Epidural hematomas which are located at the vertex are rarely seen and form a small percentage of total epidural hematomas. Tearing in the superior sagittal sinus is the usual cause of an epidural hematoma located in the vertex. The clinical features of this entity are non-specific; hence, localization of the lesion is difficult. We report an adult who was hit by a motorcycle and was initially discharged from the hospital as a case of concussional head injury. He returned back with raised intracranial pressure symptoms, so a CT scan was done but was misinterpreted, and he reported one week later with bilateral abducent nerve palsy. Magnetic resonance imaging confirmed vertex EDH for which he was operated.These hematomas are seen rarely and can be interpreted as an artifact. Its recognition is important because it has an excellent prognosis. We concluded that all head injury patients should get high axial cuts on the CT scan, and any degree of suspicion should prompt a neurosurgeon to investigate further with coronal CT scan or MRI. KeywOrds: Extradural hematoma, Vertex, Abducent nerve palsy ÖZVertekse yerleşmiş epidural hematomlar nadir görülürler ve tüm epidural hematomlar içinde küçük bir yüzde olarak bulunur. Bu hematomlara süperior sagital sinüsteki bir yırtık yol açar. Bu hematomların spesifik klinik bulguları olmadığından kafa içindeki yerini belirlemek çoğunlukla mümkün olmaz. Yaya halde iken motorsiklet tarafından çarpılan hastaya serebral kontüzyon tanısı konulmuş ve taburcu edildi, hasta tekrar hastaneye kafa içi basınç artışı bulguları ile getirildi ancak çekilen beyin bilgisayarlı tomografisinde patoloji yok denilerek hasta tekrar taburcu edildi. Hasta bir hafta sonra bu kez iki taraflı abdusent paralizisi ile hastaneye müracat etti ve yapılan kranial manyetik rezonans görüntülemesinde vertekste epidural hematom saptanan hasta ameliyat edildi. Vertekse yerleşmiş epidural hematomlar bilgisayarlı tomografide artefakt olarak değerlendirilerek kolayaca atlanabilir; bunun yanı sıra bu patoloji oldukça nadir görülür ve tanındığı zaman gerekli tedavi ile hastaların prognozu mükemmele yakındır. Kafa travması ile gelen hastaların özellikle vertikal bölgesi bilgisayarlı tomografi ile iyi taranmalı, şüphe durumunda koronal kesitler alınmalı, yine şüphe varsa hastalara kranial manyetik rezonans görüntülemesi yapılmalıdır.
Intraosseous hemangiomas are benign vascular malformations mostly seen in the spine. They rarely occur in the skull. The usual age-group involved is the 2nd to 4th decades, and females outnumber males. We hereby report a rare case of congenital intraosseous cavernous hemangioma of the skull bone in a male infant. The patient underwent total excision of the lesion.
Background:Neural tube defects (NTDs) are the most common congenital malformations affecting the brain and spinal cord and have a multifactorial etiology. Genetic and environmental factors have been found to cause these defects, both individually and in combination.Methods:A 2-year hospital-based prospective study was carried out from November 2013 to October 2015 to determine the incidence, types, demographics, risk factors, and other associated anamolies relevant to NTDs in Kashmir Valley. A detailed history of the mother was taken along with detailed clinical examination of neonate including measurement of head circumference and checking the status of fontanella, whether lax/full/bulging/or tense, type of NTD. Investigations that were done included were X-ray skull: Anterior-posterior (AP) and lateral, X-ray spine: AP and lateral, ultrasonography abdomen, magnetic resonance imaging: Spine and brain.Results:The total number of babies with NTD's was 125 with an overall incidence of 0.503. Kupwara district was having the highest incidence (1.047) and Srinagar district the lowest incidence of NTD's (0.197). Majority of NTD's (116 cases, 92.8%) were found in the rural areas. Among the different types of NTD's, spina bifida had an incidence of 0.342 (85 cases, 68%) and anencephaly had an incidence of 0.113 (28 cases, 22.4%). There was a slight preponderance of females over males with NTD's. There were 70 females (56%) and 55 males (44%), respectively, with a male: female ratio of 0.8:1Conclusions:The incidence rates of NTDs is very high for Kashmir Valley. Geographical distribution of NTDs at this place confirms a relationship between the socioeconomic status, educational status, maternal too young or advanced age, and environmental factors for the development of a NTD. The results of this study point to the importance establishing a health policy to prevent NTD in Kashmir Valley.
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