Intramedullary Thoracic Spinal Cord Abscess Mimicking an Intramedullary Tumor: A Case Report.

An intramedullary abscess is an extremely rare form of infection of the spinal cord, with only about 100 cases reported in the literature. It typically presents with back pain, neurological deficits, and, occasionally, fever. The purpose of this article is to report a case of an intramedullary thoracic spinal cord abscess that was initially misdiagnosed as an intramedullary tumor. A 48-year-old female presented with chronic inter-scapular pain and lower limb weakness. The patient was initially misdiagnosed as a case of intramedullary spinal cord tumor, primarily due to the rarity of intramedullary spinal cord abscess (ISCA) as well as the absence of ring enhancement in the lesion on MRI. However, during a surgical procedure for the excision of the lesion, it was found to be a case of ISCA. The purulent contents of the lesion were evacuated, and the patient was treated with IV antibiotics, leaving the patient with a slight residual lower limb weakness on the follow-up examination. This case highlights the importance of considering intramedullary abscess as a possible diagnosis in patients with back pain and neurological deficits, even in the absence of ring enhancement on imaging. Prompt surgical intervention should be considered in probable cases of intramedullary spinal cord tumors.

IMMEDIATE PAIN RELIEF BY MICROVASCULAR DECOMPRESSION FOR IDIOPATHIC TRIGEMINAL NEURALGIA.

BACKGROUND: Trigeminal neuralgia is a common entity which is managed by neurosurgeons in day to day practice. Up-till now many treatment options have been adopted for it but micro-vascular decompression is much impressive in terms of pain control and recurrence rate in all of them. The objective of study was known the efficacy of micro vascular decompression for idiopathic trigeminal neuralgia by using muscle patch in terms of immediate pain relief. METHODS: This descriptive study was carried out in Neurosurgery Department lady reading hospital, Peshawar from January 2010 to December 2012. All patients who underwent micro vascular decompression for idiopathic trigeminal neuralgia were included in the study. Patients were assessed 72 hours after the surgery by borrow neurological institute pain scale (BNIP scale) for pain relief and findings were documented on predesigned pro forma. Data was analysed by SPSS-17. RESULTS: Total 52 patients were included in this study. Among these 32 (61.53%) were female and 20 (38.46%) were males having age from 22-76 years (mean 49 years). Right side was involved in 36 (69.23%) and left side in 16 (30.76%) patients. Duration of symptoms ranged from 6 months to 16 years (mean 8 years). History of dental extraction and peripheral neurectomy was present in 20 (38%) and 3 (5.76%) patients while V3 was most commonly involved branch with 28 (57.69%) frequency and combined V2, V3 involvement was 1 (11.53%). Superior cerebellar artery was most common offending vessel in 46 (88.46%) while arachnoid adhesions were in 2 (3.84%) patients. We assessed patient's immediate postoperatively using BNIP pain scale. CONCLUSION: Micro-vascular decompression is most effective mode of treatment for trigeminal neuralgia in terms of immediate pain relief.

Ethnic disparity in 21-hydroxylase gene mutations identified in Pakistani congenital adrenal hyperplasia patients.

BACKGROUND: Congenital adrenal hyperplasia (CAH) is a group of autosomal recessive disorders caused by defects in the steroid 21 hydroxylase gene (CYP21A2). We studied the spectrum of mutations in CYP21A2 gene in a multi-ethnic population in Pakistan to explore the genetics of CAH. METHODS: A cross sectional study was conducted for the identification of mutations CYP21A2 and their phenotypic associations in CAH using ARMS-PCR assay. RESULTS: Overall, 29 patients were analyzed for nine different mutations. The group consisted of two major forms of CAH including 17 salt wasters and 12 simple virilizers. There were 14 phenotypic males and 15 females representing all the major ethnic groups of Pakistan. Parental consanguinity was reported in 65% cases and was equally distributed in the major ethnic groups. Among 58 chromosomes analyzed, mutations were identified in 45 (78.6%) chromosomes. The most frequent mutation was I2 splice (27%) followed by Ile173Asn (26%), Arg 357 Trp (19%), Gln319stop, 16% and Leu308InsT (12%), whereas Val282Leu was not observed in this study. Homozygosity was seen in 44% and heterozygosity in 34% cases. I2 splice mutation was found to be associated with SW in the homozygous. The Ile173Asn mutation was identified in both SW and SV forms. Moreover, Arg357Trp manifested SW in compound heterozygous state. CONCLUSION: Our study showed that CAH exists in our population with ethnic difference in the prevalence of mutations examined.