Epilepsy-Related Injuries in Children: An Institution-Based Study

BACKGROUND

Epilepsy carries a lifetime risk of seizure-related accidents. The risk varies according to the socioeconomic profile of a place. Sufficient data is lacking for epilepsy-related accidents in the pediatric population.

OBJECTIVE

We aimed to identify the proportion of pediatric epileptic patients who met with accidents and their associated factors.

METHODS

A prospective study was done. Patients of less than 18 years with epilepsy of more than 1-year duration were included and were given a questionnaire modified for the pediatric population. The demography of accidents during seizures and drugs taken were recorded.

RESULTS

135 epileptic children were included. 70.4% of patients suffered seizure-related accidents ranging from 1-10 accidents in their epilepsy duration. Falls (83.15%) were the most common, 25.26% of them required hospitalization. Accidents due to missing of drug dosage were observed in 23% patients.

CONCLUSION

Seizure-related accidents are common in the pediatric population, and may lead to major accidents. Better epilepsy management with extra care for high-risk epilepsy patients may decrease their incidents.

Endoscopic Anterior Cervical Discectomy (Disc Preserving)

Background and Introduction

Endoscopic anterior cervical approach has several advantages compared to conventional anterior cervical discectomy and fusion (ACDF).

Objective

This video demonstrates a step-by-step procedure for endoscopic anterior cervical discectomy.

Procedure

The patient is placed supine with the neck extended. A standard anterior cervical approach using about 3 cm skin incision is made and under "Easy Go" (Karl Storz, Tuttlingen, Germany) endoscopic vision, the uncinate process and uncus are drilled. Only a small portion of the normal disc, posterior longitudinal ligament (PLL), and compressing disc is removed. The closure is done in a standard manner.

Results

In 240 patients, the average postoperative reduction in disc height, operating time, and blood loss were 1.1 ± 0.2 mm, 110 ± 17 min, and 30 ± 11 mL, respectively. The average postoperative VAS score and Nurick grading improved significantly. There were no permanent complications or any mortality.

Conclusion

Endoscopic technique is an effective and safe alternative to ACDF after attaining the learning curve.

Spastic quadriparesis due to pathological fracture of odontoid secondary to carcinoma prostate: A rare presentation

Prostate carcinoma presenting as symptomatic metastases to atlantoaxial spine is extremely rare. Spastic quadriparesis due to pathological fracture of odontoid as the only initial manifestation without symptoms of primary malignancy is rarer still. We report a 64-year-old male who presented with progressive spastic quadriparesis along with urinary retention of 3 weeks duration. Computed tomography and magnetic resonance imaging cervical spine and craniovertebral junction showed type III pathological fracture of odontoid with anterior translation of C1 with spinal cord compression. Biopsy from an enlarged prostate showed adenocarcinoma of prostate. The patient was managed conservatively from neurological aspect as he refused for any surgical intervention.

Prevalence of hypothalamo pituitary dysfunction in patients of traumatic brain injury

BACKGROUND

Traumatic brain injury (TBI) is common in young soldiers of armed forces leading to significant morbidity and mortality. We studied the prevalence of hypopituitarism following TBI and its association with trauma severity.

MATERIALS AND METHODS

We conducted a 12-month prospective study of 56 TBI patients for the presence of hormonal dysfunction. Hormonal parameters were estimated during the early phase (0-10 days posttraumatically) and after 6 and 12 months. Dynamic testing was done when required, and the results were analyzed by appropriate statistical methods.

RESULTS

Hormonal dysfunction was seen in 39 of the 56 (70%) patients at initial assessment. Persisting pituitary deficiencies are seen in 7 and 8 patients at the end of 6 months and 12 months, respectively. Hypogonadotropic hypogonadism, hypothyroidism, and growth hormone deficiency are the most common diagnoses. Initial severe TBI and plurihormonal involvement predicted the long-term hypopituitarism.

CONCLUSION

Early hypopituitarism was common in severe TBI, but recovers in majority. Evaluation for the occult pituitary dysfunction is required during the rehabilitation of TBI patients.

Evaluation of mannitol as an osmotherapeutic agent in traumatic brain injuries by measuring serum osmolality

BACKGROUND

The effectiveness of mannitol as an osmotherapeutic agent has never been subjected to a controlled clinical trial against placebo. Excessive use of mannitol in brain trauma patients can result in hyperosmolar states, hypernatremia and renal failure. This prospective study was conducted to evaluate the institutional protocol of using mannitol and assess its effects on serum osmolality.

METHOD

Thirty patients with brain injury were included in the study. All the patients were given 100 mL of 20% mannitol three times a day as bolus infusion over 20-30 minutes. Serum osmolality was measured at 12 hourly intervals using Fiske osmometer. Mannitol administration was stopped whenever serum osmolality reached ≥ 320 mOsmol/Kg H2O. The total dose and duration of mannitol used to reach target osmolality of ≥ 320 mOsmol/Kg H2O was recorded.

RESULTS

On 33% of all occasions, the patients had a serum osmolality which was in excess of the desired values (i.e. ≥ 320 mOsmol/Kg H2O). This indicates that the standard protocol of administering 20% mannitol 100 mL three times a day for more than 48 hours is perhaps excessive.

CONCLUSION

The mannitol therapy should be guided by 12 hourly measurement of serum osmolality. Mannitol should be used for 48 hours only if facilities for measuring serum osmolality are not available.

Management of Spontaneous Intracerebral Haemorrhage

BACKGROUND

Management of spontaneous intracerebral haemorrhage (SICH) is still an enigma. The study was conducted to find out the most appropriate mode of treatment and other possible inclusion criteria's in addition to clot size.

METHODS

Sixty consecutive patients of SICH excluding bleeds due to arteriovenous malformations/aneurysm were included in the study. Patients with moderate and large bleeds, progressive neurological deficit and glasgow coma scale (GCS) of more than five were included in the surgical group and rest treated conservatively.

RESULT

Location of the bleed, other co-morbid conditions and GCS at presentations were more important guidelines than size of the bleed. Mortality was more in surgically treated group where cerebellar bleed fared well after evacuation.

CONCLUSION

Surgery is preferred in superficially located bleeds and cerebellar bleeds. Intra cranial pressure monitoring will help in categorizing the mode of treatment better than mere clot size.

Intraoperative blood glucose levels in neurosurgical patients : an evaluation of two fluid regimens

Based on the evidence that hyperglycaemia aggravates ischaemic cerebral injury, it has been suggested that blood glucose levels be kept within 200 mg/dL during intracranial neurosurgery. Hypoglycaemia, however, can be a serious problem if glucose-containing solutions are avoided during the first four hours, as suggested in some studies. In order to explore the possibility of administering glucose in moderation so that the blood glucose levels are within acceptable limits, but at the same time the risk of hyoglycaemia is eliminated, we compared two intraoperative fluid regimens. Of the 52 neurosurgical patients studied, 32 patients received alternately 500 ml of 5% dextrose in normal saline and Ringer's lactate (DNS/RL Group) and 18 patients received alternately 500 ml of Ringer's lactate and normal saline (RL/NS Group). Blood glucose concentrations were determined at the end of each unit of fluid, until the patient received 4 units of fluid. In the DNS/RL group, blood glucose values peaked with the administration of each unit of DNS and tended to return towards the baseline with the subsequent RL, but remained higher than the previous control value. In the RL/NS group, there was a progressive increase in blood glucose values throughout the study period, but the increase was not statistically significant. The blood glucose levels were significantly different between the two groups after each unit of fluid except at the end of the fourth unit. Two patients in the RL/NS group had hypoglycaemia. In conclusion, the DNS/RL regimen maintains blood glucose levels within acceptable limits while avoiding the risk of hyperglycaemia. Withholding glucose completely, lowers blood glucose levels, but carries a risk of hypoglycaemia in some patients.

Lp norm design of stack filters

This paper addresses the problem of designing optimal stack filters by employing an Lp norm of the error between the desired signal and the estimated one. It is shown that the Lp norm can be expressed as a linear function of the decision errors at the binary levels of the filter. Thus, an Lp-optimal stack filter can be determined as the solution of a linear program. The conventional design of using the mean absolute error (MAE), therefore, becomes a special ease of the general Lp norm-based design developed here. Other special cases of the proposed approach, of particular interest in signal processing, are the problems of optimal mean square error (p=2) and minimax (p-->infinity) stack filtering. Since an Linfinity optimization is a combinatorial problem, with its complexity increasing faster than exponentially with the filter size, the proposed Lp norm approach to stack filter design offers an additional benefit of a sound mathematical framework to obtain a practical engineering approximation to the solution of the minimax optimization problem. The conventional MAE design of an important subclass of stack filters, the weighted order statistic filters, is also extended to the Lp norm-based design. By considering a typical application of restoring images corrupted with impulsive noise, several design examples are presented, to illustrate the performance of the Lp-optimal stack filters with different values of p. Simulation results show that the Lp-optimal stack filters with p=or>2 provide a better performance in terms of their capability in removing impulsive noise, compared to that achieved by using the conventional minimum MAE stack filters.

Toxicity of Parthenium hysterophorus L. to cattle and buffaloes

Parthenium hysterophorus L., when fed to buffalo bull calves and cross bred bull calves resulted in acute toxicity leading to death. The former animals developed severe dermatitis. Autopsy revealed ulceration of alimentary tract. Extensive pathological changes were noticed in liver, kidney and skin.