Clinical profile and short-term course of post-traumatic headache in children with mild traumatic brain injury: a prospective cohort study.

OBJECTIVE: To study the clinical profile and factors associated with post-traumatic headache (PTH) in children with mild traumatic brain injury (mTBI) attending an urban public hospital. METHODS: We enrolled 130 consecutive children aged 6-12 years with mTBI (as per the International Classification of Headache Disorders-III criteria), and followed them up for 7 days. Those who developed PTH were further followed up monthly for 3 months. RESULTS: Thirty (23.1%) children developed PTH; 25 (19.2%) children had acute PTH (duration 7 days to 3 months) and the remaining 5 (3.8%) developed persistent PTH (> 3 months). Majority (50%) had bilateral headache and squeezing quality (50%). Forty percent of those with PTH met the criteria for migraine. Obesity (P = 0.84), female gender (P = 0.26), family history of headache (P = 0.93), and prior history of concussion (P = 0.70) were not associated with risk of PTH. Children who developed PTH had higher rate of nausea (RR (95% CI) = 2.42 (1.06, 5.5); P = 0.03) and vomiting (RR (95% CI) = 3.76 (1.64, 8.5); P = 0.001) after mTBI. Headache resolved within 1 month in 63.3% of children. CONCLUSION: PTH was found to be common after mTBI in children. Protocolized follow-up and directed history taking for PTH in all children with mTBI, who are frequently discharge from the emergency department after first aid, will lead to appropriate diagnosis and management of this problem.

Aspergillus fumigatus cerebral abscess following hemodialysis: A case report.

Background and Purpose: Cerebral aspergillosis is a notorious disease that causes rapid clinical deterioration and carries a poor prognosis. Therefore, it requires timely diagnosis and prompt management. Case Report: This study reports a case of fungal cerebral abscess in a 26years old man following hemodialysis,2 months afterdengue-induced acute kidney disease. Aspergillus fumigatus was recovered from a brain abscess specimen that was subjected to a parietal craniotomy. The patient was successfully treated with oral Voriconazole 400mg BD for 2 days, followed by 200 mg BD for 3months. Conclusion: Hemodialysis patients are at high risk offungal infections due to the frequent use of catheters or the insertion of needles to access the bloodstream. Therefore, a high index of suspicion of fungal infection is required in patients with hemodialysis by the clinician for early diagnosis and treatment.

Rare case of meningitis due to an emerging pathogen Chryseobacterium indologenes.

Chryseobacterium indologenes is a non-glucose fermenting Gram-negative bacteria widely distributed in nature. It has been found to cause a variety of infections like nosocomial pneumonia, bacteremia and wound infections usually in immunosuppressed patients and those with indwelling devices. The organism is resistant to a significant number of the commonly prescribed broad spectrum antibiotics. We report a rare case of meningitis due to C. indologenes in a patient diagnosed with medulloblastoma and hydrocephalus with an external ventricular drain in situ. The patient was successfully treated with trimethoprim/sulfamethoxazole combination and external ventricular drain replacement as shown by subsequent sterile cultures.

Synchronous Occurrence of Colloid Cyst With Intracranial Ossifying Fibromyxoid Tumor Masquerading as Meningioma.

Ossifying fibromyxoid tumor (OFMT) is a rare fibro-osseous neoplasm. We present a case highlighting the occurrence of an intracranial OFMT masquerading as meningioma on imaging in a 46-year-old gentleman. Brain imaging revealed an extra-axial calcified lesion along the left cerebellar convexity appearing hypointense on T1- and T2-weighted MRI sequences with no post-contrast enhancement, suggestive of a meningioma. An intraventricular colloid cyst was also noted. The lesion, which was presumed to be meningioma, and the colloid cyst were resected in two subsequent operative settings. Histopathological examination of the calcified lesion confirmed the findings of an OFMT. This report aims to inform the physician about intracranial OFMT mimicking meningioma on imaging. In addition, since multiple brain tumors are not very common, the surgeon should always have a suspicion should there be any heterogeneous and peculiar radiological and histopathological characteristics.

Primary intraosseous atypical inflammatory meningioma presenting as a lytic skull lesion: Case report with review of literature.

Primary extradural meningiomas of the skull comprise 1% of all meningiomas, and lytic skull meningiomas are still rarer and are said to be more aggressive. We present a case of 38-year-old male with an extradural tumor which on histopathological examination showed features of inflammatory atypical meningioma (WHO Grade II). The intense inflammatory nature of osteolytic primary intraosseous meningioma has not been reported before. This entity deserves special mention because of the need for adjuvant therapy and proper follow-up.

Lipomatous ependymoma: report of a rare differentiation pattern with a comprehensive review of literature.

We report the case of a 13-year-old girl presenting with left-sided hemiparesis, altered sensorium and episodic headache with bouts of projectile vomiting. Imaging revealed a large heterodense intraventricular mass lesion displaying focal calcification and hyperintensity on T1- and T2- weighted fluid attenuated inversion recovery (FLAIR) magnetic resonance images suggesting the presence of intratumoral fat. Histologically, the tumour showed sheets of glial cells, focal perithelial rosettes and individual cells showing fat vacuoles. The morphological impression was of an ependymoma with lipomatous differentiation. Glial fibrillary acid protein (GFAP) immunohistochemistry revealed positivity in the cytoplasmic processes of the tumour cells as well as in the cytoplasmic rim of the cells having an adipocytic appearance. S100 and vimentin were also immunoreactive. Ultrastructural studies confirmed the ependymal differentiation of the tumour and the presence of an osmiophilic fat component confirming the diagnosis. After 1 year of follow-up, the patient presented with similar complaints and MRI evidence of recurrence of the tumour. A comprehensive literature review revealed that half of the reported cases of this pattern recurred suggesting a possibly tenacious clinical course.

Intracranial Fungal Granulomas Mimicking High Grade Gliomas. A Decisive Role of Squash Cytology (SC): A Report of Two Cases.

Intracranial fungal granulomas can be misdiagnosed clinically and radiologically as neoplastic lesions. They also rarely occur without any history of immunodeficiency or diabetes. We report two such cases of fungal granulomas that were unsuspected clinically and radiologically but were detected on intraoperative squash cytology (SC) and later confirmed on histopathology. Timely intervention was hence possible and patient was saved from the hazards of unnecessary removal of eloquent areas of brain and was shifted on proper medical management. SC remains an indispensible tool for the neurosurgeon to get a provisional intraoperative diagnosis and in such surprising scenarios, change the surgical management of the patient, save the resection of eloquent brain areas and begin immediate postoperative medical management. These cases are being presented for their rarity and for highlighting the importance of SC as a regular tool for intraoperative neurosurgical consultation of intracranial mass lesions.

Penetrating spinal injuries and their management.

Penetrating spinal trauma due to missile/gunshot injuries has been well reported in the literature and has remained the domain of military warfare more often. Civic society's recent upsurge in gunshot injuries has created a dilemma for the treating neurosurgeon in many ways as their management has always involved certain debatable and controversial issues. Both conservative and surgical management of penetrating spinal injuries (PSI) have been practiced widely. The chief neurosurgical concern in these types of firearm injuries is the degree of damage sustained during the bullet traversing through the neural tissue and the after-effects of the same in long term. We had an interesting case of a penetrating bullet injury to cervical spine at C2 vertebral level. He was operated and the bullets were removed from posterior midline approach. Usually, the management of such cases differs from region to region depending on the preference of the surgeon but still certain common principles are followed world over. Thus, we realized the need to review the literature regarding spinal injuries with special emphasis on PSI and to study the recent guidelines for their treatment in light of our case.