Normal Pressure Hydrocephalus

Normal pressure hydrocephalus (NPH) is characterized by dilated ventricles and a combination of gait impairment, cognition impairment, and loss of urinary control (urgency and incontinence). The only effective treatment for NPH is a CSF shunt; however, only a small percentage of patients ever receive it. The features of gait impairment in patients with NPH are difficult to distinguish from patients of neurodegenerative disorders with motor involvement, such as parkinsonism or dementia with Lewy bodies. CT or MRI imaging is required for the diagnosis of idiopathic normal pressure hydrocephalus. An Evans ratio of more than 0.3 indicates large ventricles, and a ratio of more than 0.33 indicates very large ventricles, but is not specific for idiopathic normal pressure hydrocephalus. The international and Japanese guidelines support shunt surgery as effective treatment of idiopathic normal pressure hydrocephalus, as does the American Academy of Neurology practice guideline. There is a need to provide longitudinal care of patients with idiopathic normal pressure hydrocephalus after shunt surgery as all symptoms respond well to shunt surgery

Burden of traumatic brain injury in refugee population: unmet need of care and gaps in knowledge

Background and objectives. Due to marked increase in violence, the world is facing problem of refugee population either as a source of refugee population or shelter provider. These refugee population is exposed to prolonged physical and emotional distress over years, may result into spectrum of neuropsychiatric disease conditions including traumatic brain injury (TBI). Although trauma is one of the major events faced by refugee population, the exact details of the injuries still not documented and there is paucity of published literature; further these injuries may be recorded as unspecified. Methods. The present article is intended to provide a theoretical overview of existing knowledge and gaps on trauma and injuries in the refugee population. Authors analysed all relevant articles available on PubMed and Medline using the keywords: “Refugee”, “Traumatic Brian Injury”, “Head Injury”. Results. There is a gap in knowledge for this particular demographic population. They suffer a wide range of physical and emotional to social traumatic events. The most common cause of head injury was assault; however, motor vehicle accidents were less prevalent, and there is an ongoing struggle for resources to fulfil basic needs leading to health care taking a backseat. There is high prevalence of post-traumatic stress disorder. Many of the refugees are settled in relative economically poorer countries which further add to the burden of a nation already besotted with internal requirements. There is a need for international collaboration to tackle unique problem. Conclusion. Authors recommend urgent need to handle the root causes responsible for the generation of refugee population and at the same time it is necessary to identify the epidemiology, patterns, management challenges and consequences of injuries and barriers to seek and provide care in refugee population

Venous thromboembolic sequel of head injury: A narrative review

In this systematic review, we detailed the current understanding and controversies on venous thromboembolism as the sequel following traumatic brain injury (TBI). The review was conducted on the literature survey to find the thromboembolic morbidities in TBI patients. This review presented the thromboembolic sequel of patients with TBI by a comprehensive focused assembly of research publications by searching various resources. A search strategy with specific inclusion criteria was performed in PubMed, Cochrane, Web of Science, and the WHO Global Health Library. TBI is related with the incremental presence of spectrum of thromboembolic disorders from primary and secondary injuries by the significant increases in the concentrations of the initiating factors of the coagulation cascade. The incidences of thromboembolism vary on factors like the severity of TBI, methods of prophylaxis used or the processes to diagnose embolic involvement. The most effective time for the initiation of antithrombotic therapy chemoprophylaxis should be initiated after 24 h or after 72 h in patients with brain trauma is still a controversial issue. Patients with brain injury are at increased risk for thromboembolism for which prophylaxis and timely management are highly recommended, and this should be available in all levels of care

In Memoriam: A Memoir for Our Fallen "Heroes"

This article is made available for unrestricted research re-use and secondary analysis in any form or be any means with acknowledgement of the original source. These permissions are granted for the duration of the World Health Organization (WHO) declaration of COVID-19 as a global pandemic.Even though neurosurgeons exercise these enormous and versatile skills, the COVID-19 pandemic has shaken the fabrics of the global neurosurgical family, jeopardizing human lives, and forcing the entire world to be locked down. We stand on the shoulders of the giants and will not forget their examples and their teachings. We will work to the best of our ability to honor their memory. Professor Harvey Cushing said: “When to take great risks; when to withdraw in the face of unexpected difficulties; whether to force an attempted enucleation of a pathologically favorable tumor to its completion with the prospect of an operative fatality, or to abandon the procedure short of completeness with the certainty that after months or years even greater risks may have to be faced at a subsequent session—all these require surgical judgment which is a matter of long experience.” It is up to us, therefore, to keep on the noble path that we have decided to undertake, to accumulate the surgical experience that these icons have shown us, the fruit of sacrifice and obstinacy. Our tribute goes to them; we will always remember their excellent work and their brilliant careers that will continue to enlighten all of us. This memorial is intended to commemorate our colleagues who succumbed during the first 4 months

Surgical Excision with Forehead Flap as Single Modality Treatment for Basal Cell Cancer of Central Face: Single Institutional Experience of 50 Cases

Basal cell carcinoma (BCC) is the most common skin cancer worldwide. The WHO has defined it as “a locally invasive, slowly spreading tumor which rarely metastasizes, arising in the epidermis or hair follicles and in which the peripheral cells usually simulate the basal cells of the epidermis.” Here we discuss the management of BCCs of central face with surgical excision and reconstruction with forehead flap as single modality treatment. Material and Methods. This is a retrospective review of 50 patients who underwent surgical excision of BCC involving the facial region followed by primary reconstruction using forehead flaps at a single institution. There were 20 males and 30 females, mean age of 59 years. Results. No recurrence at primary site was observed during the follow-up of 1–4 yrs. There was no ectropion or exposure sequela. However, epiphora was evident. Size of lesions ranged from 2 to 6 cm. Keloid formation was seen in 2 (4%) patients. Functional and cosmetic outcomes were satisfactory. Conclusion. For the face, the best reconstructive effort eventually fails in the face of tumor recurrence. The forehead flap represents one of the best methods for repair of extensive facial defects. Complete tumor extirpation, the primary event, is the key

Unilateral visual loss after spine surgery: Lesson to be learnt from unexpected devastating complication

Visual loss following spinal surgery is a potentially devastating and rare complication. Spinal surgery is the leading cause of POVL. Although the etiology of POVL is not clearly understood, multiple risk factors have been proposed. The horseshoe is no longer an appropriate device for prone spinal surgery and its use should not be supported. Awareness, evaluation and timely management of this rare devastating complication is crucial. It is advisable to inform high-risk patients that there is a small, unpredictable risk of perioperative visual loss. We discuss a case of 32 year old lady; who had experienced unexpected visual loss after elective spine surgery. Keywords: Visual loss, Spinal surgery, Ischemic optic neuropath