Chest injuries associated with head injury

Background: Although there have been significant advances in the management of traumatic brain injury (TBI), associated severe injuries, in particular chest injuries, remain a major challenge. This paper analyses the contribution of chest injuries to the outcome of head injuries in the University of Nigeria Teaching Hospital (UNTH) and the Memfys Hospital for Neurosurgery (MHN) in Enugu, Nigeria. Materials and Methods: This is a retrospective review of the medical records, operative notes, and radiological findings of all patients admitted for head injury who had associated significant chest injuries in the MHN from 2002 to 2009 and the UNTH between 2007 and 2010. Patients with only head injury and other extracranial injury not affecting the chest were excluded. Patients who were inadequately investigated were also excluded. Results: Nineteen patients from the MHN and 11 patients from the UNTH were analyzed. Ages ranged from 9 to 65 years and the male:female ratio was 3:1. Injuries were most common between 30 and 50 years and road traffic accident accounted for 60%. Barotrauma from ventilation was documented in 2 patients. The commonest types of intrathoracic injuries are pneumothorax and hemothorax. Chest wall injuries are more common but carry less morbidity and mortality. Only 20% of patients presented within 48 hours of injury. Management of the associated chest trauma commenced in the referring hospitals only in 26.4% of the patients. All patients with hemo-pneumothorax had tube thoracostomy as did 96% of patients with pneumothorax. 10% of patients with haemothorax needed thoracotomy. Mortality is 43%, which is higher than for patients with only TBI with comparable Glasgow coma scale. Outcome is influenced by the time to admission and the GCS on admission. Conclusion: Associated chest injuries result in higher mortality from head injuries. This association is more likely in the young and more productive. All patients presenting with head and spinal cord injury should be specifically and carefully evaluated for associated chest injuries. Computerized tomographic has not replaced the need for good quality chest radiograph in the emergency management of Head Injury associated chest trauma

Unusual causes of chronic subdural hematoma

Chronic subdural hematoma (CSDH) is a common but frequently under-investigated intra cranial lesion. Most times it is attributed to an obvious or trivial head injury, but it possibly may also be a presenting feature of a more serious underlying pathology. This article highlights three patients who presented with CSDH with varying underlying pathologies: acute lymphocytic leukaemia and prostate cancer. The need for thorough investigation of patients with recurrent CSDH and the challenges of emergency neurosurgical intervention were emphasized.Keywords: CSDH, Acute Lymphocytic Leukaemia, Prostate Cance

Chest Injuries Associated with Head Injury

Background: Although there have been significant advances in the management of traumatic brain injury (TBI), associated severe injuries, in particular chest injuries, remain a major challenge. This paper analyses the contribution of chest injuries to the outcome of head injuries in the University of Nigeria Teaching Hospital (UNTH) and the Memfys Hospital for Neurosurgery (MHN) in Enugu, Nigeria. Materials and Methods: This is a retrospective review of the medical records, operative notes, and radiological findings of all patients admitted for head injury who had associated significant chest injuries in the MHN from 2002 to 2009 and the UNTH between 2007 and 2010. Patients with only head injury and other extracranial injury not affecting the chest were excluded. Patients who were inadequately investigated were also excluded. Results: Nineteen patients from the MHN and 11 patients from the UNTH were analyzed. Ages ranged from 9 to 65 years and the male:female ratio was 3:1. Injuries were most common between 30 and 50 years and road traffic accident accounted for 60%. Barotrauma from ventilation was documented in 2 patients. The commonest types of intrathoracic injuries are pneumothorax and hemothorax. Chest wall injuries are more common but carry less morbidity and mortality. Only 20% of patients presented within 48 hours of injury. Management of the associated chest trauma commenced in the referring hospitals only in 26.4% of the patients. All patients with hemopneumothorax had tube thoracostomy as did 96% of patients with pneumothorax. 10% of patients with haemothorax needed thoracotomy. Mortality is 43%, which is higher than for patients with only TBI with comparable Glasgow coma scale. Outcome is influenced by the time to admission and the GCS on admission. Conclusion: Associated chest injuries result in higher mortality from head injuries. This association is more likely in the young and more productive. All patients presenting with head and spinal cord injury should be specifically and carefully evaluated for associated chest injuries. Computerized tomographic has not replaced the need for good quality chest radiograph in the emergency management of Head Injury associated chest trauma.Keywords: Chest injuries, head injuries, outcomeNigerian Journal of Surgery, Jan-Jun 2012 | Volume 18 | Issue

Modified laminoplasty for degenerative cervical spondylosis: The technique of floating laminoplasty

Background: Laminoplasty is an established alternative to laminectomy for posterior cervical decompression in spondylotic myelopathy. However, standard laminoplasty requires internal fixation, which is often not obtainable in developing countries. We present our experience with a technique of noninstrumented (floating) laminoplasty developed to avoid the need to anchor the laminoplasty to the anterior elements.Methods: We have used floating laminoplasty (FL) for posterior cervical decompression in patients with cervical spondylosis since 2004 and report the technique and our experience with it between 2009 and 2014 when C‑arm and magnetic resonance imaging became available in our unit. Patients who had classical laminectomy and hemilaminectomies were excluded. The operation involved bilateral approach to the laminae through a midline incision with generous sparing of the supraspinous, interspinal and interlaminar ligaments. During closure the laminoplasty was hitched to the ligamentum nuchae. Nurick grading was used for clinical evaluation. Patients were followed for at least 1 year.Results: There were 36 patients with age range between 32 and 72 years (mean: 56.5 years). Male to female ratio was 3:1. Most patients presented with advanced disease, with 25%, 36%, and 30% at Nurick Grade 3, 4, and 5, respectively. Postoperatively, all (100%) patients with Nurick Grade 2 and 3 improved to Grade 1 or 0, while 9 (69%) of the 13 at Grade 4 improved to Grade 2 or better. Only 1 (9.1%) of 11 operated at Grade 5 did not improve while 3 (27%) improved to Grade 2 or better. No postoperative instability was identified on follow‑up.Conclusion: FL is a safe and simple procedure that preserves spine stability and minimizes postoperative spinal deformity.Keywords: Cervical spondylosis, laminoplasty, ligamentous suspensio

Modified Laminoplasty for Degenerative Cervical Spondylosis: The Technique of Floating Laminoplasty

Background: Laminoplasty is an established alternative to laminectomy for posterior cervical decompression in spondylotic myelopathy. However, standard laminoplasty requires internal fixation, which is often not obtainable in developing countries. We present our experience with a technique of noninstrumented (floating) laminoplasty developed to avoid the need to anchor the laminoplasty to the anterior elements. Methods: We have used floating laminoplasty (FL) for posterior cervical decompression in patients with cervical spondylosis since 2004 and report the technique and our experience with it between 2009 and 2014 when C-arm and magnetic resonance imaging became available in our unit. Patients who had classical laminectomy and hemilaminectomies were excluded. The operation involved bilateral approach to the laminae through a midline incision with generous sparing of the supraspinous, interspinal and interlaminar ligaments. During closure the laminoplasty was hitched to the ligamentum nuchae. Nurick grading was used for clinical evaluation. Patients were followed for at least 1 year. Results: There were 36 patients with age range between 32 and 72 years (mean: 56.5 years). Male to female ratio was 3:1. Most patients presented with advanced disease, with 25%, 36%, and 30% at Nurick Grade 3, 4, and 5, respectively. Postoperatively, all (100%) patients with Nurick Grade 2 and 3 improved to Grade 1 or 0, while 9 (69%) of the 13 at Grade 4 improved to Grade 2 or better. Only 1 (9.1%) of 11 operated at Grade 5 did not improve while 3 (27%) improved to Grade 2 or better. No postoperative instability was identified on follow-up. Conclusion: FL is a safe and simple procedure that preserves spine stability and minimizes postoperative spinal deformity

Dominant hemisphere and upper cervical cord tumefactive multiple sclerosis in a Nigerian teenager initially misdiagnosed and managed

A 13-year old right handed Nigerian girl presented with eleven weeks history of progressive visual loss, three weeks right hemi-body weakness which progressed to quadriparesis, dysphasia, severe headache, tonic-clonic seizures, neck pain, vomiting and fever.Examination revealed Glasgow Coma Score (E4M6V2), expressive dysphasia and depressed mood. Visual Acuity was counting finger bilaterally. Neck was supple. She had global hypotonia, grade 3 hyper-reflexia and extensor Babinski bilaterally. Power was 0/5 in the right upper limb and right lower limb, 2/5 in the left lower limb and 4/5 in the left upper limb. Other examinations were unremarkable.Contrast enhanced brain MRI revealed three cystic ring enhancing masses at left fronto-parieto-occipital region, associated oedema, midline shift and C2-C4 intramedullary mass with cord oedema. The ring enhancement was incomplete towards the cortex.Following initial suspicions of cystic brain tumour with spinal cord metastasis, she had decompression biopsy. Histology was inflammatory lesion, clinically assumed to be from brain abscess. Failure of antibiotic treatment and the deteriorating neurology prompted mini-craniectomy and biopsy of the cyst wall. Final diagnosis was tumefactive multiple sclerosis. She was successfully managed with methylprednisolone. Follow-up clinical condition has been satisfactory.Keywords: TMS, cranial masses, multiple sclerosis, visual los

Low back pain in adults: pattern of abnormal findings on MRI lumbosacral spine images in south-east Nigeria

Background: Low back pain is a leading cause of musculoskeletal disability resulting in loss of productivity and frequent outpatient physiotherapy. Magnetic Resonance Imaging (MRI) allows detailed evaluation of the soft tissue and bony components of the lumbosacral spine. It also assesses abnormalities that may be associated with low back pain.Objective: To document the frequency and most prevalent lumbosacral spine MRI findings in patients with low back pain.Methodology: Three hundred archived MRI images of patients aged 18 years and above investigated for low back pain at Memfys hospital for Neurosurgery were evaluated in this study. Analysis of data was done using SPSS Software Version 21.0 for windows.Results: The study population had a mean age of 53.9 years with a range of 18 to 91years. Positive findings were noted in 299(99.66%) of 300 subjects. Subjects aged 40 – 49 years (22.67%) were of the highest frequency followed by 50 – 59 (22.33%). Positive findings were neural foramina narrowing (96.33%), disc herniation (93.67%), disc dehydration (79%), canal stenosis (46.67%), vertebral degenerative changes (43%), scoliosis (19.67%), cord compression (11%), discitis (9%), vertebral fracture (7%), spinal mass (5.67%), vertebral mass (5%) and kyphosis (3.4%). Most prevalent findings were mainly in the 60 – 69 age group of male gender.Conclusion: This study has demonstrated a high prevalence of abnormalities in lumbosacral MRI of patients with low back pain. The most prevalent findings were neural foramina narrowing, disc herniation and disc dehydration.Keywords: Imaging, Positive findings, Soft tissue, Bony component

Cerebellar liponeurocytoma: a novel report from Nigeria in a 6-year-old girl, and review of literature

Liponeurocytoma is a newly defined clinical entity predominantly seen in the cerebellum as a slow-growing tumor. In this report, we present the case of a 6-year-old Nigerian girl with a liponeurocytoma, and review of literature