Response to: Computed Tomography-Guided Biopsy for Potts Disease: An Institutional Experience from an Endemic Developing Country

No abstract available.

Symptomatic surgically treated non-neoplastic cysts of the central nervous system: a clinicopathological study from Pakistan

To report clinicopathologic features of symptomatic surgically removed non-neoplastic cysts of the central nervous system [CNS]. Case series. The Aga Khan University Hospital, Karachi, from 2003 to 2012. All non-neoplastic CNS cysts reported during the study period were retrieved and reviewed. Age, gender, location, histologic type and clinical features were noted. A total of 124 cysts were diagnosed in the study period. These included 44 epidermoid cysts [mean age 30.5 +/- 13.8 years], 35 colloid cysts [mean age 31 +/- 13.2 years], 32 arachnoid cysts [mean age 24.8 +/- 20.2 years], 6 dermoid cysts, 3 enterogenous cysts and Rathke's cleft cysts each and 1 ependymal cyst. All cyst types mainly presented in young adults in both genders with signs and symptoms of a mass lesion. Non-neoplastic cyst mainly presented like a CNS mass lesion in young adults. Epidermoids were the most common type of these cysts in the present series followed by the colloid and the arachnoid cysts

Computed Tomography-Guided Biopsy for Potts Disease: An Institutional Experience from an Endemic Developing Country

STUDY DESIGN: A retrospective chart review. PURPOSE: In endemic resource poor countries like Pakistan, most patients are diagnosed and treated for Potts disease on clinical and radiological grounds without a routine biopsy. The purpose of this study was to evaluate the use and effect of computed tomography (CT)-guided biopsy in the management of Potts disease since the technique is becoming increasingly available. OVERVIEW OF LITERATURE: CT-guided biopsy of spinal lesions is routinely performed. Literature on the utility of the technique in endemic resource poor countries is little. METHODS: This study was conducted at the Neurosurgery section of Aga Khan University Hospital Karachi. All the patients with suspected Potts disease who underwent CT-guided biopsy during the 7 year period from 2007 to 2013 were included in this study. Details of the procedure, histopathology and microbiology were recorded. RESULTS: One hundred and seventy-eight patients were treated for suspected Potts disease during the study period. CT-guided biopsies of the spinal lesions were performed in 91 patients (51.12%). Of the 91 procedures, 22 (24.2%) were inconclusive because of inadequate sample (10), normal tissue (6) or reactive tissue (6). Sixty-nine biopsies were positive (75.8%). Granulomatous inflammation was seen in 58 patients (84.05%), positive acid-fast bacillus (AFB) smear in 4 (5.7%) and positive AFB culture in 12 patients (17.3%). All 91 cases in which CT-guided biopsy was performed responded positively to antituberculosis therapy (ATT). CONCLUSIONS: 75.8% of the specimens yielded positive diagnoses. Granulomatous inflammation on histopathology was the commonest diagnostic feature. In this series, the rates of positive AFB smear and culture were low compared to previous literature.

Melcmotic neuroectodermal tumour of infancy: a rare brain tumour of childhood

Melanotic neuroectodermal tumour of infancy is a rare, mostly benign but locally aggressive tumour of neural crest cell origin occurring in infants. The most commonly affected anatomic site is the maxilla. Such tumours of the brain and skull are very rare. We present the case of an 8 months old baby girl whose presenting complaint was a swelling in the scalp for 6 months. She was otherwise asymptomatic. CT imaging confirmed the presence of an osteolytic tumour in the anterior parasagittal skull with dural involvement. The tumour was surgically excised enbloc. The patient has been well at 2 years follow-up without any evidence of recurrence

Suicide bomb attack causing penetrating craniocerebral injury / 中华创伤杂志(英文版)

Penetrating cerebral injuries caused by foreign bodies are rare in civilian neurosurgical trauma, although there are various reports of blast or gunshot injuries in warfare due to multiple foreign bodies like pellets and nails. In our case, a 30-year-old man presented to neurosurgery clinic with signs and symptoms of right-sided weakness after suicide bomb attack. The skull X-ray showed a single intracranial nail. Small craniotomy was done and the nail was removed with caution to avoid injury to surrounding normal brain tissue. At 6 months'follow-up his right-sided power improved to against gravity.

Craniocerebral injuries in war against terrorism --- a contemporary series from Pakistan / 中华创伤杂志(英文版)

<p><b>OBJECTIVE</b>Terrorism-related bomb attacks on civilian population have increased dramatically over the last decade. Craniocerebral injuries secondary to improvised explosive devices have not been widely reported in the context of unarmored civilians. This series intends to report the spectrum of these injuries secondary to suicidal and implanted bombs as encountered at the Aga Khan University Hospital, Pakistan (AKUH). Further, a few pertinent management guidelines have also been discussed.</p><p><b>METHODS</b>The hospital database and clinical coding during a 5-year period were examined for head injuries secondary to terrorism-associated blasts. In addition to patient demographics, data analysis for our series included initial Glasgow Coma Scale, presenting neurological complaints, associated non-neurological injuries, management (conservative or operative) to associated complications, and discharge neurological status.</p><p><b>RESULTS</b>A total of 16 patients were included in this series. Among them 9 were victims of suicidal blasts while 7 were exposed to implanted devices. The patients presented with diverse patterns of injury secondary to a variety of shrapnel. A follow-up record was available for 12 of the 16 patients (mean follow-up: 7.8 months), with most patients having no active complaints.</p><p><b>CONCLUSION</b>The results of this series show that civilian victims of suicidal and improvised bombings present with a wide range of neurological symptoms and injury patterns, which often differ from the neurological injuries incurred by military personnel in similar situations, and thereby often require individualized care.</p>

Magnetic Resonance Imaging in Cervical Facet Dislocation: A Third World Perspective

STUDY DESIGN: Retrospective case series. PURPOSE: The objective of our study was to determine the change in management brought about by magnetic resonance imaging (MRI) of the cervical spine in alert and awake patients with facet dislocation and spinal cord injury presenting within 4 hours after injury. OVERVIEW OF LITERATURE: Spinal cord injury is a common clinical entity. The role of MRI is well established in evaluating spinal trauma. However, the time at which MRI should be used is still controversial. METHODS: Retrospective data from 2002-2010 was evaluated. All of the alert and awake patients with spinal cord injury, based on clinical examination with facet dislocation diagnosed on lateral cervical spine X-rays, were included. A questionnaire was also conducted, the data of which consisted of demographic details including age and sex, the mechanism of injury, clinical examination, X-ray findings, MRI findings, whether or not surgery was performed and the time elapsed since injury. Data was analyzed using SPSS ver. 17.0. Continuous variables such as age were expressed in terms of mean +/- standard deviation. Categorical variables such as change in management, X-ray/MRI findings and neurological motor level were assessed in terms of percentage. RESULTS: Fifty patients participated in our study. All these patients had spinal cord injury with defined motor levels. The mean age was 35.5 +/- 8.95 years (range, 20 to 52 years). Fifty percent showed a motor level at C6 level. None of the patients required any change in management based on the MRI. CONCLUSIONS: MRI of the spine in awake patients within 4 hours after injury does not change the management of patients. However, we can hypothesize that such patients can proceed to traction without waiting for the MRI.

Intracerebral migration of stray bullet leading to sudden and fatal worsening

Gunshot wounds to the cranium are one of the leading cause of death and disability in young adults. Stray bullets are also being increasingly seen in clinical setting. We report a case of a 14-year-old boy who sustained a stray bullet to the cranium during election festivities. He arrived at the health care facility institution nearly 24 hours after the event in good neurological condition. He remained neurologically stable for about 8 hours after his presentation and later on deteriorated due to intracranial bullet migration. This required immediate bifrontal decompressive craniotomy along with right frontal lobectomy. However, the patient could not survive

Carotid cavernous fistula in a patient with coronary artery disease

Carotid cavernous fistulas are abnormal communications between the carotid and cavernous vasculature, with potential for serious neurological and ocular sequelae. There is considerable literature on the neuro-radiological management of carotico-cavernous fistula depending upon their flow status. The coronary artery bypass grafting [CABG] for coronary artery disease [CAD] is a well established method of revascularization. However, the association of carotid cavernous fistula in presence of CAD is an infrequent occurrence. We present a case of coronary artery disease scheduled for bypass surgery, developed spontaneous bilateral carotid cavernous fistulas, highlighting a unique aspect of association between coronary and carotid disease

Dural metastases presenting as an extradural hematoma: a rare presentation

We report a case of an elderly man who presented with hemiparesis and plain CT scan findings highly suggestive of an extradural hematoma as the underlying cause. This patient was later found to have dural metastases secondary to bronchogenic carcinoma. Dural metastases are rare, usually presenting as dural mass, but may also present as chronic subdural or extradural hematoma on non contrast CT scan, leading to an erroneous diagnosis in the unsuspecting