Retained lumbar intradural bullet fragment with neurological recovery after delayed removal of bullet: Case report and literature review.

Civilian gunshot wound (GSW) to the spine is expected to increase in our environment due to the recent surge in violence and firearm attacks in the society either by herdsmen, bandits, unknown gunmen, or from exchange of gun fire with security personnel in response to insecurity issues. The management of GSW in the spine remains controversial, with no clear recommendations for surgical intervention by spine surgeons. In light of this, we report a case of civilian GSW to the lumbar spine in a 47-year-old female with resultant immediate paraplegia. Neuroradiological studies revealed a large bullet lodged in the left L2/3 spinal canal. There was a 4-week wait for consent for surgery to be obtained, with no improvement in motor function during the period. She underwent laminectomy and duratomy with removal of the bullet. Motor function returned 3 weeks after the surgery, and she was discharged home 8 weeks after the surgery, actively mobilizing on a Zimmer frame. The case report demonstrates the beneficial role of surgical intervention in properly selected patients, with resultant satisfactory functional neurological recovery.

Extrusion of ventriculoperitoneal shunt cathether through a herniotomy wound in an infant: Case report and review of literature.

Cerebrospinal fluid (CSF) diversion through the insertion of ventriculoperitoneal shunt (VPS) is the standard treatment for hydrocephalus. Many complications have been reported following VPS insertion. A case of extrusion of a VPS through a herniotomy wound is reported in a 4-month old male infant, who had a herniotomy performed on him by a General Practitioner (GP) for scrotal swelling. The extruded VPS was first externalized to the chest to aid healing of the groin wound and maintain CSF diversion. Later the VPS was removed to aid sepsis control. Although the parents did not comply with follow up instructions following their request for discharge, the patient remained well during telephonic communication 7 weeks after discharge. The case demonstrated higher risk for abdominal complications in the setting of background spina bifida and presence of intraperitoneal catheter. The need for optimal management of such complications by appropriate specialists cannot be over emphasised.

Epstein-Barr virus-associated smooth muscle tumour presenting as a parasagittal brain tumour.

Dural-based brain tumours, apart from meningiomas, are rare. Epstein-Barr virus (EBV)-associated smooth muscle tumor (SMT) is a documented but rare disease that occurs in immunocompromized patients. These tumours may be located at unusual sites including the brain. We present a 37-year-old patient, positive for the human immunodeficiency virus (HIV), who was admitted after generalized tonic-clonic seizures. MRI and CT scan revealed a dural-based brain tumour, intraoperatively thought to be a meningioma, but with an eventual histological diagnosis of EBV-SMT. Clinically the patient was well postoperatively with a Glasgow coma scale score of 15/15 and no focal neurologic deficit. This case confirms the association between EBV and SMT in patients with HIV/acquired immunodeficiency syndrome (AIDS). It also highlights the need to include EBV-SMT in the differential diagnosis of intracranial mass lesions in patients with HIV/AIDS.