Occipital Condyle Fracture – A Diagnosis Requiring High Suspicion

Traumatic injury causing occipital condyle fractures (OCF) are very rare. They are of critical clinical importance owing toimportant anatomical structures that need considerations of the occiput-atlantoaxial joint complex. Early diagnosis is of paramount importance since there may be associated lower cranial nerve palsies along with cervical spinal instability. Sometimes, this can be a diagnostic challenge in acute stage because of the inability to diagnose this injury with plain radiographs. To avoid this, high index of suspicion and relevant investigation of the craniocervical junction is indicated. Hence it helps in early recognition and diagnosis of OCF thus preventing possible neurological impairment. Here, we report a case of a 58 -year-old male who presented with complaints of neck pain and headache following physical assault

Shifting paradigm in brain abscess management at tertiary care centre in Nepal

Aim: Brain abscess is a challenging clinical entity with substantial high case fatality rates despite significant advances in imaging techniques, laboratory modalities, surgical interventions, and antimicrobial treatment.Otogenic and cardiogenic sources are among the most common. Classic clinical presentation is seen in very few cases only. Burr hole with aspiration works well with good clinical outcomes. Control of primary source in cases of ear infection in the single setting results in good outcomes, reduces for additional surgery, and decreases the duration of hospital stay.Methods: This is prospective observational study conducted at Institute of Medicine, Tribhuvan University Teaching Hospital, Kathmandu, Nepal over the period of two and a half years (from September 2014 to March 2017).We analyzed the demographic profile, management strategies and outcome of these cases diagnosed with brain abscess using Microsoft Excel 2007.Results: A total of 51 cases were undertaken for surgical management. There were 35 males and 16 females with the male to female ratio of 2.18:1. The mean age of the study population was 16.76 years with age range from 4 months to 60 years. Otogenic source was the most common. Temporal lobe was the most common abscess location. Headache was the most common clinical presentation and was seen in 86.27% of the study population. All cases were initially managed with burrhole and aspiration of the abscess. Only 3.92% (n = 2) of cases subsequently required surgical excision of the abscess wall. Only 11.76 % (n = 6) of the cases required multiple aspiration. Only 19.61% (n = 10) showed positive culture. Pseudomonas aeruginosa and E. coli were the most common organisms grown. Mortality rate among the study group was 3.92%.Conclusion: With the advent of modern technology in neuroimaging, mortality due to brain abscess has significantly decreased. Joint involvement of the otorhinolaryngology team and efforts in addressing the primary source have further helped in improving outcomes in cases of otogenic brain abscess. Hence, source control is of paramount importance in managing the brain abscess

Pediatric brain abscess clinical profile, management and outcome at tertiary care centre in Nepal

ABSTRACTBackground: Brain abscess in pediatric population is serious life threatening problem. Many risk factors are associated with this entity like congenital heart disease, ear infection and immunocompromised state. Early diagnosis and treatment with minimal invasive procedure has good outcome. Materials and Methods: This is a hospital based cross-sectional study conducted at institute of Medicine (IOM), Tribhuvan University Teaching Hospital Kathmandu, Nepal over the period of 3 years between September 2014 to August 2017. Clinical profile, management and outcome were analyzed. Results: A total of 27 cases were taken for the surgical management in the present study. There were 18 male and 9 female with the male to female ratio of 2:1. Mean age of the study population was 7.08 years. Otogenic Abscess was the most common 37.03% (n=10) and the temporal lobe was the most common site (37.5%). Headache was the most common clinical presentation seen in 74.07 %. All the cases were initially managed with the burrhole and aspiration. Only 14.8 %( n=4) of cases subsequently required surgical excision of the abscess wall. Only18.5 %( n=5) of the cases required multiple session aspiration. Positive culture was seen in 25.9% (n=7). Pseudomonas aeruginosa and E.coli were the commonest organisms grown. Mortality rate was 3.7%.Conclusion: Modern advances in radio imaging and multidisciplinary team involvement has decreased the morbidity and mortality.Keywords: otogenic brain abscess; pediatric brain abscess; tubercular abscess. </p