Combined spinal epidural anesthesia for cesarean section in a pregnant patient with rare intracranial neoplasm

There are several reports of obstetric emergencies in pregnant patients with malignant intracranial tumors precipitated by worsening of the mother's neurological status which necessitate an early delivery of the fetus before definite therapy can be administered to the mother[1-3]. We describe a patient with a sphenoid sinus tumor who developed loss of vision due to rapid tumor progression necessitating an early delivery of her twin fetuses by cesarean section. The patient had co morbidities and requested to be awake during the surgery, she was managed using a combined spinal epidural anesthesia. The advantages of combined spinal epidural anesthesia as compared to a single shot subarachnoid block, epidural block or general anesthesia are discussed in a pregnant patient with decrease in intracranial compliance

Prognostic value of admission serum albumin levels in patients with head injury

Head injury is major cause of disability and death in the society, however no effective biochemical prognostic markers are available. To assess the prognostic significance of admission serum albumin levels in patients of head injury. Prospective cohort study with control group. Within 24 hours of head injury, 154 patients underwent serum analysis for albumin along with 38 normal volunteers, studied in relation to various factors and subsequently followed-up. Statistical analysis was made with SPSS software, p<0.05 was considered significant. Mean serum albumin in head injury and control were 3.24 and 4.15 g/dL respectively [p<0.001]. Admission albumin had significant positive correlation with Glasgow coma score [GCS] [p<0.001]. Hypoalbuminemia [

Intramedullary spinal cord abscess

Intramedullary tubercular abscess is a very rare condition, however it needs to be considered in the differential diagnosis of neurological deterioration in a patient of tuberculosis as timely intervention often gives good neurological recovery. The authors report a rare case of intramedullary tuberculous abscess of dorsal spinal cord in a 35-year-old female patient who presented with paraplegia and bladder involvement. Magnetic resonance imaging scans revealed D6-D10 arachnoiditis with intramedullary lesion with extradural compression locally. A dorsal laminectomy with decompression of intramedullary abscess with biopsy of extradural granulation tissue was carried out and patient was started on antituberculous therapy and gradually improved neurologically postoperatively. Intrameduallry tuberculous abscess is a rare condition and surgical intervention is helpful even in the presence of profound neurological deficits

Giant pituitary adenomas: surgical outcome in a series of 127 cases

To analyze the surgical and visual outcome of giant pituitary adenomas. One-hundred-twenty-seven patients surgically treated over a 9-year period were studied. Fifty-four-point-three percent had non-functioning adenomas. Among the functioning adenomas, prolactinomas were the most common. A total of 90 transsphenoidal and 52 transcranial procedures were performed in 127 patients. The complications and deaths were significantly higher in the transcranial group. There were a total of 15 deaths [11.8%], Thirty-two-point-two percent had single/multiple postoperative complications. Vision improved in 49 patients [41.9%] at the time of discharge. Thirteen-point-eight percent of the pituitary adenomas are giant. Transsphenoidal surgery was the procedure of choice for most of the patients. These tumours represent a difficult group to treat. Prolactin estimation and preferably immunohistochemical analysis should be done in all patients in order to clinically diagnose indistinct prolactinomas

Neoplastic spinal cord compression-surgical experience in Bahrain

Twenty patients with neoplasms producing spinal cord compression [SCC] were analysed. Half of the neoplasms were benign and primary and in these patients, surgical resection produced a good neurological recovery and functional outcome. In the other half of the cases, neoplasms were malignant, mostly metastatic to the epidural space. These patients had complete loss of spinal cord function before surgery and no improvement ensued following surgery. To achieve good functional outcome in these cases, early diagnosis and emergency surgical decompression before or within 12 hours of complete loss of cord function, is vital

Management of intracranial suppuration in Bahrain

Sixteen cases of intracranial suppuration, 13 brain abscess and 3 subdural empyema treated over the last 10 years, were analyzed. All the cases were below 40 years of age with almost equal distribution in each decade. Headache, vomiting, fever and seizures of short duration were common presenting symptoms. Common signs included obtundation, papilloedema and focal deficits. Middle ear infection was the commonest primary source. In 75% cases suppuration was located supratentorially with temporal region as commonest site. The commonest organism grown was staphylococcus aureus. All patients underwent aspiration of pus followed by primary 5 cases or secondary 8 cases, excision of abscess capsule and irrigation of empyema cavity. Only one patient [6%] died. All other 15 cases are well and four of them require anticonvulsant therapy for control of seizures. Prompt surgical drainage is critical adjuvant to medical treatment of brain abscess and subdural empyema. CT Scan is invaluable in the initial diagnosis and follow up of these cases