International Journal of Neurology and Neurosurgery

An aneurysmal bone cyst (ABC) is a benign, locally proliferative vascular disorder of non-neoplastic osseous lesions in children and young adults, usually involving long bones. Spinal ABCs are rare. We are reporting a rare case of ABC involving dorsal spine presented with spastic paraplegia and discussing management along with
review of literature.

Keywords: Spinal tumour; Extradural Tumour; Aneurysmal Bone Cyst.
 

Background and Aim: Compound skull fracture accounts for 6% of head injuries. It is usually managed through surgical debridement of devitalized, contaminated soft tissues, fractured segments and dealing the intracranial pathology at the same time. The calvarial defects following debridement are conventionally left behind and cranioplasty is done 2 to 3 month after, to avoid infection related complications. Our aim is to analyze the result of single stage titanium mesh reconstruction in the management of compound and comminuted skull fracture and
review the previous studies.

Method: It is a retrospective study conducted at the VIMSAR, Burla, Sambalpur, odisha where case records of 43 patients of head injury associated with compound skull fracture admitted to neurosurgery department and had undergone debridement, followed by immediate titanium mesh cranioplasty procedure were analyzed between the year 2018 and 2020.The standard technique of debridement was followed in all cases. The presence of depression more than the thickness of surrounding bone, compound nature of the wound, associated dural
injury with or without underlying brain injuries in CT was considered to be the most important criteria for the early debridement. All had undergone cranioplasty. Patients having very low GCS, extensive scalp laceration with skin loss and those having delayed presentation ,post debridement brain swelling were excluded for cranioplasty. All Patients were followed until 3 month after their discharge from ward. The clinico-radiological follow up and outcome was evaluated.

Results: A total of 43 patients were included in the study. Road traffic accident (RTA) was the predominant mechanism of injury (60.5%). The frequency of skull fracture was significantly higher in men (93%) than that in women. The mean Glasgow coma scale was 13.357 at admission and 14.905 at discharge. Fracture was located most commonly in the frontal region (65.11%). 41.9 % of patients had paranasal sinus involvement and 69.8 had associated dural injury. A total of 40 patients achieved good surgical outcome. A very low incidence of complications was found amongst patients during their stay in the hospital and 3 month follow up. One patient developed surgical site infection .one patient had a sinus formation with intermittent discharge needed removal of mesh and two had transient post operative CSF leak. There was no immediate post operative seizure. Post operatively antibiotic was given for average 9 days and the mean hospital stay was 11 days.

Conclusion: Immediate cranioplasty does not pose increased risk of infection as thought earlier. Early and thorough debridement and copious saline irrigation are two most important surgical principles by which infectious complications can be reduced to minimum. So whenever feasible single stage cranioplasty should be preferred over
staged procedure for early overall recovery and return to work.

Keywords: Kull fracture; Cranioplasty; Titanium mesh.
 

Background: “A Trigeminal neuralgia is a frequent and painful condition which in mostly Idiopathic and is rated by the patients as worst of all pains that afflict the mankind, affecting the all age group people”. TGN in characterized by paroxystic episodes of lancing, or burning pain or pain felt as electric discharges, that present spontaneously or may be caused by the action of auditory or cutaneous stimuli , the basic pathogenesis is still mysterious. The safe and effective treatment for TGN and chronic pain is a large public health concern. Palmitoylethanolamide (PEA) is
a endogenously produced amide cannabimimetic compound with tissue protection and anti inflammatory activity which is a new class of drug. “Neuropathic pain is defined by international Association for the Study of Pain (IASP), Pain caused by a lesion or disease of the somato sensory nervous system”.

Objectives: The aim and objective of this study is to evaluate the effectiveness and safety of Palmitoylethanolamide (PEA) in the management of patient, suffering from TGN.

Materials and Methods: The Study was conducted in the Neurosurgery unit of Surgery Department in Gandhi Medical College and Associated Hamidia Hospital Bhopal India. A total no. of 40 patients aged 20-78 years were included in the study from Nov 1917 to May 1919 and divided into two groups group I (study group) and the group II (Controlled group) PEA was given to group I to evaluated the effect of PEA in TGN.

Result: We have studied 40 patients with PEA for 60 days and Palmitoylethanolamide 354 mg orally given Three times (TDS) a day for first2 weeks than Two times (bid) a day for 6 week. All patients refused surgery. It is available in India in the Name of Palmiges. PEA was associated with greater pain reduction in Study Group compare to the
controlled group. The primary outcome measure was the mean pain reduction evaluated by VAS scale.

Conclusion: PEA seems to be useful in the treatment of TGN and it is well tolerated in patients with Study Group.
Palmitoylethanolamide (PEA), reduces the inflammation which results in lowering/ reduction of TGN pain and PEA used successfully in the prophylaxis treatment of neuropathic pain. We used PEA in a series of patients surfing from TGN in addition to pharmacological therapy already used. The controlled trials are further needed to prove be efficacy and reliability and also to find out the adverse reaction associated with the drug. Thus, what is needed at this critical juncture is a Solution which corroborates to the care of TGN Pain with No side Effects.

Keywords: PEA; Palmitoylethanolamide; Trigeminal Neuralgia; Analgesics; VAS (Visual Analogue Score); Ticdouloureux.

 

Purpose: Despite technical and medical advances, aneurysmal subarachnoid haemorrhage (SAH) continues to be a challenging pathology, associated with high rates of morbidity and mortality. The purpose of this study is to describe the various prognostic factors of the clinical outcome in the patients ofaneurysmal clipping for spontaneous SAH.

Methods: It was a prospective study where 48 patients had microsurgical clipping for CT angiography confirmed saccular aneurysm. Various parameters studied were age, sex,hypertension, loss of consciousness, World Federation of Neurosurgical Societies (WFNS) grade and Hunt & Hess grade at admission, time of ictus to surgery,
symptomatic vasospasm, Fisher grade of SAH, Hydrocephalus, neck: dome ratio, intra-operative rupture and temporary clipping time. The primary outcome measures were mortality and Glasgow outcome score (GOS) at three-months follow-up. Prognostic study was derived from analysis of these variables.

Results: Parameters found to be associated with unfavourable outcome were increasing age, hypertension, poorWFNS grade on admission, poor Hunt and Hess grade, higher Fisher grade, time of surgery and symptomatic vasospasm. WFNS grade, Hunt and Hess grade and Fisher grade were found having statistically significant correlation with neurological outcome of the aneurysmal SAH patients.

Conclusion: Microsurgical clipping is a safe and time-tested modality for treatment of SAH due to ruptured intracranial aneurysms. Higher WFNS grade, higher Hunt and Hess grade and higher Fisher grade are the factors leading to poor outcome in patients of ruptured intracranial aneurysm presenting with SAH.

Keywords: Prognostic factor; Subarachnoid haemorrhage; Intracranial aneurysm; Microsurgical clipping; Outcome.
 

Background: After good recovery noted from Intracarotid Sodium Nitroprusside (ICSNP) previous studies in rats and then humans, there was always a hitch in preinjection period that whether this ICSNP will benefit the recipient or not. Sodium Nitroprusside (SNP) via its 10000 fold effect, is used in out timed InjrTPA (Recombinant Tissue
Plasminogen Activator) cases (5 days to 21 days) of ischemic stroke while skipping local induced Nitric Oxide Synthase Enzyme (i NOS) and superoxide (causes destructive effect) formation.Acupunture Like-Transepidermal Neural Stimulation (AL-TENS) used here for quantitative measure of the stroke recovery bedside other than NIHSS grading to evaluate the ICSNP effect.AL-TENS causes pain relief by gate theory at spinal cord with negative inputs from brain on Renshaw cells.

Objective: To prognosticate the POST-ICSNP effect by AL-TENS in humans of delayed ischemic stroke from 5th to21st day by AL-TENS, a Prospective-study.

Material and Methods: 27 ischemic stroke patients (18 male, 9 females) taken. Mean time was 7 days. Dose 0.01
mg/kg/bo/wt at ipsilateral to MRI/CT SCAN indicated infarct, carotid artery direct puncture via 20G Medikit given. Study was monitored by AL-TENS and NIHSS grading.

Results: POST-ICSNP AL-TENS showed 16.66% benefit and 30.12% in NIHSS grading overall. Thus AL-TENSshowed a favorable modality to predict the ICSNP feasibility in partial hemiplegia cases that is LACS, PACS and POCS. Complete hemiplegia with major artery block cases, PRE-ICSNP AL-TENS showed 8mAmp or more - noresponse to ITSNP.

Conclusions: AL-TENS helps us to prognosticate outcome in partial hemiplegia with ICSNP.

Keywords: Acute ischemic stroke; Intracarotid sodium nitroprusside; Acupuncture-like tens (al-tens); The 10,000 fold effect.

Key Message: This study is very crucial one for the acute ischemic stroke cases who comes after the lapse periodof rTPA injection that is after 6 hours of acute ischemic infarct.