Prognostic significance of prolonged corrected QT interval in cerebral contusion.

Background & objectives: Cerebral contusion (CC) results in a release of catecholamines, autonomic dysfunction and neural stimulation that can lead to a number of cardiac adverse events, so it is critical to determine these. So the objective of this study was to investigate the prognostic significance of electrocardiographic changes, particularly the effects of a prolonged corrected QT (QTc) interval in CC. Methods: In this retrospective cohort study, 110 patients with CC were evaluated. Age, sex, concomitant diseases, Glasgow Coma Scale on admission, radiological assessment of the contusion (location, size, course and presence of cerebral oedema), need for surgical intervention, length of hospital stay and the extended Glasgow Outcome Scale (GOS-E) were statistically analysed within the QTc interval by routine electrocardiography (ECG) on admission. Results: The prolonged QTc interval was found to be associated with a higher incidence of cerebral oedema and a significantly higher risk of needing surgery. Patients with a prolonged QTc interval had a significantly larger contusion volume, greater midline shift and longer hospital stay, so their GOS-E score was significantly lower. A prolonged QTc interval on admission resulted in a hospital stay of more than eight days (sensitivity: 0.97 and specificity: 0.86), a higher risk of midline shift of more than 0.45 cm (P=0.006, sensitivity: 0.80 and specificity: 0.99) and a GOS-E score of <7 (sensitivity: 0.97 and specificity: 0.85). Interpretation & conclusions: ECG changes on admission showing a prolonged QTc interval have prognostic significance in CC. This simple and easily applicable information should be taken into consideration at the time of clinical decision making which may prevent an adverse events survivor.

Management of Epidural Hematomas in Pediatric and Adult Population: A Hospital-Based Retrospective Study.

OBJECTIVE: We retrospectively reviewed and evaluated our treatment protocols in epidural hematoma (EDH) cases to compare surgical versus nonsurgical treatment subsections with their trauma mechanism, injury type, clinical pattern, radiological details, functional outcome, and mortality rates. METHODS: This study included 350 patients (142 females and 208 males) treated for EDH between 2010 and 2018. Two hundred seven operated and 143 observed patients for EDH were compared for demography, injury type, treatment, and outcome scores retrospectively. Glasgow Coma Scale and Glasgow Outcome Scale were used to standardize the clinical findings. Marshall and Rotterdam classifications classified radiological abnormalities. The Infinity PACS system measured hematoma volume, and volume parameters were evaluated differently in pediatric and adult groups. RESULTS: Radiological parameters showed that the observation was more favorable when the EDH volume was <30 ml in the adult and <20 ml in the pediatric group. However, close clinical follow-up with repeated computerized tomography scans suggested that when the hematoma increases in volume in the first 24 hours, it should be treated surgically. Headache, vomiting, and paresis were significant clinical symptoms in this period. Only 11% of conservatively followed cases required delayed surgical intervention. When we analyzed the findings of the 2 groups of the patient, pediatric and adult, we noticed that rebleeding after the first surgery was more common in the adult group than the pediatric group, whereas surgery due to a growing hematoma was less common in the pediatric group. CONCLUSIONS: Age, trauma severity, initial neurological statuses, and accompanying comorbidities can affect the functional outcome in acute EDH. We found that urgent surgical intervention and conservative treatment may lead to excellent results in most cases. Thus, EDH can be managed both conservatively and surgically in certain conditions. We made a comparison between pediatric and adult age groups according to treatment modalities. Both rebleeding and mortality rates are relatively lower in the pediatric operated group than in the adult operated group. In the adult observation group, rates of delayed surgery because of growing hematoma seem relatively higher than in the pediatric observation group. During radiological follow-up, we found that the progression rate of EDH in the adult observed group according to time is faster than in the pediatric observed group (P < 0.05).

A Huge Calcified Supratentorial Ependymoma: A Case Report.

Tanycytic ependymoma has been marked as Grade II by the World Health Organization (WHO), requiring considerable treatment. However, according to the fifth edition of the WHO Classification of Tumors of the Central Nervous System published in 2021, tanycytic ependymoma is no longer identified as a subtype of ependymoma. Herein, we offer an unusual case of a supratentorial ependymoma, previously tanycytic ependymoma. Which radiologically mimic pineal region tumors; however, they pathologically mimic meningiomas, schwannomas, medulloblastomas, or astroblastomas. A three-year-old girl presented to our neurosurgery department with sudden onset gait disturbance and balance impairment; we detected no additional neurologic deficit. Magnetic Resonance Imaging (MRI) revealed a giant, multilobulated, well-circumscribed right pineal mass, approximately 4.5 x 4.5 x 4.5 cm in size, crossing the midline and extending posteriorly, invading the pineal region. The initial diagnosis was a pineal region tumor. Following gross-total resection of the tumor, pathology reports showed tanycytic ependymoma. Postoperatively the patient's gait disturbance was improved, and there was no balance impairment. Follow-ups at three and six months, no sign of recurrence has been encountered. Our case demonstrates that supratentorial ependymomas may also occur in the pineal region and requires an accurate neuropathologic diagnosis. Early accurate diagnosis is essential; since those tumors may be related to a wide range of prognoses and necessitate different treatment modalities.

Treatment method selection for sleep quality due to lumbar DISC herniation: Early surgery or others?; A single center clinical trial.

BACKGROUND/AIM: Sleep deprivation may lead to individual and social insufficiency associated with many physiological and psychological pathologies. This study is reported to investigate sleep quality and the relationship between treatment modalities of lumbar disc herniation, which is the most common cause of chronic lower back pain and sciatica. MATERIALS AND METHODS: This present study was conducted on 249 cases with chronic lower back pain and sciatica caused by a single- level lumbar disc herniation diagnosed after lumbar MRI (Magnetic Resonance Imaging) between June 2017 and September 2019. Cases were divided into three groups according to the treatment modalities: early surgical treatment (n:80), extended conservative treatment (n:142), and medical treatment only (n:27). VAS (Visual Analog Scale) and PSQI (Pittsburgh Sleep Quality Index) data before the treatment and 6 months after the treatment were statistically analyzed. RESULTS: It was determined that post-treatment VAS and PSQI scores were significantly reduced in all cases, regardless of the differences in treatment modalities (p < 0.05). In the early surgical treatment group, VAS score was improved by 69% and PSQI score was improved by 63.8%. These values were 28.5% and 38.6% in the extended conservative treatment. However, VAS score was increased by 27% in the patients who received only medical treatment. Statistical analysis of the treatment modalities showed that early surgical treatment was superior to the other treatment modalities (p < 0.05). CONCLUSIONS: It was determined that early surgical treatment of lumbar disc herniation was superior to other treatment methods in terms of maintaining the sleep quality impairments associated with deterioration in sleep quality.

Transorbital penetrating head trauma leading to serious cerebral edema - A case report.

Penetrating transorbital head injuries are rarely seen. We present a 6-year old male patient who was referred to our department after a wooden stick penetrated his right eye. On admission his general condition was well and he showed no neurologic deficits. On his cranial computed tomography (CT) there was a fracture on his right orbital wall and minimal subarachnoid hemorrhage in his right frontal lobe. On later follow-ups the patient's condition worsened and his control CT showed diffuse cerebral edema. The patient underwent emergent decompressive surgery. Due to this immediate intervention the patient was released from the hospital with no major deficits later. Up to our knowledge, there are no cases in the literature reported in which decompressive craniectomy was necessary after a transorbital penetrating head trauma.