Pediatric Extradural Hematoma: Clinical Assessment Using King's Outcome Scale for Childhood Head Injury.

INTRODUCTION: Epidural hematoma (EDH) is a traumatic accumulation of blood between the inner table of the skull and the stripped off dural membrane and predominantly consists of venous blood in infants. The study aims to assess the outcome of pediatric EDH using King's Outcome Scale for Childhood Head Injury (KOSCHI). MATERIALS AND METHODS: A total of 72 patients' files were reviewed retrospectively with a diagnosis of EDH from January 2012 to December 2014. Predesigned proforma was filled using data from patient records. In addition, KOSCHI was calculated using recent telephone interviews. RESULTS: Among 72 patients, 65.3% were male and 34.7% were female. Overall, road traffic accident was the most common cause (52.8%) followed by fall, assault, and sports injury. The most common symptom was more than two episodes of vomiting which was present in 51.4% of patients followed by loss of consciousness in 37.5%, ENT bleed in 33.3%, headache in 16.7%, and fits in 11.1% of patients. The median follow-up of our patients was 19 (6-40) months. Most of our patients made good recovery with 76.4% of our patients scoring 5b on KOSCHI. CONCLUSION: EDH is not uncommon among children with head injury. It should be suspected in every child with posttraumatic skull fracture or scalp hematoma. Prompt surgical intervention can give good long-term outcome.

Orbital Meningoencephalocele and Pulsatile Proptosis: A Rare Entity.

Orbital roof defects are rare congenital osseous abnormalities that cause protrusion of intracranial contents into the orbit, resulting in a condition known as the orbital meningoencephalocele, a rare cause of pulsatile proptosis. We present a case of a 25-year-old lady, presented to us with complaints of left frontal headache, left eye protrusion and double vision from the left eye for the past three months. Her higher mental functions were intact. Local examination revealed non-axial pulsatile proptosis and an outward depression of the left eyeball along with diplopia. Extraocular movements and pupillary light response were normal with no bruit or orbital tenderness. Computed tomography (CT) scan of the brain and orbit with contrast showed deficient bone on the left orbital roof and floor with left frontal gliotic brain compressing the eyeball. Magnetic resonance imaging (MRI) of the brain and orbit with contrast showed an asymmetrical deformity of the skull and left cerebral hemisphere which was bulging towards the left orbit. We planned a two-staged surgical reconstruction. The orbital roof was first reconstructed using a titanium mesh. Within two weeks of surgery her pulsatile proptosis, diplopia, and headache had considerably improved and the proptosis had resolved with no visible pulsations. She is scheduled for second stage surgery after three months for reconstruction of the orbital floor.

Postepidural Spinal Intradural Arachnoid Cyst: A Rare Case Report.

Compression of the neural structures in spine by an intradural arachnoid cyst is a rare entity. At times such a cyst is an incidental finding. Spinal epidural injection is one of the few rare etiological factors for its development. Symptomatic cysts can present with variable neurological manifestations depending on the spinal level involved. This includes back pain, lower limb weakness, and sphincteric dysfunction. If asymptomatic, they can be followed radiologically. Surgical decompression along with a histological diagnosis is reserved for cysts that are enlarging, symptomatic or the ones for whom the diagnosis is uncertain. Incomplete excision of cyst wall or simple fenestration and decompression mandates close follow-up, clinically and radiologically for further recurrences.

Post-traumatic fibrous dysplasia of the parietal bone: A rare entity.

Fibrous dysplasia (FD) is a rare fibro-osseous lesion in which normal bone is replaced by abnormal fibrous tissue. Although a congenital disorder, a single case report of traumatic etiology had been described in the literature. We report a case of monostotic FD of the parietal calvarium in a 21-year-old female patient who presented to us with a single swelling in the parietal region been noticed after head injury sustained at the age of 7 years. After imaging investigations, the lesion was excised via craniotomy followed by cranioplasty in the same sitting. The histopathological evidence was suggestive of FD. To the best of our knowledge, this is the second case of a posttraumatic cranial FD and the first case describing the growing mass in the parietal bone secondary to head injury.

Hereditary angioedema: A rare presentation after anterior cervical discectomy and fusion.

Hereditary angioedema is an autosomal dominant disorder following a genetic defect of C1 inhibitor gene on chromosome 11. This rare condition presents itself as a recurrent attack of submucosal swelling mostly involving skin, gastrointestinal tract and upper respiratory airway and exacerbates with any physical and emotional stress. Prompt diagnosis and prevention of an acute attack with early recognition and effective treatment can protect the patient from potential laryngeal edema and fatality.

Clinical Outcome in Patients with Early versus Delayed Decompression in Cervical Spine Trauma.

STUDY DESIGN: Prospective observational study. PURPOSE: To assess the clinical outcome after early versus late decompression for traumatic cervical cord injury. OVERVIEW OF LITERATURE: Traumatic spinal cord injury is common globally with the most tragic outcomes in the cervical spine. Although recent studies have shown that early decompression results in more favourable outcome, its authority is yet to be established. METHODS: Study on 98 patients with a traumatic cervical cord injury was conducted over a period of 5 years. The patients who were operated on within 24 hours of the onset of the primary injury (n=34) were classified as the early group, and those who were operated on after 24 hours of the onset of the injury (n=64) were categorized as the late group. The outcome of both the groups was assessed using the American Spinal Injury Association (ASIA) Impairment Scale (AIS) at the 6-month follow-up. RESULTS: The patients in the early group were operated on at a mean time of 18.4 hours (range, 13-24 hours) while patients were operated on at a mean time of 52.7 hours (range, 31-124 hours) in the late group. At the 6-month follow-up, 7 (23.3%) in the early group and 5 (8.7%) in the late group showed >2 grade improvement in the AIS. CONCLUSIONS: The results of patients undergoing decompression within 24 hours of the injury are better than those who are operated on later. An attempt should be made to decompress the traumatic cervical spine early in all possible cases.

Traumatic brain injuries: experience from a tertiary care centre in Pakistan.

AIM: Traumatic Brain Injury (TBI) is one of the leading causes for morbidity, mortality and economic loss. The impact is much worse in developing countries like Pakistan. The objective of our study was to highlight the etiological pattern and distribution of TBI in Pakistan. MATERIAL AND METHODS: From July 2009 to June 2011, 1378 patients presenting to our Accident and Emergency Department with head injury were included in the study. Patients underwent detailed clinical and radiological evaluation as per trauma protocol. RESULTS: The most commonly affected age group was 21 to 30 years (34.1%) with male to female ratio of 3.3:1. Injuries were predominantly caused by road traffic accident (62.6%), followed by fall (31.7%) and assault (5.5%). Amongst those with RTA less than 1% of the patients were wearing proper safety equipment. The most common CT scan finding was brain contusion (14.1%); others included traumatic sub-arachnoid hemorrhage (7.1%), subdural hematoma (7.6%), extra-dural hematoma (5.8%) and depressed skull fracture (4.6%). CONCLUSION: Motorbike accidents are a major cause of severe traumatic brain injury. Although this can be minimized by wearing proper helmets, its use is limited. Moreover, there is an imperative need to implement proper referral system amongst hospitals citywide in order to minimize the consequences of secondary brain injury.

Intra cranial hydatid cyst: A case report of total cyst extirpation and review of surgical technique.

Hydatid cysts commonly affect liver and lung but it can also affect the brain in rare cases. We report a case of 22 year female with history of headache for one and half years. Intracranial hydatid cyst was diagnosed on computed tomography scan and magnetic resonance imaging. The cyst was delivered without rupture using hydrostatic dissection followed by post-operative anthelminthic medication. Surgery remains to be the standard management. Amongst the surgical techniques described, Dowling's technique is the most acceptable. However, care must be taken in to avoid rupture of the cyst peroperatively which can result in subsequent complications and recurrence. Albendazole and corticosteroids can be used as adjunct to surgical treatment in selective cases.