JOURNAL OF GLOBAL NEUROSURGERY

Complete brachial plexus paralysis, a rare complication of clavicular fractures: a case report

2024-06-26T23:15:39+00:00

Purpose: Collar bone fractures complicated by complete brachial plexus palsy are rare.

Case Report: We report the observation of a young man aged 30, who presented following a road accident with a left midclavicular fracture with shifted fragments and a small ipsilateral acromioclavicular diastasis.

Conclusion: The course was marked by recovery in the first months with sequelae mono paresis.

Models to predict expansive intracranial hematomas occurrence for adult traumatic brain injury patients presenting at Accident and Emergency Department at Mulago National referral Hospital in Uganda

2024-06-26T23:12:03+00:00

Intracranial hemorrhage (EIH) in traumatic brain injury (TBI) patients is a critical issue in clinical practice, particularly in resource-limited settings. This study aimed to identify predictive models for EIH occurrence among TBI patients in Uganda. A cross-sectional study included adult TBI patients with intracranial hematomas undergoing surgical evacuation from June 16, 2021, to December 17, 2022. Patients were categorized by EIH presence, determined by changes in hematoma volume. Logistic regression analyzed factors influencing EIH, including demographics, neurological assessment, hematological parameters, and neuroimaging.

Out of 324 patients, 59.3% (n=192) developed EIH. The final model included age, systolic and diastolic blood pressure, subdural hematoma (SDH), diffuse axonal injury (DAI), skull fracture, and an interaction between skull fracture and SDH. Each unit increase in systolic blood pressure raised EIH odds by 1.045, while each unit increase in diastolic blood pressure lowered odds to 0.942. SDH increased odds by 6.286, and DAI by 4.024. In cases of skull fracture, SDH reduced odds to 0.0676. The model’s five-fold cross-validated average area under the receiver operating curve (AUC) was 0.722, with 64.5% accuracy.

EIH is prevalent among TBI patients in Uganda, with a rate of 59.3%. The identified predictive factors can inform policy and interventions to anticipate and manage EIH, enhancing patient outcomes.

A Proposed Neurological Acute Subdural Hematoma Score

2024-07-01T15:50:39+00:00

Introduction

The prognosis of acute subdural hematoma (aSDH) remains poor. After identifying neurological factors associated with a poor prognosis for this condition in our series, we propose a predictive score for poor prognosis: " The Yaounde Neurological Acute Subdural Hematoma Score" (YN-aSDH Score).

Methodology

This was a cross-sectional study carried out in the neurosurgery departments of Yaounde Central Hospital, the Yaounde Military Hospital, and the Yaounde General Hospital during the period from January 01, 2008, to December 31, 2018. The prognosis was considered poor for patients who died or were in a permanent vegetative state at discharge from the hospital. Four neurological factors of poor prognosis were retained. Based on their association with a poor prognosis, we proposed a predictive score (YN-aSDH Score).

Result

The YN-aSDH score was scored as follows: GCS 3-8 = 3, GCS 9-12 = 2, GCS 13-15 = 1; Preoperative hemiplegia: present = 2, absent = 0, Postoperative convulsions: present = 1, absent = 0, Recurrence of aSDH: present = 1, absent = 0. The maximum possible score = 7 while the minimum score = 1.

Interpretation: All patients who died or were in a vegetative state had a score greater than or equal to 3.

Conclusion: A YN-aSDH between 3 and 7 predicts a poor prognosis. Its reliability and validity should be confirmed in larger prospective studies.

Intraoperative Findings During Neuro-Endoscopy for Hydrocephalus in Tanzania

2024-07-09T13:34:18+00:00

Background: Endoscopic third ventriculostomy (ETV) can be performed to treat infantile hydrocephalus with variable success.

Methods: We included patients undergoing ETV+/-Choroid plexus cauterization (CPC) in Dar Es Salaam, Tanzania from November 2011-February 2019. Prospective data collection was carried out by the chief surgeon with a total sample size of 497. A separate database from the hydrocephalus nurse provided one-year mortality outcomes from January 2017-December 2018 in 261 patients.

Results: The median age was 138 days; 6%<1 month, 57% were 1-6 months and 20% were 6-12 months old. The median occipitofrontal circumferences were: 50cm (age<1 month old); 49cm (1-6 months old); 55cm (6-12 months old). Cortical mantle was thin in 73% and normal in 27%. The aqueduct of sylvius was visualised and closed in 61% and open in 33%. Yellow deposits were seen in 40% and pus in 3%. The CSF was turbid, bloodstained, yellow and clear in 16%, 1%, 3% and 80% respectively. The prepontine cistern was clear in 73%, scarred in 12%, effaced in 11% and not seen in 4%. The tuber cinereum was thin in 85%, thick in 11% and not fenestrated 4%. The choroid plexus was normal in 65% and scarred in 35%. Clinical follow up at 1-month post op was available in 123 (<25%) patients. At 1-month postop the mortality, re-do ETV and VP shunt insertion rates were 8%, 6% and 8% respectively. From the nurse led database, the one-year overall survival was 87%.

Conclusion: ETV+/-CPC is an established treatment option for infantile hydrocephalus in Tanzania.