Objective:Patients of Chronic subdural haematoma can present with only subtle cognitive impairment without any motor deficit. It is hence imperative for the treating clinician to be aware of this entity. The aim of the study was to identify any statistically significant improvement of cognitive functions following burr hole evacuation of Chronic SDH especially in the elderly patients.Methods and Material:A Prospective observational study of 30 patients of CSDH, from Jan 2015 to Dec 2016 was done at a tertiary level Armed Forces Hospital. The study had 23 male, 07 female, with age ranging from 7-85 years. The cognitive function of each patient was assessed at admission and 24 hours after surgery by MMSE. Radiological confirmation was done by CT head. Standard two burr holes were made and hematoma evacuated. The clinical, cognitive assessment and radiological data were collected and analysed.Results:There was no statistical significance preoperatively between age and pre operative cognitive impairment, headache, hemiparesis, dysarthria (P>0.05). We however found a statistically significant improvement postoperatively in cognitive impairment, headache (P= 0.00), motor deficit (P=0.01) and dysarthria (P=0.046).Conclusion:The clinical features of dementia and other neurodegenerative disorders simulate CSDH in the geriatric population. These patients should have early neuroimaging and prompt surgical intervention to alleviate cognitive deficits.

Pleomorphic xanthochromic astrocytoma primarily of the spinal cord is a rare entity. The case is possibly the fifth such report. Complete surgical excision is the essential requirement for good survival. In the absence of any clearly laid down protocols of adjuvant treatment, anecdotal reports support treatment with chemotherapy alone or both chemotherapy and radiotherapy.

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A 30year-old male presented with sudden onset weakness of all four limbs. Clinically, he had hypotonia in all the four limbs and motor weakness was graded at 4/5. Deep tendon reflexes were bilaterally brisk and plantar response was extensor. Magnetic resonance imaging of cervical spine [ Figure 1] showed multiple, well--defined, rounded areas of flow void, suggestive of blood vessels in the anterior epidural space from C5 to T3 level. Spinal digital subtraction angiography [ Figure 2] did not reveal any dural arterio-venous fistula. Instead, it revealed coarctation of aorta with prominent collaterals. Computed tomography (CT) angiogram showed dilated vessels connecting the tortuous anterior spinal collateral to extra spinal channels, i.e., the vertebral and the intercostal arteries [ Figure 3]. He showed gradual recovery from his neurological deficits. Surgical correction of coarctation of aorta is being planned.

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Aims: This study aims to derive simple yet robust formula(s) for the calculation of cranial tumor volume using linear tumor dimensions in anterioposterior (AP), mediolateral (ML) and craniocaudal (CC) directions and also propose a reproducible methodology for tumor dimension measurements. Materials and Methods: Magnetic resonance images (MRI) of 337 patients planned for Gammaknife Stereotactic Radiosurgery for different types of brain tumors were analyzed using Leksell Gamma Plan (LGP) software. Tumor volume in three dimensional was outlined and maximum tumor diameters were measured in three orthogonal directions AP, ML, and CC on the MRI. Formulas were derived to calculate tumor volume from AP, ML, and CC diameters using linear regression technique. An agreement between the calculated volume and standard volume observed from LGP software was determined using Bland Altman (B-A) plot. A comparison was made between the volume calculated using traditionally used formula of ellipsoid, standard volume obtained from LGP software and volume calculated from formulas derived in the present study. Results: The tumors were divided into two categories based on their size for better volume prediction. The tumors having product of their diameters in the range 0–2.5cc were called “small tumors” and the formula proposed for their volume estimation ( V = 1.513) × (AP × ML × CC) + 0.047 ) was found to predict the tumor volume with an average bias of 0.0005cc. For “large tumors,” having product of diameters in the range 2.5–36cc, the proposed formula ( V = 0.444 × (AP × ML × CC) + 0.339 ) predicted the tumor volume with an average bias of 0.007cc. Conclusions: The two formulas proposed in the study are more accurate as compared to the commonly used formula that considers the tumors as ellipsoids. The methodology proposed in the study for measurement of linear tumor dimensions is simple and reproducible.

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Prostate carcinoma presenting as symptomatic metastases to atlantoaxial spine is extremely rare. Spastic quadriparesis due to pathological fracture of odontoid as the only initial manifestation without symptoms of primary malignancy is rarer still. We report a 64-year-old male who presented with progressive spastic quadriparesis along with urinary retention of 3 weeks duration. Computed tomography and magnetic resonance imaging cervical spine and craniovertebral junction showed type III pathological fracture of odontoid with anterior translation of C1 with spinal cord compression. Biopsy from an enlarged prostate showed adenocarcinoma of prostate. The patient was managed conservatively from neurological aspect as he refused for any surgical intervention.