Diagnostic Accuracy of Clinical Examination in Cervical Spine Injuries in Awake and Alert Blunt Trauma Patients

Study design: Observational, case series.Purpose: To determine the sensitivity and specificity of clinical judgment as compared to the use of X-ray images in detecting cervical spine injuries in trauma patients presenting in the emergency department of Aga Khan University Hospital, Karachi.Overview of literature: Cross-table cervical spine views are important in patients with signs and symptoms relating to cervical spine, but asymptomatic patients constitute a different subgroup. Accuracy of clinical examination in these patients has not been subjected to scrutiny.Methods: All patients with blunt trauma who presented to the emergency department and underwent cross-table X-rays as part of their trauma workup were included. The X-rays were read by a radiologist not aware of the history of the patients. We recorded demographic data along with mechanism of injury, associated neck signs or symptoms whether present or not, cervical spine range of motion, associated injuries and X-ray findings. The history and examination were carried out by the on-call neurosurgery team member. The sensitivity and specificity along with negative and positive predictive value of the clinical examination were calculated. Data were analyzed using SPSS ver. 16.0.Results: Of 50 patients with positive signs and symptoms, 4 (8%) had positive X-rays while only 1 out of 324 (0.3%) with no associated signs and symptoms had positive X-ray findings.Conclusions: The clinical examination is 80% sensitive and 73.98% specific in detecting true cervical spine injuries as compared to C-spine X-rays in alert and awake patients with blunt trauma

Role of neurosurgery in the management of stroke

Stroke is the second leading cause of death worldwide. The aim of treatment in stroke patients is to prevent further neurologic deterioration and prevent recurrence. Despite all advances in medical treatment, morbidity and mortality in stroke patients is still very high. The other alternative is surgical treatment, which still lacks class 1 evidence. However there is recent reconsideration of this form of treatment and ongoing trials are showing some promising results. In this review the recent advances in surgical treatment of stroke will be discussed along with recommendations from the latest randomized trials

Complications of in-patient cerebral angiography: Comparison between patients with and without sub arachnoid haemorrhage

Objective: To compare complications of cerebral angiography among patients with and without subarachnoid haemorrhage.Methods: This retrospective study was conducted at the Aga Khan University Hospital, Karachi, and comprised records of patients undergoing inpatient therapeutic and diagnostic cerebral angiographies from 2001 to 2010. The patients were divided into subarachnoid and non-subarachnoid haemorrhage groups. During the study period no modifications were made to the operational protocol and all patients were subjected to the same procedure and prophylactic care.Results: Of the 93 patients, 42(45.2%) were women and 51(54.8%) were men. The overall mean age was 45.27±16.15 years (range: 4-80 years). The comparison between the two groups regarding new onset of neurological deficit was statistically significant (p=0.001). However, the same comparison regarding drop in Glasgow Coma Scale was statistically not significant (p=0.073).Conclusions: The rate of neurological complications was higher in patients with subarachnoid haemorrhage

Dermoid cyst with no intracranial extension: A case report and literature review

Background: Dermoid cysts are cystic inclusion tumors. They comprise hair follicles, sweat glands, and sebaceous glands. They have lining of stratified squamous epithelium. The most common areas involved are face, lower back, and ovaries. Congenital cystic dermoid involving the anterior fontanelle with no intracranial extension is a rare scalp swelling. We present a case of dermoid cyst with no intracranial extension.Case description: We report a case of 4-month-old child presented with a history of a scalp swelling since birth. The swelling increased in size progressively. Magnetic resonance imaging of the brain revealed extracranial cystic lesion over anterior fontanelle with no intracranial extension. Cyst was excised completely with no postoperative complications. On histopathology it was dermoid cyst.Conclusion: To the best of our knowledge, congenital dermoid cyst of the anterior fontanelles is rare. Complete surgical excision is the treatment of choice

Aneurysm in the anterior inferior cerebellar artery-posterior inferior cerebellar artery variant: case report and review of literature

Abstract INTRODUCTION: There are variations in the anatomy of the vertebrobasilar system amongst which the Anterior Inferior Cerebellar Artery-Posterior Inferior Cerebellar Artery (AICA-PICA) variant is thought to have a prevalence of 20-24% (based on retrospective studies). Despite this, aneurysms of the AICA-PICA variant are rare. We present a case of an AICA-PICA aneurysm and discuss its presentation and management, along with a review of literature. PRESENTATION OF CASE: We describe the case of a 35 year old female who presented with signs of meningismus. On the basis of radiological imaging it was initially misdiagnosed as a thrombosed arteriovenous malformation (AVM). The patient was eventually discharged with a plan of interval imaging and interventional radiology (if required). The patient presented again with similar signs and symptoms. Re-evaluation of imaging revealed an aneurysm of the AICA-PICA variant which was managed surgically. DISCUSSION: Aneurysms of the AICA-PICA variant are rare. The radiological features and surgical management represent a unique clinical entity and are discussed below. CONCLUSION: The prevalence of the AICA-PICA variant might be high but aneurysms in this vessel are rare. The scant knowledge available on this subject makes it a diagnostic difficulty

Ossification of the cruciform ligament of atlas; a rare cause of cervical myelopathy: Case report and review of literature

We present a case of cervical myelopathy secondary to ossification of the cruciform ligament (also known as cruciate ligament). This is a rare phenomenon that, to the best of our knowledge, has only been reported 16 times previously in literature. We have added a review of literature after our case presentation. We hope that by doing so, we may aid clinicians reach early diagnosis so as to be able to better manage this rare disease

Lumbar morphometry: A study of lumbar vertebrae from a Pakistani population using computed tomography scans

Study design: A cross-sectional study.Purpose: To describe the characteristics of lumbar vertebrae of Pakistani patients reporting at a tertiary care hospital and compare with studies from other populations.Overview of literature: Several studies have been conducted to determine morphometry of lumbar vertebrae. Most of the studies involve Caucasian populations, still data on other populations still sparse. This is the first study describing lumbar morphometry of a Pakistani population.Methods: An observational study was conducted based on a review of thin-cut (3 mm) computed topographic images of lumbar vertebrae. Two-hundred and twenty vertebrae from forty-nine patients were studied, and various dimensions were analyzed.Results: Generally, the size of the vertebrae, vertebral canals and recesses were found to be greater in male patients. The difference was statistically significant for transverse and anteroposterior diameters of the vertebral bodies and sagittal diameter of pedicles on the left side (p\u3c0.05). Comparison of populations revealed statistically significant differences in pedicle dimensions between Pakistani population and others.Conclusions: This study provides anatomical knowledge of the lumbar region in a sample population of Pakistan. There were significant differences in various dimensions of lumbar vertebrae between female and male patients. This would prove to be critical for performing a safe operation

Clinoidal meningioma associated with an internal carotid artery aneurysm

Coexistence of primary brain neoplasms with intracranial aneurysms is rare but presents a diagnostic and therapeutic challenge to healthcare providers. We describe the case of a 60-year-old woman who had a left internal carotid artery aneurysm with a small ipsilateral clinoidal meningioma. The meningioma was an unexpected finding encountered during the surgery for aneurysmal clipping. Both the lesions were dealt with simultaneously

MoMask: Generative Masked Modeling of 3D Human Motions

We introduce MoMask, a novel masked modeling framework for text-driven 3D human motion generation. In MoMask, a hierarchical quantization scheme is employed to represent human motion as multi-layer discrete motion tokens with high-fidelity details. Starting at the base layer, with a sequence of motion tokens obtained by vector quantization, the residual tokens of increasing orders are derived and stored at the subsequent layers of the hierarchy. This is consequently followed by two distinct bidirectional transformers. For the base-layer motion tokens, a Masked Transformer is designated to predict randomly masked motion tokens conditioned on text input at training stage. During generation (i.e. inference) stage, starting from an empty sequence, our Masked Transformer iteratively fills up the missing tokens; Subsequently, a Residual Transformer learns to progressively predict the next-layer tokens based on the results from current layer. Extensive experiments demonstrate that MoMask outperforms the state-of-art methods on the text-to-motion generation task, with an FID of 0.045 (vs e.g. 0.141 of T2M-GPT) on the HumanML3D dataset, and 0.228 (vs 0.514) on KIT-ML, respectively. MoMask can also be seamlessly applied in related tasks without further model fine-tuning, such as text-guided temporal inpainting.Comment: Project webpage: https://ericguo5513.github.io/momask

Bicompartmental decompressive craniectomy: Report of two cases

A recent study of randomized controlled trials showed favorable outcomes with use of decompressive craniectomy in managing and treating uncontrolled intracranial pressures accompanied with cerebral edema due to trauma. We present the details of bicompartmental decompressive craniectomy on two patients who presented with severe head trauma of supra- and infratentorial pathologies. The surgical management techniques and long-term follow-up are discussed in detail