An intramedullary abscess is an extremely rare form of infection of the spinal cord, with only about 100 cases reported in the literature. It typically presents with back pain, neurological deficits, and, occasionally, fever. The purpose of this article is to report a case of an intramedullary thoracic spinal cord abscess that was initially misdiagnosed as an intramedullary tumor. A 48-year-old female presented with chronic inter-scapular pain and lower limb weakness. The patient was initially misdiagnosed as a case of intramedullary spinal cord tumor, primarily due to the rarity of intramedullary spinal cord abscess (ISCA) as well as the absence of ring enhancement in the lesion on MRI. However, during a surgical procedure for the excision of the lesion, it was found to be a case of ISCA. The purulent contents of the lesion were evacuated, and the patient was treated with IV antibiotics, leaving the patient with a slight residual lower limb weakness on the follow-up examination. This case highlights the importance of considering intramedullary abscess as a possible diagnosis in patients with back pain and neurological deficits, even in the absence of ring enhancement on imaging. Prompt surgical intervention should be considered in probable cases of intramedullary spinal cord tumors.
Objective: To analyze the outcome of ventriculoperitoneal (VP) shunts in terms of improvement and complications.
Material and Methods: This retrospective observational study is done in MTI Mardan medical complex and Prime teaching hospital from September 2017 to March 2020. The hospital record of all patients who underwent ventriculoperitoneal shunts was reviewed for improvement and complications. Patients undergoing ventriculoperitoneal shunt for normal pressure hydrocephalus were excluded from this study. Revision of ventriculoperitoneal shunt was the primary endpoint of the study.
Results: A total of 167 patients were operated on for ventriculoperitoneal shunts with males 106 (63.47%) and females 61 (36.52%). Age ranged from 1 month to 75 years with a mean of 14 years. The most common indication for surgery was congenital hydrocephalus in 102 patients (61.1%) while brain tumors caused hydrocephalus in 25 (15%) patients. Common presenting symptoms were the increase in head size in 75 (44.9%), and headaches in 84 (50.2%) patients. Symptomatic (headache, vomiting, and increase in OFC) improvement occurred in 145 patients (86.82%). Shunt revision was needed in 50.29% (84 patients) in one year.
Conclusion: VP shunt is a life-saving procedure and is an effective treatment of hydrocephalus but is not risk-free. Almost half of the shunted patients will need revision surgery in one year period.
Keywords: Hydrocephalus, Ventriculoperitoneal Shunt, Occipitofrontal Circumference (OFC).
Objective: To determine the prevalence of early postoperative complications in patients undergoing surgical treatment for meningomyelocele. Study Design: Descriptive study Place & Duration: Department of Neurosurgery, Saidu Teaching Hospital, Saidu Sharif, Swat for duration of three years from November 2017 to October 2020. Methods: Total one hundred and thirty six patients of both genders presented with meningomycele were included in this study. Patients’ ages were ranging from 5 to 120 days. All the patients were undergoing surgical treatment for meningomyelocele. Early post-operative complications were recorded after surgery Results: There were 76 (55.88%) males and 60 (44.12%) females. Forty (29.41%) patients were ages <1 month, 59 (43.38%) patients were ages 1 to 2 months 37 (27.21%) were ages above 2 months. Majority of patients 70 (51.47%) had defect size <5 cm. Post-operative complications such as surgical site infection, pyrexia, hydrocephalus and cerebrospinal fluid leakage in 20 (14.71%), 115 (84.56%, 29 (21.32%) and 33 (24.26%) patients respectively. Conclusion: Early and accurate diagnosis and better management may reduce the complications rate Keywords: Prevalence, Complications, Meningomvelocele
Microsurgical excision for benign cerebellopontine angle (CP angle) tumors was done retrospectively at Prime Teaching Hospital in Peshawar for two years. With a mean age of 46.5 years, 31 Male patients were observed (68%). In post-operative treatment, the research highlights the need for customized drug regimes and thorough facial nerve rehabilitation. These approaches greatly improved patient outcomes. Nonetheless, persistent effects and variability in recovery highlight how difficult treating CP angle malignancies is. Ultimately, our study aims to improve patient well-being by highlighting the significance of individualized methods and interdisciplinary treatment in neurosurgery.This research aimed to evaluate the results of microsurgical excision for benign tumors of the cerebellopontine angle (CP angle). One of the main goals was to assess the effects of treatment plans and facial nerve rehabilitation on patient recovery. The patient demographics and follow-up period were observed to put the research in perspective.
To study the effects of treatment in adults with pilocytic astrocytoma (PA), we conducted a survey including an examination of tiny case series and research in the literature. Our study comprised 50 patients who had PA surgery at MMC Mardan, Pakistan, between February 2018 and February 2023. Our main goal was overall survival (OS), whereas our secondary goals were morbidity, quality of life, and recurrence-free survival. The mean patient age was 27.7 years, with a range of 19–62 years, throughout our follow-up period of 38.3 months, which was between 0-85 months. The survival rate according to our findings was 77.2% (96% CI: 96.02-98.3%). Moreover, the adult recurrence-free survival rate after PA surgery was 95.01% (96.07% CI: 92.07-95.09%). Quality of life assessments after surgery was significantly better than before values [p 0.001]. Notably, the most frequent consequence in 7.08% of patients was postoperative seizures. These findings imply that adult patients with PA may benefit from surgical therapy in terms of quality of life and survival.
Background: Spinal meningiomas are relatively rare in comparison to intracranial meningiomas. Spinal meningiomas occur more often in females than males. The goal of surgery is precise resection of the tumor with functional recovery. This study was conducted to assess surgical management of spinal meningiomas.
Material & Methods: This descriptive hospital-based study was conducted in Department of Neurosurgery, Lady Reading Hospital, Peshawar, from January 2006 to January 2009. Patients with spinal meningioma were selected on the basis of clinical features and MRI findings, The record of all patients was analysed. We made a proforma for collection of data, which included information about patient identity, clinical features and MRI findings and histopathology.
Results: We studied 48 patients with spinal meningioma. Their age ranged from 18 to 78 years, with mean of 48 years. Among these 43(90%) were females and 5(10%) males. Paraparesis was predominant motor symptom in 27(56.25%), while hypesthesia was predominant sensory symptom in 32(66.6%) patients. There was sphincter dysfunction in 14(30%) patients. MRI spine was performed in all cases. Surgical results showed Simpson Grade-2 removal in 40(40.32%), Grade-3 in 6(12.5%), and Grade-4 in 2(4.16%) patients. Patients were followed-up for 2 years. Post-operatively 37(77%) patients improved, 2(4.16%) deteriorated due to spinal cord injury and syrinx, and 9 (18.75%) had no change. Six (12%) patients had recurrence and there was Simpson grade 3 and 4 removal in these patients. Two patients had superficial wound infection which was subsequently managed, and 4 patients had CSF leak which was managed conservatively.
Conclusion: Spinal meningioma most commonly occurs in the thoracic and cervical regions. Posterior or posterolateral approaches are the most commonly employed. Gross total resction is the treatment of choice.
Objective: A diagnosis of subacute thyroiditis (SAT) is based on history and clinical features supported by laboratory investigations and imaging studies. However, the presence of SAT with normal thyroid scintigraphy findings is exceedingly rare.Methods: We report the history, exam findings, laboratory results, and imaging studies of a 51-year-old postmenopausal female with SAT.Results: The patient had a history of recurrent SAT 10 years back and presented now with pain in her neck for 1.5 months, fever for 3 days, heat intolerance, sleep disturbances, and restlessness. Physical examination revealed enlargement and marked tenderness over the thyroid. Thyroid profile showed thyroid-stimulating hormone (TSH) 0.023 μIU/mL (normal, 0.4 to 4.2 μIU/mL), free thyroxine (FT4) 2.31 ng/dL (normal, 0.89 to 1.76 ng/dL), and free triiodothyronine (FT3) 2.74 ng/dL (normal, 1.3 to 3.1 ng/dL). Tc-99m pertechnetate scintigraphy showed bilateral normal homogenous uptake in both lobes of the thyroid. Patient was started on 1 tablet carbimazole 5 mg three times daily, but she returned 2 weeks later with persistence of symptoms. Repeat labs showed TSH, 0.008 μIU/mL; FT4, 2.64 ng/dL; and FT3, 2.5 ng/dL, with erythrocyte sedimentation rate (ESR) of 94 mm/hour (normal, 0 to 20 mm/hour). Carbimazole was stopped and prednisolone was started in tapering doses for 6 weeks. Improvement in symptoms with normalization of ESR to 8 mm/hour and FT4 to 1.04 ng/dL occurred after taking prednisolone for 6 weeks at follow-up.Conclusion: This patient presenting with typical clinical features of SAT and elevated ESR but lacking the characteristic imaging thus emphasizes diagnosis of SAT on the basis of history, physical examination, and laboratory data, even if thyroid scintigraphy findings are not in favor of disease.Abbreviations: ESR = erythrocyte sedimentation rate; FT4 = free thyroxine; SAT = subacute thyroiditis; TSH = thyroidstimulating hormone
Penetrating head injuries can be the result of numerous intentional or unintentional events, including missile wounds, stab wounds, motor vehicle and occupational accidents (nails, iron rods) or assaults (screw-drivers). Penetrating head injuries caused by screw-drivers constitute only a small part of the total number of traumatic head injuries seen in casualty. We report a case of neuro-trauma who was operated in our institution. A 25 years gentleman presented in casualty on with a screw-driver penetrating into the skull, as an unusual case of violence.
Background: Brain metastasis is the most common neurologic complication of systemic cancer. The aim of this
study was to know about the spectrum of causes of cerebral metastasis.
Material & Methods: This cross-sectional study was conducted at Neurosurgery Department, Lady Reading
Hospital, Peshawar from January 2013 to December 2014. After taking consent from ethical research committee
all patients of both genders irrespective of their age who had brain metastasis based on MRI brain and histopathology
results were included in the study and those with primary brain tumors confirmed on histopathology and
Patients with coagulopathy, unfit for GA, not willing for surgery were excluded from the study. Patients particulars
like age, gender, pre-operative symptomology, primary site of metastasis, location of metastasis and type of
treatment given were recorded on predesigned proforma. Data was analyzed by SPSS version 20 and results
were represented in the form of graphs and tables.
Results: We studied 16 cases; 10(62.5%) males and 6(37.5%) females. The age range was from 14 to 92 years
(mean 53 years). Headache and seizures were present in 5(31.25%) cases each, weakness/hemiplegia and cognitive/
behavioral disturbance in 4(25%) cases each, ataxia in one (6.25%) and one (6.25%) were asymptomatic.
In 12(75%) cases Kernofsky Performance Score was >70 and in 4(25%) cases <70. Origin of cerebral metastasis
was from the lungs in 7(43.75%) patients while from breast in 3(18.75%) cases.
Conclusion: Cerebral metastasis occurs in old age mostly in males. The most common mode of presentation
is headache, seizures, behavioral disturbance and neurological deficits. Lung tumors have greatest propensity
to metastasize to the brain.
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