BackgroundThe incidence of hypopituitarism in aneurysmal subarachnoid hemorrhage ranges from 0% to 45%. Also the screening for hypopituitarism in survivors of aneurysmal SAH is not a routine. This has led to a controversy in the management of such patients.ObjectivesThe aim of the study was to evaluate the endocrine profile of our patients who had presented with aneurysmal SAH.Patients and MethodsThis was a prospective study conducted over a period of three years in patients of aneurysmal subarachnoid hemorrhage. The serum samples for levels of free T4, free T3, TSH, prolactin, FSH, LH and testosterone were analyzed at the time of admission and at a follow-up period between 9-12 months. Patients with known endocrine abnormalities, liver or kidney disease and patients with hemodynamic abnormalities were excluded from the study. Abnormalities in levels were noted and a comparative analysis of the hormone levels between the 2-time periods was done. A total of 73 patients were enrolled in the study.ResultsSerum prolactin was raised in 17.80% (13/73) and FSH, LH and testosterone levels were reduced in 12.32% (9/73) of patients in the acute phase at admission. After 9 months follow-up, serum prolactin normalized in all except one patient and in all the males, testosterone level increased significantly. Two patients (3%) developed central hypothyroidism on follow-up.ConclusionsChronic hypothyroidism and hypogonadism is not an issue in aneurysmal SAH patients

Background:Spinal epidural abscess, although an uncommon disease, often correlates with a high morbidity owing to significant delay in diagnosis.Methods:In a prospective 5-year study, the clinical and magnetic resonance (MR) findings, treatment protocols, microbiology, and neurological outcomes were analyzed for 27 patients with spinal epidural abscess.Results:Patients were typically middle-aged with underlying diabetes and presented with lumbar abscesses. Those undergoing surgical intervention >36 h after the onset of symptoms had poor neurological outcomes.Conclusion:Early recognition and timely evacuation of spinal abscesses minimized neurological morbidity and potential mortality.

Dermoid cysts are rare, benign lesions of embryological origin that represent 0.1-0.7% of all intracranial tumors. They are mainly located in the supra tentorial space, especially in the parasellar region. Their location in the posterior fossa remains uncommon. Rupture of intracranial dermoid cysts is a rare phenomenon. We present a case of dermoid cyst, which had ruptured into ventricular system. Computed Tomography and MRI revealed fat in the fourth ventricle, prepontine cistern, and cerebellomedullary cistern. Hydrocephalus was noted. We performed right ventriculo-peritoneal shunt on which patient improved and he continues to remain asymptomatic one year after.

Aim: The implications of molecular biomarkers IDH1/2 mutations and MGMT gene promoter methylation were evaluated for prognostic outcome of glioma patients. Materials & methods: Glioma cases were analyzed for IDH1/2 mutations and MGMT promoter methylation by DNA sequencing and methylation-specific PCR, respectively. Results: Mutations found in IDH1/2 genes totaled 63.4% (N = 40) wherein IDH1 mutations were significantly associated with oligidendrioglioma (p = 0.005) and astrocytoma (p = 0.0002). IDH1 mutants presented more, 60.5% in MGMT promoter-methylated cases (p = 0.03). IDH1 mutant cases had better survival for glioblastoma and oligodendrioglioma (log-rank p = 0.01). Multivariate analysis confirmed better survival in MGMT methylation carriers (hazard ratio [HR]: 0.59; p = 0.031). Combination of both biomarkers showed better prognosis on temozolomide (p < 0.05). Conclusion: IDH1/2 mutations proved independent prognostic factors in glioma and associated with MGMT methylation for better survival.

AIm: To study the clinicopathologic characteristics of chordomas from a single institution. results:The overall mean age of the patients was 46.72 years. Males outnumbered females. Sacrum was the commonest site involved. Histopathologically, the majority of cases were conventional chordoma with four cases of chondroid variety. There was a single case of dedifferentiated chordoma that presented with bone metastasis. Most patients did well after surgery and radiotherapy. One patient had a local recurrence and one patient with dedifferentiated variant died on follow-up. BulGulAr: Hastaların ortalama yaşı 46,72 yıldı. Erkeklerin sayısı kadınlardan fazlaydı. En sık tutulan bölge sakrumdu. Histopatolojik olarak olguların çoğu konvansiyonel kordomayken kondroid tipte dört olgu vardı. Kemik metastazıyla gelen tek bir dediferansiye kordoma olgusu görüldü. Çoğu hasta cerrahi ve radyoterapiye iyi sonuç verdi. Bir hastada yerel nüks oldu ve dediferansiye varyantın bulunduğu bir hasta da takip sırasında öldü. sOnuÇ: Lokal olarak agresif olmalarına rağmen kordomalar rejeksiyon ve postoperatif radyoterapiyle etkin bir şekilde tedavi edilebilir.

Brain tumors in children represent the second most frequent tumors in this age group after hematologic malignancies. We highlight the demographic pattern after retrospective analysis of brain tumors in children from geographically and ethnically distinct Kashmir Valley managed in our center between 2000 and 2009. We had a total of 248 pediatric patients with brain tumors. The parameters analyzed were age, gender, location of tumors and histopathological subtypes as well as WHO grade of tumor. We also did a comparison between the frequencies of common varieties of tumor in the first and second 5-year periods. We found that 111 tumors (44.75%) were supratentorial, and 137 (55.25%) were infratentorial. The male-to-female ratio was 1.4:1. The proportions of low-grade and high-grade tumors were 60 and 40%, respectively. The most common tumor in our series was astrocytoma. The most common tumors in the supratentorial and infratentorial compartments were craniopharyngioma and medulloblastoma, respectively. Our experience reflects a different demographic profile of pediatric brain tumors as compared with other regions of the world.

Brain tumors are not rare in children. The common brain tumors in children are medulloblastomas and craniopharyngiomas. Intraparenchymal meningiomas are very rare. We report a case of intraparenchymal meningioma in a child who was operated with a preoperative impression of a primitive neuroectodermal tumor.

Protrusion of a ventriculoperitoneal (VP) shunt through the umblicus is one of the rare complications of shunt insertion reported in the medical literature. One such case is presented here in a child in whom a VP shunt had been placed for congenital hydrocephalus.