Pattern of subarachnoid haemorrhage in Saudi Arabia.

It has often been claimed that subarachnoid haemorrhage (SAH) is a rare condition in the Middle East. A 7-1/2-year retrospective study was undertaken to substantiate or disprove this claim. It was found that although the condition is less common than the global average, it was not as rare as previously supposed. The pattern of distribution throughout the population, in terms of sex, was significantly different. The possible reasons for this are discussed.

Brucella meningoencephalitis associated with cerebrospinal fluid shunt in a child: case report.

Brucella meningoencephalitis is rare in young children. We describe a patient who developed Brucella meningoencephalitis at the age of 20 months while he had a ventriculoperitoneal shunt in situ for treatment of hydrocephalus. This patient was treated with streptomycin and rifampicin. The shunt was left in situ, and all the clinical and laboratory test abnormalities subsided with this management. We propose that in a patient with Brucella meningoencephalitis, the cerebrospinal fluid shunt system can be left in situ and treatment with appropriate combination of antibiotics should prove to be successful.

Anaesthetic-induced ventricular tachyarrhythmia in Jervell and Lange-Nielsen syndrome.

A four-year-old deaf girl with a history of convulsions developed polymorphous ventricular tachycardia during induction of anaesthesia. The arrhythmia reverted to sinus rhythm spontaneously. Post-anaesthetic ECG showed marked prolongation of the QTc interval (570-690 msec). Deafness and prolonged QTc interval in association with microcytic-hypochromic anaemia confirmed the diagnosis of the Jervell and Lange-Nielsen syndrome. This case report highlights the potentially lethal complication of halothane anaesthesia in patients with long QTc interval syndrome.

The role of computerised tomography in the management of spinal tuberculosis.

Computerised axial tomography of the spine has been carried out in 56 patients with spinal tuberculosis; the extent of the bone and soft tissue involvement, spinal canal encroachment and neural compression were demonstrated. This accurate information made it possible to lay down guide lines for conservative and surgical management.

Brain abscess in Saudi Arabia.

There are significant variations among countries in the incidence of brain abscess. We report here 26 cases of brain abscess treated at the Neurosurgery Department of King Faisal University and Dammam Central Hospital Saudi Arabia over a six year period (1982-1988). This is 2.3% of total admissions to the two neurosurgery departments serving a population of approximately 1.2 million in the same period. Young males were most often affected (M/F ratio 3.3:1; 31% were less than 15 years old, 46% aged between 15-39 years, and 23% older than 40 years). Streptococcus was found to be the most common microorganism (38.4%). Mixed infection was seen in 15.3%, and sterile abscesses were found in 11.5% of the patients after aerobic and anaerobic cultures of the pus. Chronic otitis media and paranasal sinusitis predisposed the patients to abscess formation in 57.6% of the cases. The temporo-parietal area was the commonest site. Epilepsy was a complication in 30.7% of our patients, and the mortality rate was 15.3%.

The outcome of head injury: the Saudi experience.

The outcome in 159 cases of head injury was evaluated in terms of the Glasgow Coma Scale (GCS) score, age, and computed tomographic (CT) findings. Children below the age of 10 accounted for 30% of the head-injured patients, and 69% were Saudis. 81% of the patients had a GCS score of 8 or higher, and in this group the outcomes were favorable. In contrast, 19% had an initial GCS score of 7 or less, tended to be older, and had worse outcomes, with a mortality rate of 68%. The initial GCS score, age, presence or absence of associated injuries, and the degree of midline shift according to CT were useful prognostic indices in patients with head injury.

Tecto-cerebellar dysraphia with occipital encephalocele.

We report four cases with the rare syndrome of tecto-cerebellar dysraphia with occipital encephalocele. The clinical features seen in these patients included episodic tachypnea and irregular breathing, opsoclonus, ataxia, marked hypotonia of the limbs, coloboma, and polydactyly. All four patients had midline occipital encephalocele. The cranial computed tomography scan showed partial to total agenesis of the vermis with a large communication between cisterna magna and the fourth ventricle. The computed tomography scan also showed partial deficiency of the midbrain tectum. We discuss the clinical and radiological findings and review the literature.

The outcome of head injuries: the Saudi experience.

One analysis of the outcome of 159 cases of head injuries was based on patients' admission Glasgow Coma Scale (GCS), score, age, CT scan findings and uniform protocol of management. Fifty-three percent of the patients were children below the age of 10 years and 70% of all patients were Saudis. Eighty-point-five percent (80.5%) of the patients had a GCS score of 8 or more and their outcome was favorable. By contract, the 19.5% who had an initial GCS score of 7 or less tended to be older and had a worse prognosis (mortality 68%). A high initial GCS score, old age, associated multiple injuries and a shift of more than 4 mm of the midline structures on CT scan of the brain are useful prognostic indices in predicting the outcome of head injury.

Drug-induced arterial spasm relieved by lidocaine. Case report.

Following major intracranial surgery in a 35-year-old man, sodium pentothal was intravenously infused to minimize cerebral ischaemia. Intense vasospasm with threatened gangrene arose in the arm used for the infusion. Since the cranial condition precluded use of more usual methods, lidocaine was given intra-arterially, with careful cardiovascular monitoring, to counteract the vasospasm. The treatment was rapidly successful.

Turcot syndrome (glioma polyposis). Case report.

A case of Turcot syndrome (glioma polyposis) is described in a 22-year-old woman. The patient initially presented with a frontoparietal glioma, and was subsequently found to have segmental colonic polyposis with adenocarcinomatous changes. Her colonic polyposis was nonfamilial.

Comparative clinical trial of epsilon amino-caproic acid and tranexamic acid in the prevention of early recurrence of subarachnoid haemorrhage.

A comparative controlled clinical trial of epsilon aminocaproic acid (EACA), 36 g/day and tranexamic acid (TEA), 6 g/day, was undertaken to assess their effectiveness in reducing early recurrence of subarachnoid haemorrhage (SAH). Of 90 patients treated with EACA recurrent haemorrhage was seen in 8% of these patients and 7% of the patients developed delayed ischaemic deficit. The total pre-operative mortality in EACA-group was 11%. Of 61 patients treated with TEA, 10% had recurrent haemorrhage and delayed ischaemic deficit occurred in 5% of the patients. The total pre-operative mortality in TEA-group was 11%. No difference was found between the effectiveness and side-effects of these drugs.

Prevention of early recurrence of spontaneous subarachnoid haemorrhage by epsilon-aminocaproic acid.

A controlled clinical trial of epsilon-aminocaproic acid (E.A.C.A.), 36 g/day, was undertaken to assess its effectiveness in reducing immediate recurrence in patients with spontaneous subarachnoid haemorrhage (S.A.H.) proved by lumbar puncture. Of 83 patients treated with E.A.C.A., 3 (4%) had recurrent haemorrhage, and 1 (33%) of these died. Of 82 control patients who were not given any antifibrinolytic drug, 22 (26%) had recurrent haemorrhage, and 10 (45%) of these patients died. E.A.C.A. produced a striking reduction in the early recurrence of S.A.H. No serious side-effect resulted.