Brain CT Scan Research Articles

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.

Glossopharyngeal neurinoma of incidental finding in a 65-year-old female patient: case report

BackgroundThe glossopharyngeal nerve is both a sensitive and motor entity that emerges from the posterior lateral sulcus of the bulb and exits the skull through the jugular foramen. Schwannomas arising from glossopharyngeal nerves are extremely rare, and the clinical and imaging features of glossopharyngeal schwannomas closely resemble that of acoustic schwannomas.Case presentationWe report a case of a 65-year-old female patient with glossopharyngeal neurinoma of incidental finding on brain CT scan requested after she sustained a minor traumatic brain injury. She was taken to the operating room, and the tumor was excised endoscopically via a retrosigmoid approach and the postoperative course was simple and uneventful. Histopathology of the sample showed short spindle-shaped cells with poor atypia proliferated in fascicles, and shelf-like arrangement of nuclei was seen partially, which was in keeping with a neurinoma.ConclusionsGlossopharyngeal neurinoma may not present with obvious symptoms and signs related to its compression and may also be found incidentally compared to its counterpart vestibular schwannoma.

Case study of Guillain-Barré syndrome with acute flaccid paralysis

Guillain-Barre syndrome (GBS) is a sudden and a complicated degenerative neurological disorder which can be acute or chronic in nature. Etiology remains unclear, but pathophysiology shows demyelination of spinal nerve roots characterised by symmetrical limb weakness and muscle stiffness. Death is rare. Early diagnosis and prompt treatment should occur in severe cases. Here we discuss a rare case of GBS as paraesthesia and acute flaccid paralysis. This case report focuses on a 9-year-old male patient presenting with c/o progressive muscle weakness and paraesthesia in the lower extremities. The clinical examination revealed bilateral lower limb weakness, absent deep tendon reflexes, and diminished vibration sense, acute flaccid paralysis. Diagnostic evaluations of CT scan of brain and spine and other preliminary tests confirmed the diagnosis of GBS by demonstrating characteristic findings of demyelinating polyneuropathy and elevated protein levels without pleocytosis, respectively. Prompt initiation of intravenous immunoglobulin therapy and supportive measures, such as physical therapy, were implemented. Over a four-week period, the patient showed progressive improvement in muscle strength, starting from the slight movement in fingers and toes. This case report underscores the importance of accurate diagnosis, and timely initiation of appropriate treatment strategies in managing GBS, highlighting the efficacy of intravenous immunoglobulin therapy as a first-line intervention for GBS patients.

Clinical decision rules in predicting computed tomography scan findings and need for neurosurgical intervention in mild traumatic brain injury: a prospective observational study.

In this study, we will compare the diagnostic values of head CT decision rules in predicting the findings of CT scans in a prospective multicenter study in university emergency departments in Iran. The primary outcome was any traumatic lesion findings in brain CT scans, and the secondary outcomes were death, the need for mechanical ventilation, and neurosurgical intervention. Decision rules including the Canadian CT Head Rule (CCHR), New Orleans Criteria (NOC), National Institute for Health and Clinical Excellence (NICE), National Emergency X-Radiography Utilization Study (NEXUS), and Neurotraumatology Committee of the World Federation of Neurosurgical Societies (NCWFNS) were compared for the main outcomes. In total, 434 mild TBI patients were enrolled in the study. The NCWFNS had the highest sensitivity (91.14%) and the lowest specificity (39.42%) for predicting abnormal finding in CT scan compared to other models. While the NICE obtained the lowest sensitivity (79.75%), it was associated with the highest specificity (66.67%). All model performances were improved when administered to predict neurosurgical intervention among patients with GCS 13-15. NEXUS (AUC 0.862, 95% CI 0.799-0.924) and NCWFNS (AUC 0.813, 95% CI 0.723-0.903) had the best performance among all evaluated models. The NCWFNS and the NEXUS decision rules performed better than the CCHR and NICE guidelines for predicting any lesion in the CT imaging and neurosurgical intervention among patients with mTBI with GCS 13-15. For a subset of mTBI patients with GCS 15, the NOC criteria havehigher sensitivity for abnormal CT imaging, but lower specificity and more requested CTs.

Giant Hydatic Cyst in a 2-Year-Old Infant

Background: Infantile cerebral hydatidosis is a serious infection and represents a major problem of public health that threatens the economy of countries in which it is endemic. It imposes a large-scale prophylaxis based on the interruption of the parasite cycle. Case description: We present a case of a 2-year-old girl with no medical history living in a rural region (Sidi Ifni), where contact with dogs, sheep, and cattle is not uncommon. One month before her admission, increased intracranial pressure (ICP) symptoms appeared made of headaches, vomiting, and visual disturbances. 15 days later, motor deficits and impaired consciousness were installed. The clinical examination found a sleepy infant with a Glascow Coma Scale at 14, left hemiparesis at 2/5 (Medical Research Council score), and bilateral 6th nerve palsy, A brain CT scan was performed, showing a round hypodense intraparenchymal lesion at the right frontal lobe. The intervention was performed to remove the gliant hydatic cyst according to the Dowling-Orlando technique. Postoperatively the patient had no motor deficit. The histopathological exam confirmed the diagnosis of an echinococcus granulosis cyst. Conclusion: Presentation of such a giant cyst in a 2-year-old infant is very rare. In such cases, genotype analysis of the parasite should be performed. The surveillance of dogs and periodic testing of their stools, with treatment if they are found to be infected, and preventing their access to raw offal at slaughterhouses and farms, will be effective in controlling the menace of hydatidosis.

Informasi Anatomi dan Dosis Radiasi pada MSCT Brain Pediatric Menggunakan Adaptive Statistical Iterative Reconstruction (ASiR)-V

Background: Multislice CT Scan (MSCT) brain examination in pediatric cases should pay attention to the lowest possible dose but still provide optimal anatomical information. Pediatric has a higher risk of developing cancer compared to adults who receive the same dose. The purpose of this study is to obtain the optimal value of the use of the Adaptive Statistical Iterative Reconstruction (ASIR)-V technique with variations in tube current strength and Iterative Reconstruction value which is implemented in pediatric patients under the age of 5 (five) years. Methods: This research was experimental with brain image samples of pediatric patients at the Radiology Installation of RSUD dr. Moewardi Surakarta. The variations of the tube currents selected were 80, 100, and 165 mA with a combination of AR20, AR40, AR60, and AR80 variations. Anatomical information processed descriptively sourced from the assessment of 3 (three) radiologists who were experienced in assessing MSCT images. Meanwhile, the effect of tube current variation on radiation dose was tested using linear regression. Results: The results showed differences in anatomical information between the combinations of 165 mA-AR60 and 165 mA-AR80 "very clear", 165 mA-AR20 "clear", 80 mA-AR20 "fairly clear" and 100 mA-AR80 "less clear". There was an effect of strong variation of tube current on radiation dose with a regression coefficient value of 0.690. The estimated effective doses of the three tube current values were still below the national Dose Reference Level (DRL). Conclusions: It was concluded that there were differences in anatomical information on the MSCT brain pediatric examination with variations in tube current and ASiR-V, there was an effect of variations in mA on radiation dose and mA values and the optimal value of the combination of techniques studied is 80 mA and 20% Iterative Reconstruction.

Impact of e-ASPECTS software on the performance of physicians compared to a consensus ground truth: a multi-reader, multi-case study.

The Alberta Stroke Program Early CT Score (ASPECTS) is used to quantify the extent of injury to the brain following acute ischemic stroke (AIS) and to inform treatment decisions. The e-ASPECTS software uses artificial intelligence methods to automatically process non-contrast CT (NCCT) brain scans from patients with AIS affecting the middle cerebral artery (MCA) territory and generate an ASPECTS. This study aimed to evaluate the impact of e-ASPECTS (Brainomix, Oxford, UK) on the performance of US physicians compared to a consensus ground truth. The study used a multi-reader, multi-case design. A total of 10 US board-certified physicians (neurologists and neuroradiologists) scored 54 NCCT brain scans of patients with AIS affecting the MCA territory. Each reader scored each scan on two occasions: once with and once without reference to the e-ASPECTS software, in random order. Agreement with a reference standard (expert consensus read with reference to follow-up imaging) was evaluated with and without software support. A comparison of the area under the curve (AUC) for each reader showed a significant improvement from 0.81 to 0.83 (p = 0.028) with the support of the e-ASPECTS tool. The agreement of reader ASPECTS scoring with the reference standard was improved with e-ASPECTS compared to unassisted reading of scans: Cohen's kappa improved from 0.60 to 0.65, and the case-based weighted Kappa improved from 0.70 to 0.81. Decision support with the e-ASPECTS software significantly improves the accuracy of ASPECTS scoring, even by expert US neurologists and neuroradiologists.

Work like a doctor: Unifying scan localizer and dynamic generator for automated computed tomography report generation

Computed Tomography Report Generation (CTRG) aims to generate medical reports towards a series of radiological images, which is an advancement of the conventional X-ray report generation (generating one medical description only based on a single X-ray snapshot). Beyond the difficulties faced in the traditional task, CTRG requires the model to filter out the lesion regions from sequential scans, producing a fine-grained report that conforms to medical logic and common sense. Limited to available datasets, there are few methods trying to tackle this task. Besides, although densely aggregating sequential features may be beneficial, it introduces extra noise. Moreover, radiology reports are long narratives composed of abnormal descriptions and template sentences, but most studies ignore this hierarchical nature and generate the entire reports uniformly. This paper aims to bridge the gap from three distinct perspectives: first, we develop two large-scale clinical datasets termed CTRG-Brain-263K and CTRG-Chest-548K, which contain 263670 brain CT scans and 548696 chest CT scans with authoritative diagnosis reports, respectively. Second, we design a self-attention-based Scan Localizer (SL) that captures a representation most reflective of the lesion area. And a reconstruction loss is introduced to minimize the distance between focused and original scans. Finally, we propose a Dynamic Generator (DG) that decouples the decoder into abnormal and template branches, with produced proposals dynamically aggregated for the final generation. Experimental results confirm the proposed SL-DG outperforms existing methods, i.e., about ＋5.2% and ＋0.4% CIDEr points on CTRG-Brain-263K and CTRG-Chest-548K, respectively.

Subacute Partially Reversible Leukoencephalopathy Expands the Aicardi-Goutières Syndrome Phenotype.

To report a series of atypical presentations of Aicardi-Goutières syndrome. Clinical, neuroimaging, and genetic data. We report a series of six unrelated patients (five males) with a subacute loss of developmental milestones, pyramidal signs, and regression of communication abilities, with onset at ages ranging from 7 to 20 months, reaching a nadir after 4 to 24 weeks. A remarkable improvement of lost abilities occurred in the follow-up, and they remained with residual spasticity and dysarthria but preserved cognitive function. Immunization or febrile illness occurred before disease onset in all patients. CSF was normal in two patients, and in four, borderline or mild lymphocytosis was present. A brain CT scan disclosed a subtle basal ganglia calcification in one of six patients. Brain MRI showed asymmetric signal abnormalities of white matter with centrum semi-ovale involvement in five patients and a diffuse white matter abnormality with contrast enhancement in one. Four patients were diagnosed and treated for acute demyelinating encephalomyelitis (ADEM). Brain imaging was markedly improved with one year or more of follow-up (average of 7 years), but patients remained with residual spasticity and dysarthria without cognitive impairment. Demyelination relapse occurred in a single patient four years after the first event. Whole-exome sequencing (WES) was performed in all patients: four of them disclosed biallelic pathogenic variants in RNASEH2B (three homozygous p.Ala177Thr and one compound heterozygous p.Ala177Thr/p.Gln58*) and in two of them the same homozygous deleterious variants in RNASEH2A (p.Ala249Val). This report expands the phenotype of AGS to include subacute developmental regression with partial clinical and neuroimaging improvement. Those clinical features might be misdiagnosed as ADEM.

Imaging in Testicular Tumors

It is the purpose of this article to describe and discuss the relative roles of these imaging modalities in the diagnosis of testicular neoplasms and work-up of metastatic disease. The ultimate role of MRl has yet to be evaluated. Other imaging modalities such as chest radiography, radionuclide scanning, and brain CT scanning may be performed as the need arises. Special procedures such as arteriography and venography are occasionally performed in search of undescended testicles complicated by malignancy.

A 30-Year-Old Pregnant Woman Presented With Altered Consciousness During Vaginal Delivery

<p>懷孕婦女併發腦血管意外是罕見的產科急症，其中重要的危險因素是子癲前症。本文案例是一位 30 歲初次懷孕39週又3天婦女，無特殊疾病史， 入院待產時出現高血壓合併蛋白尿，被診斷為子癲前症，於自然生產時發生嗜睡及意識改變。醫療團隊藉由神經學檢查及電腦斷層掃描診斷為腦梗塞，立即給予血栓溶解劑治療。治療中密切監測覺察病人有新的神經學異常，立即再度執行電腦斷層掃描，發現後續發生的右側大腦出血，緊急行顱骨切開手術清除血塊。術後病人仍有明顯的左側偏癱，經過積極的復健治療，出院時左上肢肌力3分，左下肢肌力4分，可使用拐杖步行移動。對於子癲前症的高危險妊娠，從待產、生產以至產後過程，均應密切監測血壓及神經學變化，如併發嗜睡及意識改變時，應快速及正確做相關腦血管疾病的鑑別診斷，早期診斷發現，預防惡化再發生，期能在中風黃金時間三小時內及早治療，降低病人殘障、失能及死亡的機率。</p> <p> </p><p>Stroke is an uncommon but serious potential complication of pregnancy. A 30-year-old woman was in her 39+3 weeks of first pregnancy without any past medical history . After admission, she was diag­nosed as preeclampsia due to hypertension with p1roteinuria. Drowsiness and changes of conscious­ness occurred during delivery. The neurological examination and brain CT scan revealed cerebral infarction and thrombolysis was performed. During the treatment new neurological abnormalities was found, CT scan was immediately performed again. Right cerebral hemorrhage was confirmed and an emergency craniotomy was performed. After the operation, the patient still suffered from obvious left hemiplegia. After active rehabilitation treatment, the muscle strength of the left upper limb was 3 points and the muscle strength of the left lower limb was 4 points at the time of discharge, and she could walk with crutches. For high-risk pregnancy with preeclampsia, blood pressure and neurological changes should be closely monitored during labor, delivery, and postpartum. If symptoms as drowsi­ness and changes in consciousness are shown, the differential diagnosis of related cerebrovascular dis­eases should be made quickly and correctly. To prevent the recurrence of deterioration, early treatment is expected within three hours of the prime time of stroke. The probability of handicapped, disability and death of patients can be reduced.</p> <p> </p>

Assessment of prognostic ability of intracerebral hemorrhage score with special reference to a tribal population

Background: Stroke is the second leading cause of death worldwide. Intracerebral hemorrhage (ICH) accounts for 10% of all strokes, and about 35–45% of patients die within the 1st month. The scarcity of robust data on the validity and utility of the ICH score on the Indian population in a resource-poor health facility is a compelling factor for more study in this field, especially among the tribal population in this region. ICH score is a simple, easy-to-calculate prognostic indicator of hemorrhagic score. Aims and Objectives: The aim of this study is to estimate the prognostic significance of ICH score (both modified and the original) in hemorrhagic stroke in terms of mortality and morbidity and to analyze associated risk factors like mortality, morbidity, and motor recovery of hemorrhagic stroke in tribal and non-tribal population. Materials and Methods: The study was institution-based observational and prospective study of 120 new-onset hemorrhagic stroke cases diagnosed by clinical and radiological evaluation admitted in this medical college during the period of study. Along with history, clinical examination and CT scan brain guided ICH scoring is done, follow-up at the end of 1 week and at the 5th week including physical performance assessment and reviewing of records and certificates. P<0.05 was considered statistically significant. Results: The patients with modified ICH score 0 had 100% improvement whereas the improvement was seen in 54.84% of patients with scores 1 and 2. A total 50% of patients with scores 3 and 4 improved significantly. The incidence of hypertension was more in non-tribal population (70.45%) than total tribal population (56.25%) of study and Compared to non-tribal population (23.86%), tribals had more history of addiction (40.63%). Conclusion: Both the ICH Scores, modified and the original, were practical and valid predicting mortality in our setup. However, the modified one was more accurate and pragmatic in our study.

Evaluation of Ring Enhancing Lesions in the Patient Undergoing Brain CT Scan

Introduction: Ring enhancing lesions in CT of the brain can be caused by different pathological conditions. The common lesions being some granulomas, primary brain tumors, abscess etc. CT remains essential for the investigation of ring enhancing lesions of brain. Materials and methods: A cross-sectional study was performed on a total of 60 patients undergoing brain CT scans and found to have ring enhancing lesion(s) on contrast administration. Results: The result of the study revealed that ring enhancing lesions was more common in man than women (34 out of 60 patients; 56.7%) The overall male to female ratio was 1.3:1. The age of the patients ranged from 7 to 77 years with peak incidence of lesion was found in >40 years of age comprising 28 patients (46.7%) followed by 21 to 30 age groups constituting 12 patients (20%). Single ring enhancing lesions were most common lesions comprising about 49 cases (81.67%). Neurocysticercosis (NCC) was the most common cause of ring enhancing lesions of brain comprising about 38 patients (63.3%) followed by glioblastoma multiforme (GBM) comprising about 9 patients (15%). Conclusion: CT plays an important role in the diagnosis of ring enhancing lesion and their causes. Neurocysticercosis (NCC) was the most common cause of ring enhancing lesions followed by glioblastoma multiforme (GBM).

Intensive Management of A 21-Year-Old Male Patient with Acute Respiratory Failure Due to Near Drowning: A Case Report

Background: The mechanism of near drowning involves decreased lung compliance and aspiration of water into the lungs, which damages surfactants and disrupts alveolar capillary membranes. This leads to the development of alveolar oedema, and ventilation-perfusion mismatch, which causes hypoxemia leading to acute respiratory distress syndrome (ARDS) and cause other organ dysfunction and death.
 Case presentation: The patient was found drowned by his friends while on vacation and swimming in the river. Initial physical examination in the ED obtained a Glasglow coma scale (GCS) score of 14/15 (E3-V5-M6), blood pressure 124/70 mmHg, and pulse 124 beats/min. The patient breathed spontaneously 25 breaths/min with oxygen saturation (SpO2) of 90% on room air. The patient was initially managed with oxygenation using a non-rebreathing mask (NRM semi-fowler positioning and peripheral access. Chest X-ray and other radiologic examinations, including a brain CT scan, were performed before the patient was immediately transferred to the ICU, and there was no evidence of other trauma. During the 9 days of intensive management in the ICU, there was a good improvement from GCS 14 to 15.
 Conclusion: Intensive management of a 21-year-old male patient with acute respiratory failure due to near drowning.

Association between Hemorrhagic Stroke and Diabetes Mellitus; A Hospital-Based Case-Control Study

Introduction: Stroke is the third leading cause of death in the world. Numerous studies show that diabetes mellitus is one of the risk factors for stroke. In general, stroke is divided into two types: hemorrhagic & ischemic, and approximately 15-25% of strokes are the hemorrhagic type. Objective: As it is claimed that diabetes mellitus is an important risk factor of hemorrhagic stroke, in this study, an attempt is made to explain the association between diabetes and hemorrhagic stroke. Method and Data Collection: According to Epi Info statistic software; 102 participants who were 40_ years old, and had a hemorrhagic stroke in their brain CT scan or MRI, were selected as cases, and 255 Participants without having a hemorrhagic stroke, included as controls. The proportional distribution of cases and controls in terms of sex and age was considered. Data has been obtained primarily through the design of a questionnaire from admitted patients in the neurosurgery and neurology wards of Aliabad university hospital. Results: Out of 357 participants, 181 (50.7%) participants were female and 176 (49.3%) were male. The study found that 25.5% of the participants in the case group, and 13.3% of the participants in the control group, were exposed to diabetes mellitus. Considering (P-Value = 0.006) and Odds ratio (OR=2.224; 95% CI = 1.253 - 3.945), the association between hemorrhagic Stroke and diabetes mellitus is suggested to be significant. Conclusion: As a result of the study, we can claim that among other risk factors, Diabetes Mellitus can also be considered a possible predisposing factor for Hemorrhagic Stroke and there is a significant association between Hemorrhagic stroke and Diabetes mellitus.

Cephalometric Assessment of the Brain Ventricular System Index Using Computerised Tomography in Sokoto North-Western, Nigeria

Aim: To determine the normal brain ventricular system 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: One hundred and seventy-eight normal brain CT scans of subjects from the Radiology Department, whose ages ranged from 1 to 70 years, were recruited for this study.
 The Bi-frontal and Bi-occipital indices were calculated as ratios of measured distances of the frontal and occipital horns of the lateral ventricles and the transverse intracranial diameter, at the same level, respectively. The brain ventricular system index was then determined by a ratio of the Bi-frontal index and Bi-occipital index.
 Results: The largest brain ventricular system indexes were 7.83cm and 7.68cm in males and females respectively and these were observed between the age of 2-4years for both sexes. While, the smallest brain ventricular system indexes were 7.47cm in males and 7.29cm in females, which were observed in age group 61-70years for both sexes.
 Conclusion: This study was conducted to determine the Ventricular Brain System Index and it relation with sex and age in our environment.

Study protocol for investigating the clinical performance of an automated blood test for glial fibrillary acidic protein and ubiquitin carboxy-terminal hydrolase L1 blood concentrations in elderly patients with mild traumatic BRAIN Injury and reference values (BRAINI-2 Elderly European study): a prospective multicentre observational study

IntroductionTwo blood brain-derived biomarkers, glial fibrillar acidic protein (GFAP) and ubiquitin carboxy-terminal hydrolase L1 (UCH-L1), can rule out intracranial lesions in patients with mild traumatic brain injury (mTBI) when assessed...