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A Case of Classical ‘SCIWORA’ in an Adult Following Trivial Trauma
Toivo Hasheela,
Aaron Musara
Issue:
Volume 2, Issue 2, December 2018
Pages:
23-26
Received:
8 August 2018
Accepted:
11 September 2018
Published:
17 October 2018
DOI:
10.11648/j.ijn.20180202.11
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Abstract: Spinal cord injury without radiographic abnormality (SCIWORA) is a well-documented finding in the paediatric population age groups, however in adults it is a rare occurrence. This case report gives an account of a case of an adult patient in whom a diagnosis of cervical SCIWORA was made and confirmed by MRI, following, seemingly, trivial trauma. A 46 year old man jumped from a small bridge, landed on his feet and fell backwards, immediately thereafter could no longer move or feel his trunk and limbs. Upon neurological assessment, he was found to have spastic quadriparesis, sensory level of C4, as well as bowel and bladder dysfunction. CT scan did not reveal any abnormalities; however MRI demonstrated spinal cord signal changes consistent with spinal cord contusion. Patient was managed conservatively in a rigid cervical collar, as well as per local protocols for the management of quadriplegia. He however eventually succumbed to respiratory failure compounded by aspiration pneumonia. Although SCIWORA is rare in the adult population groups, it does occur and can lead to significant morbidity and high mortality rates. Therefore adult patients presenting with neurologic deficits and normal static radiographs and CT scans, on a background of any degree of trauma, be it trivial, should not be brushed off lightly but rather investigated further with dynamic radiographs and MRI.
Abstract: Spinal cord injury without radiographic abnormality (SCIWORA) is a well-documented finding in the paediatric population age groups, however in adults it is a rare occurrence. This case report gives an account of a case of an adult patient in whom a diagnosis of cervical SCIWORA was made and confirmed by MRI, following, seemingly, trivial trauma. A ...
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Perceived Stress and Quality of Life in Spinal Cord Injured Individuals
Gunjan Chaudhary,
Shazia Mattu
Issue:
Volume 2, Issue 2, December 2018
Pages:
27-30
Received:
15 March 2018
Accepted:
4 October 2018
Published:
25 October 2018
DOI:
10.11648/j.ijn.20180202.12
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Abstract: Background: Spinal cord injury (SCI) involves severe physical, social, but also psychological consequences. The risk for major depression, anxiety disorder, post-traumatic stress disorder, substance abuse and suicide is elevated for people with SCI compared with the general population. The objective of this study was to evaluate the quality of life and stress variation among spinal cord injured Individuals. 100 subjects in the age group OF 30-60 YEARS, including both males and females. The questionnaire was used by asking questions to the subjects regarding their stress and limitation in their activities of daily living. Some were filled by telephonic conversations and some by person. The present study was to evaluate the perceived stress and quality of life in spinal cord injured patients using “The Perceived Stress Scale and short form - 36 Questionnaire”. The questionnaire comprised of Health Screening Questions and questions that related with their life styles and emotional and physical limitations in daily activities after spinal cord injury. In Conclusion, spinal cord injury affects many facets of individuals life. Often spinal cord injured patients are of often younger age group. The physical, personal, financial and social impact of spinal cord injury is such that most patients are lost in follow up to life threatening complication associated with Spinal cord Injury.
Abstract: Background: Spinal cord injury (SCI) involves severe physical, social, but also psychological consequences. The risk for major depression, anxiety disorder, post-traumatic stress disorder, substance abuse and suicide is elevated for people with SCI compared with the general population. The objective of this study was to evaluate the quality of life...
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White Cerebellum Sign After Ventriculo-Peritoneal Shunt Insertion: A Case Report and Review of the Literature
Serge Eddy Mba,
Kazadi Kalangu,
Aaron Musara,
Dumisani Ndlovu,
Nathaniel Harunangoni Zimani
Issue:
Volume 2, Issue 2, December 2018
Pages:
31-34
Received:
19 September 2018
Accepted:
7 November 2018
Published:
3 December 2018
DOI:
10.11648/j.ijn.20180202.13
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Abstract: White cerebellum sign a reversal of the normal gray/white matter densities and a relatively increased density of the thalami, brainstem and cerebellum; it is also known as dense cerebellum sign or reversal sign. On Computed Tomography, it is seen as hypodensity of the supratentorial brain with reverse increased attenuation of the cerebellum. This ominous sign is a poor prognostic indicator for patients with brain injury. We document a rare case of white cerebellum sign occurring in an eight year old girl who presented to the emergency department with signs of raised intracranial pressure following Ventriculo-peritoneal shunt revision. Our patient improved significantly after resuscitation with mannitol, she was discharged from hospital with an improved Glasgow Coma Score. Our case presents a new opportunity for management of patients with white cerebellar sign. Mannitol is an antioxidant that decrease H2O2 by upregulating catalases. It is postulated to have played a role in the clinical improvement of our patient. In this review, only one other patient improved after developing a white cerebellar sign, the etiological factor was meningitis as in our case, and the patient had received osmotherapy as well. Mannitol seems to have a protective effect in patients who develop a white cerebellum sign following meningitis.
Abstract: White cerebellum sign a reversal of the normal gray/white matter densities and a relatively increased density of the thalami, brainstem and cerebellum; it is also known as dense cerebellum sign or reversal sign. On Computed Tomography, it is seen as hypodensity of the supratentorial brain with reverse increased attenuation of the cerebellum. This o...
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A Rare Case of Scalp Aplasia Cutis Congenita in a Zimbabwean Child
Brighton Valentine Nyamapfene,
Tafadzwa Moreen Dube,
Killion Madondoro,
Aaron Musara,
Kazadi Kaluile Kalangu
Issue:
Volume 2, Issue 2, December 2018
Pages:
35-38
Received:
23 October 2018
Accepted:
8 November 2018
Published:
4 December 2018
DOI:
10.11648/j.ijn.20180202.14
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Abstract: Skull and scalp defects can be a challenge in the pediatric population. They predispose to meningitis and at times catastrophic exsanguination. Aplasia Cutis Congenita is a very rare condition resulting in a variable degree of absence of epidermis and dermis. It can be associated with skull defects especially the parietal vertex. We report a case managed at our hospital of a 2 week old Zimbabwean baby with a scalp and bi-parietal bone defect present at birth. He had no other congenital anomalies. Our case was managed by rotational pedicled flap to cover the skull defect. Various methods to close the skull defects have been highlighted in literature. These may include either split skin graft or full thickness graft especially if the pericranium is viable for nutritional support. Subgaleal scoring with flap advancement can also be employed by making longitudinal incisions perpendicular to the direction of advancement. Rotational flaps are especially useful in parieto-occipital lesions like our case. Patient factors for example size of defect, location and associated skull defects determine the optimal option to be used. Aplasia Cutis Congenita is therefore a rare condition which needs a multimodal approach. Lesions above 2 cm in greatest diameter and associated skull defects should have early surgery to avoid complications like infections and hemorrhage.
Abstract: Skull and scalp defects can be a challenge in the pediatric population. They predispose to meningitis and at times catastrophic exsanguination. Aplasia Cutis Congenita is a very rare condition resulting in a variable degree of absence of epidermis and dermis. It can be associated with skull defects especially the parietal vertex. We report a case m...
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Cutaneous Carcinosarcoma of the Scalp - A Case Report and Literature Review
Hlatywayo Lawrence,
Nyamapfene Brighton Valentine,
Nathaniel Zimani,
Aaron Musara,
Khita Phiri,
Kazadi Kalangu,
Rudo Makunike Mutasa
Issue:
Volume 2, Issue 2, December 2018
Pages:
39-42
Received:
30 October 2018
Accepted:
12 November 2018
Published:
17 December 2018
DOI:
10.11648/j.ijn.20180202.15
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Abstract: Carcinosarcomas are a group of biphasic tumours. They are composed of co-existing malignant epithelial and mesenchymal components. They are extremely rare in the skin. We present a case of a 43 year old female patient who came as a referral from a local district hospital with a chronic painless mass for 7 years. It had ulcerated 6 months prior to presentation with bleeding. The scalp mass was resected with a 10 mm margin. The histological diagnosis was carcinosarcoma as both carcinomatous and sarcomatous. Diagnosis of carcinosarcoma rests on demonstration of pleomorphic spindle cells with pressence of both epithelial and mesenchymal elements within the same tumour. The biphasic nature of the tumour may be seen on light microscopy showing atypical squamoid epithelial cells admixed with mucoid secreting variants as shown in our case. Immunopositivity to both cytokeratin and vimentin on a background of the described light microscopy findings confirms the diagnosis. Generally, surgery with resection of at least 10mm margin is the primary therapeutic modality. Local spread is rare. In conclusion, cutaneous carcinosarcoma of the scalp is rare and management is patient dependant with surgery being the mainstay treatment.
Abstract: Carcinosarcomas are a group of biphasic tumours. They are composed of co-existing malignant epithelial and mesenchymal components. They are extremely rare in the skin. We present a case of a 43 year old female patient who came as a referral from a local district hospital with a chronic painless mass for 7 years. It had ulcerated 6 months prior to p...
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Clinical Profile, Risk Factors and Outcome Assessment of Aneurysmal Subarachnoid Hemorrhage (SAH) Patients: A Multicenter Study in Bangladesh
Abhishek Chaturbedi,
ATM Mosharef Hossain,
SK Sader Hossain,
Zillur Rahman,
Kanak Kanti Barua
Issue:
Volume 2, Issue 2, December 2018
Pages:
43-49
Received:
18 November 2018
Accepted:
5 December 2018
Published:
15 January 2019
DOI:
10.11648/j.ijn.20180202.16
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Abstract: The vast majority of the literature on aneurysmal Subarachnoid Hemorrhage (aSAH) is flawed by the homogeneity of Caucasian population in western based studies. There is dearth of such studies in the Indian Subcontinent which has different demographics, cultural differences and health problems, which we aim to explore with this study. This cross-sectional observational study on aSAH patients was conducted in 3 different hospitals in Bangladesh from 2016 to 2017. A total of 45 adult patients who fulfilled the selection criteria were enrolled in this study. Patients with confirmed SAH from ruptured cerebral aneurysm by various cerebral angiographic studies were evaluated for clinical profile, risk factors and outcome assessment. Headache (100%) was the most common presenting symptom. We found female predominance (62%), the age group with maximum number of patients was 41-60 years (60%). The most common clinical risk factor was hypertension (55%). Half of the patients have size of the ruptured cerebral aneurysm dome <7 mm. The most common location of the aneurysm was anterior communicating artery (51%). Statistically significant association was found between the Glasgow Outcome Scale at the time of discharge from the hospital with the Fischer Grading of SAH (p value of 0.03). Our study comprising Bangladeshi patients with aSAH had certain similarities and dissimilarities with predominantly white based western studies. Half of the patients in our study had small sized aneurysm which are known to rarely rupture, should provoke new thoughts about their management among neurosurgeons.
Abstract: The vast majority of the literature on aneurysmal Subarachnoid Hemorrhage (aSAH) is flawed by the homogeneity of Caucasian population in western based studies. There is dearth of such studies in the Indian Subcontinent which has different demographics, cultural differences and health problems, which we aim to explore with this study. This cross-sec...
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