BackgroundThis study evaluates post-ICU outcomes of patients admitted with moderate and severe Traumatic Brain Injury (TBI) in a tertiary neurocritical care unit in an low middle income country and the performance of trauma scores: A Severity Characterization of Trauma, Trauma and Injury Severity Score, Injury Severity Score and Revised Trauma Score in this setting.MethodsAdult patients directly admitted to the neurosurgical intensive care units of the National Hospital of Sri Lanka between 21st July 2014 and 1st October 2014 with moderate or severe TBI were recruited.A telephone administered questionnaire based on the Glasgow Outcome Scale Extended (GOSE) was used to assess functional outcome of patients at 3 and 6 months after injury. The economic impact of the injury was assessed before injury, and at 3 and 6 months after injury.ResultsOne hundred and one patients were included in the study. Survival at ICU discharge, 3 and 6 months after injury was 68.3%, 49.5% and 45.5% respectively. Of the survivors at 3 months after injury, 43 (86%) were living at home. Only 19 (38%) patients had a good recovery (as defined by GOSE 7 and 8). Three months and six months after injury, respectively 25 (50%) and 14 (30.4%) patients had become “economically dependent”. Selected trauma scores had poor discriminatory ability in predicting mortality.ConclusionsThis observational study of patients sustaining moderate or severe TBI in Sri Lanka (a LMIC) reveals only 46% of patients were alive at 6 months after ICU discharge and only 20% overall attained a good (GOSE 7 or 8) recovery. The social and economic consequences of TBI were long lasting in this setting. Injury Severity Score, Revised Trauma Score, A Severity Characterization of Trauma and Trauma and Injury Severity Score, all performed poorly in predicting mortality in this setting and illustrate the need for setting adapted tools.

BackgroundIntracranial abscesses are rare among transplant recipients, and Nocardia is responsible for less than 2 % of them. Nocardiosis, a chronic infection and is difficult to treat. Primary infection involves lungs and eventually disseminates. Primary nocardial abscesses are rare and we report a case from Sri Lanka.Case presentationA 38 year old Sri Lankan, who has received his 2nd ABO matched live donor transplantation, which was complicated with perinephric hematoma and massive transfusion syndrome. He presented with fever, worsening headache and papilledema. An urgent magnetic resonance image (MRI) showed an occipital abscess with midline shift. Craniotomy and drainage followed by 3 week course of imipenem and levofloxacin, which rendered him symptom free. After 12 months he has stayed recurrence free. Imaging and bacteriology of the respiratory tract failed to demonstrate Nocardia infection.ConclusionIsolated (Primary) nocardial brain abscess are rare, and have an excellent response to medical therapy. We achieved a good response from a relatively short course of antibiotics (not using sulfonamides, due to allergy), where long courses of antibiotic had been the norm.

Background: Head injury is a leading cause of morbidity and mortality among the young. The aim of this audit was to analyze the head injured patients admitted to the neurosurgical unit of the Teaching Hospital Karapitiya. The analysis was according to the type of injury, age, sex distribution and the functional outcome. Method: All details of patients admitted to the neurosurgical unit are computerized. Data collection was done retrospectively for a period of 3 months. Results: Patients with head injury admitted to the neurosurgical unit accounted for 37% of all admissions with trauma. The most affected age group was 20-40 years. Out of the 108 patients admitted, 91 were males giving a male: female ratio of 5.3:1. 15 patients died. Road traffic accidents (RTA) were the commonest cause of head injury. Conclusion: Head injury is mainly due to road traffic accidents and affects the young adult male population.

Introduction:Depression rates are higher in patients with a history of traumatic brain injury than those in the general population. According to the literature 25% of patients meet the criteria for major depression one month after a traumatic brain injury. Sri Lankan data with regard to this are lacking.Aim:To determine prevalence of clinically significant depression among patients with a history of traumatic brain injury who attend the neuro-trauma clinic at National Hospital of Sri Lanka.Methods:A descriptive cross sectional study conducted in neuro-trauma Clinic, National Hospital of Sri Lanka. A Sample of 112 patients who attended the clinic with a history of traumatic brain injury within one year was selected using systematic sampling method. They were interviewed using a self - administered questionnaire to assess presence and degree of depression (Sinhala version of Beck Depression Scale) which was followed by a clinical interview to confirm the results.Results:Hundred and seven (95.5%) were males. Mean age was 37.1 years (Range 17-74). Leading causes of traumatic brain injury were road traffic accidents (36.6%) and accidental falls (30.4%). Thirty two patients (28.5%) had mild depression; 10.7% (n=12) had moderate depression; 1.8% (n=2) had severe depression. Twenty seven (54%) patients did not have depression.Conclusions:A significant proportion of patients with a past history of traumatic brain injury had depression. Every patient diagnosed to have a traumatic brain injury should undergo psychiatric evaluation in the course of their treatment and if they have symptoms of depression need to treat it vigorously.