HYPERTENSIVE HEMORRHAGIC STROKE;

Objectives: The aim of our study is to evaluate the use of intracranial pressuremonitoring as a predictor of neurological deterioration in patients with hemorrhagic stroke andevaluate the relationship of continuous intracranial pressure monitoring with warning signsof brain herniation and hematoma enlargement in our setup. Study Design: Randomizedcontrolled trial. Period: 02 years duration from June 2014 to June 2016. Setting: Tertiary CareHospital in Karachi Pakistan. Method: Patients in group A had continuous monitoring of theintracranial pressures by having an implant device placed under general anesthesia. Bothgroups were given the required treatment as per guideline, including blood pressure reduction,diuretic and mannitol as per requirement. Both the groups were assessed clinically after every8 hours in the initial three days and then every day till no deterioration were observed for 5 days(pupils, reflexes, extremity test etc) and a repeat CT scan was performed at 24 hours after theonset of initial stroke. While in the control group pressures were monitored using neurologicalsigns and clinical measurements, and the dose of mannitol was adjusted accordingly. Theoutcome was assessed within 1 month duration from the onset of hemorrhagic stroke, and theparameters used were hematoma progression and herniation of the brain. Results: The patientpopulation consisted of n= 100 patients, who presented to our hospital with a primary diagnosisof hemorrhagic stroke, as confirmed by CT scan. The patient population was divided into twogroups using a random number generator, group A consisted of the patients who underwentintracranial pressure monitoring and had n= 52 patients, while group B consisted of the controlgroup (no objective ICP measurement) and had n= 48 patients in the group. The incidence ofenlargement of the hematoma in group A was n= 16 (30.76%) and in the control group was n=18 (37.5%). And when it comes to brain herniation n= 6 (11.53%) patients developed it in theICP monitoring group and n= 10 (20.833%) developed it in the control group respectively. Wefound that the mortality rate in our study population was n= 4 (7.69%) in ICP monitoring groupand n= 5 (10.41%) in the control group having a p value of 0.04, the neurological outcome in thetwo groups also had statistically significant differences, having a p value of 0.03. Conclusion: Inour study we found a lower incidence of secondary brain herniation in patients who underwentcontinuous intracranial pressure monitoring as compared to control group, furthermore thesepatients had better neurological outcomes.</jats:p

DANDY-WALKER SYNDROME;

Introduction: Dandy-Walker Malformation is an inborn condition that includesthe triumvirate of cystic enlargement of the fourth ventricle, posterior fossa distension with riseof the tentorium and agenesis of cerebellar vermis. The purpose of this study is to determinethe Clinical presentation and associated complications, mortality and morbidity of patientundergoing placement of shunt with Y- connector in Dandy Walker Malformation. StudyDesign: Case Series comprised of 85 cases. Setting: Neurosurgery Ward of Tertiary CareHospital in Karachi. Period: February 2011 to December 2015. Methodology: All patients whowere presented in OPD with complaints reminiscent of DWM with accompanied Hydrocephalusand then underwent CT scan Brain without contrast to confirm the diagnosis were admitted.The patients who have previous history of operation and other co-morbid anomalies wereomitted. These patients undergo drainage of Ventricular system and Posterior Fossa cyst wasdone mutually via Dual Shunt including Ventricular-peritoneal and Cysto-peritoneal shunt withY connector. There were few complications and mortality after this surgical intervention whichwas noted for a month. All records were recorded and evaluated by SPSS v.20. Result: Avast majority of patients included were Female. The average age of patients was 2.5 years+/- 1 Standard Deviation. The chief complaint was Hydrocephalus, existing in all patients,after that cerebellar signs in 55 (64.7%) and other signs in 10 (11.8%) patients. Others signsincludes; milestones were delayed, atypical gait and few patients were suffered from psychiatricproblems. Complications which were observed were shunt; Fracture/Dislocation in 10 (11.8%),shunt blockage in 8 (9.4%), malpositioning is also 8 (9.4%), Intracranial Hemorrhage in 7(8.24%) patients and Infection in 10 (11.8%). These complications were observed within amonth of surgery. Unfortunately, two (2.35%) patient were also expired after surgical approach.Conclusion: It is concluded that Dandy Walker Malformation is categorized by a triumvirate.Hydrocephalus is a most common symptom and principal cause of referral to hospitals. Thecommonest difficulty acknowledged after shunting is Malfunction and shunt infections. Thelowest mortality is related to Dual Shunt with Y connector when compared to other approachesfor management of shunt with Y-connector. Thus, it is found to be a worthy decision in givenDWM patients.</jats:p

POST HEMORRHOIDECTOMY PAIN RELIEF

Background: The aim of my study is to evaluate post-operative pain reliefon patients who had hemorrhoidectomy. Materials and Methods: 300 patients who hadhemorrhoidectomy were divided equally in to three groups, according to anesthesia type,group 1 (local anesthesia and sedation), while spinal anesthesia was group 2 and generalanesthesia was considered to be group 3. Pain relief, post-operative complications, hospitalstaying time were measured and compared between the three groups. Period: Study wasperformed between Jan 2012 to Dec 2014. Results: The study showed that patients who hadlocal anesthesia infiltration and sedation a significant decrease of post-operative total painscores at 6/12/18/24 hours of more than 50%,200/240/300/320 out of 1000 points in group IIas compared to 420/500/540/580,700/680/660/660 in 3rd groups respectively. The total postoperativeanalgesia doses in the 3 groups were 120:140:180 respectively, total hospital stayingtime were 130:210:260 days, headache in the ratio of 0:8:1, urine retention in 0:6:1 patients,nausea and vomiting in 0:1:5 patients were reduced by 30 %,. P-value &lt; 0.05. On the otherhand, spinal anesthesia which is group 2 showed slight decline of patients numbers who hadrespiratory symptoms, hypotension and urticarial.Conclusion: Post-operative pain, analgesia,total cost, hospital staying time, nausea and vomiting have been significantly reduced by localanesthesia infiltration compared to non-infiltrated groups while spinal anesthesia had a higherrate in post-operative urine retention, headache and hypotension compared to local anesthesiawith sedation and general anesthesia. Respiratory symptoms, urticaria, were slightly reduced inlocal anesthesia with sedation compared to spinal and general anesthesia.</jats:p

Aseptic meningitis after 20 years of endoscopic transsphenoidal pituitary surgery: a rare complication

A transsphenoidal surgical (TSS) approach is used for pituitary gland surgery involving pituitary adenomas, as well as for the biopsy of various neurosurgical tumors. TSS, although a relatively safe procedure, can lead to complications like hypopituitarism, visual impairment, nasal septal perforation, diabetes insipidus, carotid artery injury, and cerebrospinal fluid (CSF) leaks. Aseptic meningitis is also one of the complications of this procedure with an incidence of 1-2%, presenting with symptoms similar to bacterial meningitis, but with a low-grade fever of &lt;102 F or even apyrexia. Here, we present a rare case of aseptic meningitis due to CSF leakage, presenting after 20 years of endoscopic surgery. A ventriculoperitoneal shunt was placed to stem the leak after two unsuccessful attempts of endonasal repair.</jats:p