Posttraumatic herniation of brain and CSF into the eyelid, variously termed as blepharocele, blepharoencephalocele, or encephalocele, is not a common entity, with only a few reported cases in the literature. A 4-year-old girl was seen for gradually increasing left upper eyelid swelling after she had sustained a head injury due to a fall from height. A few days later she developed swelling of the upper eyelid. Posttraumatic CSF blepharocele was suspected. The patient underwent surgery with excellent cosmetic outcome. This case is discussed with a review of literature.

Aim:Abnormal motor response in the form of decerebration signifies either injury or compression of brain stem. The presence of decerebrate rigidity following head injury is a grave prognostic sign. Mortality may increase up to 70% in patients showing signs of decerebration. Although many studies have identified the prognostic factors in severe head injuries, few studies have focused on the operated patients with decerebration in predicting the long-term outcome. This study was planned to determine the outcome in this group of patients for prognostication and to help plan further line of management.Materials and Methods:All the patients admitted with severe head injury with decerebration (M2 motor response) admitted in neurosurgery department from September 2009 to January 2011 were included in the study. All the patients had operable supratentorial mass lesions with no direct evidence of brain stem damage. Patients with penetrating injury and diffuse injury with no operative mass lesions were excluded from the study. Clinical and computerized tomography (CT) data were correlated with outcome retrospectively. Glasgow outcome scale (GOS) was used as a measure of functional outcome.Results:The patients admitted with decerebration (M2 motor response) comprised 8% of the total head injury related operative procedures performed at our institute during the period. Of the 72 patients, 14 (19%) patients were more than 60 years old and 21% (15) were females. The surgical mass lesions comprised extradural hematoma in 27 (38%), cerebral contusions in 19 (26%), acute Subdural Hematoma alone in 7 (10%), and acute Subdural Hematoma (SDH) with cerebral contusion in 19 (26%) of the patients. Of the 72 patients, 36(50%) were operated within 24 hours of injury Follow-up of all, but 2 (3%) was obtained. Favorable outcome (GOS 4 and 5) was obtained in 14% (n = 10) of the patients with 83% (n = 60) mortality rate. The favorable outcome rate among the patients operated for Extradural Hematoma was 26% and for cerebral contusions was 11%. Only 5% of the patients operated for acute SDH survived.Conclusion:Radiological diagnosis (type of lesion), followed by duration of decerebration and age of the patient are the most important prognostic factors determining the outcome of surgery in decerebrating patients. Our results confirm that despite the poor prognosis in decerebrate patients, a significant number of patients may still survive and have a good outcome.

Deep burns of the scalp and skull can be caused by high-voltage electrical injuries. Electrocution can occur while working and illegal handling of the lines. Compared to conventional burns, these injuries are characterized by an increased morbidity and mortality. We encountered an unusual case of high-voltage electrical burn of the head causing charring of scalp, bone and dura with herniation of infected brain matter.

Object In this paper the authors' goal was to investigate the clinical usefulness of Gd-enhanced MR ventriculography (MRV) in pediatric patients affected by multiloculated hydrocephalus. Methods Eighteen patients (11 boys and 7 girls, age range 2–14 months) with a diagnosis of multiloculated hydrocephalus were included in the study. After injection of gadodiamide (0.02–0.04 mmol) into the lateral ventricle by tapping the anterior fontanel, sagittal, coronal, and axial T1-weighted MR images were acquired. The location of the septations and the sites of obstruction of CSF flow were assessed. Postoperative MRV was obtained to confirm the results of endoscopic treatment in most complex cases. Results No adverse events were observed after injection of contrast medium into the ventricular system. Preoperative MRV accurately defined the exact morphology of septae and ventricular walls in all cases. In 1 case the diagnosis of multiloculated hydrocephalus was ruled out. Sites of obstruction of CSF flow within the ventricular system were also well established. In 4 cases the multiple compartments were proven to intercommunicate. Postoperative MRV was useful in assessing the functional status of third ventriculostomy, aqueductoplasty, and other endoscopic fenestrations. Conclusions Magnetic resonance ventriculography is a safe, effective, and reliable technique. The accurate definition of the anatomy of the ventricles and the site of obstruction in multiloculated hydrocephalus can help to plan the most appropriate treatment and minimize the number of procedures. Although MRV is also useful during postoperative follow-up to determine the results of endoscopic treatment, it should be limited to particularly complex cases, due to its invasiveness.

Introduction?There is a dramatic increase in the incidence and little is known about outcome and recovery of penetrating brain injuries. Our study is based on analysis of clinical-radiological profile and outcome of patients of penetrating brain injuries. Method?This is a retrospective analysis of patients with penetrating head injury during the period from June 2004 to May 2013. Patients with penetrating head injury were selected from our hospital record. Their operative findings were evaluated and only those patients with documented penetration of the dura by a foreign material were selected for data collection and analysis. Results?A total of 60 patients were recruited in the study. Their mean age was 27 years, and most patients were male. Most common clinical presentation was brain matter and cerebrospinal fluid (CSF) leak in 48 (60%) patients followed by decreased level of consciousness in 40 (66.67%) patients. Frontal lobe was most commonly involved part in 24 (40%) patients followed by multiple lobe injury noted in 16 (26.66%) patients. Twelve patients expired during the hospital stay. Thirteen patients were discharged in GOS-2, 15 in GOS-3, and 20 in GOS-4. Wound infection occurred in 11 (18.33%) patients, and seizure developed in 8 (13.33%) patients. Conclusion?Penetrating brain injuries are most common in 11- to 30-year-old age group and occur more commonly in male. Most common presentations were brain matter or CSF leak and most common mode of injury was firearm. Frontal lobe was the most commonly injured part of the brain and mortality was 20%. Higher mortality was observed among patients with seizure than in other patients with penetrating brain injury.