Spontaneous intraventricular rupture of brain abscess presenting as meningitis

Intraventricular rupture of a brain abscess is a natural but uncommon course of an incompletely or untreated brain abscess. Though the occurrence is not uncommon, the real event is not seen often in daily practice. Mortality is high in catastrophic presentation. Early diagnosis based on CSF study and neuro-imaging improves the outcome. Magnetic resonance characteristics of brain abscess and its rupture into the ventricular system are highlighted. Spontaneous intraventricular rupture of brain abscess presented as meningitis and was successfully treated with simple external ventricular drainage [EVD] and parenteral antibiotics. He made good recovery. A good outcome can be achieved in a potentially dangerous condition like meningitis due to spontaneous intraventricular rupture of brain abscess if the condition is diagnosed early and treated well in time even by simple maneuvers of external ventricular drainage [EVD] and parenteral antibiotics

Delayed traumatic interacranial haematoma in postoperative patients: a case for serial computerised tomography

Delayed traumatic intracranial haematoma [DTIH] is an uncommon entity and an epiphenomenon of head injury. Its time of evolution and location is unpredictable. We report two cases of DTIH. First patient was a road traffic accident victim who had left fronto-temporal acute subdural haemoatoma [SDH] with brainstem haemorrhage. Following evacuation of acute SDH, his intracranial pressure [ICP] remained high and repeat computerised tomography [CT] scan of the head done 36 hours later, revealed a large right parieto-temporal acute extradural haematoma [EDH]. The second patient had a minor head injury, 2 weeks prior to admission and CT scan of the head revealed an isodense right fronto-parietal chronic SDH. Eleven days following evacuation of chronic SDH, he developed headache and altered sensorium and repeat CT scan of the head showed right medial temporal intracerebral haematoma [ICH]. Evolution of second intracranial haematoma changes the total clinical scenario. Their clinical manifestation, especially in a postoperative patient is delayed and the prognosis adversely affected by the delay in treatment. Early detection of such haematoma is crucial. Combination of close clinical surveillance, ICP monitoring and radiological evaluation is suggested, however there are limitations and inherent fallacies. Mechanism of evolution and strategies for early detection of DTIH in a postoperative situation is discussed

Petroclival tumour surgery: a personal experience of 20 cases

petroclival lesions are amongst the most difficult lesions in Neurousrgery and carry a significant mortality and morbidity. However, over the last decade, publications from specialized centers have reported on the outcome of surgery for these lesions. we have analysed 20 patients, who had undergone surgery for petroclival tumour in general neurosurgical center over a 3-year-period [January 1997- December 1999]. there were 10 meningiomas, 5 chordomas, 3 trigeminal neurofibromas and 2 giant cell tumours. Seventeen patients had primary surgery while 3 had surgery for recurrent lesions. Investigations included CT scan, MRI and DSA or MRA in all patients. Ten patients were operated through retromastoid post-sigmoid approach, 7 through subtemporal combined with orbito-zygomatic approach and 3 were operated through combined retromastoid and subtemporal approach. There were two deaths. One was primarily related to surgery and the other due to respiratory complications. Six patients developed postoperative chest infection and 3 postoperative haematoma, of whom only 1 required surgical evacuation. Postoperative meningitis was recorded in 2 patients. Follow-up ranged from 9 months to 36 months with a mean of 21 months. None of the patients have, so far, developed recurrence or re-growth significant enough to merit a re-operation. tumour could not be removed totally in a significant number of cases inspite of all advances. Radiosurgery is an important adjuvant in the management of residual and recurrent lesions. Outcome was not different when compared to a specialized Neurousurgery unit