Mri an imaging tool to evaluate cerebral changes in victims of heat stroke presenting with cerebral symptoms

Heat stroke usually presents as medical emergency that causes altered cerebral status and deterioration of multiple organ functions. Heat stroke leads to many different physiological changes within the body, some of which result in neurologic dysfunction. The imaging characteristics of neurological changes of heat stroke are not well documented in literature although the pathophysiologic mechanism of neuronal damage is fairly well understood. We conducted a study to evaluate the imaging appearances of human brain after heat stroke on MRI presented with cerebral symptoms

Material and methods: The retrospective study conducted in radiology department of Ziauddin university hospital from May 2015 till July 2016. All the patients with heat stroke presented with neurological deficit were underwent MRI brain, evaluated by two senior radiologists

Results: 56 patients were included in study, 12 female and 44 male, all patients had clinical symptoms of fever and most of them had additional symptoms of altered level of consciousness. Out of 54 patients, 8 patients had normal MRI brain. 6 patients presented with bilaterally symmetrical hyperintense signals on T2WI in thalami and basal ganglia. 2 patients demonstrated focal high signal intensity in pons representing pontine myelinosis, rest of the patients presented with cerebral or cerebellar infarcts

Conclusion:Many cerebral lesions can result as cerebral damage of heat stroke which includes cerebral infarct, white matter changes, haemorrhages and inflammatory reactions, in these clinical scenarios MRI would be imaging modality of choice to evaluate the disease pattern

Surgical approach to manage cerebrospinal fluid rhinorrhea through vault or through nose

Objective: Background: Surgical management of cerebrospinal fluid [CSF] rhinorrhea can be done through a transcranial approach or endoscopically using a transnasal approach. The endoscopic technology is relatively fresh in developing countries. Keeping this in mind we conducted an audit of patients undergoing endoscopic repair of CSF leaks to review their outcome in terms of recurrence and complications and compare them with the patients had transcranial repair. The objective of the study is to review the management of patients who underwent repair of CSF rhinorrhea at Lyari General Hospital, Aga Khan University Hospital and Memon Medical Institute Hospital – 10 years experience

Study design: Cross-sectional observational study

Place and duration of Study: Lyari General Hospital, Aga Khan University Hospital and Memon Medical Institute Hospital, from January 2005 to December 2014

Patients and methods: A review of patient charts having undergone surgical repair for CSF rhinorrhea in the last 10 years at our institution was conducted. Thirty eight patients meeting the inclusion criteria of having undergone a surgical procedure for the repair of CSF rhinorrhea with a minimum post operative follow up of 6 months were included in the study

Results: Skull base defects were repaired with the help of minimally invasive transnasal endoscopic approach with a success rate of 80% in comparison to transcranial repair success rate of 29%. Post-operative complications were seen in only 10% of endoscopic group and 53% of transcranial group

Conclusion: Although endoscopic management is associated with better outcomes there is room for improvement in the approach in developing countries and training programs and detailed internal audits need to be conducted to improve the situation to the level of developed countries

Diagnostic accuracy of computed tomography [CT] in patients with neck and mediastinal lymphoma and correlate with gold standard histopathology results

Objective: To determine the diagnostic accuracy of Computed Tomography [CT] in patients with neck and mediastinal lymphoma and correlate with gold standard histopathology results. Period: This study was conducted during six months period extended from March 2013 to September 2013. Setting: Department of diagnostic radiology, Dr. Ziauddin University Hospital, Karachi

Methodology: A total of 366 patients presenting with sign and symptoms such as fever, night sweats, weight loss or having any swelling in the cervical region were included and CT was performed; regardless of scan result suggestive of either presence or absence of lymphoma; patients were followed and histopathological findings of each patient was collected and recorded on Performa. Other demographic variables were also obtained and data were analyzed by Statistical Package for the Social Sciences [SPSS] -17

Results: Sensitivity, specificity, positive and negative predictive value as well as accuracy of computed tomography in the detection of neck andmediastinal lymphoma were found to be 75%, 89.9%, 59.2, 94.8% and 87.4% respectively. For patients with 10 months duration of disease, the accuracy of CT scan was observed as 84.7% and 93.6% respectively

Conclusion: CT scan is cross-section modality of choice for evaluating patients with suspected malignant tumors. CT is readily available and has high accuracy in distinguishing a mass compared with other tumors

Role of CT- scan in assessment of anatomical variants of nasal cavity and paranasal sinuses

Objective: To evaluate the role of CT scan of nasal cavity and paranasal sinuses in preoperative assessment of anatomical variants and in determining their frequencies

Materials and Methods: This descriptive study was done as a part of residency training for FCPS in the subject of Radiology on 132 patients who visited the hospital, Sindh Institute of Urology and Transplantation [SIUT] from March 2012 to April 2013. All CT scans were reviewed for presence of concha bullosa, variations of uncinate process, haller cell, onodi cells, aggernasi cells, ethmoid bulla, paradoxical middle turbinate, deviated nasal septum [DNS], pneumatization in the nasal septum, superior and middle turbinate, and uncinate process. Frequencies of all anatomical variants were calculated using SPSS version 16

Results: Deviated nasal septum was found to be the most frequent variant 31% followed by Concha bullosa 18.9% and variations in uncinate process 12%. Rhino sinusitis was found in all cases with paradoxical medial turbinate and patients with variation in uncinate process

Conclusion: CT scan can play an important role in preoperative assessment of variants and in determining their frequencies in nasal cavity and paranasal sinuses. It could be of great help for surgical planning and minimizing the surgical complications in patients