Intradural lipomas are rare lesions, usually associated with spinal dysraphism, affecting the spinal cord. Intracranial lipomas make up less than 1% of intracranial tumours; only 13 cases of these lesions being located at the craniocervical junction are reported in the literature. These lesions tend to present with neurological deficits such as quadraparesis and incontinence. We present the first case of a successfully treated intradural lipoma at the foramen magnum in a 15-year-old girl who presented with classical Chiari symptoms and no neurological deficits.
Traumatic brain injury (TBI) is amongst the leading causes of morbidity and mortality worldwide. The unprecedented emergence of COVID-19 has mandated neurosurgeons to limit viral spread and spare hospital resources whilst trying to adapt management plans for TBI. We aimed to characterize how this affects decision-making on TBI management and drive strategies to cope with future expected waves.
MethodsRetrospective TBI data collection from a single tertiary referral unit was performed between: 01/04/2019 -30/06/2019 ('Pre-Epidemic') and 01/04/2020 -30/06/20 ('Epidemic'). Demographics, mechanism of injury, TBI severity, radiological findings, alcohol/anticoagulants/antiplatelets use, and management decisions were extracted.
Results646 TBI referrals were received in 'Pre-Epidemic' (N=317) and 'Epidemic' (N=280) groups.There was reduction in RTA-associated TBI (14.8 vs 9.3%; p=0.04) and increase in patients on anticoagulants (14.2 vs 23.6%; p=0.003) in the 'Epidemic' group. Despite similarities between other TBI-associated variables, a significantly greater proportion of patients were managed conservatively in local referring units without neurosurgical services (39.1 vs 56.8%; p<0.0001), predominantly constituted by mild TBI.
ConclusionDespite COVID-19 public health measures, the burden of TBI remains eminent. Increases in local TBI management warrant vigilance from primary healthcare services to meet post-TBI needs in the community.
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