Surgical management of traumatic extra dural hematoma in children: Experiences and analysis from 24 consecutively treated patients in a developing country

Background: Children with epidural hematoma (EDH) present differently thanadults. The outcome of treatment is also different. We aim to report our experiences with EDH in pediatric age group in terms of mode of injury, presenting features, management, and outcomes. We also aim to identify different prognostic indicators in pediatric patients with EDH. Methods: We prospectively collected data from 24 consecutively surgically treated pediatric patients. The data collected included presenting features, radiological imaging, details of management, and outcomes. Descriptive analysis was performed and different variables were tested for any statistical significance with Glasgow Outcome Score (GOS). Results: There were 19 male and 5 female patients. The mean GlasgowComa Scale (GCS) score at presentation was 9.3 ± 4.4. Falls were the mostcommon cause of EDH. Outcome assessment was done at 3 month follow up.A total of 15 patients had a GOS score of 5, 4 patients had a GOS score of4, 2 patients had a GOS score of 3, while 3 patients had a GOS score of 1.On univariate analysis, admitting GCS score, patient’s age, the time frominjury to admission and injury to surgery, anisocoric pupils at presentation andeffacement of basal cisterns were significantly associated with the outcome ofGOS score. Conclusion: Falls are the most common mode of injury leading to EDH inchildren. Lower GCS at presentation, younger age at trauma, increased timesince trauma to surgery and admission, anisocoria and effacement of basalcisterns are statistically significant variables in surgically treated pediatric patients of EDH that confer a poorer prognosis. A timely surgical intervention can result in excellent outcomes

Intra-medullary tuberculoma of the spinal cord presenting with typhoid and paraplegia: a case report

<p>Abstract</p> <p>Introduction</p> <p>Intra-medullary spinal tuberculoma is a rare form of tuberculosis, with an incidence of only two in 100,000 patients with tuberculosis. We present a case of intra-medullary tuberculoma from Pakistan, which was diagnosed by radiological findings and analysis of cerebrospinal fluid using polymerase chain reaction testing.</p> <p>Case presentation</p> <p>We present the case of a 28-year-old Sindhi male with intra-medullary tuberculoma of the spinal cord at the C3 level. Our patient was treated solely with anti-tubercular drug therapy with no surgical intervention.</p> <p>Conclusions</p> <p>We discuss the possible clinical management of such rare cases, considering both chemotherapeutic and surgical options. Additionally, diagnostic procedures and findings are discussed; we suggest cerebrospinal fluid analysis via polymerase chain reaction and gadolinium-diethylenetriamine pentaacetic acid magnetic resonance imaging as important chemical and radiological tests to be performed in such cases.</p

Delayed diagnosis of post-traumatic C7 vertebra anterior subluxation with an unusual neurological pattern: a case report

<p>Abstract</p> <p>Introduction</p> <p>Post-traumatic subluxations are potentially devastating injuries to the axial skeleton. Of utmost priority are an expedient and timely diagnosis and realignment because of its association with spinal cord and nerve root trauma, which lead to progressive deleterious neurological deficits. A good radiological study of the occipitocervical joint and first thoracic vertebra is key to a successful early diagnosis. However, cases might still fail to be diagnosed, leading to trouble. A case of post-traumatic subluxation at the C7 vertebral level with an unusual neurological pattern is presented here.</p> <p>Case presentation</p> <p>A 35-year-old farmer from the Sindh province of Pakistan presented to our neurology department after a fall 2 months earlier and complained of lower limb pain and difficulty in walking. He had numbness in both of his lower limbs up to his umbilical region, with sparing of bladder function along with intact strength in the upper extremities bilaterally.</p> <p>Conclusions</p> <p>Our case highlights the unusual sparing of upper limbs and intact urinary continence with severe lower limb deficits in a 70% subluxation. Our case is unusual because highly detrimental effects such as quadriplegia are expected with such extreme subluxation, but our patient presented with only lower limb deficits. This case serves as a reminder to emergency medicine doctors, spine surgeons, and even radiologists (a) to evaluate spine injuries by using computed tomography in trauma patients to identify artifact around a suspected injury and (b) to be mindful of negative conventional radiographs.</p