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Indocyanine green (ICG) video-angiography is used intraoperatively to visualize the vascular integrity during neurovascular surgical procedures [1]. Oxygen desaturation following ICG injection has not been described previously nor is it mentioned in the list of adverse effects of the dye by the manufacturer.We report here a 42-year-old female who underwent clipping of the basilar artery aneurysm. The ICG dye (Aurogreen TM , Aurolab, Madurai, India) was injected at the recommended dose of 0.25 mg/kg before clip application to visualize the vessels and their branches. After clipping, ICG was repeated to confirm correct clip placement and patency of parent and perforator vessels. On both occasions, there was reduction in the pulse-oximeter saturation reading (99-96 %), the decrease more after the second dose (94 %). We had a monitor (Radical-7 Pulse CO-Oximeter (Masimo Corporation, Irvine, CA) where we observed that the methemoglobin level too increased during desaturation from 0.2 to 0.9 % and gradually returned to previous value in 8 min along with return of saturation to 99 %. The patient did not have any complications associated with these changes. This finding was reproducible and consistent in other patients as well. Decreased pulse-oximeter reading has been observed in dogs following ICG administration [2]. Therefore, though the change is insignificant and transient, it is desirable that this effect be listed by the manufacturer in the list of side effects. Caution should be exercised when repeat doses of ICG are administered especially within short periods of time.

Ventriculo peritoneal (VP) shunt uncommonly complicates as intracranial hematomas which can still occur in patients with a functioning VP shunt leading to a delay in the diagnosis which can be extremely dangerous and lead to adverse outcomes. We report a case of an incidental diagnosis of delayed post-operative EDH following VP shunt in an young adult patient with a right cerebellar lesion and highlight the need for meticulous post-operative neurological examination.

Aim Only few studies of hormonal dysfunction in acute setting after traumatic brain injury (TBI) are available in literature with variable results. The aim of the present study was to determine the incidence of anterior pituitary hormone deficiencies, and correlate with in hospital mortality. Methods This study was carried out on 30 patients with moderate to severe TBI presenting within 24 h of injury. Chemiluminiscence immunoassay using an automated chemiluminiscence analyser was used to determine the basal hormone levels. Thyroid stimulating hormone (TSH), prolactin (PRL), cortisol, growth hormone (GH), and testosterone in males or luteinizing hormone (LH) and follicle stimulating hormone (FSH) in females were measured. Results Out of the 30 cases, 12 cases underwent surgery for various reasons. Six patients expired, and all of them had a poor GCS at presentation (mean 4.8 ? 0.9). In the acute setting high cortisol level showed a trend towards significance (p = 0.097) in terms of mortality. Other hormonal levels were also found to be abnormal, but no conclusion could be drawn due to small number. Conclusion Anterior pituitary hormone imbalance is common after TBI in acute setting. Elevated cortisol is associated with increased mortality.

Background:Ventilator-associated pneumonia (VAP) is a common complication with endotracheal intubation. The occurrence of VAP results in significant mortality and morbidity. Earlier studies have shown reduction in the incidence of VAP with subglottic secretion drainage. The incidence of VAP in neurologically injured patients is higher and can impact the neurological outcome. This study aimed to compare the incidence of VAP with standard endotracheal tube (SETT) and suction above cuff endotracheal tube (SACETT) in neurologically ill patients and its impact on clinical outcome.Methods:Fifty-four patients with neurological illnesses aged ≥18 years and requiring intubation and/or ventilation and anticipated to remain on ETT for ≥48 h were randomized to receive either SETT or SACETT. All the VAP preventive measures were similar between two groups except for the difference in type of tube.Results:The data of 50 patients were analyzed. The incidence of clinical VAP was 20% in SETT group and 12% in SACETT group; (P = 0.70). The incidence of microbiological VAP was higher in the SETT group (52%) as compared to SACETT group (44%) but not statistically significant; (P = 0.78). There was no difference between the two groups for measured outcomes such as duration of intubation, mechanical ventilation, and Intensive Care Unit stay.Conclusions:In this pilot study in neurological population, a there was no significant difference in incidence of clinical and microbiological VAP was seen between SETT and SACETT, when other strategies for VAP prevention were similar. Other outcomes were similar with use of either tube for intubation.