Background. This article attempts to evaluate the clinical profile and outcome determinants following hypertensive SICH in a South Indian population. The study represents the largest series of SICH reported from a single centre in India. Materials and Methods. Prospective data collection and analysis of patients with SICH admitted to our centre between 1st January 2015 and 31st December 2018. The variables analysed include: age, sex, comorbidities, Glasgow coma score (GCS) on admission, radiological features, treatment modality, and outcome at three months. Modified Rankin score (mRS) was used to assess the outcome at discharge and three months. Results. Our study group of 905 patients included 638 males and 267 females and the mean age at presentation was 58.10 ± 12.76 years. The study group included 523 patients (57.8%) previously diagnosed hypertensive, of whom 36.3% (n=190) were on irregular medication. The most frequent locations of hematoma were basal ganglia (478), thalamus (202), lobar (106), cerebellar (61), brainstem (31), and primary intraventricular haemorrhage (27). Secondary intraventricular extension was seen in 425 (47%) patients on admission. The mean volume of the clot on admission was 23.45 ± 19.79 ml, and clot progression was seen in only 46 (5.08%) cases. Surgical evacuation through craniotomy was done in 147 (16.8%) patients, and external ventricular drainage (EVD) was placed in 56 (6.2%) patients. Overall 3−month mortality was 30.1% (266 patients). On the last follow up a favorable outcome (mRS 0−3) was observed in 412 (45.53%) patients and a poor outcome (mRS 4−5) in 207 patients (22.87%). Independent predictors of mortality are Age >70 (p=<0.001, OR 4.806, 95% CI 3.064–7.54), admission GCS <8 (p=<0.001, OR7.684, 95% CI 5.055#x2013;11.68), and Hematoma volume >30 ml (p=<0.001, OR 2.45, 95% CI 1.626–3.691). Intraventricular haemorrhage was an additional poor outcome predictor (p<0.015, CI 1.105–2.585). Surgical evacuation reduced mortality in the group, but morbidity rates remained the same. Conclusions. SICH predominantly affects a younger population in India in comparison to the Western society. Elderly age, poor GCS on admission, clot volume above 30 ml and intraventricular extension remain the most consistent predictors of death and poor outcome. Further studies are needed to assess the risk of SICH among hypertensive patients and to prognosticate the outcome after SICH using novel predictors, including biomarkers.

Background and Aims: Hyperglycemia or elevated blood glucose levels have been associated with poor outcomes in patients with ischemic stroke yet control of hyperglycemia has not resulted in good outcomes. High admission blood glucose (ABG) values have been mitigated by other poor prognosticators like large hematoma volume, intraventricular extension (IVE) of hematoma and poor GCS. The aim of this study was to evaluate the effects of blood glucose levels at admission, on mortality and functional outcomes at discharge and 3 months follow up.Methods: This was a retrospective observational study conducted at a tertiary care. Patients with spontaneous SICH were enrolled from a prospective SICH register maintained at our hospital. Blood glucose values were recorded on admission. Patients with traumatic hematomas, vascular malformations, aneurysms, and coagulation abnormalities were excluded from our study.Results: A total of 510 patients were included in the study. We dichotomised our cohort into two groups, group A with ABG>160 mg/dl and group B with ABG<160 mg/dl. Mean blood glucose levels in these two groups were 220.73 mg/dl and 124.37 mg/dl respectively, with group A having twice the mortality. mRS at discharge and 3 months was better in Group B (p ≤ 0.001) as compared to Group A. Age, GCS, volume of hematoma, ABG, IVE and Hydrocephalus were significant predictors of mortality and poor outcome on univariate analysis with a p < 0.05. The relationship between ABG and mortality (P = 0.249, 95% CI 0.948–1.006) and outcome (P = 0.538, 95% CI 0.997–1.005) failed to reach statistical significance on multivariate logistic regression. Age, Volume of hematoma and GCS were stronger predictors of mortality and morbidity.Conclusion: Admission blood glucose levels was not an independent predictor of mortality in our study when adjusted with age, GCS, and hematoma volume. The effect of high ABG on SICH outcome is probably multifactorial and warrants further research.

Schwannomas account for around half of all intradural spinal tumours, with chronic progressive symptoms as the most common presenting features. Intratumoural haemorrhage as a presenting feature of spinal schwannoma is very rare and only 11 cases have been reported till date. Authors here report a previously asymptomatic 40-year-old male who presented with acute onset paraplegia 12 hours after a minor trauma. MR imaging revealed a C7-D3 intradural-extramedullary lesion with features of acute blood and showing no enhancement. Emergency laminectomy and complete removal of the mass was performed and histopathology revealed features of schwannoma with haemorrhage. Patient had modest improvement of his neurological deficits at a follow-up of 6 months. Pertinent literature is reviewed in brief.

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A 28-year-old male patient presented to the triage with an alleged history of snake bike, while walking by the roadside at dawn. His friends identified the snake to be a "kanthodi" or Viper, however they were unable to capture it. He fell unconscious soon after the incident and was brought within 30 minutes to the triage. There were no spontaneous bleeding manifestations, either, local, or systemic.On admission his vitals were stable. He was not opening eyes to painful stimuli but he was moving all four limbs spontaneously. Both his conjunctiva appeared congested. He did not show any sign of systemic envenomation in the form of diffuse spontaneous bleeding from mucosal surfaces or haematemesis. No signs of central or peripheral cyanosis or compartment syndrome. His pupils were equal and reacting well and there were no cerebral localizing signs in the form of hemiparesis or plegia. A plain Computed Tomographic scan of the brain (CT Brain) was done, which was normal [Table/ Fig-1a-c].He was started on Anti Snake Venom (ASV) as per guidelines and supportive treatment was started. Two days following his admission, he had an episode of focal seizures involving the right upper and lower limb. A repeat CT Brain was done which showed a large intraparenchymal bleed in the right frontal region with uncal and right parafalcine herniation with significant cerebral oedema [ AbSTRACTSnakebite envenomation is a commonly encountered emergency in tropical countries with potentially fatal complications. Life threatening neurosurgical complications are rare and infrequently documented in literature. We discuss the case of 28-year-old gentleman, managed successfully for an intracerebral haemorrhage following a viper bite and attempt to obviate some management dilemmas often encountered in viperine envenomation.[ Table/

DESCRIPTIONThe ventriculoperitoneal shunt has been the mainstay for definitive treatment of hydrocephalus since time immemorial. As such, several case reports describing the complications of this procedure have been documented in the literature over the past few decades. The spectrum ranges from ventricular catheter dislodgement to abdominal catheter end perforating the stomach and causing intussusception; several case illustrations have depicted the possible aftermath of this blind procedure. After the advent of neuronavigation and planning procedures on CT scans, the complication rates have significantly reduced.Shunt malfunction, secondary to migration of the abdominal end, remains as one of the most common complications following ventriculoperitoneal shunting.1 Large bowel perforation is a rare complication with an incidence of 0.1-0.7%.2 In rare instances, there have been cases of herniation of the peritoneum along with the distal end of the catheter through a lax posterior rectus sheath.3 The unprecedented cases we describe, the first of a child and the other of an elderly woman, mandate a separate mention in the literature. We present our institutional experience, treatment dilemma, surgical management and outcomes in both the patients.Case 1: A 1½-year-old boy presented with intermittent appearance of the distal end of a ventriculoperitoneal shunt tube at the anus, while attempting to pass stools. The mother said that the child had been treated for obstructive hydrocephalus with a medium pressure Chhabra shunt, 9 months prior. On neurological examination, the child was active and alert; he had acquired appropriate milestones for his age and had no meningeal signs. The shunt chamber seemed to be functioning well. He was investigated with a shunt series X-ray, which revealed the distal end of the shunt tube traversing the entire lumen of the large intestine and ending in the sigmoid colon ( figure 1A). A CT scan (brain CT) was ordered, which showed a significant

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