ABSTRACT
Hydatidosis is a zoonotic disease caused by Echinococcus parasite that frequently involves liver and lungs. Primary intracranial hydatidosis is a rare condition which can be life threatening if ruptured. Here we report an unusual case of primary intracranial hydatid cyst without any other organ involvement, diagnosed in a 12-year-old boy in Emam Reza hospital, Birjand, Iran in November 2016, in order to focus on the importance of proper diagnosis and management, especially in endemic areas.
ABSTRACT
OBJECTIVES: Minor head injury is the most common type of head injury. Despite of high incidence and numerous studies performed, there is much controversy about correct evaluation of these patients. The aim of this study was to find clinical signs and symptoms which help to predict the indications for brain CT scan following minor head injury. METHODS: A series of 682 consecutive patients who had been attended at two university hospitals (Alzahra and Kashani) with minor head injury (GCS=15) were prospectively enrolled in this cohort study. In all cases clinical signs and symptoms were collected and a cranial computerized tomography (CT) scan was obtained. The relationship between the occurrence of clinical findings and appearance of intracranial posttraumatic lesions on cranial CT was analyzed by chi-square tests and statistic logistic regression methods, with 95% confidence intervals. RESULTS: Of 682 patients, 46 (6.7%) presented brain injuries on CT scan. All patients with abnormal CT scans had at least one of the following factors (risk factors): posttraumatic amnesia, loss of consciousness, posttraumatic seizure, headache, vomiting, focal neurological deficit, skull fracture, coagulopathy or antecedent of treatment with anticoagulants and patient age older than 60 years. No abnormal CT scans were found among patients without any of those risk factors on admission. Vomiting, skull fracture and age greater than 60 years were risk factors significantly correlated to an abnormal cranial CT after head injury. The presence of several risk factors in a patient increased the probability of posttraumatic lesion on CT scan. CONCLUSION: Some clinical risk factors can be used as a guide to predict the probability of abnormal CT following minor head injury.
Subject(s)
Head Injuries, Closed/diagnostic imaging , Tomography, X-Ray Computed , Adolescent , Adult , Aged , Aged, 80 and over , Algorithms , Brain Injuries/complications , Brain Injuries/diagnostic imaging , Child , Cohort Studies , Female , Glasgow Coma Scale , Head Injuries, Closed/complications , Humans , Male , Middle Aged , Neurologic Examination , Prospective Studies , Risk Factors , Skull Fractures/complications , Skull Fractures/diagnostic imaging , Vomiting/etiologyABSTRACT
STUDY DESIGN: A prospective, randomized triple-blind clinical trial. OBJECTIVE: To evaluate the effect of 40 and 80 mg intravenous (IV) dexamethasone versus placebo to reduce postlumbar diskectomy pain. SUMMARY OF BACKGROUND DATA: Lumbar discectomy is a procedure to ablate radicular and low pack pain (LBP) in select patients. Unfortunately, some patients have radicular pain for several days after successful surgery, possibly caused by nerve root inflammation. METHODS: A total of 61 patients with single-level herniated lumbar disc at L4-L5 or L5-S1 were randomly assigned to 3 groups. After the skin incision, group 1 received 40 mg, group 2 received 80 mg IV dexamethasone, and group 3 received placebo. All patients also received 50 mg ranitidine IV at the same time. Preoperative and postoperative radicular and LBP were evaluated using the visual analog scale. Morphine was administered and recorded as a sole pain-killer during hospital admission if indicated. Collected data were analyzed using the 1-way analysis of variance test. RESULTS: A total of 61 consecutive patients entered the study. There were 19 patients who received 40 mg dexamethasone IV (group 1), 20 received 80 mg (group 2), and 22 received placebo (group 3). Preoperative data, including age, sex, level of disc herniation, and radicular and LBP, were statistically matched among groups. Postoperative LBP was decreased in all groups equally. Based on the visual analog scale, mean radicular pain was significantly decreased 4.26 points in group 1, 4.15 points in group 2 versus 2.73 points in group 3 (P = 0.006). Mean total morphine used was also significantly lower in group 1 versus group 3 (5.26 vs. 9 mg P = 0.012). CONCLUSION: Intraoperative IV injection of 40 mg dexamethasone could effectively reduce postoperative radicular leg pain and narcotics usage in patients with single-level herniated lumbar disc.