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Background: Acute Computerized Tomography (CT) characteristics are used widely and most accepted for prediction of outcome among Traumatic Brain Injury (TBI). The commonly available and simple combinations of existing and unexplored CT parameters may be more useful in prediction of outcome. The present study explores commonly available CT characteristics by possible combinations based on anatomical basics. Methods: Abnormal CT sign was considered with any cranial lesion. Based on anatomical locations of cortical lobes, nine possibilities were made that include individual and combinations of mentioned lobes. The laterality was either right or left or bilateral. The outcome was favourable or unfavourable based on discharge Glasgow Outcome Scale (GOS). Binary logistic regression was used to predict outcome. Results: 452 patients were recruited in the present study. There was significant risk of unfavourable outcome among patients with location of Sub Dural Haemorrhage (SDH) in Parietal + Temporal region (OR=10,p

Terminal myelocystocele (TMC) results from failure of embryonic CSF to drain outside the neural tube creating CSF reservoir within a dorsal meningocele. Association of Chiari II malformation with diastematomyelia and myelocystocele is extremely rare. Myelocystoceles do not have neural tissue so they have good prognosis after treatment, however when associated with hydromelia and Chiari malformation they present with neurological deficits. We present details of a 2 year old female who presented to us with this rare anomaly.

Varicella zoster is one of the common infective etiological factors known to produce arteriopathy of cerebral vasculature. Varicella zoster infection spreads transaxonally first to the adventitia and later transmurally to intima. Primary infection or reactivation of varicella zoster, both are associated with involvement of cerebral vessels of large as well as of small calibre varicella zoster associated arteriopathy was reported up to 12 months after the infection. Recurrence of strokes are seen post varicella infection. Hence the identifi cation of varicella zoster as an etiological agent of ischemic stroke in neonatal age group patients is necessary and requires follow-up. Other neurologic sequelae following varicella infection are aneurysm formation leading to subarachnoid and cerebral haemorrhage, carotid dissection and rarely peripheral arterial disease. Due to lack of adequate epidemiological, neuroimaging and laboratory data, guidelines for treatment of varicella ateriopathy are not clear.

Cerebellar infarction is a challenge for the neurosurgeon. The rapid recognition will crucial to avoid devastating consequences. The massive cerebellar infarction has pseudotumoral behavior, should affect at least one third of the volume of the cerebellum. The irrigation of the cerebellum presents anatomical diversity, favoring the appearance of atypical infarcts. The neurosurgical management is critical for massive cerebellar infarction. We present a review of the literature.

Intraventricular septations can lead to compartmentalization of the ventricles that can result in “complex or loculated hydrocephalus”. We report a case of 7 year old female child who underwent multiple shunt revisions where there was intraventricular entrapment of shunt catheter leading to obstruction of the shunt and malfunction. In present case we placed the ventricular catheter in contra-lateral ventricle with good clinical outcome. With the recent advancements endoscopic guided removal of the old malfunctioning ventricular catheters is considered the safest option.

Spinal hydatid disease is a rare form of hydatid disease caused by the larval form of Echinococcus granulosus (E. granulosus). Dogs are primarily the definitive hosts of E. granulosus with man and sheep serving as intermediate hosts. Spinal HD contributes to approximately 45 % of all skeletal hydatid disease cases. Spinal HD is perhaps the worst form of parasitic infestations associated with morbidity requiring surgical correction. Braithwaite and Lees have classified spinal hydatids into five types (1) intramedullary (2) intradural extramedullary (3) extradural intraspinal disease (4) vertebral hydatid (5) paravertebral hydatid. When hydatid disease from spinal canal extends into retroperitoneal space through the neural foramen, it gives dumbell formation (similar to nerve sheath tumors). Symptoms of hydatid are mainly due to compressive effects of the cyst, low back pain accompanying motor weakness, sensory disturbances, bowel and bladder disturbances and cauda equina syndrome. Extensive vertebral hydatidosis can cause fractures of vertebrae. Serology tests are used in diagnosing suspected cases of hydatid disease. MRI with soft tissue detail is more preferable than other modalities in diagnosing spinal hydatid. Successful treatment of spinal hydatid disease necessitates adequate neuroimaging evaluation, careful surgical removal without spillage of cystic components and adding adjuvant chemotherapy in few cases is the mainstay of treatment. Sometimes when it is difficult to retrieve all the cysts in toto, debulking is advised.

Pneumocephalus can develop immediately following head trauma or clinical presentation may be delayed for days. We report a case of 35 year male whose initial CT scan brain plain small specks of pneumocephalus in left para-sellar region. However the next day he was complaining of severe headache and had multiple episodes of vomiting. Repeat CT scan showed increase in the size of pneumocephalus including appearance of intraventricular air with mild cerebral edema. The patient recovered well with conservative management. The present case is a gentle reminder that in a subgroup of head injury patients, intracranial air can produce significant mass effect leading to tension pneumocephalus which can can behave like other intracranial mass lesions and causes worsening of the neurological status of these patients.

A missed or delayed detection of intracranial injuries can lead to progressive neuronal damage and secondary brain damage. We present a case of 45 year female presented 8 after the road traffic accident and had a large posterior extradural hematoma on left side with mass effect. In addition there was a small speck of right frontal contusion with localized cerebral edema. The patient initially improved after evacuation of the hematoma. However on 3rd post-operative day she was complaining of headache and became progressively drowsy. A follow up CT scan showed increase in peri-lesional edema around the right frontal contusion with squashing of the lateral ventricles suggestive of diffuse cerebral edema. The patient was shifted back to intensive care unit and responded well to further conservative management. In our patient the events could be collaborated well with existing evidence (presence of contrecoup contusion and on clinical deterioration at day 3).

Cavernous sinus thrombosis (CAST) is a rare and potentially fatal complication following tooth extraction. In present case of a 55 year old male known case of diabetes mellitus underwent tooth extraction. After 5 days, he noticed swelling around the cheek, high grade fever, and frontal headaches. Diagnosis of alveolar abscess after inspection was made, for which incision and drainage was done. Next morning, he noticed that the cheek swelling progressed to left eye and there was CT brain was performed which showed hyperdense areas in cavernous sinus on left side and left sylvian fissure with hemorrhagic venous infarct in left temporal and frontal lobes. More caudal sections revealed mucosal thickness in left maxillary and ethmoidal sinuses, edema over cheek, preseptal orbital swelling, retro-orbital fat stranding and axial proptosis. A diagnosis of rhino-orbital infection from dental source with cavernous sinus extension causing left temporo-frontal hemorrhagic venous infarction was made Emergency surgery for decompression was performed but the patient did not responded to the treatment and succumbed to the infection. This case is a reminder that in patients with uncontrolled diabetes, undergoing dental procedures should be carefully dealt with appropriate antibiotic cover. Early signs like unilateral facial edema, orbital chemosis, edema, and proptosis should raise high index suspicion of cavernous sinus thrombosis.

Extraneural metastasis from anaplastic ependymoma is uncommon. In a study from Memorial Sloan Kettering Cancer Center where the authors reviewed 81 ependymomas cases (between 1956 and 1989) there were only five (6.2%) cases had extraneural metastases. We present a case of anaplastic ependymoma with scalp metastasis and discuss the possible mechanism of spread. In majority most of the cases of metastatic extracranial ependymoma patients have underlying progressive intracranial disease. Although these patients receive standard treatment for the primary tumor (Gross total resection and radiotherapy) and the management options for recurrences includes re-excision, focal re-irradiation, stereotactic radiosurgery, or craniospinal radiotherapy for metastatic disease the long term outcome is not favorable.

Diffuse and reactive pituitary gland enlargement secondary to primary hypothyroidism is an uncommon occurrence and that can masquerade many pituitary disorders. In present article, we report a case of 19 year female severe hypothyroidism presenting with diffuse enlargement of pituitary gland and hyperprolactinemia and review the clinical importance of this entity. Knowledge of this entity is very important to avoid unnecessary surgery and irreversible complications in this sub-group of patients.

Cortical venous thrombosis is one of the less common types of stroke. Diagnosis is usually delayed due to a wide spectrum of clinical manifestations. Subdural hemorrhage with subarachnoid hemorrhage secondary to cerebral venous sinus thrombosis is very rare. We report a case of 65 year-old male with cerebral venous sinus thrombosis who presented to us with an acute subdural hematoma and subarachnoid hemorrhage associated with venous infarct. Management of such patients is complicated due to contraindication for the use of anticoagulation. [ABSTRACT FROM AUTHOR]

Occult spinal dysraphism with spinal lipoma, is a rare congenital spinal dysraphic anomaly which usually involves lumbosacral region and manifests in childhood. In the present article, we discuss a case of a 26-year-old man who developed sudden low back pain following intercourse. Magnetic resonance imaging of the lumbosacral spine was suggestive of spina bifida occulta with hemorrhage. The patient underwent a L4–5 laminectomy in the emergency. There was the presence of altered blood in the vicinity of the lesion suggestive of recent hemorrhage. Histopathological examination of the lesion was suggestive of the lipoma. In the present case, the patient had occult spina bifida due to lumbosacral lipoma leading to the tethering of the dura. Strenuous activity resulted in overstretching of the tethered structures and subsequent hemorrhage and intense low back pain which responded well to the surgical treatment.