Toddler with repeated fall frequently visiting hospital presented with acute subdural hematoma on readmission with ultra-rapid evolution: surgical management strategy

Repetitive fall producing head injury in children may lead to development of intracranial hematoma. The course of evolution may be rapid in case of repeated fall due to induction of sub-clinical coagulopathy caused by repetitive cranial injury. The awareness of such possibility is highly desired among the pediatrician and neurosurgeon and emergency team and quick diagnosis and pertinent imaging study is of immense value and appropriate surgical management for prompt and expediting the evacuation of intracranial hematoma evacuation should be attempted to preserve good neurological outcome. Authors reports a case, who had rapid neurological worsening, managed surgically with good neurological outcome, further various surgical management options along with pertinent literature are briefly reviewed

Air in acute Extradural Hematoma: Management and outcome analysis

Extradural hematoma with air bubbles has been described in literature. However the significance of it needs special attention with respect to prognosis. We report five case of extradural hematoma with air bubble and its management along with pertinent literature is reviewed briefly

Traumatic complete transection of dorsal spinal cord un-associated with spinal fracture or subluxation: Management review

Complete transection of spinal cord is an extremely rare occurrence, and usually associated with spinal instability, fracture or spondylolisthesis and also have associated systemic polytrauma involving multiple organs injury. However, a complete transaction of spinal cord unassociated with fracture or dislocation or without abnormality on X-ray and CT scan imaging is extremely uncommon. Kalfas et al. observed 11.2 % of cases had cord transection in the study of sixty-two cases spinal cord-injured patients, who underwent spinal MRI, were additionally had evidence vertebral injury. In 2010, Cha et al reported the first case of transection of cord in the cervical region in a 34- year- adult male, as the first case in literature, which was not associated with any vertebral body fracture or dislocation. Authors report an interesting case, 15-year boy, who had complete transection of the spinal cord associated with polytrauma following a motor vehicle accident, spinal X-ray and CT scan imaging was unremarkable, however spinal MRI scan established the diagnosis. Briefly, imaging, management and pertinent literature are reviewed

Spontaneous chronic subdural hematoma development in chronic myeloid leukemia cases at remission phase under maintenance therapy, management strategy: A series with literature review

Chronic subdural hematoma (CSDH) is common squeal of trauma and rarely associated with anticoagulant therapy, antiplatelet, chemotherapeutic drugs, arterio-venous malformation, aneurysms and post-craniotomy. However its occurrence is very unusual with systemic haematological malignancy and mostly reported with acute myeloid leukemia; however incidence of SDH occurrence in chronic myelogenous leukemia (CML) is very rare. CML is a haematological malignancy characterized by chromosomal alteration, pathologically represents increased proliferation of the granulocytic cell line without loss of capacity to differentiate. CML has three phases – remission phase, accelerated phase and blast crisis. About 85 % of patients present in remission phase of disease and carries a favorable prognosis. As intracranial, subdural hematoma usually occur in the accelerated phase or blast crisis phase or extremely uncommon during chronic remission phase, although only those affected, who are neglecting therapeutic medication or discontinued therapy or rarely as an adverse effect of medications. However, important role of neurosurgeon lies in early detection and correction of platelet count and associated hematological abnormality as quite sizeable proportion of cases may not need surgical intervention instead can be managed conservatively under regular supervision in association with oncologist colleague, but few cases may need urgent surgical intervention. So, selecting a subgroup of CML cases in the remission phase requiring surgical intervention, presenting with CSDH is not only challenging, as failure to make an informed and timely precise decision can lead to catastrophic worse outcome and even mortality. So, purpose of current article is to formulate the management therapeutic plan. Authors report three cases of CML in chronic remission phase, receiving treatment under guidance of Haemto-oncologist at our institute presented with spontaneous chronic SDH. The mean age was 36 years (range 29- 44 years), 66% were male, headache was presenting feature in all 100% (n=3), 66% cases were hemiplegic and 33% unconscious each, in 66% cases CSDH were located on right fronto-temporal region and 33% had small left sided thin CSDH. About were 66% cases (n=2) were managed surgically by burr hole placement and drainage drain placement while 33% case (n=1), who had thin CSDH was managed conservatively. Favorable outcome was observed in 100% cases (n=3) Outcome was favorable in all of our cases

Migration and Sub-galeal coiling of distal components of V-P shunt in a 2-year-boy: Does Electrical stimulation as part of physiotherapy is cause or casual association?

The ventriculo-peritoneal (VP) shunt surgery in resource constrained centre still remains, most common form of treatment for hydrocephalus. The V. P. shunt complications can occur along entire course of shunt, distal complications are obstruction of catheter, cerebrospinal fluid ascites, abscess and ulceration of skin. However, total cranial migration and getting coiled in subgaleal space, of peritoneal catheter end is very rare occurrence and is reported in only seven cases as isolated case- report in western literature, further more rare is associated extrusion of ventricular catheter and rarer is subgaleal coiling of both peritoneal and ventricular end. Author reports a rare and unique case of complete migration of peritoneal catheter into subgaleal space in a 2-year old boy associated, with partial extrusion of ventricular end, the child was also given electric stimulation by untrained physiotherapist along the shunt tract, which might have facilitated cranial migration of distal catheter in our case. Pertinent literature is briefly reviewed

Liponeurocytoma of Cerebellum: Rare entity, case based study

Cerebellar liponeurocytoma (LNC) is a very rare neuroepithelial tumor. About thirty eight cases have been reported, in literature till date, mostly in the form of isolated case reports due to rarity of the occurrence. Authors report interesting case in 27-year old male presented with headache and cerebellar signs. MRI imaging revealed posterior fossa mass. He underwent sub occipital ctraniectomy with gross total resection of lesion. Histopathological report of specimen was consistent with liponeurocytoma with range of MIb index less than three. He is under regular follow-up. However he was not advised any adjuvant therapy. Diagnosis of LNC requires high index of suspicion and neuroimaging with typical MRI findings may be help to confirm the diagnosis. The tumor needs to be differentiated from medulloblastoma, which is far more common and aggressive and requires post-operative chemo-radiation and carries poor prognosis Management and pertinent literature will be reviewed

Transient internuclear ophthalmoparesis associated with mutism following midline cerebellar tumour surgery in an 8-year boy

Mutism and neurobehaviour symptoms are well known features, which may occur following surgical excision of mass lesion of various histopathologies in the posterior cranial fossa, during the postoperative period. Mutism may be rarely associated with ataxia of eyelid closure and paresis of external ocular muscles. However, internuclear ophthalmoparesis is not reported in association with mutism following posterior cranial fossa surgery. We report an 8-year–boy, who developed internuclear ophthalmoparesis following suboccipital craniectomy for decompression of vermian medulloblastoma. The clinical features, aetiopathogenesis, management of transient internuclear ophthalmoparesis associated with mutism and pertinent literature is reviewed in short

First report of two synchronous but separately placed intramedullary angiolipomas located in the dorsal spine causing progressive compressive myelopathy: management strategies and outcome review

Spinal angiolipoma is a benign lesion and presents with compressive myelopathy. Typically, it is located in epidural compartment. However, intramedullary angiolipoma is extremely uncommon, and till date only eight cases are reported in the literature and all reported cases had isolated solitary lesion. Authors report an interesting case of intramedullary spinal angiolipoma (ISAL) in a - 48- years male, presented with compressive myelopathy, magnetic resonance imaging study revealed presence of two separate angiolipomas, which were located at D8-D9 and D10-D12 vertebral levels respectively, underwent successful near total surgical resection with good neurological outcome. Current case represents first of its kind in the western literature. Management of such rare pathology along with pertinent literature is briefly discussed

Elizabethkingia meningoseptica causing meningitis after decompressive craniectomy for traumatic brain injury in a immunocompetent adult: Serious Neurocritical care Concern

Elizabethkingia is aerobic Gram negative bacteria is widely distributed in soil, food and food. It is very rarely pathogenic for human and especially those who are immunocompromised and various risk factors includes intravenous catheter, ventilatory support. We report a case, who had undergone decompressive craniectomy for traumatic brain injury, developed meningitis, CSF culture showed growth of Elizabethkingia and treated successfully with antibiotics therapy. This study reminds that rare pathogen should also be considered as causative organism for meningitis especially in postoperative cases and it responds well to antimicrobial therapy

Primary giant myxoma of the temporal bone with major intracranial extension: Presenting with hearing impairment and ear polyp

Myxomas are mesenchymal origin, benign tumor, constituting approximately half of the benign cardiac tumors. Occasionally, it may also occurs at other locations, though the intracranial location of a myxoma is considered exceptionally rare. Only isolated few cases of intracranial myxoma are reported in the literature, almost all were locally confined within the originating bone. The extensive Pubmed and Medline search yielded only eight cases of primary myxoma arising in the temporal bone with extension into intracranial compartment. However intracranial extension is limited as early detection, however, Osterdock et al reported a case also arising from temporal bone with extensive intracranial extension. Author report an interesting case of intracranial myxoma in 27- year- old- male, involving the temporal bone associated with extensive bony erosion and also extending into infratemporal fossa, mastoid, and frontoparietal region and a polypoidal mass protruding into external ear. To the best of knowledge of authors, temporal myxoma presenting with external ear polypoidal mass, which underwent successful surgical excision is not reported and represent first case in the world literature