ABSTRACT
Background: Chronic subdural hematoma [CSDH], a common type of intracranial hemorrhage and one of the most common clinical entities encountered in daily neurosurgical practice tends to occur in elderly patients
Objective: To determine the frequency and risk factors of chronic subdural hematoma recurrence after burr holes surgery
Patients and Methods: This descriptive cross sectional study was conducted in neurosurgery department Nishtar Hospital Multan from 1[st] January 2013 to 31[st] December 2013. All the patients diagnosed as CSDH, confirmed on computed tomography [CT] and treated by hematoma evacuation and drainage through cranial bur hole during the study duration were included in the study. Routine computed tomography [CT] was performed in all the patients, the day after the surgery, one week after the surgery, two months after the surgery and all the patients were followed up to three months after the surgery. Preoperative and postoperative CT findings were compared to calculate the recurrence rate. Data was entered and analyzed by using SPSS version 17. P-value = 0.05 was considered significant
Results: There were 72.64% male and 27.36% female patients. 78.31% patients were = 70 years age and 21.69% below 70 years. CT demonstrated CSDH as hypo dense to cerebral parenchyma in 49.05%, isodense in 29.24% and hyperdense in 21.71%. Recurrence of chronic subdural hematoma after the bur holes craniotomy was observed in 10.8% [12] patients. Major risk factors identified for recurrence were age = 70 years and re-expansion of the brain after the surgery
Conclusion: It is concluded that recurrence of chronic subdural hematoma after burr holes evacuation is directly related with age and re-expansion of the brain after surgery
ABSTRACT
Background: hemorrhagic disease of the newborn [HDN] is not an uncommon entity in developing countries particularly in under privileged rural areas like southern pun jab, where the prophylactic administration of vitamin-K at birth is not routinely practiced. The commonest mode of presentation of late HDN is intracranial hemorrhage
Objective: the present study was conducted to assess the clinical profile and risk factors of patients with Late [HDN]
Patients and Methods: all infants above the age of 7 days were admitted in pediatric unit with vitamin K deficiency bleeding. An infant fulfilling the criteria of late HDN was included in the study Infants with clinical and laboratory evidence of liver disease were excluded from the study. In these selected infants a detailed history, physical examination and investigations were carried out with special emphasis on risk factors for vitamin K deficiency and clinical features secondary to bleeding. Vitamin K 5 mg intravenous was given to all the patients and investigations were repeated after 24 hours
Results: thirty two infants fulfilled the criteria of late HDN; 24 [75%] were males and 8 [25%] females. Majority of the babies [75%] were in the age group 4 to 12 weeks. Prophylactic Vitamin K was not given to any of the infants at birth or later. All were on exclusive breastfeeding, two had history of prolonged diarrhea and two had received antibiotics for one week. Majority of the infants 24 [75%] presented with neurological features i.e. convulsions 62%, altered sensorium 56%. Purpura and bleeding from other orifices were less frequent i.e. <10%. Six [18.75%] infants died
Conclusion: intracranial hemorrhage is the commonest mode of presentation of late HDN and carries significant morbidity and mortality. Hence, vitamin K prophylaxis at birth is a deadly desirable intervention to avoid this potentially preventable life threatening condition