Scissoring of a Cobalt Alloy Aneurysm Clip causing Slippage during Cerebral Aneurysm Surgery : Case report and review of literature

Clip slippage is a rare occurrence, and the scissoring or torsional failure of aneurysm clips is rarer still. Titanium clips have been implicated in a few such reported cases. The authors report its occurrence while using a fenestrated cobalt alloy clip for an internal carotid artery aneurysm which was identified by intraoperative angiography and rectified by re-applying a non-fenestrated cobalt alloy clip. The possible mechanism of this complication, and measures that may prevent its occurrence, including meticulous dissection, decompression when possible, proper clip selection, and intraoperative angiogram are described. 

Traumatic Acute Brain Herniation through the Ear in a Child : Concealed compound fracture

A seven-year-old girl presented to Sultan Qaboos University Hospital, Oman, with a history of having been hit by a motor vehicle. After this, she had right-sided cerebrospinal fluid otorrhoea, and a week later, brain matter extruded through the right ear. A computed tomography scan of the brain demonstrated a tegmen fracture communicating with the external auditory canal. There was no hearing or facial nerve impairment and an otoscopic examination showed an intact tympanic membrane. She underwent a transcranial repair of the middle cranial fossa base, which revealed a wide dural and bony defect of the tegmen with herniation of the temporal lobe. Repair was made with an intradural patch of artificial dura. The rarity of this type of presentation of temporal bone fracture and its management are discussed

Fungal Granuloma following Endoscopic Third Ventriculostomy for Infantile Hydrocephalus

Endoscopic third ventriculostomy (ETV) is increasingly being used in the treatment of hydrocephalus in infancy. Infective complications rarely occur following ETV and fungal infections or granulomas have not been reported so far. The authors report the occurrence and management of a fungal granuloma incidentally detected during a repeat ventriculoscopy for a non-functioning ETV

ACTH Secreting Pituitary Microadenoma Presenting with Acute Psychosis, Delirium and Paroxysmal Sympathetic Hyperactivity

ACTH secreting pituitary adenomas are known to be associated with behavioral changes but acute presentation including psychosis and delirium are less common. We report the case of a 42-year-old lady with a known medical history of hypertension and diabetes mellitus, presenting with acute onset behavioral changes suggestive of psychosis. Further evaluation revealed an ACTH dependent Cushing’s disease with a pituitary microadenoma. The patient was admitted for endoscopic resection of the adenoma. During the peri-operative period, she experienced worsening of psychosis along with delirium. She also developed episodes of unresponsiveness, posturing, severe diaphoresis and dyspnea accompanied by tachycardia and hypertension which were managed with Midazolam and Levetiracetam. A seizure work-up and CT brain were unremarkable. At follow-up, she showed full resolution of symptoms with good blood pressure and glycemic control. ACTH secreting pituitary microadenoma presenting with acute psychosis, delirium and paroxysmal sympathetic hyperactivity. Keywords: Cushing’s disease, neuropsychiatric, dysautonomia

Cerebellar Mutism Following Closed Head Injury in a Child

Cerebellar mutism is a rare occurrence following paediatric trauma. Although it is quite common after posterior fossa surgery in children, this phenomenon has rarely been reported following other insults, such as trauma, and its pathophysiology remains poorly understood. We report a seven-year-old child who presented to the casualty department of Sultan Qaboos University Hospital in Muscat, Oman, in May 2013 with a traumatic right cerebellar contusion. The child presented with clinical features of cerebellar mutism but underwent a rapid and spontaneous recovery. The possible mechanism of this occurrence is discussed

Anterior Inferior Cerebellar Artery Loop-Induced Paroxysmal Otalgia in a Child

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Primary Extradural Meningioma Presenting as Frontal Sinusitis with Extensive Bony Changes : Case report

Primary extradural meningiomas are rare tumours and calvarial meningiomas with extensive bony changes and frontal sinusitis are rarer still. We report a 40-year-old female patient who presented to the otorhinolaryngologist at the Sultan Qaboos University Hospital in Muscat, Oman, in October 2013 with headaches and frontal swelling. She was diagnosed with frontal sinusitis complicated by osteomyelitis. Further clinical examination and imaging revealed a left frontal calvarial meningioma with extensive bony changes and extracalvarial extension into the frontal sinus. She underwent a left frontal craniotomy during which the tumour was removed. The postoperative period was uneventful and a follow-up computed tomography scan after three months showed only postoperative changes. This report discusses the radiological differential diagnosis and management of this type of lesion

Tension Subdural Hygroma Following Resection of Posterior Fossa Tumour in a Child: A new clinico-radio-pathological entity

Persistent hydrocephalus is common in child after resection of posterior fossa tumours. Occurrence of subdural hygroma, but is very rare, with only few cases reported. We report the rare case of a child who developed a tense subdural hygroma with stable hydrocephalus, in the early postoperative period, following posterior fossa tumour resection. We describe the distinctive clinical, radiological and pathological features associated with the development of a tense subdural hygroma.  We also discuss the management by cerebrospinal fluid diversion, which includes either a ventriculoperitoneal or subduroperitoneal shunt. This unique condition is distinguished from external hydrocephalus by features that are critical to the management strategy.  Keywords: Child, Posterior fossa tumour, Postoperative period, Hydrocephalus, Subdural hygroma, Hygroma, External hydrocephalus

Delayed Transient Post-Traumatic Quadriplegia

Transient neurological deficit following cervical trauma have been reported following sports injuries, and has been referred to as cervical cord neurapraxia. The so-called "whiplash injuries" following minor motor vehicle collisions usually do not produce any neurological deficit. Here we report the case of a whiplash type of injury presenting with a delayed onset neurological deficit, which was followed by rapid and complete recovery. The patient, an otherwise healthy 34-year-old male, attended the emergency department of Sultan Qaboos University Hospital following a rear-end motor vehicle collision. We present images showing degenerative disc disease causing spinal canal narrowing and mild cord compression in the patient, but no spinal instability. Differential diagnoses are also discussed