Neurogenic pulmonary edema following Endoscopic third Ventriculostomy in patient with Hydrocephalous; case report.

INTRODUCTION AND IMPORTANCE: Neurogenic pulmonary edema (NPE) post endoscopic third ventriculostomy (ETV) is rare but fatal. Acute central brain injury complications are the most frequent cause.in this case uncommonly occur post ETV procedure. Prevalence of NPE varies 2-49 %. CASE PRESENTATION: A teen with hydrocephalus visited Operation Theater for ETV. An airway of Mallapathy ΙΙ & short neck. General anesthesia (GA) Induced & tracheal intubation succeeded on the second try. Until the surgery was over, the vital signs were normal. Patient recovered while suctioning oropharengial, pink frozen sputum observed through endotracheal tube (ETT). In the meantime, the O2 saturation ↓from 99 to 63 %, the heart rate (HR) ↓ but BP↑. Chest auscultation revel crackle. Spot diagnoses of NPE were treated with 100%O2, 20 mg of furosemide intravenously, mild hyperventilation after a hr. O2 saturation ↑ to 89 %. Patient moved to ICU with 100 % O2 by mask 2 h later. X-ray confirms the diagnosis. Furosemide, head up & 100 % O2 are still being used during treatment. 24 h later O2 saturation maintained to 92 to 94 %. After 48 h patient transferred to regular ward with stable condition. CLINICAL DISCUSSION: Rare yet lethal NPE is typically brought on by serious Brain injury. It happened here after the ETV surgery. We think that irrigation fluid and endoscopic stimulation may be the triggers. Hence there may be question with irrigation fluid and endoscopic stimulation. CONCLUSION: Early detection and therapy of NPE following an ETV procedure helps to prevent serious complications. Considering the volume of endoscopic irrigation and optimize endoscopic stimulation.

Preliminary Review of Spine Tumor Radiologic, Intra-Operative and Histopathology Findings, Addis Ababa, Ethiopia.

Background: Spinal tumors constitute 10-32% of all primary central nervous system tumors. Accurate radiologic and histopathology diagnosis is crucial in the management and prognosis. The aim of the study was to describe the imaging patterns and to determine the agreement of imaging pattern of spinal tumors with intra-operative and histopathology findings. Methods: A retrospective cross-sectional study of 47 patients with spinal tumor done from May 2018 to October 2020. Medical records were reviewed for clinical data, history, physical examination, magnetic resonance imaging (MRI), intraoperative findings and histopathology reports. The agreement between imaging, intraoperative finding and histopathology diagnosis was analyzed. Results: Intradural extramedullary tumors constituted 37 (78%) cases followed by six (12.8 %) extradural tumors and four (9.2%) intramedullary tumors. Schwannoma accounted for 13 (27.7%) cases followed by meningioma, 12 (25.5%) cases. Twenty-seven (57.4%) cases were thoracic level and cervical level were nine (19.1%) cases. Twelve (25.5%) cases did not have a definite intraoperative diagnosis. Imaging and intraoperative diagnosis was in agreement in 21 (44.6 %) cases and disagreed in 14 (29.7%) cases. For the imaging diagnosis and histopathology, 29 (61.7%) were in agreement and 18 (38.3 %) were in disagreement. Conclusion: In conclusion, the commonest site to be involved was the thoracic spine and schwannoma was the commonest tumor. The low agreement between imaging and histopathology could have been improved by optimizing the imaging reports and techniques.

Preventing birth defects, saving lives, and promoting health equity: an urgent call to action for universal mandatory food fortification with folic acid.

July 20, 2021 marked the 30th anniversary of the publication of the landmark trial by the British Medical Research Council showing unequivocally that maternal intake of folic acid (vitamin B9) starting before pregnancy prevents most cases of infant spina bifida and anencephaly-two major neural tube defects that are severe, disabling, and often fatal. Mandatory food fortification with folic acid is a safe, cost-effective, and sustainable intervention to prevent spina bifida and anencephaly. Yet few countries implement fortification with folic acid; only a quarter of all preventable spina bifida and anencephaly cases worldwide are currently avoided by food fortification. We summarise scientific evidence supporting immediate, mandatory fortification with folic acid to prevent the development of spina bifida and anencephaly. We make an urgent call to action for the World Health Assembly to pass a resolution for universal mandatory folic acid fortification. Such a resolution could accelerate the slow pace of spina bifida and anencephaly prevention globally, and will assist countries to reach their 2030 Sustainable Development Goals on child mortality and health equity. The cost of inaction is profound, and disproportionately impacts susceptible populations in low-income and middle-income countries.

Projected impact of mandatory food fortification with folic acid on neurosurgical capacity needed for treating spina bifida in Ethiopia.

Spina bifida, also known as meningomyelocele, is a major birth defect mostly associated with folate deficiency in the mother early in pregnancy. The prevalence of spina bifida is disproportionately high in Ethiopia compared to the global average; about 10,500 liveborn are affected annually. Many affected infants do not receive timely repair surgery. There are a high number of stillbirths, and neonatal, infant, and under-five deaths. Mandatory fortification of staple foods such as wheat and maize flour with folic acid, a B vitamin, is an effective primary prevention strategy for spina bifida. Survival in those with spina bifida increases if neurosurgical intervention is available soon after birth, along with continuous surgical and clinical aftercare throughout the lifespan. Currently, Ethiopia does not have mandatory food fortification for primary prevention or adequate neurosurgical capacity to meet the need to prevent adverse outcomes associated with spina bifida. We present in this paper two concurrent and complementary policy and practice solutions occurring in Ethiopia through global partnerships: (1) capacity-building of neurosurgery care through training programs; and (2) promoting national mandatory folic acid fortification of staples for primary prevention of spina bifida. These two policy and practice interventions ensure all affected infants can receive timely pediatric neurosurgery and sustained surgical aftercare through required neurosurgeon availability, and ensure primary prevention of spina bifida. Primary prevention of spina bifida frees up significant neurosurgical capacity in resource-poor settings that can then be directed to other critical neurosurgical needs thus lowering child mortality and morbidity.

Giant chronic calcified subdural empyema: a case report.

BACKGROUND: Chronic calcified subdural empyema is an exceedingly rare central nervous system infection with a handful of cases published to date. Reported cases presented with nonspecific clinical signs and symptoms. The duration between the initial onset of symptoms and diagnosis can vary drastically from a few years to up to 46 years. Although there are known predisposing causes, the initial source of infection can sometimes be difficult to identify. CASE PRESENTATION: Our patient was a 39-year-old Ethiopian man who presented with left-side body weakness of 6 years' duration with worsening of symptoms of 6 months' duration. He had no history of trauma, meningitis, or previous surgery. The results of routine laboratory tests were normal. The diagnosis was made by computed tomography and magnetic resonance imaging and was confirmed by surgery. Frontoparietal craniotomy was performed, and evacuation of non-foul-smelling collection was done. The patient was reoperated for tension pneumocephalus 48 hours after the initial surgery. He died 10 days later. CONCLUSION: This is a rare case of a giant chronic calcified subdural empyema with no known preceding history of trauma or infection.