ABSTRACT
Background: Cervical spondylotic myelopathy (CSM) is a commonly seen spinal cord disease. There are no well-defined indications and optimal timing for surgical intervention. Therefore, defining predictors for outcome after surgical intervention will have great advantage in taking decisions for interventions.Methods: A consecutive series of all patients having signs and symptoms of cervical spondylotic myelopathy admitted to Department of Neurosurgery, Medical College, Thiruvananthapuram who underwent decompressive surgery with or without stabilization in one year were studied. Pre-operative magnetic resonance imaging (MRI) findings were correlated with post-operative surgical outcomes (Nurick grade) after 3 months of follow up. The pattern of spinal cord signal intensity was classified as: group A (MRI N/N) - no SI T1WI or T2WI, group B (MRI N/Hi) - no SI T1WI and high SI on T2WI and, group C (MRI Lo/Hi) - low SI T1WI and high SI on T2WI. CSM clinical outcomes were evaluated using Nurick grading system, which was used pre- and post-operatively (pre op and post op).Results: Post operatively improvement was seen in 75% of group A and 61.35 % of group B patients, but among group C only 25% patient improved according to Nurick grading pre op and post op.Conclusions: Patients with high intramedullary signal intensity on T2WI may experience a good surgical outcome. A less favorable surgical outcome is predicted by the presence of low intramedullary signal on T1WI.
ABSTRACT
Background: Alcohol use and traumatic brain injury (TBI) are closely linked public health problems. Alcohol intoxication is one of the major risk factor for TBI, and is a main determinant of prognosis in terms of mortality and functional outcome. The aim of the study is to find out the impact of alcoholism in the neurobehavioral outcome following TBI.Methods: A total of 150 head injury patients were divided into two groups: alcoholics and non-alcoholics, and evaluated between six weeks to one year after injury using the revised neurobehavioral rating scale by Levin et al (NRS-R) for the evaluation of neurobehavioral sequelae and the outcome was compared between groups.Results: The study showed significant difference between the groups indicating that the neurobehavioral sequelae were more in the chronic alcoholics group. In the comparison of individual factors, all except factors III (negative symptoms) and IV (mood and affect) were found to be significantly different. The factors I (executive), II (positive symptoms), V (oral and motor), and VI (not loading on any of the factors) were significant at 0.01 level.Conclusions: Chronic alcoholism significantly increases the risk of developing neurobehavioral sequelae after traumatic brain injury.
ABSTRACT
Background: This study investigated the epidemiological pattern of traumatic brain injury (TBI) in our hospital, so as to juxtapose with available statistics and formulate recommendations for patient betterment.Methods: The Government Medical College, Thiruvananthapuram was the setting of this cross-sectional longitudinal study and included all patients admitted with clinical/radiological evidence of TBI over a period of three months (October 2019 to December 2019). Details regarding mechanism of injury and the socioeconomic background of the subjects were collected during the stay in hospital, by means of a semi structured questionnaire. SPSS software was used to analyze the data collected.Results: Out of 658 patients included in the study, majority of the subjects belonged to the age group 30-60 years. About 80% of subjects were males. 63% were manual laborers. Majority of the patients had about 10-15 days’ stay in the hospital. Road traffic accidents were the most common mechanism of injury and involved two wheelers mainly. Lack of helmet and restraining seat belt was noted in a sizeable percent of the subjects. Loss of consciousness was the most common complaint and GCS in the majority of subjects ranged from 9-13. Subdural hematomas and hemorrhagic contusions were the most common CT findings. 39.7% of the patients had associated spinal injury. About 48% of the subjects were operated. There was 7% mortality.Conclusions: Road traffic accidents accounted for the majority of traumatic brain injury incidents and a sizeable portion of patients required expert neurosurgical care.
ABSTRACT
Background: Cervical spine injuries, according to severity can leave victims with long standing neck pain or varying degrees of weaknesses. The purpose of this study is to determine the epidemiological pattern of cervical spine injury in our hospital so that comparison may be made with other institutions and guidance regarding management may be formulated for the betterment of patients.Methods: This cross-sectional longitudinal study was conducted in Government Medical College, Thiruvananthapuram and included all patients admitted with clinical or radiological evidence of cervical spine injury, over a period of three months. Semi-structured questionnaire was used to collect socio demographic data and details regarding mechanism of injury. Data was analyzed using SPSS.Results: Out of 452 patients enrolled, 69.7% were males and 30.3% were females. Patients were the most commonly between 30-60 years of age (52.4%). Majority (56.1%) had hospital stays lasting less than 10 days. Most common mechanism of injury was road traffic accidents (46.6%). Neck pain was the most common symptom and cervical spine straightening was the most common radiological abnormality. The severity of injuries was more severe in patients who were not restrained by seat belt or using a helmet.Conclusion: Road traffic accidents are the most common cause for cervical spine injuries and majority of patients required only symptomatic care.