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Background:Epidural hematoma (EDH) is accumulation of blood between the inner table of the skull and thedural membrane due to trauma and predominantly consists of venous blood in case ofchildren.Children with extradural hematoma (EDH) present differently than adults and outcome would also be different. Methods and Materials: This is a prospective interventional study done in the Department of Neurosurgery, Dhaka Medical College and Hospital (DMCH) in between period of January 2016 to December 2019. Children of both sex below 12 years of age with EDH were included after fulfilling inclusion and exclusion criteria. Follow up period was 1 month after surgery. Results: Among 90 patients, 73.3% were male and 26.7% were female. Age 5 - 12 years is most commonly affected among all age groups, attributing to 58.9%, fall from height was the most common cause (58.9%) followed by road traffic accident (32.2%), fall of heavy object over head (7.8%) etc. The most common symptom was vomiting which was present in 85.6% of patients followed by altered consciousness in 72.2%, headache in 60% and scalp swelling in 25.6% of patients. The follow-up of our patients was 1 month after surgery. Most of our patients made good recovery. Among them 73 patients (81.1%) were neurologically intact (GOS 5), 10 (11.1%) patients had some deficit but could do their daily activity independently (GOS 4), 03 patients (3.3%) was dependant on other for daily activity with cognitive deficit (GOS 3) and 4 patients (4.4%) died. Conclusion:EDH in children can be managed by surgery with good outcomes. Even in the presence of poor initial clinical and radiologic conditions, timely intervention can lead to a good recovery. Bangladesh Journal of Medical Science Vol. 21 No. 04 October’22 Page : 865-874

Background: There is no consensus in the literature on the effects of the development of hydrocephalus on survival and disability after intracerebral haemorrhage (ICH) and the benefits of external ventricular drainage (EVD). This study is planned to describe the role of external ventricular drainage in treating patients of spontaneous, either primary or secondary, intraventricular haemorrhage with hydrocephalus.Material & Methods:A hospital based prospective interventional study was conducted in the Department of Neurosurgery of Dhaka Medical College Hospital, which is a tertiary level hospital, from April 2016 to September 2017.Total 42 patients of spontaneous intraventricular haemorrhage, either primary or secondary, with hydrocephalus were selected for this study. All the collected data were entered into IBM SPSS software, Version 24. For statistical analysis, paired t-test to compare the preoperative GCS with postoperative GCS at 24 hours was done.Results:Among 42 patients, age range was 26-75 years with the mean age 65.2 ± 10.87 years. Male were 26 (61.9%) and female were 16 (38.1%). Male-Female ratio was 1.625:1. No patient needed conversion of EVD into VP shunt. EVD drain became blocked in 5 cases which were managed accordingly. 5 patients developed ventriculitis among which 2 patients died and rest 3 improved with antibiotics.Conclusions:The results of present study shows that EVD has a good role in the treatment of spontaneous IVH with hydrocephalus when ICH volume is low (

Background: There is no consensus in the literature on the effects of the development of hydrocephalus on survival and disability after intracerebral hemorrhage (ICH) and the benefits of external ventricular drainage (EVD). Some studies showed good outcomes whereas some showed poor outcomes after insertion of EVD in patients with spontaneous intraventricular hemorrhage with hydrocephalus. Objective: This study is planned to describe the role of external ventricular drainage in treating patients with spontaneous, either primary or secondary, intraventricular hemorrhage with hydrocephalus. Method: A hospital-based prospective interventional study was conducted in the Department of Neurosurgery of Dhaka Medical College Hospital, which is a tertiary level hospital, from April 2016 to September 2017. A total of 42 patients of spontaneous intraventricular hemorrhage, either primary or secondary, with hydrocephalus were selected for this study. Glasgow Coma Scale score for level of consciousness and Modified GRAEB score for severity of ventricular hemorrhage were recorded preoperatively. All the collected data were entered into IBM SPSS software, Version 22.0. Correlations were determined by linear regression analysis. Results: Among 42 patients, the age range was 26-75 years with a mean age of 65.2±10.87 years. Male were 26(61.9%) and females were 16(38.1%). The male-Female ratio was 1.625:1. A total of 9(21.42%) patients had a primary intraventricular hemorrhage and the rest of 33(78.58%) had an intraventricular hemorrhage. Preoperative GCS ranged from 4 to13 with a mean value of 7.14 ± SD 1.995. Modified GRA Escoresre was ranged from 5 to 19 with the mean 8.85± SD 0.7693. The difference in GCS at 24 hours was ranged from a minimum of 3 to a maximum of +10 with an increase of +1.67± SD 2.09. Collected CSF volumes at 24 hours were ranged from a minimum of 50 to a maximum of 480 ml with a mean of 338 of 0.33 ml ±SD 113.329. Total 5 patients died within 30 days. ...........

Introduction: An acute subdural hematoma (SDH) is one of the most lethal of all head injuries. A good number of patients are encountered in Dhaka medical college and hospital with acute subdural hematoma. There are many modalities for the treatment of acute subdural hematoma, such as decompressive craniectomy with multidural stabs, craniotomy with durotomy. This comparative study was carried -out in the Department of Neurosurgery, Dhaka Medical College and Hospital, Dhaka, during Jan 2016 – Dec 2017, to compare the effect of the decompressive craniectomy with multidural stabs and craniotomy with durotomy in respect to the post operative GCS and GOS. As well as to assess and compare the post operative complications. The type of the study is prospective randomized controlled clinical trial. Materials and Methods: For this purpose, a total of 56 patients of both sex and any age with acute subdural hematoma attended in the above hospital were included in this study. Among them 28 patients underwent decompressive craniectomy with multidural stabs and rest 28 underwent craniotomy with durotomy. Data were collected and analyzed by different variables like age, sex, GCS on admission, GCS on 7th POD, GOS at one month and some complication like operative recurrence, seizure and mortality. Patients or attendants who refuse interview, who managed conservatively and patient who didn’t give consent, patients having severe respiratory distress and or shock, who came after 24 hours of trauma and who had no history of trauma were excluded from the study. Results: The following observations and results were obtained in this study. Nearly two third (63.0%) patients of DC MDS group and 18 (64.3%) in CT DT group age belonged to 21 to 40 years. Most (85.7%) of the patients of DC MDS group and 22 (78.6%) in CT DT group were male. Almost a half (46.4%) patient of DC MDS group and 12 (42.8%) patients of CT DT group GCS on admission belonged to 4 to 8 scale. The differences between two groups were not significant (p>0.05). Nearly a half (46.4%) patient of DC MDS group and 6 (21.4%) patients of CT DT group GCS on 7th POD belonged to 9 to 12 scale. Mortality observed almost one third (32.1%) and 12 (42.9%) in patients of DC MDS group and CT DT group respectively. Regarding the GOS at one month follow up, it was observed 12 (42.9%) patients of DC MDS group and 2 (7.1%) patients of CT DT group had good recovery. About the relation between GCS (on admission) with GOS at one month, we saw that 10(37.7%) patient. GCS was ≥8 where GOS was 4+5 and compare to CT with DT group 9 (32.1%) patients. The difference was statistically significant (p

Background Traumatic brain injury (TBI) is one of the leading causes of mortality and morbidity. Economic impact is much worse in developing countries like Bangladesh, as victims are frequently male, productive, and breadwinners of the families. Objectives The objective of our study was to highlight the etiological pattern and distribution of varieties of head injuries in Bangladesh and give recommendations regarding how this problem can be solved or reduce to some extent at least. Methods From January 2017 to December 2019, a total of 14,552 patients presenting with head injury at emergency got admitted in Neurosurgery department of Dhaka Medical College and Hospital and were included in this study. Results The most common age group was 21 to 30 years (36%: 5,239) with a male-to-female ratio of 2.6:1. Injury was mostly caused by road traffic accident (RTA [58.3%: 8,484]), followed by fall (25%: 3,638) and history of assault (15.3%: 2,226). The common varieties of head injury were: acute extradural hematoma (AEDH [42.30%: 1,987]), skull fracture either linear or depressed (28.86%: 1,347), acute subdural hematoma (ASDH [12.30%: 574]), brain contusion (10.2%: 476), and others (6.04%: 282). Conclusion RTA is the commonest cause of TBI, and among them motor bike accident is the severe most form of TBI. AEDH is the commonest variety of head injuries. Proper steps taken by the Government, vehicle owners, and drivers, and proper referral system and prompt management in the hospital can reduce the mortality and morbidity from TBI in Bangladesh.

Introduction: Epidural hematoma (EDH) is characterized by the acute onset of traumatic haemorrhage into potential space between the dura mater and skull following head injury. About 85% of the epidural cases are caused by skull fracture with rupture of the middle meningeal artery or its branches and rest of 1the time ruptured venous sinuses, fractured diploic bone. The BTF recommends that all patients with an EDH volume of greater than 30 cc should undergo surgical evacuation regardless of Glasgow Coma Scale (GCS). Aim of the Study: To assess the surgical outcome of extradural hematoma patients by using Glasgow Outcome Scale (GOS) postoperatively. Material & Methods: This prospective study was conducted in the Department of Neurosurgery, Dhaka Medical College and Hospital (DMCH), during the period of January 2016 to December 2017. A total of 98 patients of both sex and any age with EDH were selected purposively. Statistical analyses were carried out by using the Statistical Package for Social Sciences version 22.0 for Windows (SPSS Inc., IBM and New York, USA). Prior to commencement of this study, the “Research Review Committee” & the “Ethical Committee” of DMCH, Dhaka, approved the research protocol. Results: In this study, 98 patients were included; they were divided into 6 groups. Age range was 04 - 55 years. It was observed that majority, 30 (30.60%) patients were from 21 - 30 years of age. The mean age was found 25.24 ± 12.2 years. Other age related distributions were shown in the table. Male patients were 78 (78.55%) and 22 (22.44%) patients were female. A male predominance was observed. Among admitting GCS 3-8, 56.25% patients had unfavorable outcome and 43.25% had favorable outcome. Admitting GCS 9-13, 2.5% patients had unfavorable outcome and 97.5% had favorable outcome. Admitting GCS 14-15, all patients (100.0%) had favorable outcome. Unfavorable outcome was observed in 9 (9.18%), 1 (1.00%) patients who belong 3-8, 9-13 GCS on admission. Mean GCS on admission was found 6.7 ± 2.44 score in unfavorable outcome group and 13.45 ± 2.30 score in favorable outcome group. Conclusion: This study revealed good surgical outcome in extradural hematoma patients. Preoperative GCS is an important predictor of outcome. Other preoperative neurological statuses like pupillary changes, neurological focal deficit, cranial nerve involvement, plantar reflexes and seizure also influence the surgical outcome.

Background: Severe traumatic brain injury can be a serious condition. Objective: The purpose of the present study was to see the decompressive craniectomy (DC) of severe traumatic brain injury. Methodology: This clinical trial was conducted in the Department of Neurosurgery at Dhaka Medical College Hospital, Dhaka, Bangladesh from January 2012 to December 2013 for a period of two (02) years. Patients with the age of 18 years and above, GCS of the patients 8 to 4, severe traumatic brain injury (TBI) with multiple hemorrhagic contusions and midline shift, on CT scan and severe TBI with gradual neurological deterioration were included for this study. Total 60 patients were included. Result: A total of 60 patients were included in this study. Almost two third 18 (60.0%) patients had favorable outcome (GOS 4 and 5) in group A and exactly two third 20(66.7%) patients had Unfavorable outcome (GOS 1,2 and 3) in group B (p

Spinal cystic Schwannomas are very rare tumors and have been reported in only a few case reports in literature. Our case, Mrs. Halima, a 48-year-old female was admitted in Neurosurgery department of Dhaka Medical College Hospital with the complaints of low back pain more at night occasionally radiating to right buttock and numbness and tingling of the right lower limb for 2 years. MRI of Lumbo-sacral spine revealed a large circumscribed and well delineated intradural extramedullary space occupying lesion of iso to hypointense appearance in T1WI with ring enhancement on administration of gadolinium. Per-operative observation and post-operative histopathological examination revealed schwannoma. Contrast enhanced MRI was very important for the diagnosis of this rare type of tumor and surgical planning. Surgical removal was complete and patient was recovered uneventfully. Bang. J Neurosurgery 2021; 10(2): 223-225

A subdural hematoma is a collection of blood below the inner layer of the dura but external to the bran and arachnoid membrane.Chronic subdural hematoma is commonly associated with cerebral atrophy, occur in the elderly after apparently insignificant head trauma. The incidence of Chronic subdural hematoma increases with age and after 70 years of age. Surgical evacuation of hematoma is indicated in patients who are clinically deteriorate or do not improve. Surgery can bring a rapid clinical improvement with a favorable outcome in over 80% of patient. Methods: This study was a prospective intervention study. Results: It was observed that 29 (96.6%) patients were alive in group A and 27 (90.0%) patients alive in group B in GOS scoring on the 7th POD. The alive patients were again divided into 4 sub groups, as shown in the table. Among total 60 patients, in Group A 1(3.4%) died and 3 (10.0%) died in Group B. After 3 months follow up, it was observed that 29 (96.6%) patients were alive in group A and 27 (90.0%) patients alive in group B. The alive patients were again divided into 4 sub groups, as shown in the table. Persistent vegetative and severe disability was not improved in Group B. Conclusion: In my study it was observed that the surgical outcome in single burr hole craniotomy is better than double burr hole craniotomy for treating of chronic subdural hematoma. Bang. J Neurosurgery 2020; 9(2): 99-104

Osteoma is a slow growing benign mesenchymalosteoblastic tumor formed by maturebone tissue. The most common site reported is the fronto-ethmoidal region andneighboring sinuses.Involvement of the temporal and occipital squama is extremelyrare. Like giant osteomas in other locations of the skull, they can reach large volumesbut are essentially benign and potentially curable by excision.The author present acase of giant osteoma in Temporo-Parieto-Occipital region in a teenage girl. Bang. J Neurosurgery 2020; 9(2): 173-177

Purpose: Traumatic spinal cord injury (SCI) is a severe neurological disease which causes sensory loss, motor paralysis and autonomic difficulties which is usually treated with physiotherapy. Complete spinal cord injury with ASIA Grade A patients remains untreated and neglected in our country since long back. Here we describe an effective strategy for the treatment of complete spinal cord injury by autologous bone marrow derived stem cell. Material and Method: The study was conducted in the Neurosurgery department, Dhaka Medical College Hospital, Dhaka, Bangladesh from January, 2016 to January 2019. Total 22 Patients with spinal cord injury (ASIA Grade-A) were included in this study. Total 60 ml of autologous bone marrow was aspirated and processed to prepare 6-7 ml of bone marrow aspirate concentrate (BMAC) which was transplanted at the site of cord injury. Bony alignment was done by decompression and stabilization. Post-surgical physiotherapy and regular follow up was given. Result: Surgical outcome was assessed by ASIA Grading. Among 22 patients, 10 patients (45.45%) improved by one grade, 7 patients (31.82%) improved by two grade, 2 patients (9.09%) improved by three grade, 3 patients (13.64%) did not show any improvement of any grade as because their follow-up period was less than 6 months. 19 patients (86.36%) noticed sensory, 16 patients (72.72%) noticed bladder improvement and 19 patients (86.36%) noticed bowel improvement to some extent. Conclusion: Stem cell therapy is safe and effective. Steady and focused progress in stem cell research will open the door for many disable patients in the country like Bangladesh. Bang. J Neurosurgery 2019; 9(1): 3-10

Introduction: Endovascular treatment offers different technique (Balloon assisted coiling / simple coiling, glue embolization) to treat Carotid Cavernous Fistula (CCF). This less invasive approach avoids morbidity and residual fistulas. The choice of treatment depends on the anatomy of the fistulas and cost effectiveness. Objective: To describe different endovascular treatment option of Carotid Cavernous fistulas (CCF), its short term outcome (clinical and angiographical) and to compare between trans-venous coiling and trans-arterial balloon assisted sinus coiling. Method: We have treated nine (9) cases of CCF during a period of three years. Out of them eight patients had direct CCF and one had indirect CCF. In two patients simple coiling done through trans-venous route and in another three patients through trans-arterial route. Balloon assisted coiling through trans-arterial route done in three patients. In two patients trans-arterial glue embolization was done. Results: Successful obliteration of fistula was achieved in all cases. Vision was improved in eight (8) patients. Postoperatively some proptosis remains in two patients. In one patient there was reappearance of proptosis two months after treatment, then balloon assisted coiling was done. One patient died from complication of glue (NBCA). Conclusion: Endovascular treatment is the mainstay of treatment in CCF. Trans-venous is the treatment of choice but recently balloon assisted sinus coiling through trans-arterial route is adopted. Bang. J Neurosurgery 2019; 8(2): 68-76

Meningiomas were named by Harvey Cushing in 1922 and described as common tumors that arise from arachnoid cap cells...

Background: Metabolic syndrome confers the risk of developing acute myocardial infarction which is the most common form of coronary heart disease and the single most important cause of premature death worldwide. The frequency and association of different components of metabolic syndrome on AMI are not well understood and has not been well evaluated.Objective: The aim of this study was to assess the components of the metabolic syndrome and its association with AMI patients. This study will help in awareness building in reducing AMI by early detection of components of metabolic syndrome.Patients and methods: This was a prospective observational study consisted of 325 AMI patients who were aged >20 years. Patients with first time AMI arriving in CCU of Rajshahi medical college during the period of 2012-2014, were included. Data were collected through interview, clinical examination, and laboratory tests within 24 hrs of AMI. Five components of metabolic syndrome were defined according to criteria set by modified NCEP ATP III (according to ethnic variation).Results: In AMI patients (n=325), no metabolic components were in 24 (7.4%) patients, one in 53 (16.3%), 2 components in 91(28.0%), 3 components were in 61(18.8%), 4 in 67(20.6%) and all 5 components were in 29 (8.9%) patients. In this study, there was no component in 7.4% of AMI patients, at least 1 component was 92.6%, at least 2 components were 76.3%, at least 3 components were 48.3%, at least 4 components were 29.5% and at least 5 components were 8.9%. The Metabolic syndrome was 48.3% (n=157). Among metabolic syndrome (≥3 components) in AMI (n=157, 48.3%) 4 components (20.6%) were more, next was 3 components (18.8%) and than 5 components (8.9%). Overall frequencies of components in acute myocardial infarction (n=325) were in order of abdominal obesity (54.8%) > high blood pressure (54.5%) > high FPG (54.2%) > Triglyceride (46.2%) and low HDL-C (46.2%) in acute myocardial infarction. Highest percentage was observed in abdominal obesity (54.8%) followed by high blood pressure (54.5%) and FPG (54.2%).TAJ 2016; 29(2): 6-10

Background: The impacts of socio-demographic characteristics on acute myocardial infarction (AMI) are not well understood and have not yet been studied much more in our country. Acute myocardial infarction is the most common form of coronary heart disease and the single most important cause of premature death worldwide.Objective: The aim of this study was to assess the impacts of the socio-demographic characteristics on AMI patients and to investigate the association between socioeconomic status and its various indicators and the risk of acute myocardial infarction (AMI). This study will help in awareness building in reducing AMI by early detection of socio-demographic variables.Patients and methods: This was a prospective observational study consisted of 325 persons of AMI patients who were aged >20 years. Patients with first time AMI arriving in Coronary Care Unit (CCU) of Rajshahi medical college during the period of 2012-2014, were included. Data were collected through interview.Results: Among the AMI patients, male were more sufferer than female (68.3% vs. 31.7%) and male and female ratio was 2.15:1.0. Highest percentage of education was up to primary level (53.85%). Most of studied subjects (92.0%) monthly income were ≤15000. More than half (59.38%) of the studied population were from rural area, mostly they were Muslim (94.46%) and smokers (50.15%). The mean±SD age of the acute Myocardial infarction patients was 53.75±11.64 years. Mean age of the female patients were a little bit higher than the male patients (female 54.28±11.78 vs. male 53.51±11.63). Highest percentage was in the age group 51-60 years (32%) followed by 41-50 (26.8%) and then age group >60 (23.7%). Among the male patients highest percentage was in the age group 51-60 years (31.1%) followed by 41-50 years (27%) and then age group >60 (24.3%). However, among the female patients, highest percentage were in the age group 51-60 years (34%) followed by 41-50 years (26.2%), and then age group >60 (22.3%). Acute Myocardial infarction patients was more in age group >40 years of age. Interestingly after 60 years of age occurrence of AMI was low in both sexes.Conclusion: Both sex and age influenced AMI. An association was also found among educational level, monthly income, residence area, religion, smoking habit and AMI.TAJ 2016; 29(1): 16-20

Non-alcoholic fatty liver disease (NAFLD) is an emerging chronic liver disease and may lead to liver cirrhosis and hepatocellular carcinoma. It is now the most common chronic liver disease in many developed as well as developing countries. This hospital based study was done to see the prevalence of non-alcoholic fatty liver disease (NAFLD) and metabolic syndrome among patients attending in a tertiary care center in Bangladesh. Here, 334 nonalcoholic subjects of both sex and age were included. Metabolic syndrome was assessed by modified ATP III criteria and fatty liver diagnosis was based on ultrasound findings. 27.2% had the metabolic syndrome and was more common in female. Prevalence of NAFLD was 44% and was more common in female. Metabolic syndrome was found in 61.5% with NAFLD.TAJ 2015; 28(2): 44-51

Background : Subarachnoid hemorrhage (SAH) is a catastrophic neurological event. Aside from its neurological morbidities, SAH is associated with significant medical complications. Cardiac manifestations are common and can impact morbidity and mortality in SAH patients. Myocardial enzyme release occur frequently after Subarachnoid hemorrhage that reflect adverse intracranial events .These changes often are unrecognized or misinterpreted, potentially placing patients at risk for inappropriate management.Objective : The aim of this study was to assess Troponin I changes after acute SAH and these changes were compared with neurological severity. The result of the study might be helpful for better understanding diagnostic and therapeutic implications of acute neurocardiogenic injury after SAH.Patients and methods : This cross sectional descriptive study was conducted over 30 patients with SAH in medicine, neuromedicine and intensive care unit of Rajshahi Medical College Hospital during the period of January 2015 to December 2016. Predictor variables reflecting demographic (age, sex, occupation), hemodynamic (pulse, systolic and diastolic blood pressure) and neurological (WFNS score) informations were recorded. We evaluated their cTnI level, which had been measured at admission. A cTnI level above 0.12 ng/ml was defined as an indicator of cardiac injury following SAH.Results : Out of 30 patients 26.7% were both in between 40-49 years and 60-69 years age group & 50% were male and 50% were female. Among the risk factors 60% of patient had history of hypertension, 40% smoking, 10% Diabetes mellitus and 3.3% alcohol abuse. On admission the mean GCS was 12.53±2.69,. The most frequently occurring WFNS grading were grade 1 and grade 4 (both were 43.3% of patients). Out of Thirty, 43.3% of patients demonstrated elevations of Troponin I. WFNS score ≥ 3 (92.3%, p =

Background: Acute myocardial infarction is the most common form of coronary heart disease and the single most important cause of premature death worldwide. A large proportion of patients with coronary disease have metabolic syndrome, although the frequency and association of its different components are not well understood. The risk of the metabolic syndrome on AMI has not been well evaluated.Objective: The aim of this study was to assess the prevalence of the metabolic syndrome and its association with AMI patients. This study will help in awareness building in reducing AMI by early detection of metabolic syndrome.Patients and methods: This was a prospective observational study consisted of 222 persons of male AMI patients who were aged >20 years. Patients with first time AMI arriving in CCU of Rajshahi medical college during the period of 2012-2014, were included. Data were collected through interview, clinical examination, and laboratory tests. Five components of metabolic syndrome were defined according to criteria set by modified NCEP ATP III (according to ethnic variation) which had abdominal obesity (waist circumference), FBS, HDL-C, Triglyceride, and hypertension were measured within 24 hrs of AMI.Results: A total of 222 patients diagnosed with AMI were inducted in the study. The mean±SD age of the male was 53.51±11.63 years. Among the male patients highest percentage was in the age group 51-60 years (31.1%) followed by 41-50 years (27%) and then age group >60 (24.3%). Study showed that acute Myocardial infarction patients was more in age group >40 years of age. Highest percentage was observed in abdominal obesity (52.3%) followed by high blood pressure (50.0%) and FPG (46.4%). The Metabolic syndrome was 37.4 % (n=83).Conclusion: The metabolic syndrome was associated with an increased risk of AMI. The metabolic syndrome had a high prevalence in patients with AMI.TAJ 2014; 27(1): 57-61

Background: Serum-Ascitic Albumin Gradient (SAAG) can identify ascites related to portal hypertension. Esophageal varix (EV) is another feature of portal hypertension in cirrhosis. This study was done to find out the relation between SAAG and esophageal varices.Materials and methods: It was a cross- sectional descriptive study of 50 cases of cirrhotic ascites. SAAG was measured and upper gastrointestinal endoscopy was done for esophageal varices.Results: Among 50 cases, mean SAAG value 1.77 (±0.45 SD). Esophageal varices were found in 43(86%) cases. All cases with SAAG value >2.0gm/dl had EV. A significant statistical association was found between level of SAAG and the presence of esophageal varices (p=0.01).Conclusion: In patients of cirrhosis, the level of SAAG has positive association with the esophageal varices. This finding may permit us to use SAAG as a preliminary parameter of esophageal varices (EV) especially where endoscopy facilities are not available.TAJ 2014; 27(2): 36-38

Intracranial arterial dissection or dissecting aneurysm is relatively uncommon and usually involve the vertebrobasilar system. Here we report a pediatric case of middle cerebral artery dissection/dissecting aneurysm with sub arachnoid hemorrhage and Sylvian fissure hematoma on dominant side. After initial evacuation of hematoma, we went for trapping and excision of dissection/dissecting aneurysm followed by STA-MCA bypass. Patient recovered fully from her neurological deficit. Probably this is the first reported case of STA-MCA bypass in Bangladesh.J Bangladesh Coll Phys Surg 2014; 32: 94-98

Tuberculoma involving the cerebellopontine angle is very rare. Preoperative neuroradiological features of such lesions may mimic neoplastic lesions and postoperative histopathological study brings the ultimate diagnosis. Here we present a patient with a large tuberculoma at the cerebellopontine angle who had another small lesion at the right fronto-basal region and was managed by surgical excision of the cerebellopontine angle lesion along with post-surgical antitubercular therapy for 18 months. On the 14th postoperative day, the patient developed status epilepticus, left hemiplegia and left-sided complete hearing loss. Computed tomography showed right frontal oedema. Then he recovered his motor function slowly and incompletely but left-sided hearing loss remained unchanged. Magnetic resonance imaging of the brain at 18 months after surgery showed no residual lesion with right frontal cortical atrophy.

Intractable Temporal Lobe Epilepsy may be due to Mesial Temporal Sclerosis (MTS), tumors [i.e. low grade glioma, Arterio-venous Malformation (AVM) etc], trauma, infection (Tuberculosis) etc. Intractable Temporal Lobe Epilepsy (TLE) from Mesial Temporal Sclerosis (MTS) is usually resistant to antiepileptic drugs and surgery is the treatment of choice like other form of TLE . MTS is the most common cause of intractable epilepsy in adult. Here we report three cases of surgically treated TLE that were due to MTS in the department of neurosurgery, Dhaka Medical College Hospital and a private Hospital, Dhaka, Bangladesh from August 2009 to February 2010. In all cases the only presenting symptoms was complex partial seizure (Psychomotor epilepsy) for which all underwent scalp EEG (Electro Encephalogram) and MRI (Magnetic Resonance Imaging) of Brain. All patients were managed by amygdalohippocampectomy plus standard anterior lobectomy. All patients are seizure and disease free till last follow up. Keyword: Intractable temporal lobe epilepsy; Mesial temporal sclerosis; Microneurosurgical management; Amygdalohippocampectomy. DOI: 10.3329/jom.v12i1.6934J Medicine 2011; 12 : 61-65