JNMA; journal of the Nepal Medical Association
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JNMA J Nepal Med Assoc · Oct 2008
Case ReportsSpontaneous intracystic hemorrhage of the arachnoid cyst: a case report and review of literature.
Arachnoid cysts represent benign cysts that occur in the cerebrospinal axis in relation to the arachnoid membrane and do not communicate with the ventricular system. We report a case of a years right handed lady, who presented to the emergency department with the complaints of headache and vomiting for one week CT scan showed extraaxial cystic lesion in the left fronto-parietal region. On the fifth day of admission, patient had sudden onset of severe headache associated with loss of consciousness for about 3-4 minutes with neck rigidity. ⋯ Intraoperatively, there was intradural cystic lesion containing xanthochromic fluid with normal brain surface and there were no evidence of any vascular malformations. Marsupilization of the cystic lesion was carried out and she improved. The literature regarding arachnoid cyst with spontaneous intracranial haemorrhage is reviewed.
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Tracheal agenesis is a rare but uniformly fatal congenital condition that obstetricians, neonatologists or anaesthesiologists may encounter as an unexpected emergency. Ventilation with bag and mask or through an endotracheal tube placed in the oesophagus may be the only options left for immediate survival and evaluation. ⋯ We report a case of neonate in which ventilation and anaesthesia were maintained through an endotracheal tube in the oesophagus and frequent episodes of drop in oxygen saturation were observed during surgery. Anaesthetic management, airway and other issues are discussed.
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A retrospective study of 68 eclamptic women who received Magnesium sulphate at Koshi Zonal Hospital were analyzed during a one year period (2006-2007 AD). Maternal conditions at admission, associated complications in mothers and babies, delivery outcomes and cause of death were also studied in each case. There were 5240 deliveries during the period of analysis. ⋯ Eclampsia is a major cause of maternal and perinatal morbidity and mortality in our setup. Magnesium sulphate is an excellent drug of choice in management of eclampsia and pre-eclampsia. Wider coverage of pre-natal care, timely referral and optimal management of cases of eclampsia with magnesium sulphate in hospitals are key issues to prevent mortality/morbidity associated with it.
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JNMA J Nepal Med Assoc · Jul 2008
Case ReportsIntracranial ricocheting of bullet from anterior clinoid process.
Gunshot wounds to the head are usually mortal injuries. We present a unique case of intracranial ricocheting of bullet without neurological deficits. Patient was treated conservatively with antibiotics for one week and prophylactic anticonvulsants for six weeks. ⋯ Repeat X-ray skull showed that bullet was lying in the occipital region. It is recommended that deep seated bullets should be left behind as any attempt to remove that bullet may increase the morbidity and mortality. However close follow up of these patients is very important as these patients may come back with brain abscess.
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JNMA J Nepal Med Assoc · Jul 2008
Children with first episode of fever with seizure: is lumbar puncture necessary?
Fever with seizure, a common presentation with which a child may present to the emergency is mainly due to febrile seizure, but it may also be due to meningitis. This study was done to find out the incidence of meningitis and to find out whether lumbar puncture is necessary in different age groups of children presenting with first episode of fever with seizure. A prospective study was conducted in the emergency department of Kanti Children's Hospital. ⋯ Organisms grown were Haemophilus influenza in three cases, Streptococcus pneumoniae in two cases and Staphylococcus aureus in three cases. In conclusion, incidence of meningitis was found to be high in children presenting with first episode of fever and seizure. Lumbar puncture to rule out meningitis should especially be considered in children in the younger age group even without evidence of meningeal irritation.