Bilateral subdural hematoma a rare complication of common procedure in 30-year-old female patient: A case report and literature review

Background: Lumbar puncture (LP) is a frequent procedure done for administration of spinal anesthesia or for obtaining cerebrospinal fluid for analysis. The common complications of LP are pain at the local site and post LP headache. Rarely the following complication could occur: infections of central nervous system, brain stem herniation, and subdural hematoma. Post LP hematoma needs to be suspected in those patients whom post LP conservative management failed and headache lasts more than one week.Case presentation: We report a 30-year-old, Ethiopian woman who present with bilateral subdural hematoma following lumbar puncture for spinal anaesthesia. She presented with three weeks history of persistent headache, nausea and vomiting. The symptoms started three days following spinal anaesthesia procedure done for cesarean section.Conclusion: Post-dural puncture headache is the commonest benign complication of lumbar puncture. However, change in character of headache, absence of response to routine measures, development of neurological signs, and persistence of headache beyond one week should prompt physicians to consider rare and fatal complications of post-dural puncture such as subdural hematoma. Moreover, timely diagnosis and management is often associated with good prognosis. French title: Hematome sous dural bilateral secondaire a une ponction lombaire   Introduction: La ponction lombaire (PL) est une procédure fréquente effectuée pour l'administration de l'anesthésie rachidienne ou pour obtenir du liquide céphalo-rachidien pour analyse. Les complications courantes de la PL sont la douleur au site local et la céphalée post PL. Les complications suivantes sont plus rares : infections du système nerveux central, engagement du tronc cérébral et hématome sous-dural. Un hématome post PL doit être suspecté chez les patients dont la prise en charge conservatrice du syndrome post PL a échoué et chez lesquels les maux de tête durent plus d'une semaine. Observation :Nous rapportons le cas d’une femme éthiopienne de 30 ans qui a présenté un hématome sous-dural bilatéral après une ponction lombaire pour une rachianesthésie. Elle avait des antécédents de céphalées persistantes, de nausées et de vomissements pendant trois semaines. Les symptômes ont commencé trois jours après la procédure d'anesthésie rachidienne effectuée pour la césarienne. Conclusion: La céphalée post-PL est la complication bénigne la plus courante de la ponction lombaire. Cependant, la modification du caractère des céphalées, l'absence de réponse aux mesures de routine, le développement de signes neurologiques et la persistance des céphalées au-delà d'une semaine devraient inciter les médecins à envisager des complications rares et mortelles de la PL telles qu'un hématome sous-dural. De plus, un diagnostic et une prise en charge rapides sont souvent associés à un bon pronostic. &nbsp

Prevalence of neural tube defects among pregnant women in Addis Ababa: a community-based study using prenatal ultrasound examination

Purpose The primary aim of this study was to estimate the prevalence of NTDs at ultrasound examination in communities of Addis Ababa and secondarily to provide a description of the dysmorphology of the NTD cases. Methods We enrolled 958 pregnant women from 20 randomly selected health centers in Addis Ababa during the period from October 1, 2018, to April 30, 2019. Of these 958 women, 891 had an ultrasound examination after enrollment, with a special focus on NTDs. We estimated the prevalence of NTDs and compared it with previously reported hospital-based birth prevalence estimates from Addis Ababa. Results Among 891 women, 13 had twin pregnancies. We identified 15 NTD cases among 904 fetuses, corresponding to an ultrasound-based prevalence of 166 per 10,000 (95% CI: 100–274). There were no NTD cases among the 26 twins. Eleven had spina bifida (122 per 10,000, 95% CI: 67–219). Among the 11 fetuses with spina bifida, three had a cervical and one had a thoracolumbar defect while the anatomical site for 7 was not registered. Seven of the 11 spina bifida defects had skin covering, while two of the cervical lesions were uncovered. Conclusion We report a high prevalence of NTDs among pregnancies in communities of Addis Ababa based on screening by ultrasound. The prevalence was higher than in previous hospital-based studies in Addis, and the prevalence of spina bifida was particularly high.publishedVersio

Comparative analysis of informed consent for spine surgery in patients in Ethiopia and Poland and the importance of verbal contact with patients based on the medical mission "Polish Medical Team Helping Hand"

The authors present a comparative analysis of the issue of legal consents for surgical procedures between Ethiopia and Poland. The analysis is based on the procedures performed as part of the Polish medical mission "Polish Medical Team Helping Hand". As part of this project, the authors performed ten surgical procedures for percutaneous spine stabilization in soldiers injured during the war with gunshots of the spine and after falling from a height. All soldiers signed informed written consent to the procedure. However, the authors noticed a significant role of additional oral/ verbal (not written) information in discussing the details of the procedure, which in Polish hospitals must be in writing for formal and legal reasons. The authors conclude that while the written consent for surgical treatment is key and necessary both in Poland and in Ethiopia, in the case of medical procedures performed in Ethiopia, oral communication between the doctor and patients and oral explanations are more binding even regardless of the language barrier

Prospective Study of Surgery for Traumatic Brain Injury in Addis Ababa, Ethiopia: Surgical Procedures, Complications, and Postoperative Outcomes

Under embargo until: 2022-06-02Background Traumatic brain injury (TBI) is an important cause of trauma-related mortality and morbidity in Ethiopia. There are significant resource limitations along the entire continuum of care, and little is known about the neurosurgical activity and patient outcomes. Methods All surgically treated TBI patients at the 4 teaching hospitals in Addis Ababa, Ethiopia were prospectively registered from October 2012 to December 2016. Data registration included surgical procedures, complications, reoperations, discharge outcomes, and mortality. Results A total of 1087 patients were included. The most common procedures were elevation of depressed skull fractures (49.5%) and craniotomies (47.9%). Epidural hematoma was the most frequent indication for a craniotomy (74.7%). Most (77.7%) patients were operated within 24 hours of admission. The median hospital stay for depressed skull fracture operations or craniotomies was 4 days. Decompressive craniectomy was only done in 10 patients. Postoperative complications were seen in 17% of patients, and only 3% were reoperated. Cerebrospinal fluid leak was the most common complication (7.9%). The overall mortality was 8.2%. Diagnosis, admission Glasgow Coma Scale (GCS) score, surgical procedure, and complications were significant predictors of discharge GCS score (P < 0.01). Age, admission GCS score, and length of hospital stay were significantly associated with mortality (P ≤ 0.005). Conclusions The injury panorama, surgical activity, and outcome are significantly influenced by patient selection due to deficits within both prehospital and hospital care. Still, the neurosurgical services benefit a large number of patients in the greater Addis region and are qualitatively comparable with reports from high-income countries.acceptedVersio

Prospective Study of Surgery for Traumatic Brain Injury in Addis Ababa, Ethiopia: Trauma Causes, Injury Types, and Clinical Presentation

Under embargo until: 2022-04-27Background Traumatic brain injury (TBI) is a public health problem in Ethiopia. More knowledge about the epidemiology and neurosurgical management of TBI patients is needed to identify possible focus areas for quality improvement and preventive efforts. Methods This prospective cross-sectional study (2012–2016) was performed at the 4 teaching hospitals in Addis Ababa, Ethiopia. All surgically treated TBI patients were included, and data on clinical presentation, injury types, and trauma causes were collected. Results We included 1087 patients (mean age 29 years; 8.7% females; 17.1% 50 km from the hospitals, whereas 46% of road traffic accident victims came from the urban area. Delayed admission was associated with higher Glasgow Coma Scale scores and nonsevere TBI (P < 0.01). Conclusions The injury panorama, delayed admission, and small number of operations performed for severe TBI are linked to a substantial patient selection bias both before and after hospital admission. Our results also suggest that there should be a geographical framework for tailored guidelines, preventive efforts, and development of prehospital and hospital services.acceptedVersio

Surgical treatment outcome of children with neural-tube defect: A prospective cohort study in a high volume center in Addis Ababa, Ethiopia

Introduction Prevalence of neural tube defects (NTD) is high thus many children are born with a neural tube defect in Addis Ababa, and surgical closure is a commonly performed procedure at the pediatric neurosurgical specialty center. Research question The primary aim is to study the outcomes in children undergoing surgical closure of NTDs and to identify risk factors for readmission, complications and mortality. Material and methods Single-center prospective study of all surgically treated NTDs from April 2019 to May 2020. Results A total of 228 children, mean age 11 days (median 4) underwent surgery during the study period. There were no in-hospital deaths. Perioperatively 11 (4.8%) children developed wound complications, none of them needed surgery and there was no perioperative mortality. The one-year follow-up rate was 62.7% (143/228) and neurological status remained stable since discharge in all. The readmission and reoperation rates were 38 % and 8 % and risk factors for readmission were hydrocephalus (80%) and open defects (88%). Hydrocephalus (P = 0.05) and younger age (P = 0.02) were identified as risk factors for mortality. The wound-related complication rate was 55% at and was associated with large defects (P = 0.04) and delayed closure due to late hospital presentation (P = 0.01). Discussion and conclusion The study reveals good perioperative surgical outcome and further need for systematic improvement in treatment and follow-up of NTD patients especially with hydrocephalus. We identified risk factors for wound-related complications, readmission and mortality.publishedVersio

Bilateral abducens nerve palsy from post-spinal-anesthesia-induced bilateral chronic subdural hematoma: case report

BackgroundA chronic cranial subdural hematoma arising after post-spinal anesthesia is a rare but serious and life-threatening complication of spinal anesthesia. It usually mimics the typical post-spinal-anesthesia headache or post-dural-puncture headache, potentially masking its detection. Abducens nerve palsy tends to occur in chronic subdural hematoma of post-dural-puncture etiology rather than in cases attributed to other causes of subdural hematoma. Preferential damage to the abducens nerve is frequent and can be attributed to its anatomic course because the abducens nerve runs in the direction of the typical caudad displacement of the brain related to intracranial hypotension.ObservationHere, we present a report on the clinical presentation, pathogenesis, and management of two cases that developed bilateral abducens nerve palsy following post-spinal anesthesia administered for cesarean sections due to obstetric indications.LessonPost-spinal-anesthesia-induced chronic subdural hematoma, although a rare, life-threatening complication, must be differentiated from post-spinal-anesthesia headache and treated surgically. Cranial nerve palsy (more commonly called abducens nerve palsy) is more common in post-spinal-anesthesia-induced subdural hematoma than subdural hematomas of other etiologies as the cerebrospinal fluid brain cushioning is partly lost. Cranial nerve palsies resolve in most cases if surgery is performed in a timely manner

Needs of Young African Neurosurgeons and Residents: A Cross-Sectional Study.

Introduction: Africa has many untreated neurosurgical cases due to limited access to safe, affordable, and timely care. In this study, we surveyed young African neurosurgeons and trainees to identify challenges to training and practice. Methods: African trainees and residents were surveyed online by the Young Neurosurgeons Forum from April 25th to November 30th, 2018. The survey link was distributed via social media platforms and through professional society mailing lists. Univariate and bivariate data analyses were run and a P-value < 0.05 was considered to be statistically significant. Results: 112 respondents from 20 countries participated in this study. 98 (87.5%) were male, 63 (56.3%) were from sub-Saharan Africa, and 52 (46.4%) were residents. 39 (34.8%) had regular journal club sessions at their hospital, 100 (89.3%) did not have access to cadaver dissection labs, and 62 (55.4%) had never attended a WFNS-endorsed conference. 67.0% of respondents reported limited research opportunities and 58.9% reported limited education opportunities. Lack of mentorship (P = 0.023, Phi = 0.26), lack of access to journals (P = 0.002, Phi = 0.332), and limited access to conferences (P = 0.019, Phi = 0.369) were associated with the country income category. Conclusion: This survey identified barriers to education, research, and practice among African trainees and young neurosurgeons. The findings of this study should inform future initiatives aimed at reducing the barriers faced by this group

Casemix, management, and mortality of patients rreseceiving emergency neurosurgery for traumatic brain injury in the Global Neurotrauma Outcomes Study: a prospective observational cohort study.

BackgroundTraumatic brain injury (TBI) is increasingly recognised as being responsible for a substantial proportion of the global burden of disease. Neurosurgical interventions are an important aspect of care for patients with TBI, but there is little epidemiological data available on this patient population. We aimed to characterise differences in casemix, management, and mortality of patients receiving emergency neurosurgery for TBI across different levels of human development.MethodsWe did a prospective observational cohort study of consecutive patients with TBI undergoing emergency neurosurgery, in a convenience sample of hospitals identified by open invitation, through international and regional scientific societies and meetings, individual contacts, and social media. Patients receiving emergency neurosurgery for TBI in each hospital's 30-day study period were all eligible for inclusion, with the exception of patients undergoing insertion of an intracranial pressure monitor only, ventriculostomy placement only, or a procedure for drainage of a chronic subdural haematoma. The primary outcome was mortality at 14 days postoperatively (or last point of observation if the patient was discharged before this time point). Countries were stratified according to their Human Development Index (HDI)-a composite of life expectancy, education, and income measures-into very high HDI, high HDI, medium HDI, and low HDI tiers. Mixed effects logistic regression was used to examine the effect of HDI on mortality while accounting for and quantifying between-hospital and between-country variation.FindingsOur study included 1635 records from 159 hospitals in 57 countries, collected between Nov 1, 2018, and Jan 31, 2020. 328 (20%) records were from countries in the very high HDI tier, 539 (33%) from countries in the high HDI tier, 614 (38%) from countries in the medium HDI tier, and 154 (9%) from countries in the low HDI tier. The median age was 35 years (IQR 24-51), with the oldest patients in the very high HDI tier (median 54 years, IQR 34-69) and the youngest in the low HDI tier (median 28 years, IQR 20-38). The most common procedures were elevation of a depressed skull fracture in the low HDI tier (69 [45%]), evacuation of a supratentorial extradural haematoma in the medium HDI tier (189 [31%]) and high HDI tier (173 [32%]), and evacuation of a supratentorial acute subdural haematoma in the very high HDI tier (155 [47%]). Median time from injury to surgery was 13 h (IQR 6-32). Overall mortality was 18% (299 of 1635). After adjustment for casemix, the odds of mortality were greater in the medium HDI tier (odds ratio [OR] 2·84, 95% CI 1·55-5·2) and high HDI tier (2·26, 1·23-4·15), but not the low HDI tier (1·66, 0·61-4·46), relative to the very high HDI tier. There was significant between-hospital variation in mortality (median OR 2·04, 95% CI 1·17-2·49).InterpretationPatients receiving emergency neurosurgery for TBI differed considerably in their admission characteristics and management across human development settings. Level of human development was associated with mortality. Substantial opportunities to improve care globally were identified, including reducing delays to surgery. Between-hospital variation in mortality suggests changes at an institutional level could influence outcome and comparative effectiveness research could identify best practices.FundingNational Institute for Health Research Global Health Research Group

An international, prospective observational study on traumatic brain injury epidemiology study protocol: GEO-TBI: Incidence [version 2; peer review: 2 approved]

Background The epidemiology of traumatic brain injury (TBI) is unclear – it is estimated to affect 27–69 million individuals yearly with the bulk of the TBI burden in low-to-middle income countries (LMICs). Research has highlighted significant between-hospital variability in TBI outcomes following emergency surgery, but the overall incidence and epidemiology of TBI remains unclear. To address this need, we established the Global Epidemiology and Outcomes following Traumatic Brain Injury (GEO-TBI) registry, enabling recording of all TBI cases requiring admission irrespective of surgical treatment. Objective The GEO-TBI: Incidence study aims to describe TBI epidemiology and outcomes according to development indices, and to highlight best practices to facilitate further comparative research. Design Multi-centre, international, registry-based, prospective cohort study. Subjects Any unit managing TBI and participating in the GEO-TBI registry will be eligible to join the study. Each unit will select a 90-day study period. All TBI patients meeting the registry inclusion criteria (neurosurgical/ICU admission or neurosurgical operation) during the selected study period will be included in the GEO-TBI: Incidence. Methods All units will form a study team, that will gain local approval, identify eligible patients and input data. Data will be collected via the secure registry platform and validated after collection. Identifiers may be collected if required for local utility in accordance with the GEO-TBI protocol. Data Data related to initial presentation, interventions and short-term outcomes will be collected in line with the GEO-TBI core dataset, developed following consensus from an iterative survey and feedback process. Patient demographics, injury details, timing and nature of interventions and post-injury care will be collected alongside associated complications. The primary outcome measures for the study will be the Glasgow Outcome at Discharge Scale (GODS) and 14-day mortality. Secondary outcome measures will be mortality and extended Glasgow Outcome Scale (GOSE) at the most recent follow-up timepoint