Spontaneous acute subdural hematoma in a patient with multiple myeloma

Acute spontaneous subdural hematoma in a patient of multiple myeloma receiving chemotherapy is an unknown event, needing an urgent neurosurgical management. We report this patient who presented with progressive neurological deterioration and a low platelet count. She was successfully managed by craniotomy and evacuation of subdural hematoma with intraoperative transfusion of platelets. The acute spontaneous subdural hematoma in her was probably related to the bleeding diathesis due to thrombocytopenia associated with chemotherapy

Original Article - Role of methylprednisolone in acute cervical cord injuries

BACKGROUND: Management of acute cervical cord injury with neurodeficit continues to evoke debate. Glucocorticoid steroid methylprednisolone has been found to be effective in preventing secondary cord injury. Aims: This study was done to evaluate the role of methylprednisolone in acute cervical cord injury. MATERIAL AND METHODS: Thirty patients of acute cervical cord injury with demonstrable neurological deficit were administered methylprednisolone within 8 hours of acute cervical cord injury while eighteen others were not administered this drug. The patients were assessed for neurological recovery. RESULTS: Patients who received methylprednisolone within 8 hours of injury had more motor recovery (P<0.001) than those who were not given the drug. Improvement in the pinprick scores and light touch scores were also greater at 6 weeks (P<0.001). Similar effect was also seen after 6 months. CONCLUSION: Methylprednisolone prevents secondary cord injury to a great extent and hence its administration in the immediate post injury period results in a better functional (motor and sensory) outcom

Original Article - Role of methylprednisolone in acute cervical cord injuries

BACKGROUND: Management of acute cervical cord injury with neurodeficit continues to evoke debate. Glucocorticoid steroid methylprednisolone has been found to be effective in preventing secondary cord injury. Aims: This study was done to evaluate the role of methylprednisolone in acute cervical cord injury. MATERIAL AND METHODS: Thirty patients of acute cervical cord injury with demonstrable neurological deficit were administered methylprednisolone within 8 hours of acute cervical cord injury while eighteen others were not administered this drug. The patients were assessed for neurological recovery. RESULTS: Patients who received methylprednisolone within 8 hours of injury had more motor recovery (P<0.001) than those who were not given the drug. Improvement in the pinprick scores and light touch scores were also greater at 6 weeks (P<0.001). Similar effect was also seen after 6 months. CONCLUSION: Methylprednisolone prevents secondary cord injury to a great extent and hence its administration in the immediate post injury period results in a better functional (motor and sensory) outcome

Outcome in thoracolumbar injuries.

Objectives: 1) To study the epidemiological and clinico-radiological features of thoracolumbar injuries; 2). To see the efficacy of canal compromise and canal clearance on neurological outcome in thoracolumbar injuries. Study Design: Retrospective study from Jan. 2007 to Jan. 2009. Material & Methods: A total of 40 patients were included in the study out of which, 31 were operated and 9 were managed conservatively. All the patients were evaluated by plain X-rays, CT scan supine with 3D reconstruction and plain MRI and neurological evaluation done by Frankel’s grading. Patients were operated to the anterolateral approach with grafting with inter-body fusion. Results: Males were affected more than females and trauma was more common in rural areas. Fall was the commonest cause of thoracolumbar injuries and trauma was more common in summer and autumn seasons. Dorsolumbar junction was the commonest site of injury. Patients with more canal compromise were having more neuro-deficit and there was no correlation between canal clearance and outcome at surgery. Conclusions: Patients with more canal compromise have more neuro-deficit and there is no correlation between canal clearance and outcome at surgery

Ventriculoperitoneal shunt blockage by hydatid cyst

Ventriculoperitoneal (VP) shunt is one of the commonest procedures done in neurosurgical practice throughout the world. One of the commonest problems after putting the VP shunt is the shunt obstruction, which can be due to varied causes. Shunt obstruction secondary to the parasitic infections is rarely seen. We are presenting a 15-year-old child, a case of operated cerebral hydatid cyst with hydrocephalus. She presented with shunt malfunction after 1 year of surgical excision of the hydatid cyst. Revision of the VP shunt was done and peroperatively, it was found that the shunt tubing was obstructed due to small hydatid cysts. This is the first reported case of VP shunt obstruction by hydatid cyst