International Journal of Neurology and Neurosurgery

Introduction: Fahr’s syndrome is a rare, degenerative neurological idiopathic condition characterized by basal ganglia calcification. It often appears between 40 - 60 years of age and can occasionally be seen in children. Case Report: In our case, it was a 40 year old female who presented with seizures and lab investigation showed-hypocalcemia & hypothyroidism. On Computed Tomography (CT) study, bilateral symmetrical calcifications in centrum semiovale, corona radiata, subcortical white matter of fronto parietal regions, caudate & lentiform nuclei and cerebellum were noted. Conclusion: Patients presenting with seizures and laboratory investigations showing hypocalcemia and abnormal parathyroid hormone levels, detailed neurological clinical examination and Computed tomography should be performed to rule out any abnormal intracranial calcification.

Background: Tension free closure of large neural tube defects after excision poses a significant challenge to the operating surgeon. We are studying the role of one sided or double sided rhomboid flap tailored according to the shape and size of the large defect. Aim: A decision making for wound reconstruction in large neural tube defects: Role of one sided or double sided rhomboid flaps. Materials and Methods: This was a retrospective study where the case records of all the cases of neural tube defects performed over 1 year from January 2021 to January 2022 in the department of paediatric surgery at a tertiary care hospital were reviewed after approval from the institutional ethics committee. We reviewed a total number of 20 infants admitted to the pediatric surgery department at our center. Their age ranged between 10 days and 4 months. We classified the defect into mild, moderate and major; mild defect was defined as defect less than 3cms in diameter, the moderate one is between 3-5cms in diameter while the major defect more than 5cms. Data is collected regarding location and type of lesion, ruptured or intact MMC, associated bony deformity, dimension of the defect (vertical and transverse) when one or double sided rhomboid flap was done. Dressing is opened in post operative day 5 and different complications like wound infection, flap necrosis and wound dehiscence in post operative period were noted. Data were tabulated and analysed statistically by calculating the mean and range of the data for different measures. Result: A total of 20 patients were operated during this period. Mean age of surgery for NTDs excision and repair is 68 days (10 days – 4 months). Average dimension of the defect when one sided rhomboid flap used was 4.1cms x 3.9cms (average total surface area~16cm2) and average dimension of the defect when double sided rhomboid flap used was 6.3cms x 5.2cms (average total surface area~32.7cm2). Wound infection is the most common short term complication, total of 5 (25%) patients developed wound infection. Wound infection was mainly limited to redness and serous discharge but none of them had CSF leak. Three patients (15%) had flap necrosis while only single patient (5%) had wound dehiscence. Conclusion: We concluded that the rhomboid flap is safe and a versatile option with less morbidity and flap related complications. It is a good aesthetic solution that permits tension free closure in large neural tube defects

Context: Prognosis of meningitis depends on early diagnosis and initiation of and treatment. The role of CSF markers like CRP needs to be evaluated in diagnosis of infectious meningitis.
Aims: To evaluate the diagnostic significance of CSF CRP and Serum CRP in cases of infectious meningitis
Methods Settings and Design: This was prospective clinical study which included the clinical evaluation and routine CSF analysis including CSF CRP and Serum CRP levels of 50 cases of meningitis and 50 other
control patients.
Statistical Analysis used: Analysis of data was done using SPSS-17. Independent t-test and chi-square test were used to calculate difference between two groups
Results: Our study showed that sensitivity of CSF CRP for bacterial, viral and tubercular meningitis was 88.8%, 10% and 9% respectively where as sensitivity of Serum CRP in bacterial, viral and tubercular meningitis was 100%, 10% and 90.9% respectively.
Conclusions: Our findings suggest that CSF CRP is highly specific to diffrentiate pyogenic meningitis from tubercular and viral meningitis. We also recommend doing serum CRP along with CSF CRP to diagnose and differentiate pyogenic and tubercular meningitis from viral meningitis 
Keywords: C Reactive protein (CRP); Cerebrospinal fluid (CSF); Meningitis.