scholarly journals Outcome of External Ventricular Drainage in Spontaneous Intracerebral Haemorrhage with Ventricular Extension in different GCS Score

2019 ◽  
Vol 4 (3) ◽  
Keyword(s):  
Intracerebral Haemorrhage ◽  
Glasgow Outcome Scale ◽  
External Ventricular Drainage ◽  
Medical Emergency ◽  
Ventricular Drainage ◽  
Scoring Method ◽  
College Hospital ◽  
Medical College ◽  
Gcs Score ◽  
Spontaneous Intracerebral Haemorrhage

Background: Intracerebral Haemorrhage (ICH) is a medical emergency of the highest degree with frequent early neurological deterioration or death. External ventricular drainage (EVD) is the procedure of choice for the treatment of spontaneous intracerebral haemorrhage with ventricular extension or blood within the ventricles, acute hydrocephalus and increased intracranial pressure in patients of intracerebral haemorrhage and subarachnoid haemorrhage (SAH) with hydrocephalus and its sequelae. Objective: The aim and objective of this study was to predict the outcome of pre operative GCS following external ventricular drainage in spontaneous intracerebral haemorrhage with ventricular extension. Method: In this was prospective observational studies, a total number of 60 cases were taken purposively for a period of July, 2015- March, 2017 diagnosed by CT scan of brain at Department of Neurosurgery, Dhaka Medical College Hospital. All the patients, fulfilling the inclusion and exclusion criteria, were enrolled for the study. For assessing outcome of EVD in post operative patients and evaluating the efficacy of EVD surgery in follow ups. Glasgow Coma Scale and Glasgow Outcome Scale scoring method for patient assessment were used for outcome of EVD surgery. Result: A total of 60 patients were included in this study, age range was 45 to 86 years. Majority patients, 24 (40.0%) were from 61-70 years of age. The mean age was found 62.0±20. It was observed that 24 (40.00%) patients had GCS 5. GCS 6 was observed in 14(23.33%) patients. GCS 5 and 6 were not found post operatively in any cases. GCS 7 was observed in 14 (23.33%) cases. Whereas, GCS 8, 9, 10 were found in 11 (18.33%), 13 (21.66%), 10(16.66%) cases respectively and 4 cases were died on first post operative day. In most cases GCS level rose to 2 points. GOS at 7th POD died total 12 (20.00%) cases. It was observed that 48 (80.00%) patients were alive Moderate disability existed in 12(25.00%) cases. Again, severe disability and persistent vegetative cases observed in 14(29.16%), 9(18.75%) cases. Glasgow Outcome Scale at 3 months follow up of my study patients, it was observed that total died patients 16 (26.66%). Conclusion: According to my study, majority of the study patients survived following EVD in spontaneous ICH with ventricular extension but most cases was unfavorable outcome which was statistically

scholarly journals The relationship between modified Graeb score and intraventricular hematoma volume with Glasgow outcome scale and modified Rankin scale in intraventricular hemorrhage of brain: a comparative study

2021 ◽  
Author(s):  
Mohammad H. Rashid ◽  
Mohammad N. Hossain ◽  
Muhammad S. Hossain ◽  
Israt Z. Eva ◽  
Rumana Habib ◽  
...  
Keyword(s):  
Glasgow Outcome Scale ◽  
Intraventricular Hemorrhage ◽  
External Ventricular Drainage ◽  
Modified Rankin Scale ◽  
Hematoma Volume ◽  
College Hospital ◽  
Presenting Symptoms ◽  
Quasi Experimental ◽  
Gcs Score ◽  
The Relationship

Background: Intraventricular hemorrhage (IVH) is an acute neurosurgical condition. The aim of this study was to identify the relationship between modified Graeb score (mGS) and intraventricular hematoma volume with Glasgow outcome scale (GOS) and modified Rankin scale (mRS).Methods: This is a Quasi-experimental study conducted in the department of neurosurgery, Chittagong Medical College Hospital, Chittagong, Bangladesh during the period from 24 July 2018 to 23 July 2019. After a detailed history and clinical examination, 150 patients were selected for this study. The study participants were divided into two major groups- external ventricular drainage (EVD) and conservative; both groups consisted of 44 patients. Written informed consent were taken from the participants. Data were analyzed using statistical package for the social sciences (SPSS) software.Results: Overall mean age was around 60 years with an age range from 15-85 years. More than three fourth of the patients in both groups were from the age group of >50 years (73.83%). There were no differences between EVD and conservative groups regarding medical comorbidities. Most prevalent comorbidity among the patients of both groups’ hypertension, followed by diabetes and previous ischemic stroke. Overall the most frequent symptoms in the studied patients were vomiting, followed by loss of consciousness, headache and convulsion. There were no significant differences between the two groups regarding presenting symptoms. The mean Glasgow coma scale (GCS) score level was significantly lower in the patients with EVD than their counterpart from 1st post-operative day to 8th post-operative day. However, within-group comparison shows that the GCS score was significantly increased from 1st day to 8th day in both groups of patients.Conclusions: These findings can be used to identify patients in whom an EVD may provide measurable outcomes benefit with respect to patient mortality and help guide neurosurgical decision-making in particular patient subgroups with acute IVH.

scholarly journals Surgery for primary intracerebral haemorrhage: is it safe and effective?

2013 ◽  
Vol 38 (3) ◽  
pp. 74-78
Author(s):  
MMH Talukder ◽  
KMT Islam ◽  
M Hossain ◽  
MU Jahan ◽  
F Mahmood ◽  
...  
Keyword(s):  
Intracerebral Haemorrhage ◽  
Glasgow Outcome Scale ◽  
Control Group ◽  
Intracerebral Haematoma ◽  
College Hospital ◽  
Conservative Group ◽  
Best Medical Treatment ◽  
Significant Difference ◽  
Group A ◽  
Group B

This prospective study was conducted to compare the outcome between medical and surgical treatment of primary intracerebral haemorrhage at the department of Neurosurgery, Dhaka Medical College Hospital from January 2006 to October 2007. All patients with primary intracerebral haematoma with Glasgow Coma Scale (GCS) 5-15 (on admission) and heamatoma volume 30 cc or above admitted at Neurosurgery department managed conservatively or surgically were included in this study. Total 60 patients were selected, of them 30 patients managed conservatively and 30 patients managed surgically. Conservatively managed patients regarded as control group (Group-A) and surgically managed patients regarded as experimental group (Group-B). Patients or attendants refused to operate were included in the conservative group. All the selected patients were evaluated on the basis of detailed history, clinical examination (general and neurological examination) and CT scan findings. Outcome was evaluated in term of Glasgow Outcome Scale (GOS). Best medical treatment was given for conservative group and operations were done for surgical group and followed up after surgery till discharge by observing GCS and GOS at discharge. Number of death were 15 (50%) patients in group- A and 13 (43%) patients in group-B. There was no significant difference in mortality rate between two groups but outcome was relatively better in group-B. According to Glasgow Outcome Scale, dependency in group-A and group-B was 26.6% and 23.4% respectively. So dependency were more in group-A. But there was no significant difference statistically. Seven (23.4%) patients were independent in group-A but 10(43.3%) patients were independent in group-B. However in relative terms of outcome of group-B was better than that of group-A. In our study we found no statistically significant difference in outcome between medical and surgical management of primary intracerebral haemorrhage. DOI: http://dx.doi.org/10.3329/bmrcb.v38i3.14328 Bangladesh Med Res Counc Bull 2012; 38(3): 74-78 (December)

scholarly journals PROGNOSIS OF ACUTE FULMINANT HEPATIC FAILURE

2012 ◽  
Vol 19 (04) ◽  
pp. 496-500
Author(s):  
JAVED AHMED PHULPOTO
Keyword(s):  
Mortality Rate ◽  
Fulminant Hepatic Failure ◽  
Hepatic Failure ◽  
Developed Countries ◽  
Medical College Hospital ◽  
Medical Emergency ◽  
College Hospital ◽  
Medical Unit ◽  
Medical College ◽  
Geographical Variations

Acute fulminant hepatic failure (ALF) is a medical emergency and associated with high mortality rate. Its etiology showsconsiderable geographical variations. The viral causes are the most common in our region, [whilst acetaminophen (Paracetamol) inducedhepatotoxicity forms the most common precipitant in many developed countries]. Objective: To assess the causes and prognosis of acutefulminant hepatic failure in patients attending medical unit I, Ghulam Mohammad Mahar Medical college hospital, Sukkur. Study Design: Across-sectional study. Place of Study: Medical Unit-I, Ghulam Mohammad Mahar Medical College Hospital, Sukkur. Duration of Study: FromJanuary 2010 to July 2011. Methodology: A total one hundred twenty (120) patients of ALF were studied during the study period to evaluate thecauses and prognosis. Those patients who were admitted during the study period were included in the study. The selected patients presentedwith jaundice and hepatic encephalopathy of varying grades. Results: Almost all the cases the causative agents were viruses. Among these,the hepatitis E virus (HEV) was the top most causative agent followed by hepatitis B Virus (HBV) in this study. Despite good effort ofconservative treatment, the mortality rate was 77.5%. The mortality rate was higher in grade-III and grade-IV encephalopathy patients,whereas the prognosis is better in grade-1 and grade-II encephalopathy patients.

Endoscopic Third Ventriculostomy for Occlusive Hydrocephalus Caused by Cerebellar Infarction

Neurosurgery ◽  
2006 ◽  
Vol 59 (3) ◽  
pp. 539-544 ◽  
Author(s):  
Jörg Baldauf ◽  
Joachim Oertel ◽  
Michael R. Gaab ◽  
Henry W.S. Schroeder
Keyword(s):  
Glasgow Coma Scale ◽  
Scale Score ◽  
Glasgow Coma Scale Score ◽  
Glasgow Outcome Scale ◽  
Endoscopic Third Ventriculostomy ◽  
External Ventricular Drainage ◽  
Third Ventriculostomy ◽  
Cerebellar Infarction ◽  
Ventricular Drainage ◽  
Occlusive Hydrocephalus

Abstract OBJECTIVE: The surgical management of occlusive hydrocephalus caused by massive cerebellar infarction remains controversial. The procedures that are more commonly used to avoid progressive neurological deterioration are based on transient external ventricular drainage or the placement of permanent shunt systems. To our knowledge, this is the first report regarding using endoscopic third ventriculostomy (ETV) in patients with an occlusive hydrocephalus caused by cerebellar ischemic stroke. We report our experience of 10 reviewed cases. METHODS: Between 1997 and 2004, 10 patients with a resulting hydrocephalus caused by a space-occupying cerebellar infarction were managed with ETV. Glasgow Coma Scale score on admission, cause of stroke, and computed tomographic signs, including the ischemic vascular territory involved and brain edema, were noted. Clinical outcome was evaluated using the Glasgow Outcome Scale. RESULTS: In all patients, there was a mean interval of 4 days from the onset of deterioration of consciousness to operation. Mean Glasgow Coma Scale score on admission was 11.2. In nine patients, ETV was the initial procedure of ventricular drainage. One patient was primarily treated with an external ventricular drainage, but the device dislocated and ETV was performed. In one patient, an external ventricular drainage became necessary 7 days after the initial ETV because of a malfunction of the stoma. One patient showed a progressive brain edema 2 days after ETV, and suboccipital decompression was performed. Eight successfully treated patients demonstrated an improvement in the level of consciousness after ETV. Mean Glasgow Outcome Scale score on discharge of all patients was 3.4. CONCLUSION: Occlusive hydrocephalus caused by cerebellar infarction is infrequent. When occlusive hydrocephalus is observed, ETV can be used successfully with minimal risks, especially with avoidance of a higher rate of infectious complications caused by external drainage systems.

scholarly journals Study on specific species of malaria in relation to haematological changes

2021 ◽  
Vol 7 (1) ◽  
pp. 1-8
Author(s):  
Dr. Binita Kanaujia ◽  
◽  
Dr. Anand AS ◽  
Dr. Sagar Mhetre ◽  
◽  
...  
Keyword(s):  
Malaria Diagnosis ◽  
Medical Emergency ◽  
Common Symptom ◽  
College Hospital ◽  
Medical College ◽  
Duration Of Illness ◽  
Haematological Profile ◽  
Red Cell Indices ◽  
Haematological Changes ◽  
Specific Species

Background: As malaria is a potential medical emergency, prompt and accurate diagnosis is criticalfor its effective management. Conventional microscopic examination of peripheral thick and thinblood smear examination remains the “gold standard” for malaria diagnosis. Material: A 2 yearprospective study from 2011 to 2013 was conducted at Navodaya Medical College Hospital andResearch Centre, Raichur. The study comprised of a total number of 150 cases positive for Malaria,collected from above mentioned centre and those referred from peripheral referral centres. Clinicalhistory regarding age, sex, nature and duration of illness were elicited. Blood sample forhaematological study was taken before starting anti-malarial drugs in all these cases. Result: Out oftotal cases, P. vivax infected cases (62%) were common than P. falciparum (34%) and mixedinfection cases [PV & PF] (4%). Most common presenting symptom of cases affected by PV, PF andmixed infection were fever and chills & rigors and least common symptom was cough. Mostimportant haematological changes observed were anaemia and thrombocytopenia (77.3% each) andleucopenia (31.3%). All the above mentioned changes in haematological parameters were speciesspecific and statistically significant, except for red cell indices, DLC and ESR. Conclusions: Inconclusion, changes in haematological profile can help in early diagnosis of specific species ofmalaria for timely and appropriate treatment that can reduce the severity and prevention ofadditional consequences.

scholarly journals The Functional Outcome of Spontaneous Hypertensive Supratentorial Intracerebral Haemorrhage after Surgery

2020 ◽  
Vol 7 ◽  
Author(s):  
Saumitra Sarkar ◽  
Avijit Dey ◽  
Kamal Hossen ◽  
Saumik Sarkar
Keyword(s):  
Functional Outcome ◽  
Intracerebral Haemorrhage ◽  
Glasgow Outcome Scale ◽  
Vascular Malformations ◽  
Intracerebral Hematoma ◽  
College Hospital ◽  
Female Ratio ◽  
Significant Difference ◽  
Surgical Evacuation ◽  
The Mean

This study was to determine the different parameters that affect the outcome and the functional recovery after surgical evacuation of spontaneous hypertensive supratentorial intracerebral haemorrhage. This cross-sectional analytic study was conducted in the Department of Neuro- surgery, Shaheed Suhrawardy Medical College Hospital, Dhaka, Bangladesh during a period of 4 years from January 2016 to December 2019 and total 96 patients were included in this study. Patients with post-traumatic hematomas, intracranial space-occupying lesions with bleeds, haemorrhagic transformation of an ischemic stroke, vascular malformations, aneurysms, and infratentorial haemorrhages were excluded from the study. Decompressive craniotomy and evacuation of clot was performed in most of the cases. The outcome of the patients was categorized according to the Glasgow Outcome Scale. Outcome was classified as “favourable” if the Glasgow Outcome Scale (GOS) score was 5 or 4, and classified as “unfavorable” if GOS score was 3 or less. The mean age of the patients was 57.99±12.74 years with male and female ratio was 1.66. The mean blood volume was 28±19.99 cc and all patients were hypertensive. There was significant difference (p <0.001) in outcome in relation of age and volume of blood. Age > 70 years, GCS < 8 on admission, clot volume above 40 cc, and intraventricular extension remain the most consistent predictors of mortality and poor outcome following surgical evacuation of spontaneous supratentorial intracerebral hematoma. The present study could only assess mortality and the functional outcome. Since a proportion of survivors had an unfavorable outcome, quality of life measures is important and need to be addressed in future studies.

scholarly journals Immediate outcome and risk factors determining the outcome of status epilepticus in children attending tertiary care centre

2017 ◽  
Vol 4 (4) ◽  
pp. 1289
Author(s):  
Murali Thandavarayan ◽  
Sureshkumar Ramaswamy ◽  
Priyadarsini Bose ◽  
Sivaraman Thirumalaikumarasamy
Keyword(s):  
Risk Factors ◽  
Status Epilepticus ◽  
Tertiary Care ◽  
Medical Emergency ◽  
Time Of Arrival ◽  
Care Hospital ◽  
Tertiary Care Centre ◽  
College Hospital ◽  
Medical College

Background: Status epilepticus (SE) is a paediatric and neurological medical emergency, continuous seizure lasting more than 30 min, or two or more seizures without full recovery of consciousness between any of them. Determination of immediate outcome of SE in children in a tertiary care hospital and to identify the risk factors influencing the outcome was the objectives of the present study.Methods: A study was conducted in Dept of Pediatrics, Tirunelveli Medical College Hospital among the children from 1 month to12 years of age, who had admitted for SE in hospital’s pediatric causality from October 2009 to October 2010 were selected for the study.Results: Out of 92 patients, total 87 patients completed the study and out of those 74 have recovered and 13 have died. The risk factors significantly affecting the outcome were hypoxia at the time of arrival, decompensated shock, respiratory failure requiring intubation and acidosis.Conclusions: Proper prehospital therapy, early referral, proper care while transporting, anticipitating risk factors involved, and protocol based approach uniformly at all hospital can reduce the mortality due to status epilepticus in children. 

scholarly journals Clinical Profile of Kerosene Poisoning in a Tertiary Level Hospital in Bangladesh

2014 ◽  
Vol 38 (1) ◽  
pp. 11-14 ◽  
Author(s):  
S Anwar ◽  
AKMN Rahman ◽  
SK A Houqe ◽  
AKMA Moshed ◽  
L Yasmin ◽  
...  
Keyword(s):  
Soft Drink ◽  
Clinical Findings ◽  
Summer Season ◽  
Clinical Profile ◽  
Medical Emergency ◽  
College Hospital ◽  
Economic Class ◽  
Medical College ◽  
Respiratory Complaints ◽  
Level Hospital

Background: Accidental ingestion of kerosene continues to remain a common medical emergency among children in developing countries. The importance of this poisoning makes it imperative that parents should be aware about this poisoning. Objective: To see clinical profile of Kerosene poisoning in Bangladesh. Methodology: This retrospective study analyzed 56 children with acute kerosene poisoning admitted in Dhaka Medical College Hospital from January 2010 to June 2010 Result: Fifty six kerosene poisoning cases were admitted within 6 months period. Among the cases boys 29(51.8%), aged less than three years 52(93%), from a rural background 36(64%) and belonging to lower economic class 51 (91%) were found. Inappropriate container of kerosene like soft drink bottle 40 (71%) & summer season 40 (71%) were found major risk factor for kerosene ingestion. Cough 52 (92%) and dyspnea 51(91%) were the commonest clinical findings. Conclusion: Respiratory complaints are predominant clinical features of Kerosene poisoning. Toddler age, children from rural area, summer season were found major risk factors for kerosene ingestion and is mostly due to faulty packing & storage of kerosene. DOI: http://dx.doi.org/10.3329/bjch.v38i1.20021 Bangladesh J Child Health 2014; VOL 38 (1) : 11-14

scholarly journals Decompressive craniectomy in severe traumatic brain injury - a study of 20 cases

2014 ◽  
Vol 43 (2) ◽  
pp. 100-102
Author(s):  
Sukriti Das ◽  
Md Jahangir Alam ◽  
KM Tarikul Islam ◽  
Fazle Elahi ◽  
Ehsan Mahmud
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Decompressive Craniectomy ◽  
Severe Traumatic Brain Injury ◽  
Operative Management ◽  
College Hospital ◽  
Cross Sectional ◽  
Medical College ◽  
Included Patient ◽  
Gcs Score

Severe traumatic brain injury is common in all developing countries like Bangladesh. These patients are commonly managed conservatively in the most of the hospitals of our country where immediate surgical intervention and perioperative ICU facilities are not available.This cross sectional interventional study was aimed at evaluating and comparing the post operative surgical outcome of decompressive craniectomy in patients with severe traumatic brain injury (TBI) with conservatively treated patients.This study was done in Dhaka Medical College Hospital from January 2010 to December 2012. Twenty clinically suspected patients who sustained severe head injury with a GCS of 3-8 with neurological deterioration and evidence of brain contusion, laceration or evidence of brain swelling on CT Scan were included. Patient with primary fatal brain stem injury, an initial and persisting GCS score of 3, or bilaterally dilated and fixed pupil are not candidate for operative management. Outcome was assessed by Glasgow outcome scale (GOS). Follow up was given for a period of six to twelve months. DOI: http://dx.doi.org/10.3329/bmj.v43i2.21392 Bangladesh Med J. 2014 May; 43 (2): 100-102

scholarly journals Clinical and investigational study for the aetiological evaluation of patients in nontraumatic altered sensorium and its outcome

2019 ◽  
Vol 7 (4) ◽  
pp. 1113
Author(s):  
Siba Narayan Jali ◽  
Sachida Nanda Nayak ◽  
Biju K. Alexander ◽  
Diptimayee Tripathy ◽  
Bijaya K. Behera
Keyword(s):  
Tertiary Care ◽  
General Medicine ◽  
Diagnostic Methods ◽  
P Value ◽  
Care Hospital ◽  
College Hospital ◽  
Metabolic Encephalopathy ◽  
Altered Sensorium ◽  
Medical College ◽  
Gcs Score

Background: Apart from head injury many patients present to the tertiary care hospital in unconscious state, the etiology of which is obscure in most of the cases. The present study was conducted with on objective to provide insight into the clinical features and diagnostic methods to know the aetiology of patients with non-traumatic cases of altered sensorium and to study the outcome of these patients.Methods: This is an observational study on 100 patients of altered sensorium of non-traumatic origin during the period from October 2012 to September 2014 conducted in the Department of General Medicine, MKCG Medical College Hospital, Berhampur, Odisha, India. All patients were selected for the study based on the inclusion exclusion criteria. Detailed history, clinical evaluation, laboratory investigations like neuroimaging studies etc. were carried out. Statistical data analysis was done using Graph pad Prism 6 and Microsoft Excel. P value <0.0001 was considered statistically extremely significant.Results: Out of 100 patients of altered sensorium, 64 were males and 36 were females. All patients were in the age group of 19 to 89 years. Cerebrovascular accident was the most common aetiology of altered sensorium followed by metabolic encephalopathy and infection. Altered sensorium in patients with CVA carries a high mortality. Metabolic causes and younger age indicated a better prognosis, patients with low (Glasgow Coma Score) GCS score of 3 to 4 had poorer prognosis.Conclusions: The results suggest that clinical assessments yield accurate predictive information about the potential for recovery in cases of altered sensorium. So, this study concludes that empirically based estimates of prognosis in the neurologically severely ill provides great reassurance to those involved in a decision-making process, including patients’ families and physicians.

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