Complications in craniocerebral aspergillosis of sino-nasal origin in immunocompetent patients

Four immunocompetent patients of craniocerebral aspergillosis of sino-nasal origin who developed complications have been described. They developed intracerebral haemorrhages, multifocal infarctions and intraventricular dissemination of aspergillus infection and 2 patients developed acute hydrocephalus. All 4 patients have been managed by standard therapeutic regimens including both surgical resection followed by antifungal therapy while CSF shunting was done as required. Only one patient survived till the last clinical follow-up. Magnetic resonance angiography along with routine magnetic resonance imaging at the time of initial work-up may be helpful to pick up mycotic aneurysms and vascular occlusions

Gas-producing brain abscess

A case of a known psychiatric patient who presented with rapid neurological deterioration is reported. Neuroimaging revealed a gas-producing brain abscess in left parietal lobe with a contiguous focus of infection in the adjacent bone and scalp initiated by obsessive scalp scratching. On complete surgical excision of abscess, followed by culturebased antibiotic therapy, a good neurological recovery was achieved with minimal residual deficits at follow-up

audit of head trauma care and mortality

To analyze the factors contributing to deaths from head trauma by using standardized assessment parameters and to provide a peer-review of head injury deaths with focus on identifying deficiencies and analyzing contributory factors. Design: Descriptive study. Place and Duration of Study: The study was carried out at the Emergency, Aga Khan University Hospital during January 1998 to December 1999. Subjects and Method: One hundred and three patients above the age of 15 years presenting alive to the Aga Khan University Hospital [AKUH] emergency with head injury were included in this study. Identified deaths data was reviewed by the Hospital Trauma Peer Review Committee and consensus arrived at for categorization of deaths. The potential deficiencies in care were identified and final recommendations made. The data was computed on CDC Trauma Registry [V 3.0] and SPSS [V 8.0]. Mean age was 31.9 years [n=103] with predominant male population [4:1]. Severe head injury [GCS<8] accounted for 21.3% [n=22] of all cases with a total number of deaths being 12.6% [n=13]. Deaths were categorized preventable in 3 cases with non-preventable and potentially preventable in 4 and 6 cases respectively. Road traffic accidents were the predominant mechanism [n=8] in all deaths [n=13]. The time interval in relation to mortality was biphasic, most deaths occuring either within 24 hours or between 3-7 days of injury. Inappropriate pre-hospital treatment, pre-hospital delays and inappropriate mode of transportation without inter-hospital communication were the process-related defects in pre-hospital care with major determinant of deaths outside AKUH [n=5]. Prolonged emergency stay, delayed intensive care availability were the process-related deficiencies whereas inappropriate initial resuscitation, inappropriate initial head injury management were provider-related deficiencies in in-hospital care. Transfer of inappropriately managed patients, lapses in inter-hospital communications, delayed transfers were identified as the major pre-hospital factors whereas lack of ICU beds, portable ventilators in emergency room, delays in CT scan facilities were the deficiencies in the hospital services. Opportunities for improvement in head trauma care are needed to focus on initial resuscitation and appropriate surgical management

Chance-type flexion-distraction fracture of lumbar spine

A 20-years old male, motor mechanic was working in kneeling position. His buttocks were resting on his heels with the back facing the bumper of a close-by van. His fellow colleague in the driving seat accidently ran the van forward and the bumper of the van hit the lumbar region of the patient with a tremendous force. He was brought to the emergency room two weeks later and was found to have bruises in the lumbar region with complete flaccid paraplegia and incontinence of both urine and faeces since the time of injury. Plain X-ray film and computed tomographic scanning with 3-D imaging revealed a shearing of spine with fracture line completely slicing through the second lumbar [L2] vertebra going across all the three vertebral columns. There was significant backward listhesis of upper fragment [along with the whole vertebral column above] of sliced L2 vertebra on the lower segment resulting in complete anatomical transection at this level. He was treated with strict immobilization and bed rest, taking all the measures of protecting the unstable spine. He was provided with intensive supportive care, nursing and physiotherapeutic rehabilitation. At three months, he was propped up in a lumbar corset and further rehabilitated in a wheel chair. This patient showed no neurological recovery till the last clinical follow up at 12 months and remained wheel chair-bound with complete paraplegia and double incontinence

Peritumoral Cystic Meningioma

A case of 39 years old male is described who presented with headache, right-sided focal fits and decreased power in the right hand. CT scan brain showed a left fronto-parietal cystic lesion with centrolateral intramural nodule with homogenous enhancement. At surgery, the extra-axial lesion with cyst containing xanthochromic fluid had a well-defined capsule that could easily be separated from the peri-lesional cortical surface. The dural-based nodule with its cyst wall was resected in toto. The histopathology of mural nodule was reported as meningioma while the cyst wall histology revealed meningothelial cells