Objective: To evaluate the role of the degree of midline shift on CT scans in predicting clinical outcomes in traumatic brain injury (TBI). Materials and Methods: A prospective observational study was conducted at the Department of Neurosurgery of a tertiary care hospital. We included 148 patients. After fulfilling the inclusion criteria, the patient’s baseline data, including the patient's age, gender, and CT scan findings with the degree of midline shift, was noted. The patients were monitored for three months to evaluate the outcome. The collected data was analyzed using SPSS version 22.0. Results: Our study showed that 105 (70.9%) patients showed satisfactory outcomes while 43 (29.1%) showed unsatisfactory outcomes. Patients with no midline shift were 70, out of which 55 (78.6%) showed satisfactory outcomes. Similarly, patients with 1-2 mm midline shifts showed satisfactory outcomes in 39 (69.6%) while 3-5 mm midline shifts showed 11 (50%) satisfactory outcomes. In our study, the degree of brain midline shift on CT scan was a statistically significant outcome factor (p = 0.035). Conclusion: Patients with TBI who had an increasing degree of midline shift on brain CT scans had considerably worse clinical outcomes. Keywords: Midline shift, CT scan, Glasgow Coma Score, Head Injury.
Aim: To identify the specificity and the sensitivity of MRS in diagnosing supratentorial brain lesions and will help the surgeons to rely on the respective diagnostic modality Method: A cross-sectional study was conducted in the Neurosurgery Department, at Jinnah Postgraduate Medical Center. The patients with conventional MR imaging showing space-occupying lesions which show a malignant diffusion restriction and enhancement were included. The histopathological diagnosis and the metabolites of the brain were detected by MR Spectroscopy were recorded. To find the association of the ratios of the brain metabolites, the chi-square test was used where a p-value of <0.05 was considered significant. The sensitivity and specificity of the MRS were evaluated then. Result: Overall, 112 patients were included in our study. 76(67.9%) patients were male. Headache (34.8%) was found to be the most common symptom. 39(34.8%) patients were diagnosed with Oligodendroglioma on histopathology. The Cho/Cr ratio >2 was found in 70(82.4%) patients diagnosed with neoplastic lesions. In 62(72.9%) patients diagnosed to have a neoplastic lesion on histopathology reported increased lipid peak and 67(78.8%) with the neoplastic lesion showed to have increased Cho/NAA ratio on MRS. The Cho/Cr ratio was found to be significantly associated with the neoplastic lesions with a significant p-value of <0.001. The MRS was determined to be 82.4% sensitive and 70.4% specific in the diagnosis of supratentorial brain lesions. This study will be quite beneficial as it will help surgeons rely on the more accurate method of diagnosing brain lesions and provide an outlook of a non-invasive method to diagnose the lesions. Conclusion: The study concludes that MRS has high diagnostic accuracy in diagnosing neoplastic and inflammatory lesions and is Keywords: Spectroscopy, brain lesions, medical resonance imaging
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