14.31 years. Most of the patients were male (65.39%) and belonged to the pediatric age group, i.e., < 15 years (60.6%). CT scan brain was done in all the cases for diagnosis. In 68.3% of cases, an associated occipital bone fracture was observed. Surgery was done in almost 71.2% of cases, and most of the patients experienced good recovery after surgery, as indicated by the GOS score. Linear regression model revealed that treatment (β=-0.20, p=0.038), time duration between surgery and trauma (β=0.43, p=0.000) and GCS category (β=-0.47, p=0.000) were significantly associated with PFEDH outcomes. In conclusion, PFEDH was frequent among males and the pediatric age group. Serial CT brain is highly recommended in all suspected cases for early diagnosis.

A Prospective Study On Ventriculoperitoneal Shunt Surgery Complications In Tertiary Care Hospital

Background and Aim: Hydrocephalus is defined as enlargement in ventricles size due to the increase in cerebrospinal fluid volume. Impaired cerebrospinal fluids in terms of absorption and pathways obstruction or subarachnoid spaces are the different causes for hydrocephalus. Ventriculoperitoneal shunt is the most prevalent performed treatment modality on elective or emergency basis for hydrocephalus in neurosurgery. However, this treatment modality is apprehended due to its various complications. There is paucity of data regarding ventriculoperitoneal shunt surgery complications. The present study aimed to evaluate the ventriculoperitoneal shunt complications in a tertiary care hospital.&#x0D; Methodology: This prospective study was conducted on 96 hydrocephalus patients who underwent ventriculoperitoneal shunt in the Department of Neurosurgery, Lady Reading Hospital, Peshawar from January 2020 to December 2021. Hospital research and ethical committee approved the study protocol and written informed consent was obtained from each patient. Hydrocephalus patients of either gender without age discrimination who underwent first ventriculoperitoneal shunts were enrolled. Patients who underwent external ventricular drain, lumboperitoneal shunts, shunts revision, and ventriculoatrial shunts were excluded. Detailed history, clinical inspections, and full investigations such as cerebrospinal fluid, C-reactive protein (CRP), X-rays examinations, full blood count (FBC), brain CT scans and abdomen pelvis ultrasound has been carried out in all eligible patients. Post-surgery routine follow-up was scheduled one and six months after discharge. SPSS version 25 was used for data analysis.&#x0D; Results: Of the total 96 hydrocephalus patients, there were 63 (66%) male and 33 (34%) females. Patient’s age-wise distribution was as follows: Age&lt; 1 year 36 (37.5%), 1-10 years 28 (29.2%), 11-20 years 22 (22.9%), 21-30 years 7 (7.3%), and 31-40 years 3 (3.1%). The incidence of ventriculoperitoneal shunt surgery complications such as shunt blockage, infection, shunt erosion, and extrusion was 44 (45.8%), 34 (35.4%), 16 (16.7%), and 9 (9.4%) respectively. The mortality rate was 3.1% due to the complications of ventriculoperitoneal shunt surgery. Brain tumors was the most prevalent cause of hydrocephalus in 37 (38.5%) followed by Post-meningitis 21 (21.9%), encephaloceles 11 (11.5%), Cerebellar hematoma 10 (10.4%), Intraventricular hemorrhage 6 (6.3%), Aqueduct stenosis 4 (4.2%), Neurocysticercosis 2 (2.1%) and others 2 (2.1%). &#x0D; Conclusion: Our study concluded that the most prevalent ventriculoperitoneal shunt surgery complications were shunt blockage and shunt infection. Brain tumors were the common cause of hydrocephalus followed by post-meningitis and encephaloceles. Shunt upper end is more susceptible to complications than the lower end. The overall mortality rate was 3.1%. These complications might leads to server clinical issues that results patient’s death.