Search

A 33-year-old man with anti-phospholipid antibody syndrome associated with Budd Chiari syndrome and subdural hematoma. He developed venous thrombosis in his hepatic vein (stenting done) when laboratory studies demonstrated prolongation of activated partial thromboplastin time (APTT). Subdural hematoma demonstrated with Computed tomography (CT) of brain. Laboratory studies revealed thrombocytopenia, prolonged bleeding time and APTT, positive antinuclear antibody and positive test results for both lupus anticoagulant and an anti-cardiolipin antibody, namely antiphospholipid antibodies. Based on these findings, we consider that the tendency of this bleeding may have been due to antiphospholipid antibodies, attacking the platelet membranes and that the bridging veins in the subdural space may be the site at which the bleeding tendency easily appears. Antiphospholipid antibody syndrome accompanied by hemorrhagic complications had rarely been reported. We suggest that special attention should be given to hemorrhagic complications in patients with antiphospholipid antibody syndrome associated with fragility of the vessels and/or platelet dysfunction and on anticoagulant (warfarin).Pulse Vol.10 January-December 2017 p.25-28

Background : A meningioma is a tumor that arises from the meninges- the membranes that surround the brain and spinal cord. Objective : This is a retrospective analysis of the recorded data of patients managed for intracranial meningiomas between January 2007 and June 2015 at Apollo Hospital, Dhaka. Methodology : Demographic data was analyzed for all but only patients who had surgery and histological diagnosis were analyzed for outcome. Results : This study shows that meningiomas had female preponderance. Majority cases were above 50 years of age. Convexity is the most common anatomical location of meningioma. Most common symptoms were headache (70%) followed by seizure in 34.3% of patients. 90% of the cases were benign. Malignant meningioma was 1.4% and recurrence was found in 1.4% of cases. Six patients with histological grades I, II and III meningi- omas were sent for stereotactic radiotherapy after incomplete tumor resection or for residual tumour. Total removal was done in 80% cases and the mortality was 1.4%, in patient who had poor GCS score on admission. Pulse Vol.9 January-December 2016 p.22-26

Introduction: Cerebellopontine angle tumors are a surgical challenge to many neurosurgeons who want to operate in this space. Although most of these tumors are benign, they are a challenge because of the complex anatomy and important neurovascular structures that traverse this space. Most common cerebellopontine angle tumor is vestibular schwannoma. The management of these cases is essentially surgical. There has been a change in the surgical strategy over the years from simple intratumoral decompression to complete microsurgical excision, to radical excision with facial nerve and hearing preservation. Objectives: To study the clinical and radiological characteristics, know the pathological types and determine the surgical resectability and outcome of cerebellopontine angle tumor. Materials and Methods: It is a retrospective study done in the department of Neurosurgery, Apollo Hospitals Dhaka. 34 patients diagnosed with cerebellopontine angle tumor were recruited into the study. Results: Among 34 cases of cerebellopontine angle tumors vestibular schwannoma alone constituted 79%. Most of the tumors were large or giant tumors. Total resection was done in 25% of vestibular schwannoma and 50% of meningiomas. Anatomical preservation of facial nerve was achieved in 73% of patients. Facial nerve function as measured by the House Brackmann system. Postoperatively 61% had a score of 1 or 2; 29% had a score of 3 or 4; and 8% had a score of 5 or 6. Other complications included 2 cases of CSF leak, 3 cases of meningitis, 2 cases of lower cranial nerve palsy and 1 patient died. Conclusion: Cerebellopontine angle tumors show high incidence from 3rd to 5th decade with common symptoms being hearing loss and ataxia. Most of the patients presented at a delayed stage with large to giant tumors with no useful hearing. Sub total excision with keeping anterior part of tumor for preserving facial nerve function is the goal. Pulse Vol.8 January-December 2015 p.8-14

Objectives: The aim of this study was to analyze efficacy and safety of decompressive hemicraniectomy (DHC) in hypertensive basal ganglia hemorrhage (HBGH). Neurosurgical management of HBGH is still a controversial issue. Surgical techniques are diverse, from the open large craniotomy, to the minimally invasive techniques like stereotactic aspiration of the HBGH, endoscopic evacuation and stereotactic catheter drainage after instillation of thrombolytic agents. Decompressive hemicraniectomy lowers intracranial pressure and improves outcome in patients with HBGH. Methods: 8 patients with HBGH who underwent decompressive craniectomy in the last 2 years were analyzed. Parameters investigated included clinical presentations, radiologic profile, time interval from ictus to surgery, and modified Rankin Scale score at 6 months. Results: The patients mean age 55 years, the mean Glasgow Coma Scale (GCS) score was 7 (range 5–13), the mean ICH volume was 58 ml (range 40–70 ml), and the mean midline shift was 10.62 mm (range 6-16 mm). The outcome after 6 months was appreciated as good (modified Rankin Scale 0–4) or poor (modified Rankin Scale 5-6). Five patients had good and three had poor outcomes (including two deaths). Conclusion: We conclude, based on this small cohort, that DC can reduce mortality in some cases. Larger prospective studies are needed to assess safety and efficacy of this method. Pulse Vol.8 January-December 2015 p.38-42

A 41 year old nondiabetic, non hypertensive male was admitted in AHD through neurosurgery OPD with the complaints of left eye watering and left sided weakness for 1 month. MRI examination revealed a mass / lesion in the left prepontine cistern, left CP angle with extension to left middle cranial fossa which was histologically found to be chondroma, an extremely rare tumour in the above mentioned location.Pulse Vol.8 January-December 2015 p.81-84

Objectives: The aim of this study was to test the hypothesis that decompressive hemicraniectomy (DHC), compared with craniotomy with evacuation of hematoma, and would improve clinical outcomes of patients with supratentorial intracerebral hemorrhage (SICH). Methods: We compared patients (November 2008–February 2014) with supratentorial ICH treated with DHC without hematoma evacuation and craniotomy with hematoma evacuation. DHC measured at least 150 mm and included opening of the dura. We analyzed clinical, radiological, and surgical characteristics. Outcome at 6 months was divided into good (modified Rankin Scale 0–4) and poor (modified Rankin Scale 5–6). Results: Fifteen patients (mean age 58 years) with ICH were treated by DHC. Median hematoma volume was 61 ml and mean preoperative Glasgow Coma Scale (GCS) was 7. Ten patients had good and five had poor outcomes. In hematoma evacuation group 29 patients were treated. Median hematoma volume was 55 ml and mean preoperative Glasgow Coma Scale (GCS) was 8. Seventeen patients had good and twelve had poor outcomes. Conclusions: DHC is more effective than hematoma evacuation in patients with SICH. Based on this small cohort, DHC may reduce mortality. Larger prospective study is warranted to assess safety and efficacy. Pulse Vol.7 January-December 2014 p.16-21

Congenital dermoid inclusion cyst over the anterior fontanelle (CDIC) is an uncommon cystic lesion. It is a benign and curative lesion. In these two cases a soft, cystic mass located over the anterior fontanelle. The cyst had no intracranial extension and was easily excised intact. The clinical and image findings of the cysts were described and compared with the usual dermoids. Many different types of lesions over the children's skull exist and some are commonly diagnosed in daily practice. Congenital dermoid inclusion cyst over the anterior fontanelle (CDIC) is a rare and benign lesion.Pulse Vol.7 January-December 2014 p.42-45

A 30 year old man admitted with the complaints of generalized convulsions, headache and amnesia. The radiological and neuro-pathological findings were interhemispheric epidermoid tumor, which is a rare location. The tumor was removed completely. The diagnosis and management of epidermoid tumors are discussed by reviewing the literature.Pulse Vol.7 January-December 2014 p.46-49

A 56 years old diabetic hypertensive male was admitted through neurosurgery OPD with the complaint of vision problems in the right eye for the last 1 and 1/2 years. Peri-metry reveals bilateral temporal field defects and MRI examination showed a sellar and suprasellar mass infiltrating the surrounding structures including cavernous sinus. Histomorphologically and inmmunohistochemically, a diagnosis of atypical pituitary adenoma was made.Pulse Vol.8 January-December 2015 p.66-68

Isolated cerebral mucormycosis without rhino-orbital focus is an extremely rare but life-threatening infection of central nervous system that most commonly found in intravenous drug abuser. We present a case of isolated cerebral mucormycosis diagnosed by open biopsy and treated with amphotericin B. DOI: http://dx.doi.org/10.3329/pulse.v5i2.20267 Pulse Vol.5 July 2011 p.54-57

Pineal region tumours are rare, even though it gives rise to diverse array of tumour. Among these, pineal parenchymal tumour of intermediate differentiation is a newly recognized entity. We have described a 56 year old male of pineal parenchymal tumour of intermediate differentiation. As this tumour is very rare with uncertain behavior and optimal management, this case report will add value to the existing database. DOI: http://dx.doi.org/10.3329/pulse.v6i1-2.20356 Pulse Vol.6 January-December 2013 p.60-61

Central neurocytoma is a tumour showing neuronal differentiation. This tumour usually located in ventricles occurs at young age and carries favorable prognosis. For this, accurate diagnosis is essential. There is no published case report of central neurocytoma in Bangladesh. With these objectives, we have presented a case report of central neurocytoma in a 37 years old female. DOI: http://dx.doi.org/10.3329/pulse.v6i1-2.20351 Pulse Vol.6 January-December 2013 p.51-52

Aim and Objective: Dysembryoplastic neuroepithelial tumour is an unusual brain tumour with varied incidence commonly occured in younger age group. We report a 16-year old female diagnosed as a case of dysembryoplastic neuroepithelial tumour. Clinical presentation: A 16 year old female was examined for headache and convulsion for two months. MRI revealed a brain tumour which was later confirmed as dysembyroplastic neuroepithelial tumour by histopathological examination.DOI: http://dx.doi.org/10.3329/pulse.v4i1.6968Pulse Vol.4 January 2010 p.43-44