Head trauma due to earthquake October 2005 - experience of 300 cases at the combined military hospital Rawalpindi

To assess the spectrum and management of he ad injuries among earthquake victims. Case series. The study was conducted at Surgical Ward II, Combined Military Hospital, Rawalpindi, from October 2005 to December 2006. Three hundred consecutive cases of head injury, secondary to earthquake were included in the study. Plain X-rays of skulls were undertaken in clinically stable patients with head injuries. Cases with altered level of consciousness and compound depressed fractures were advised CT scan of head. Pus swabs were taken from open wounds. Proformas were maintained for every patient. Head injury was classified as mild, moderate and severe, and each patient was treated accordingly. One hundred and twenty three [41%] patients were children under 10 years of age. Adults below 55 years were 69 [23%] and above 55 years were 108 [36%]. Mean age was 32.2 years [SD + 6.7]. Female to male ratio was 1.1:1. One hundred and sixty five [55%] cases were of mild head injury, 103 [34.3%] patients had moderate head injury and 32 [10.7%] patients had severe head injury. Majority [48.7%] of patients was managed conservatively. Minor surgeries were done in 17% of patients and major surgeries were done in 34.3% of patients. Glasgow Outcome Scale assessment was made at the end of 6 months and 1 year. Mortality increased from 3.3% to 7% in one year time. Patients at the extremes of age are more vulnerable to trauma and should be given timely attention in disaster management plans. General and trauma surgeons should be well-versed with the techniques and indications of burr hole evacuation of life threatening intracranial haematomas in situations, where early evacuation is unattainable

Non dysraphic intramedullary spinal cord lipoma

True intramedullary spinal cord lipomas are extremely rare. Two cases of intramedullary spinal cord lipoma are presented. The patients did not exhibit any form of spinal dysraphism. The patients presented with gait difficulty, upper limb weakness, sphincter disturbance, dysesthesias and neck pain. The tumors were removed sub-totally and the neurological grade improved postoperatively in one of the patients

Post-traumatic vomiting-a predictor of severity of head injury

To determine whether post-traumatic vomiting can predict risk of a skull fracture in minor head injury patients. Design: A non-interventional study, carried out prospectively. Place and Duration of Study: The Neurosurgical Centre, CMH Rawalpindi over a period of 06 months from November, 1999 to April, 2000. Subjects and All the patients of head injury presenting at our centre over a period of 06 months were included in our study. We collected the data related to a consecutive series of 142 head injury patients. Data included age, sex, mechanism of injury, level of consciousness on initial examination, incidence of skull fracture and the presence and frequency of post-traumatic vomiting.Radiographs of skull[AP, Lateral and Towne's view] were obtained for all the patients diagnosed as having a minor head injury [Glasgow Coma Score Scale 14-15]. Post-traumatic vomiting in patients with minor head injury was encountered in 36.23% adults and 65.85% children.In patients with a skull fracture, vomiting was encountered in 81.81% adults and76.92% children. Post-traumatic vomiting was associated with a significant [p=0.79] increase in the relative risk for a skull fracture. Conclusions: It was concluded that a question about vomiting should be included in the guidelines for skull radiography. Patients found to have a skull fracture can thus be admitted for neuro-observation and computed tomography if indicated

Cervical spondylotic myelopathy: Indications for surgery and choice of operative approach

Cervical Spondylotic Myelopathy [CSM] is a common neurosurgical problem with varied clinical presentation and natural course. The surgical approach to the treatment of CSM has been controversial both clinically and in literature. We present here the operative results of 23 patients with CSM, 9 were operated through the anterior approach and 14 through the posterior approach. Immediate postoperative improvement was noted in 88% patients, operated by anterior approach, and 64% in patients operated by posterior approach. Anterior approach is recommended when there is anterior compression at one or two levels. We recommend posterior decompression where compression is at more than two levels, posteriorly situated and/or. associated with spinal stenosis