scholarly journals Spontaneous Intracranial Hypotension – Not Always Benign

2021 ◽  
Vol 7 (2) ◽  
pp. 85-91
Author(s):  
Pavithran Vadakkam Muriyil ◽  
◽  
Rajeev Mandaka Parambil ◽  
Shanavas Cholakkal ◽  
Akhil Mohan ◽  
...  
Keyword(s):  
Subdural Hematoma ◽  
Intracranial Hypotension ◽  
Spontaneous Intracranial Hypotension ◽  
Patch Repair ◽  
Common Symptom ◽  
Duration Of Symptoms ◽  
Symptom Pattern ◽  
The Mean ◽  
One Year

Background and Aim: Spontaneous Intracranial Hypotension (SIH) is a rare cause of headaches. It commonly presents with newly-developed persistent postural headaches and resolves with conservative treatment but rarely becomes a life-threatening disease. We retrospectively reviewed all cases of SIH patients treated in our institution for over ten years. Their clinical and radiological findings and the treatment given were analyzed. Their outcomes were assessed at a minimum of one year of follow-up. Materials and Methods: We retrospectively reviewed all cases of SIH patients treated in our institution over ten years. Clinicoradiological aspects, as well as the treatment given, were analyzed. The outcome was assessed at a minimum of one year of follow-up. Results: Six cases of SIH were studied. The Mean±SD age of the study population was 41.6±2.87 years. Four cases (66%) were female. The most common symptom was orthostatic headache which was present in all of them. The Mean±SD duration of symptoms before the diagnosis of SIH was 3±1.78 months. Four cases were managed conservatively, while one patient was managed with surgery and the other with epidural patch repair. The exact site of the leak could be delineated in 2 cases (33%). Two patients who were managed invasively for Cerebrospinal Fluid (CSF) the leak had a subdural hematoma. All patients had a favorable outcome at one year of follow-up. Conclusion: Prompt and early identification of changes in symptom pattern and the onset of subdural hematoma are essential markers of shifting to definitive management rather than continuing conservative measures. Subdural hematoma, secondary to SIH, warrants evacuation if it causes clinical deterioration.

scholarly journals Bedside Percutaneous Twist Drill Craniostomy of Chronic Subdural Hematoma—A Single-Center Study

2019 ◽  
Vol 11 (01) ◽  
pp. 084-088 ◽  
Author(s):  
Geo Senil Kidangan ◽  
Binoy Damodar Thavara ◽  
Bijukrishnan Rajagopalawarrier
Keyword(s):  
Statistical Analysis ◽  
Ct Scan ◽  
Clinical Improvement ◽  
Subdural Hematoma ◽  
Chronic Subdural Hematoma ◽  
Mass Effect ◽  
Common Symptom ◽  
Twist Drill ◽  
Duration Of Symptoms ◽  
The Mean

Abstract Background Chronic subdural hematoma (CSDH) is predominantly a disease of the elderly. Objectives This article studies the clinical and radiological outcomes in patients with CSDH who had undergone bedside percutaneous twist drill craniostomy (TDC). Patients and Methods A retrospective study was conducted in 80 patients who had undergone percutaneous TDC for CSDH between January 2017 and December 2018. Patients between 18 and 90 years of age were selected. CSDH showing computed tomography (CT) scan findings of homogeneous hypodensity, homogeneous isodensity, mixed density, and CSDH with hyperdense gravity-dependent fluid level were selected. CT evidence of multiple septations, recurrent CSDH, bilateral CSDH, and acute on CSDH were excluded. The presence of midline shift (MLS) was measured as any deviation of the septum pellucidum from the midline. The mass effect was determined by the effacement of the sulci, Sylvian fissure obscuration, or compression of lateral ventricles. Postoperative decrease in the signs and symptoms were considered as the postoperative clinical improvement. Improvement in the postoperative CT scan was determined by the decrease in the thickness of CSDH and absence of MLS with decrease in the mass effect. The presence of the CSDH with mass effect and MLS was considered as the significant residue in the postoperative CT scan. Statistical Analysis Statistical analysis is done using Epi Info software. Results The mean age range was 67.78 years ± 12.03 standard deviation (SD). There were 49 (61.25%) males and 31 (38.75%) females. Thirty-eight (47.5%) CSDHs were on the right side and 42 (52.5%) on the left side. The locations were in the frontotemporoparietal region in 91.25% patients and in the frontoparietal region in 8.75% patients. The mean duration of symptoms was 4.62 days ± 5.20 SD. History of trauma was present in 58.75% patients. The mean duration of trauma was 45.78 days ± 28.32 SD. The most common symptoms were weakness of the limbs (68.75%), altered sensorium or decreased memory (52.5%), and headache (32.5%). The preoperative Glasgow Coma Scale (GCS) score ranged from 4 to 15 (mean 12.86 ± 2.98 SD). Limb motor weakness was noted in 75% patients. The maximum thickness of the CSDH (in millimeter) in axial CT scan was 8 to 32 (mean 23.22 ± 4.87 SD). All of the 80 patients had MLS. Postoperative GCS ranged from 3 to 15 (mean 14.1 ± 2.78 SD). Postoperative power was improved in 95% of affected limbs. Postoperative power was deteriorated (including patients of complications and death) in 5% patients. Clinical improvement was noted in 93.75% patients. Postoperative CT scan improvement was noted in 95% patients. Two patients (2.5%) had significant residue which required reoperation. Two patients (2.5%) developed extradural hematoma which was operated. Five (6.25%) patients developed complications, among which 4 (5%) patients died. The mean duration of stay in the hospital was 6.82 days ± 4.16 SD. Conclusions CSDH is a disease of elderly population. CSDH is more common in male population. The most common symptom is weakness of the limbs. High clinical and radiological improvement can be achieved with TDC. TDC should be considered as a safe and effective alternative to burr hole craniostomy.

Coma

Neurology ◽  
2018 ◽  
Vol 90 (19) ◽  
pp. e1638-e1645 ◽  
Author(s):  
Wouter I. Schievink ◽  
M. Marcel Maya ◽  
Franklin G. Moser ◽  
Stacey Jean-Pierre ◽  
Miriam Nuño
Keyword(s):  
Glasgow Outcome Scale ◽  
Intracranial Hypotension ◽  
Spontaneous Intracranial Hypotension ◽  
Csf Leak ◽  
Surgical Closure ◽  
Percutaneous Procedures ◽  
The Mean ◽  
Brain Sagging ◽  
Comprehensive Study

ObjectiveTo review our experience with patients with spontaneous intracranial hypotension (SIH) and coma because, although disorders of consciousness may complicate SIH, no comprehensive study of such patients has been reported.MethodsUsing a prospectively maintained registry, we identified all patients with SIH in whom coma developed. Patients or their caregivers/families were contacted for follow-up. Patients were compared to a cohort of patients with SIH without coma.ResultsThe mean age of the 12 men and 3 women with SIH was 56.2 years (range 34–72 years) at the time of onset of coma. In one-third of patients, coma developed after craniotomy for subdural hematomas or for an unrelated intracranial pathology. Imaging showed brain sagging, including bilateral temporal lobe herniation, in all 15 patients and brainstem edema in 8 patients (53%). Overall, coma was reversible in 7 of 15 patients treated with epidural blood patches, in 2 of 4 treated with percutaneous glue injections, and in 6 of 6 treated surgically. Only 1 patient had residual neurologic deficit related to coma (Glasgow Outcome Scale score 4 [moderate disability]). Compared to patients with SIH without coma (n = 568), those with coma were older, more often were male, and more often underwent surgery.ConclusionsComa in SIH is rare, reversible, and invariably associated with brain sagging. Coma due to SIH may be refractory to the usual percutaneous procedures, and surgical closure of the CSF leak may be required to regain consciousness.

scholarly journals Long-term clinical results of autologous Platelet Rich Plasma (PRP) in recalcitrant plantar fasciitis

2021 ◽  
Vol 7 (1) ◽  
pp. 12-16
Author(s):  
Ankit Kumar Garg ◽  
Ranjeet Choudhary ◽  
Alok Chandra Agrawal ◽  
Anupam Pradip Inamdar ◽  
Shilp Verma
Keyword(s):  
Plantar Fasciitis ◽  
Platelet Rich Plasma ◽  
Post Injection ◽  
Duration Of Symptoms ◽  
Low Level ◽  
Autologous Platelet Rich Plasma ◽  
The Mean ◽  
One Year ◽  
Autologous Platelet

In recent years, biologic therapies such as platelet-rich plasma (PRP) have gained prominence in multiple orthopedics degenerative tendinopathy and ligamental pathology. This research aimed to assess the clinical effectiveness of autologous platelet-rich plasma injection in cases of recalcitrant plantar fasciitis (RPF) over a long period.A prospective observational study was performed on RPF that did not experience pain relief after three months of conservative therapy. Under sterile conditions, inject approximately 3ml of platelet-rich plasma mixed with 0.5ml lignocaine into the maximum tender point of the heel. Visual Analogue Score for Pain, the American Orthopedics Foot, and Ankle Society (AOFAS) Ankle, and Hind Foot Score at one month, three months, six months, one year, and two years after injection.A total of 60 patients of RPF which 23 (38.33%) were male, and the rest 37 (61.66%) were female. The mean age was 45 ± 7.25 and the mean duration of symptoms was 7.4 ± 2.1months. The mean VAS score was 7.92 ± 1.2 at pre-injection, was progressively reduced post-injection to 5.61 ± 1.56 at one month, 3.1 ± .83 at three months, and 2.4 ± .68 at six months and remained at low level 2.5 ± .92 at one year and 2.7 ± .56 at two years. The mean AOFAS score was 56.92 ± 13.24 at pre-injection, was progressively increased post-injection to 66.41± 10.26 at one month, 78.31 ± 12.64 at three months, and 90.54 ± 10.71 at six months and remained at a low level 89.24 ± 8.92 at one year and 87.54 ±10.56 at two years. Mean VAS and AOFAS scores showed statistically significant pain reduction and functional improvements at successive follow-ups till 6month (p<.05); the improvement remained stable and did not change significantly until the last appointment at 2year follow-up (p > 0.05).The outcomes of autologous PRP injection in recalcitrant plantar fasciitis are reliable, stable, and predictable in both long- and short-term follow-up. PRP injection is safer and not associated with serious complications as in the case of steroid injection.

scholarly journals Our experience with Amyand’s hernia

2019 ◽  
Vol 6 (12) ◽  
pp. 4572
Author(s):  
Brajesh Gupta ◽  
Ghanshyam Hatwar ◽  
Charu Tiwari ◽  
Shweta Gupta
Keyword(s):  
Inguinal Hernia ◽  
Clinical Presentation ◽  
Amyand’S Hernia ◽  
Rare Type ◽  
Duration Of Symptoms ◽  
Female Ratio ◽  
Duration Of Hospital Stay ◽  
The Mean ◽  
One Year

Amyand’s hernia is a rare type of inguinal hernia with appendix as its content, which may be normal or pathological. We present our experience with Amyand’s hernia in 6 patients. A retrospective review of 6 cases with Amyand’s hernia that were managed over a 2-year period was done by reviewing the hospital records. The variables assessed and analyzed were demographic details, clinical presentation, management and follow-up. There were 4 children and 2 adults; male and female ratio being 5:1. The mean age of four children was 1.5 years; the two adults were 72 and 54 years of age. The duration of symptoms of inguinal hernia ranged from 1 month to one year; mean duration of irreducibility was 5.33 days (range: 2 days to 15 days). Five patients had symptoms of obstruction. All 5 patients with obstruction underwent emergency surgery. The sixth patient was posted for elective hernioplasty the next day. Appendix was inflamed only in one patient. The post-operative course was uneventful in all patients. The mean duration of hospital stay was 3.33 days. Only one patient had surgical site infection. Amyand’s hernia, thus presents with features of incarcerated right hernia. Pre-operative diagnosis is difficult. Intra-operatively, the surgical procedure needs to be individualized depending upon the pathology.

scholarly journals Incomplete Kawasaki disease - a diagnostic and therapeutic challenge

2014 ◽  
Vol 9 (4) ◽  
pp. 30-35
Author(s):  
S Datta ◽  
S Maiti ◽  
G Das ◽  
A Chatterjee ◽  
P Ghosh
Keyword(s):  
Kawasaki Disease ◽  
Intravenous Immunoglobulin ◽  
Incomplete Kawasaki Disease ◽  
Duration Of Symptoms ◽  
Clinical Criteria ◽  
Echocardiographic Finding ◽  
2D Echocardiography ◽  
Acquired Heart Disease ◽  
The Mean ◽  
One Year

Background The diagnosis of classical Kawasaki Disease was based on clinical criteria. The conventional criteria is particularly useful in preventing over diagnosis, but at the same time it may result in failure to recognize the incomplete form of Kawasaki Disease. Objective To suspect incomplete Kawasaki Disease, because early diagnosis and proper treatment may reduce substantial risk of developing coronary artery abnormality which is one of the leading causes of acquired heart disease in children. Method Nine cases of incomplete Kawasaki Disease were diagnosed over a period of one year. The diagnosis of incomplete Kawasaki Disease was based on fever for five days with less than four classical clinical features and cardiac abnormality detected by 2D- echocardiography. A repeat echocardiography was done after 6 weeks of onset of illness. The patients were treated with Intravenous Immunoglobulin and/or aspirin. Result The mean age of the patients was 3.83 years and the mean duration of symptoms before diagnosis was 12.1 days. Apart from other criteria all of our patients had edema and extreme irritability. All the patients had abnormal echocardiographic finding. Five patients received only aspirin due to nonaffordability of Intravenous Immunoglobulin and four patients received both aspirin and Intravenous Immunoglobulin, but the outcome was excellent in all the cases. Conclusion Incomplete Kawasaki Disease can be diagnosed with more awareness and aspirin alone may be used as a second line therapy in case of non affordability of Intravenous Immunoglobulin. Journal of College of Medical Sciences-Nepal, 2013, Vol-9, No-4, 30-35 DOI: http://dx.doi.org/10.3126/jcmsn.v9i4.10234

scholarly journals 690 Intracranial Hypotension Due to CSF Leak Secondary to Ventral Thoracic Osteophyte Complex: Resolution After Transdural Thoracic Discectomy and Dural Repair

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
B Kewlani ◽  
I Hussain ◽  
J Greenfield
Keyword(s):  
Intracranial Hypotension ◽  
Spontaneous Intracranial Hypotension ◽  
Bed Rest ◽  
Structural Defects ◽  
Csf Leak ◽  
History Of ◽  
Surgical Cure ◽  
Thoracic Discectomy ◽  
Herniated Discs

Abstract The hallmark symptom of spontaneous intracranial hypotension (SIH) is orthostatic headaches which manifests secondary to cerebrospinal fluid (CSF) hypovolaemia. Well-recognised aetiologies include trauma which includes procedures such as lumbar punctures and spinal surgery. More recently, structural defects such as bony osteophytes and calcified or herniated discs have been attributed to mechanically compromising dural integrity consequently resulting in CSF leak and symptom manifestation. A thorough literature review noted only a handful of such cases. We report the case of a thirty-two-year-old Asian female who presented with a one-month history of new-onset progressively worsening orthostatic headaches. Workup included MRI of the thoracic spine which revealed an epidural collection of CSF consequently prompting a dynamic CT-myelogram of the spine which not only helped to confirm severe cerebral hypotension but also suggested the underlying cause as being a dorsally projecting osteophyte-complex at level T2-3. Conservative and medical management including bed rest, analgesia, mechanical compression, and epidural blood patches failed to alleviate symptoms and a permanent surgical cure was eventually sought. The surgery involved T2-T3 laminectomy and osteophytectomy and at a 3-month follow-up, complete resolution of symptoms was noted.

scholarly journals Delayed Subdural Hematoma After Epidural Blood Patching in a Patient With Spontaneous Intracranial Hypotension

2010 ◽  
Vol 50 (6) ◽  
pp. 479-481 ◽  
Author(s):  
Hao-Kuang WANG ◽  
Po-Chou LILIANG ◽  
Cheng-Loong LIANG ◽  
Kang LU ◽  
Kuo-Chuan HUNG ◽  
...  
Keyword(s):  
Subdural Hematoma ◽  
Intracranial Hypotension ◽  
Spontaneous Intracranial Hypotension ◽  
Epidural Blood Patching

Diagnostic Utility of Lower Extremity Radiographs of Young Children With Gait Disturbance

PEDIATRICS ◽  
1991 ◽  
Vol 87 (2) ◽  
pp. 138-140
Author(s):  
Steven D. Blatt ◽  
Bruce M. Rosenthal ◽  
Douglas C. Barnhart
Keyword(s):  
Lower Extremity ◽  
Failure To Thrive ◽  
Gait Disturbance ◽  
Diagnostic Utility ◽  
Duration Of Symptoms ◽  
Soft Tissue Swelling ◽  
Chief Complaints ◽  
The Mean ◽  
Limiting Condition

The diagnostic utility of lower extremity radiographs was evaluated using 84 outpatients 1 to 5 years of age with gait disturbance whose lower extremities appeared physically normal. Chief complaints included limp (65 children [77%]), refusal to walk or stand (37 children [44%]), and frequent falling (6 children [7%]). A total of 43 children (51%) had more than one complaint. The mean age of patients was 26 months and the median duration of symptoms was 1 day. Trauma was reported in 43 (51%) cases and fever in 14 (17%). Results of radiographical studies appeared normal in 81 children (96%), demonstrated soft tissue swelling in 2 children, and revealed a bony island in 1 child. In 1 patient admitted to the hospital for failure to thrive and irritability, and whose radiographic results appeared normal, findings consistent with osteomyelitis later developed. Of the remaining children, 68 (81%) were available for follow-up observation 4 to 28 months after the initial visit and all reported spontaneous resolution of the initial complaint. It was concluded that in a well-appearing child with an otherwise normal physical examination results, an acute gait disturbance is likely to be a self-limiting condition and radiographs are unlikely to contribute to the diagnosis.

scholarly journals Surgical Treatment in Bronchiectasis: Analysis of Our Patients.

2018 ◽  
Vol 2 (1) ◽  
Author(s):  
Fadil Gradica ◽  
Lutfi Lisha ◽  
Dhimitraq Argjiri ◽  
Fahri Kokici ◽  
Alma Cani ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Pulmonary Resection ◽  
Lower Lobe ◽  
Lung Abscess ◽  
Duration Of Symptoms ◽  
Operative Morbidity ◽  
Massive Haemoptysis ◽  
Localized Disease ◽  
The Mean

Background: Bronchiectasis is usually caused by pulmonary infections and bronchial obstructions. It is still a serious problem in developing countries, as our country. We reviewed the morbidity and mortal-ity rates and outcomes of bronchiectasis surgical treatment. Patients and methods: Between years 2000 and 2016, one hundred and seven (107) patients, sixty nine (69) of whom female and thirty eight (38) male underwent pulmonary resection for bronchiecta-sis. The mean age was 35years (range, 13–66 years). Mean duration of symptoms was 12 years. Results: Symptoms were copious amount of purulent sputum in 84 patients, expectoration of foul-smelling sputum in 72, haemoptysis in 21 and cough in all patients. The indications for pulmonary resection were: medical therapy failure in eighty two (82) patients, massive haemoptysis in eighteen and lung abscess in seven (7) patients. The disease was bilateral in twenty seven (27) patients and mainly confined in the lower lobe. Eighty six (86) patients had a lobectomy, 7 had a segmentectomy, two patients right pneumonectomy. Operative morbidity was seen in 47 patients (43.9 %) and mor-tality in two (2) patients. Follow-up was complete in 97 patients with a mean of 5 years. Overall, 78 patients were asymptomatic after surgical treatment; symptoms were improved in 24, and unchanged or worse in 5. Conclusions: Surgical treatment of bronchiectasis is more effective in patient with localized disease. It is satisfactory with acceptable ratio of morbidity and mortality.

scholarly journals Effect of phacoemulsification with intraocular lens implantation in eyes with cataract and functioning filtering blebs

2013 ◽  
Vol 13 (2) ◽  
pp. 33-41
Author(s):  
Devendra Maheshwari ◽  
Rengappa Ramakrishanan ◽  
Mohideen Abdul Kader ◽  
Neelam Pawar ◽  
Ankit Gupta
Keyword(s):  
Visual Acuity ◽  
Intraocular Pressure ◽  
Intraocular Lens ◽  
Intraocular Lens Implantation ◽  
Corrected Visual Acuity ◽  
Lens Implantation ◽  
The Mean ◽  
One Year ◽  
Best Corrected Visual Acuity

Aim: To evaluate the effect of phacoemulsification with intraocular lens implantation in eyes with pre-existing trabeculectomy.Methods: This prospective single-center clinical study evaluated intraocular pressure in 60 eyes of 60 patients who underwent phacoemulsification and implantation of a foldable intraocular lens after a previous successful trabeculectomy. Patients who had a trabeculectomy more than one year prior to the study were included. Intraocular pressure, number of antiglaucoma medications, bleb appearance, and visual acuity were recorded preoperatively, and at each follow-up examination and 12 months after phacoemulsification.Results: The mean intraocular pressure before phacoemulsification was 12.42 mmHg (SD, 4.60 mmHg), which increased to 14.98 mmHg (SD, 4.18 mmHg), 14.47 mmHg (SD, 3.58 mmHg), 15.44 mmHg (SD, 3.60 mmHg), and 15.71 mmHg (SD, 3.47 mmHg) after one, three, six, and 12 months, respectively. At each follow-up visit, the mean IOP was significantly higher than the preoperative value (p < 0.001, p = 0.015, p ≤ 0.001, and p = 0.001 at month one, three, six, and 12, respectively). The mean preoperative best-corrected visual acuity was 0.98 logMAR (SD, 0.44 logMAR) and the mean postoperative best-corrected visual acuity at 12 months was 0.20 logMAR (SD, 0.21 logMAR) [p = 0.0001]. The mean preoperative number of antiglaucoma medications used was 0.57 (SD, 0.63), which increased to 0.65 (SD, 0.63 ), 0.70 (SD, 0.72 ) 0.68, (SD, 0.70), and 0.67 (SD, 0.77 ) at one, three, six, and 12 months, respectively, but there were no statistically significant differences. Bleb size decreased clinically after phacoemulsification. Nineteen of 60 eyes (32%) developed fibrosis of bleb with decreased bleb size.Conclusion: Phacoemulsification with intraocular lens implantation significantly increased intraocular pressure and increased the number of antiglaucoma medications in eyes with pre-existing functioning filtering blebs.

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