Traumatic pseudoaneurysm of the middle meningeal artery is rare and is associated with high mortality. Skull fracture is usually an associated feature of this entity. An elderly male was brought to our hospital in a stage of coma. The details of ictus were not known. The Glasgow coma scale score was 9/15. Examination revealed a pseudo-aneurysm arising from the posterior branch of the left middle meningeal artery which was excised. The case is presented for its rarity and its characteristic radiology. Traumatic pseudoaneurysm of middle meningeal artery is rare. It is important to recognize this treatable entity. KeywOrds: Skull fracture, Extradural hematoma, Pseudoaneurysm, Middle meningeal artery ÖZOrta meninjial arterin travmatik psödoanevrizması nadir görülmekle beraber yüksek mortalite ile seyreden bir olaydır. Kafatasında kırık görülmesi orta meninjial arterin travmatik psödoanevrizmasının bir özelliğidir. Yaşlı erkek hasta hastanemize koma halinde getirildi. Hastanın bilinç kaybı ile ilgili bir bilgi elde edilemedi. Hastanın Glasgow Koma ölçeği 9/15'di. Hastanın muayenesinde sol orta meninjial arterin arka dalından kesilmiş olduğu görüldü. Olgu nadir görülmesi ve karakteristik radyolojik özelliği nedeni ile sunulmuştur. Orta meninjial arterin psödoanevrizması nadir görülen ve tanı konulunca tedavi edilebilen bir patolojidir.
Background: Geographically Kashmir valley is isolated from the rest of the country. It has a different climate with people having different social and dietary habits. Gastric cancer, esophageal, and skin (Kangri) cancer have a higher prevalence but there is little data available on the cancers of brain. Objectives & Methodology: Aim was to study brain tumors prospectively and retrospectively, to analyse brain tumors geographically and to analyse the age and sex ratio of brain tumors in Kashmir valley. In this Retrospective and Prospective study, retrospectively (initial seven years) all patients were analyzed for their clinical symptoms, age, sex, residence, histopathologic characteristics of tumors. Prospectively (later three years) after get-ting the radiological diagnosis pathological diagnosis was arrived by procedures like open, stereotactic, and endoscopic procedures. All patients were then analysed for age, sex, residence, signs and symptoms and histopathological characteristics. Follow up was done for gliomas. Mortality and morbidity was analysed for gliomas in these 3 years. Patients who lost the follow up were considered dead. Out of 1730 patients included in our study, there were 1031 males and 699 females. The most common age group was between 41-50 years. Results: The most common tumor was gliomas followed by meningiomas. Gliomas were most common in men and meningiomas in females. Out of all the histological grades in gliomas, the glioblastoma multiforme (GBM) was the most common, and frontal lobe was the commonest anatomical site involved. The most common symptom in our study was headache followed by vomiting.
Objectives: Pneumocephalus, air in the cranial cavity, is a common occurrence after cranial surgery and less common after head trauma. However, delayed intraventricular tension pneumocephalus, causing a mass effect and abnormal neurological signs as seen in our case, is very rare. Only few cases are reported so far. Understanding the conditions that contribute to tension pneumocephalus, a potentially fatal complication, including the related signs and symptoms, is imperative. Immediate collaboration with a neurosurgeon allows for timely treatment and patient recovery. Treatment measures include preoperative teaching, immediate removal of intracranial air, supine positioning, administration of 100% oxygen, repair of the bony and dural defect, and, if indicated, drain placement into the air cavity, temporary tracheotomy, and antibiotics.Clinical Presentation: A 45-year-old female patient presented with a history of road traffic accident with head trauma. After primary aid, the patient underwent computed tomographic (CT) scan of the head, which showed frontal, small extradural hematoma with pneumocephalus and fractured anterior cranial fossa (left orbital roof). She was managed conservatively and discharged.After 15 days of injury, the patient returned with complaints of drooping of the left eyelid (left oculomotor cranial nerve palsy) and sudden clear fluid nasal discharge (cerebrospinal fluid rhinorrhea). Repeat CT scan showed resolved extradural hematoma and pneumocephalus. Again she was managed conservatively to achieve spontaneous closure of cerebrospinal fluid rhinorrhea in 7 days, and was discharged. After 2 months of injury, she returned the third time with a history of dementia followed by altered sensorium (Glasgow coma score 11 at the time of admission), gait ataxia, vomiting, and urinary incontinence. Clinical features were consistent with those of normal pressure hydrocephalus. Newly taken CT scan of the head showed bifrontal intraventricular tension pneumocephalus.Surgical Intervention: The intraventricular aeroceles were tapped using a twist drill on both sides with evacuation of air. The patient recovered to her full conscious level (Glasgow coma score 15), but showed delayed recovery of urinary incontinence and gait ataxia.Conclusions: Posttraumatic delayed intraventricular "tension pneumocephalus" as seen in our case is a very rare entity, presenting as features mixed with those of normal pressure hydrocephalus and signs of raised intracranial pressure. Immediate tapping is the treatment of choice to reverse deficits and for recovery of the patient. CASE REPORTWe had a 45-year-old female patient who presented to the Department of Accident and Emergency with a history of road traffic accident followed by transient loss of consciousness, vomiting, headache, nasal bleeding, and pain and deformity in the left wrist (Colles fracture). After primary aid, the patient underwent computed tomographic (CT) scan of the head (Figs. 1A, B), which showed left frontal, small extradural hematoma with pneumocephalus...
Objectives: The aim of this study was to assess the head injury in children caused by an unusual projectile, a tear gas cartridge. The study is the only one on this subject which has been done in a teenage population. Method: This was a prospective study conducted over a period of 4 years in which all the patients aged less than or equal to 18 years and who had a head injury due to a tear gas cartridge were included. Results: We had 5 patients in our study group. All the patients were males. Commonest CT scan finding was brain contusion with skull fracture. One of our patients died. One patient continues to be in vegetative state whereas 3 had a good outcome. Conclusion: Tear gas cartridge, though considered as one of the benign modalities of controlling agitated crowds, is not really benign. It can cause serious injuries and mortality. The personnel using them might be trained in a better way so that the people do not receive direct hits. In addition some changes in the design of tear gas cartridge can be done to decrease the impact to the skull.
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