Background. Traumatic brain injury (TBI) imposes an enormous burden on health systems and it is the most frequent cause of hospitalization in children. This study aimed at describing the causes, presentation, management, and outcome of children with TBI admitted at a tertiary referral hospital in Harare, Zimbabwe. Methods. This prospective cohort study was conducted with a convenience sample of children aged ≤ 12 years and admitted with TBI at the study site from June 2018 to May 2019. The children were followed from their admission to one-month post-discharge. Sociodemographic, clinical, and neuroimaging data were collected. The median length of stay was calculated and the Chi-square, Fisher’s exact, and Kruskal Wallis tests were used. Results. 84 children with TBI were recruited. Most were males (66.7%) and (56.0%) had sustained TBI following a motor vehicle accident. An initial period of loss of consciousness that lasted a median of 6.5 (IQR = 4.8) hours was noted in 60.7% of patients. The most common symptom at presentation was headache (61.9%), and mild TBI was the most common type of TBI. Skeletal injuries were the most encountered associated injuries (13.1%) and the majority of patients were managed non-operatively – 79 (94.0%). Most patients (56.0%) experienced upper good recovery at one-month follow-up. Conclusions. Motor vehicle accidents are the main cause of pediatric TBI in Zimbabwe. Most patients do not require surgical treatment and have a good recovery.
Bu çalışmada, beyin anevrizması nedeniyle cerrahi tedavi uygulanan bir hasta grubunda İndosiyanin Yeşili Videoanjiyografi (ICG-VA) yönteminin sonuçlarının değerlendirilmesi amaçlanmıştır. Bu intraoperatif değerlendirme yönteminin güvenilirliğini saptamak için, ICG-VA bulguları postoperative anjiyografi ile karşılaştırılmıştır ve bu yöntemin faydaları ve kısıtlılıkları tartışılmıştır. Bu çalışmaya, 75 anevrizma saptanan altmış bir ardışık hasta dahil edilmiştir. Anevrizmanın kliplenmesini takiben; anevrizmayı, ana arterleri ve perforan arterleri gözlemlemek için intravenöz yoldan ICG uygulandı. Ameliyat sonrasında tüm hastalara taburculuk öncesi anjiyografi yapıldı. Anevrizmaların %86,6'sında, ICG-VA tatmin edici klipleme sağlandığını gösterdi ve ICG-VA bulguları postoperatif anjiyografi ile uyumluydu. Anevrizmaların %6.6'sında, anormal ICG-VA bulguları saptandı ve kliplerin değiştirilmesi veya düzeltilmesi gerekli oldu. Anevrizmaların bir diğer % 6.6'sında ise, ICG-VA herhangi bir patolojik bulgu göstermezken postoperatif anjiyografide anormal bulgular saptandı. ICG-VA ameliyat esnasında kan akımının değerlendirmesinde altın standart yöntem olan intraoperatif anjiyografinin yerini almamakla birlikte, beyin anevrizmalarının cerrahi tedavisinde hasta güvenliğine büyük katkıda bulunmaktadır. ICG-VA, iyi görüntü kalitesiyle cerrahi alanın gerçek zamanlı değerlendirilmesini mümkün kılmaktadır. İşlemi gerçekleştirmek ve değerlendirmek kolaydır. Bu teknik, anevrizma cerrahisinin standart bir uygulaması olarak değerlendirilmelidir.
Cardiovascular disease is a leading cause of mortality in all ages worldwide. Tetralogy of Fallot (TOF) is the most common cyanotic congenital heart disease (CHD) accounting for 10%. There have been several reports of neurological complications associated with TOF. Although it is known, brain abscess (BA) is a serious complication in patients with uncorrected CHD mostly in the age of 4-7 years-old. We report a case of a 7 year old male who presented with a 3 month history of left sided body weakness and a 3 week history of a headache and fever. Patient was chronically unwell since birth where he would experience occasional episodes of exertional dyspnoea which was never investigated. Chest xray showed a globular-shaped heart. CT scan brain showed a 1,8 x 1,3 x 1,5 cm ring-enhancing lesion in the right parietal region with minimal perilesional vasogenic edema communicating with the body of the lateral ventricle, with enhancement of the ependymal lining of the ventricle; echocardiography revealed ventricular septal defect (VSD), overriding of aorta, obstruction to right ventricular outflow tract and hypertrophy of right ventricle consistent with a diagnosis of TOF. We elected to manage the patient conservatively on intravenous antibiotics, Patient improved significantly neurologically and was transferred to the cardiothoracic surgeons for further management of TOF.
Neurofibromatosis type 1 (NF1) is an autosomal dominant condition affecting approximately 1 in 3000 live births.The manifestations of this condition are extremely variable, even within families, and genetic counseling is consequently difficult with regard to prognosis. Individuals with NF1 are acknowledged to be at increased risk of malignancy. Several studies have previously attempted to quantify this risk, but have involved relatively small study populations. Soft tissue tumors represent a heterogeneous group of mesenchymal and neural lesions. We report a case of giant scalp Fibrosarcoma of the scalp in patient with neurofibromatosis type I without intracranial extension, in a 35 year old female which was excised completely along with the involved overlying skin, and reconstruction was done to cover the defect using trapezius flap and split thickness skin graft from the right thigh. She is doing well after treatment and is in regular follow up while awaiting further management by the oncologists.
Abstract:The Chiari malformations are a family of conditions characterized by developmental or, less commonly, acquired displacements of the cerebellum. The original 19th century description by Hans Chiari delineated 4 types, but only types 1 and 2 are more than just curiosities. In his initial description, Chiari classified the hindbrain malformations into type I, II and III and then latter added type IV malformation. Type IV is a very rare type. It is characterized by cerebellar hypoplasia or aplasia and tentorial hypoplasia. There is no hindbrain herniation in this type. We report a case of a 6 year old male patient who presented to us with a 6 year history of an occipitocervical mass and inability to stand and walk for one year and a 5 month history of headache and vomiting. CT scan of the brain showed a midline posterior fossa bone defect with a meningocele with active obstructive hydrocephalus and hypoplastic cerebellum without hindbrain herniation. A diagnosis of a posterior fossa congenital anomaly (Chiari 4) with obstructive hydrocephalus and occipito-cervical meningocele was made. Ventriculo-peritoneal shunt was inserted three days post admission. Patient was then electively taken to theatre five months later for repair of the occipitocervical meningocele.
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