International Journal of Neurology and Neurosurgery

Introduction: The adjuvant therapeutic radiation therapy (RT) results in the development of cranial neoplasms, though is a rare entity but a serious complication.Tthe most common form of radiationinduced neoplasm is the radiation induced meningiomas. These are the late complications in patients who have received adjuvant radiation therapy for brain tumors. In 1953, Mann, et. al. first described a 4yearold girl who was treated with 65 Gy for an optic nerve glioma developed a meningioma in the irradiated field which eventually became malignant. The most common form of the RIBT is the Meningioma as reported in the literature [3]. Radiationinduced meningiomas developing after the surgical excision of medulloblastoma are seen very rarely.

Case Report: A 13yearold male patient presented with left frontal meningioma which developed after 9 years from receiving adjuvant radiation therapy for medulloblastoma. Surgical resection and RT was applied at the age of 4 for medulloblastoma. At age of 13, the patient had features of raised ICP (Intra Cranial Pressure). A neurological examination was normal. Magnetic resonance imaging demonstrated a left frontal mass. The patient underwent left frontal craniotomy and the mass removed totally. Histopathological examination revealed a meningotheliomatous meningioma.

Conclusion: The adjuvant RT given post operatively for medulloblastoma resulted in the cytological changes of tumor cells. All the cases of pediatric malignancies and those particularly exposed to adjuvant radiation therapy are advised for followup for a longer period of time as it is crucial for the early detection of the radiation induced tumors and it should be considered as a part of the effective therapy of the primary disease.

Keywords: Radiation Induced Meningiomas (RIM); Sporadic Meningiomas; Medulloblastoma. 

Patent foramen ovale (PFO) is a flaplike opening between the atrial septa primum and secundum at the location of the fossa ovalis that persists after age 1 year. With increasing evidence being found that PFO is the culprit in paradoxical embolic events. By demonstrating our case report, we want to highlight the relevant aspects of the patent foramen ovale and the association of cryptogenic stroke, its clinical presentation, diagnosis and management.

Keywords: Ischemic Stroke; Cryptogenic Strokes; Interatrial Septal Abnormalities.

Pott’s puffy tumor is described as an osteomyelitis of the frontal bone with associated subperiosteal abscess. It usually presents as a swelling over the forehead. Despite its decreased incidence in the postantibiotic era, intracranial complications can be seen in upto 40% of cases. Rupture resulting in a draining cutaneous fistula has also been reported. We present one such case of a patient with two paramedian scalp masses that were initially ignored. Rupture of one of the masses led to a discharging sinus in an atypical location behind the coronal suture.The subsequent development of hemiparesis brought the patient to emergency. The location and clinical presentation led us to initially suspect an epidermoid/dermoid pathology until the final radiological and histological correlation. A bifrontal craniectomy with ultrasound guided aspiration of the abscess led to improved outcomes.

Keywords: Puffy Tumor; EpiduralCutaneous Fistula. 

Introduction: Management of unidentified and unaccompanied patients is difficult in any health care setup due to challenges in managing their daytoday care, treatment, and finally their rehabilitation as compared to patients having their attendants.

Aims & Objectives: This study was designed to collect data of unidentified & unaccompanied traumatic brain injured patients to prepare a framework for better outcome of these patients.

Patients and Methods: All unidentified and unaccompanied traumatic brain injured patients admitted in department of Neurosurgery, K.G.M.U., Lucknow from June 2015 to December 2017 (2.5 years) were enrolled in this study. We have devised various strategies to utilize the available infrastructure such as reserved the beds for these patients in the ward, allocation of designated fund for consumables, dedicated trained paramedical staff for nursing and care, enthusiastic multidisciplinary team of doctors for overall management during hospital stay, speeding the identification process through intense web based search of information available in Voter list & Aadhaar card. We do our our search on the basis of some clues gained during history taking of patient and daily rounds. Departmental staff, social workers, police and media personal help were taken for relocation of these patients to their home or non government organization shelter homes.

Results: There were 86 patients, 0.25% of all visits. Mortality was highest for polytrauma patients having severe traumatic brain injury (n=32, mortality= 68.7%), followed by moderate head injury (29, 41.3%) & mild head injury (25, 8%). Overall mortality was 41.8%. Outcome of these patients was comparable to patients who are accompanied by their relatives. Identification was made prior to hospital discharge in 96%. In this group, the most common source of information were the patient (40%, successful web based voter list search for home address in 12% of these cases), family (22%), or document eventually found on the person or belongings (8%). Survivors were much more likely to be identified than those who died (94% versus 83%, P less than .0001).

Conclusion: Comprehensive team approach of sensitized hospital staff, society and media is need for better management of unidentified and unaccompanied head injury patients. Web based Voter list search for home address is important digital tool helping in relocation. Framework development and strict adherence to strategies leads gratifying results.

Keywords: Unknown Patients; Traumatic Brain Injury; Unaccompanied patients. 

Objective: To evaluate the various outcome variables in posterior fossa haematomas following surgical evacuation.

Methods: This is a prospective study done from August 2013 to February 2016 done on 68 patients with posterior fossa EDH, traumatic cerebellar haematomas, brainstem contusions, spontaneous cerebellar haematomas, sub dural haematomas were initially resuscitated, examined and graded according to GCS. The patient was thoroughly investigated and underwent conservative management and surgical evacuation and outcome parameters were measured.

Results: The patients admitted were evaluated with the preoperative GCS, of which the score of 812 with good outcome is present in 10 patients (66%) (P value0.0414), and the haematoma size and volume was measured showing a good outcome in 9 patients (69%) (P value0.0490) and 5 patients (83%) (P value0.0493) of haematoma size of < 4cm and volume of < 15ml. The patient’s outcome was also measured by effacement of 4th ventricle, as the good outcome was seen in 14 patients (73%) (P value0.0161). External ventricular drinage was performed in 14 cases of associated hydrocephalus. Significant no. of patients (17) had a GOS of 5 at disharge and followup. The mortality rate of the study was 14%.

Conclusions: The preoperative GCS, clot size, clot volume and configuration of the fourth ventricle on CT scans is a useful sign and valuable in measuring the oucome of the patient to apply the various and the best management protocol. These outcome variables can definitely change the mortality and morbidity in posterior fossa haematomas.

Keywords: Posterior Fossa Haematoma; GCS; GOS. 

Breath holding spells, otherwise called as “Infantile syncope”, are well recognized, common clinical entity characteristically seen in infants and younger children aged 6 months to 5 years. Breath holding spells are nonepileptic paroxysmal event that occur in otherwise healthy children. The attacks are benign but may cause fearfulness and anxiety to parents, until the condition is “defused” by explanation and reassurance. The events are self limited and gradually disappear before child reaches 5 years of age. It is important to differentiate breath holding spells from epileptic seizures so that inappropriate treatment with antiepileptics can be avoided. To differentiate from closely resembling epilepsy, one hundred children with breath holding spells in this study, were examined electroencephalographically during sleep between the intervals of the spells. Our study found that all of the children in the study group had normal EEG findings except for one child, which showed slow waves but no epileptic form discharges. Hence it is concluded that EEG study in combination with detailed history and clinical observation is of value in differentiating breath holding spells from convulsive disorders.

Keywords: Breath Holding Spells; EEG; Children; South India. 

Introduction: The incidence of epilepsy in the continent has not been changed much for the past few decades and Asia contains more than half of the world‘s epileptic patients with an estimated 8 10 million in India alone. Data also states that only half of them are under medical treatment. Despite innumerable studies presented over the years the acknowledgment and understanding of the overall prevalence is not entirely understood. Regional studies help us to understand the distribution in the specific population.

Aim: To study on the demographic distribution of epilepsy in a tertiary referral hospital.

Materials and Methods: With the institutional ethical committee authorization this study was done in a tertiary referral hospital to understand the demographic configurations for a period of a year based on preformed questionnaire in 100 patients consulting in the epilepsy clinic.

Observation and Results: 100 patients were interviewed based on the questionnaire and the data was studied. Men were more than women. Majority of the patients were between 11 and 30 yrs of age (51 out of 100). Etiology in most of the patients was unknown etiology (45 out of 100) which was followed by symptomatic epilepsy (41/100) including Hypoxic ischemic encephalopathy, CNS infection, Metabolic encephalopathy, Septic, vascular (CVT, acute hemorrhagic stroke), Alcoholic and Mesial Temporal Sclerosis etc. Idiopathic epileptic syndrome was present in 10 patients and cryptogenic being the least with four. Generalized tonic clonic seizure (GTCS) was seen in 43% followed by complex partial (34%), Myoclonic (10%), Absence (8%), Simple partial (5%) in that order. Treatment gap was seen in 19 out of 100 patients.Most of the patients 56/ 100 were unemployed and 80/100 had primary, secondary or university education.

Conclusion: Epilepsy is identifiable and can be controlled with regular treatment and follow up. Early identification, prompt diagnosis and treatment, reduction in treatment gap and social support can help the patients to progress in many ways such as education, employment and better living.

Keywords: Epilepsy in India; Idiopathic Epilepsy; Idiopathic Epileptic Syndrome; Symptomatic Epilepsy; Cryptogenic; Treatment Gap.

Introduction: In India 10 million people are suffering from epilepsy. The etiology of epilepsy is complex and heterogeneous amongst various studies. The distribution of subtypes of epilepsy is variable in different parts of our country. There is dearth of data on epilepsy from central India.

Aims and Objective: To study subtypes of epilepsy and to findout nuro imaging and EEG abnormalities.

Material and Methods: This is an retrospective observational study of 122 patients of epilepsy done during a period of one year conducted in the department of Neurology. All patients underwent detailed clinical EEG and neuroimaging.

Results: Mean age of the patients was 26.31years. Male to female ratio was 2.29:1. Majority of patients belonged to the second to fourth decade of life. Total 71.31% patients had generalized seizures while 28.69% patients had partial seizures. Interictal EEG was abnormal in 37% patients. Neuroimaging abnormality was found in 42.62% patients. Neurocysticercosis was diagnosed in 9%, tuberculoma was found in 5% cases while a vascular cause was identified in 15.57% patients.

Conclusion: The young age males were more commonly affected & predominant seizure semiology was generalized tonic clonic and predominant epilepsy type was idiopathic generalized. The most common cause is vascular followed by granuloma. Majority of patients responded to monotherapy and compliance of drug intake is very good that might be due to good counselling policy of our department regarding need of continue management.

Keyword: Epilepsy Profile; Seizure Profile; Epilepsy Epidemiology; EEG in Epilepsy; Neuroimaging in Epilepsy. 

Introduction: Endoscopic techniques are being increasingly used in the management of various neurosurgical pathologies, in recent times. Endoscopic third ventriculostomy (ETV) is a well accepted mode of treatment for obstructive hydrocephalus of various etiologies. Success rate of endoscopic third ventriculostomy is poor in posthemorrhagic, postinfective hydrocephalus. It is safe in correctly selected cases. Good preoperative planning, appropriate imaging, surgeons experience and good postoperative care help in successful results. The purpose of this study was to define the success rate of endoscopic third ventriculostomy in the treatment of obstructive hydrocephalus.

Aim of the Study: The purpose of this study is to determine the success rate of endoscopic third ventriculostomy (ETV) in the treatment of obstructive hydrocephalus in our Institution.

Materials and Methods: Patients with triventricular hydrocephalus secondary to posterior fossa lesions, brain stem gliomas, CP angle tumours, pineal tumours, aqueductal stenosis and patients with blocked shunts inserted for triventricular hydrocephalus were included. Patients with normal pressure hydrocephalus, postsubarachnoid haemorrhage hydrocephalus and age less than 2 years were excluded.

Results: A total of 52 patients with hydrocephalus were treated by the Endoscopic third ventriculostomy (ETV) procedure. There were 26 males and 26 females with age ranging from 2 years to 69 years and with a mean age of 30 years. Successful outcome was seen in almost 75% of patients (39 cases), while 13.5% of patients (7 cases) required VP shunt. Clinical and radiological improvement was observed in 2 patients (5.1%) and clinical improvement was observed in alone in 37 patients (94.9%) in final followup review of endoscopic third ventriculostomy functioning cases.

Conculsion: From this study, it can be concluded that endoscopic third ventriculostomy is the first line surgical procedure which is safe, fast and effective for treating obstructive hydrocephalus.The procedure is successful in 75% of cases. The success rate is highly dependent on the underlying pathology regardless of Endoscopic Third Ventriculostomy (ETV), Obstructive Hydrocephalus, Posterior fossa tumour, Aqueductal stenosis the age of patients.

Keywords: Endoscopic Third Ventriculostomy (ETV). 

Context: CSF rhinorrhea is a potentially devastating condition which if left untreated leads to significant morbidity and mortality so timely and appropriate intervention is needed.

Aims and Objectives: To determine feasibility of conservative approach and to find out whether this approach increases complications and recurrence.

Settings and Design: All patients attending OPD or admitted in the ward with CSF rhinorrhea were included in the study.

Methods and Material: Clinical history and physical examination followed by certain investigations were performed in all patients and clinical outcome of each patients were noted in terms of improvement of symptoms

Results: Extended conservative approach was found to be safe and effective in management of CSF rhinorrhea

Conclusion: Extended conservative approach can be safely applied to treat CSF rhinorrhea.