Nepal Journal of Neuroscience https://www.nepjol.info/index.php/NJN <p>Official journal of the Nepalese Society of Neurosurgeons (NESON). Also available on its own site at <a title="NESON" href="http://neson.org/" target="_blank" rel="noopener">http://neson.org/</a></p> <p>The Nepal Journal of Neuroscience is now accepting online submissions. Please <a href="/index.php/NJN/user/register">register</a> with the journal and select the author role to be able to submit your manuscript using the 5 step submission process.</p> en-US njns2004@yahoo.com (Dr Resha Shrestha) sioux.cumming@ubiquitypress.com (Sioux Cumming) Tue, 15 Mar 2022 17:45:33 +0000 OJS 3.3.0.6 http://blogs.law.harvard.edu/tech/rss 60 Reversible Splenial Lesion Syndrome developing in the setting of sleep deprivation https://www.nepjol.info/index.php/NJN/article/view/36628 <p>In this report, we present a rare case of reversible splenial lesion syndrome which was etiologically associated with sleep deprivation. Up to our knowledge, there is no previous research reporting sleep deprivation as an inducer agent of RESLES. To elucidate our observation, future reports of larger case series are surely warranted. The clarification of the possible association between sleep deprivation and the reversible splenial lesion may also provide substantial perspectives regarding the mechanisms and health impact of sleep deprivation; the functional and pathophysiological role of the splenial corpus callosum in sleep physiology. Besides, we think that the awareness of this entity should increase among clinicians to avoid unnecessary investigations as the case in our patient.</p> Halil Onder, Tulin Akturk, Hikmet Sacmaci Copyright (c) 2021 Nepalese Society of Neurosurgeons (NESON) http://creativecommons.org/licenses/by-nc/4.0 https://www.nepjol.info/index.php/NJN/article/view/36628 Wed, 16 Mar 2022 00:00:00 +0000 Fetal Ventricular Dilation; prelude to Dandy-Walker Syndrome and Hydrocephalus: Synopsis of Two Case Reports https://www.nepjol.info/index.php/NJN/article/view/40252 <p>Accurate measurement of the 3<sup>rd</sup> and 4<sup>th</sup> ventricles is important in cases of prenatal and postnatal diagnosis of suspected cranial anomalies. Ventricular dilation occurs with excess fluid in the embryologic ventricles during brain development, we make a comparative analysis of two case reports on a 23rd-week fetus and a 10-month-old neonate. Ultrasound findings related to horns and ventricular system through transfontanelle ultrasound (excluding any &gt; 95<sup>th</sup> error margin and &lt; 5<sup>th</sup> percentile) can be utilized for a specific diagnosis of ventricular dilation. Hydrocephalus is defined as the accumulation of excessive CSF resulting in dilation of the cerebrospinal compartment in the calvaria; which can be acquired or congenital in origin. Hydrocephalus can also be seen due to obstructed flow, faulty absorption, and overproduction of CSF (in the subarachnoid space) by a choroid plexus papilloma. The diameter of the anterior horn of the RT and LT (hydrocephalic) lateral ventricles measured 15.3mm and 14.1mm respectively, far above the threshold for normal (control) neonates / RT and LT (anterior) lateral ventricles averaging 2.40mm and 2.51mm. These documented findings indicate the excellent agreement between fetal brain sonography in the diagnosis of fetal ventriculomegaly (anterior horn/ 10.4mm) and dilation (combined 40.8mm). Mean Head Circumference (MHC) for neonatal hydrocephalus was 44.2cm far above the normal average of 36.7cm. When we assessed the clinical benchmark of 10mm or (&gt;19mm) for the neonate ventricle, it was far above the normal range (greater than &gt; 95<sup>th</sup> percentile value).</p> Adam Moyosore AFODUN, Khadijah Kofoworola Quadri, Mustapha Akajewole MASUD, Sulaiman Oluwadare Sheu, Katembo Sikakulya Franck, Olatayo Segun Okeniran, Raymond Joseph Malinga, Julius Namasake Wandabwa Copyright (c) 2022 Nepalese Society of Neurosurgeons (NESON) http://creativecommons.org/licenses/by-nc/4.0 https://www.nepjol.info/index.php/NJN/article/view/40252 Tue, 15 Mar 2022 00:00:00 +0000 Bruns–Garland syndrome precipitated by anti-tuberculous therapy in a patient with type 2 diabetes mellitus https://www.nepjol.info/index.php/NJN/article/view/40952 <p>India has a high prevalence of tuberculosis as well as diabetes mellitus, and both contribute to a major disease burden. Diabetes mellitus increases the risk of tuberculosis. Patients with diabetes are more prone to develop cavitary lesions than non-diabetics. Tuberculosis can worsen the glycemic status of an individual and anti-tuberculous drugs like Rifampicin can interact with oral anti-diabetic drugs, further worsening the glycemic control. This can result in complications related to diabetes, like diabetic amyotrophy. We hereby report the case of a 69-year-old gentleman with diabetes mellitus, who developed uncontrolled blood sugars, leading to Bruns Garland syndrome or diabetic amyotrophy on starting anti-tuberculous therapy for sputum positive pulmonary tuberculosis.</p> Amith, Sheetal S Copyright (c) 2022 Nepalese Society of Neurosurgeons (NESON) http://creativecommons.org/licenses/by-nc/4.0 https://www.nepjol.info/index.php/NJN/article/view/40952 Tue, 15 Mar 2022 00:00:00 +0000 Temporal lobe parenchyma herniation: An etiological cause of headache or coexistence? https://www.nepjol.info/index.php/NJN/article/view/39152 <p>This report illustrates a patient presenting with a unilateral headache at whom brain magnetic resonance imaging showed temporal lobe parenchyma herniation. In our patient, there were no clinical or neuroimaging findings of increased intracranial pressure (ICP) that might lead to a headache. On the other hand, considering the dynamic nature of headache in our patient, we cannot exclude a mechanism of possible episodic ICP increments that might be related to encephalocele. We think that the detailed illustration of this case may present substantial perspectives for further deliberations regarding the headache pathophysiology.</p> Halil Onder, Beria Ertugrul, Yasemin Eren, Fatma Yılmaz Can, Selcuk Comoglu Copyright (c) 2022 Nepalese Society of Neurosurgeons (NESON) http://creativecommons.org/licenses/by-nc/4.0 https://www.nepjol.info/index.php/NJN/article/view/39152 Wed, 16 Mar 2022 00:00:00 +0000 Role of Lumboperitoneal shunt in CSF diversion: Outcome in common indications and beyond https://www.nepjol.info/index.php/NJN/article/view/39292 <p> </p> <p>Dr. Sameer Aryal<sup>1</sup>, Dr. Ramchandra Shrestha<sup>1</sup>, Dr. Alok Deo<sup>1</sup>, Dr. Gopal Raman Sharma<sup>1</sup></p> <p><sup>1</sup><em>Dhirghayu Guru Hospital, Chabahil, Kathmandu</em></p> <p><strong>Introduction: </strong>A Lumboperitoneal shunt is a procedure of diverting Cerebrospinal Fluid from the lumbar thecal sac to peritoneum. Common indications are Idiopathic Intracranial Hypertension (IIH), Normal Pressure Hydrocephalus (NPH), recurrent CSF fistulas, growing skull fractures etc. It has been often used as a last resort in patients with communicating hydrocephalus who underwent multiple failed ventriculostomy procedures. We present our study of 14 cases of LP shunting done for common indications, we retrospectively analyzed the clinical data of these cases and present our outcome.</p> <p><strong>Objective:</strong> Objective of this study was to evaluate the outcome of Lumboperitoneal Shunt and assess its overall role in cerebrospinal fluid diversion procedures.</p> <p><strong>Materials &amp; Methods:</strong> Retrospective Study (June 2015- January 2020)</p> <p><strong>Results: </strong>A total of 14 cases (6 males and 8 females) were operated from June 2015 to January 2020.Majority of the cases 64.3% (n= 9) were IIH, 21.4% (n=3) were cases of NPH and 14.3% (n=2) were cases of communicating hydrocephalus. Two cases presented with repeat of symptoms after initial improvement and underwent shunt revision. Blockage of thecal catheter due to kinking was found in both cases. Symptomatic improvement was seen in all cases.</p> <p><strong>Conclusion: </strong>These results show that Lumboperitoneal Shunt is an excellent option in cerebrospinal fluid diversion whenever indicated. It carries low risk and has good outcome.</p> <p> </p> <p><strong>Key Words:</strong> Lumboperitoneal, shunt, theco-peritoneal, idiopathic, benign, intracranial, hypertension, cerebrospinal, fluid, diversion, normal, pressure, hydrocephalus</p> Sameer Aryal Copyright (c) 2022 Nepalese Society of Neurosurgeons (NESON) http://creativecommons.org/licenses/by-nc/4.0 https://www.nepjol.info/index.php/NJN/article/view/39292 Tue, 15 Mar 2022 00:00:00 +0000 Changing paradigm in learning in the field of Neurosciences during COVID-19. https://www.nepjol.info/index.php/NJN/article/view/43657 <p>Although the number of COVID-19 cases are decreasing in recent days and a sense of normality can be felt, the situation was completely different for a couple of years. Like most of the fields, learning in the field of neurosciences was also heavily impacted due to COVID-19. Multiple ways of learning gained popularity during the pandemic which has changed the way neuroscience is taught and learnt these days.</p> Resha Shrestha Copyright (c) 2022 Nepalese Society of Neurosurgeons (NESON) http://creativecommons.org/licenses/by-nc/4.0 https://www.nepjol.info/index.php/NJN/article/view/43657 Tue, 15 Mar 2022 00:00:00 +0000 Primary Spinal Schwannoma: A Single Center Study Of 37 consecutively Operated Cases https://www.nepjol.info/index.php/NJN/article/view/41113 <p>Primary spinal Schwannoma (PSS) remains uncommon nerve sheath tumor of the spine with male preponderance and presenting in fourth to fifth decades. They arise from the Schwann cells in sensory root as PSS or part of Neurofibromatosis 2.</p> <p>This is a retrospective study of histopathologically confirmed cases of PSS treated between 2010 to 2021. They were operated and age, sex, clinic-radiological findings, surgical technique used and outcome studied. Laminectomy or laminoplasty or combined anterior-posterior approach was used with either an intracapsular or extracapsular tumor removal. Follow-up was at 15 days, 2 months, 6 months and yearly intervals.</p> <p>There were 37 cases operated with age ranging from 16 to 81 years and majority in the 21–40-year group (40%) followed by 41 to 60 years (32%). There were 22 males and 15 females. Localized pain in the back or cervical region was the commonest finding (75%) followed by myelopathy in 38%, radiculopathy in 35% and bladder disturbances in 13%. They were most common in the lumbar region (35%) followed by thoracic (30%). With relation to the level and sex, the cervical level showed equal sex distribution while the rest had male preponderance</p> <p>PSS although can frequently present to the spine surgeon and the diagnosis is clinched with help of an MRI. Surgery remains the main modality of treatment either by laminectomy, laminoplasty or minimal invasive spine surgery. The nerve root of origin must be preserved in all that can be aided with help of intraoperative neurophysiological monitoring.</p> Yam Bahadur Roka, Mohan Karki, Arati Dahal Chettri Copyright (c) 2022 Nepalese Society of Neurosurgeons (NESON) http://creativecommons.org/licenses/by-nc/4.0 https://www.nepjol.info/index.php/NJN/article/view/41113 Tue, 15 Mar 2022 00:00:00 +0000 Comparison of scoring tools EMSE and STESS for the prediction of in-hospital mortality in convulsive status epilepticus in adults and the elderly https://www.nepjol.info/index.php/NJN/article/view/41968 <p><strong>Aim</strong>: The aim of this study was to compare the predictive accuracy of the Status Epilepticus Severity Score (STESS) and the Epidemiology-based Mortality Score in Status Epilepticus—etiology, age, and levels of consciousness (EMSE-EAL) score for in-hospital mortality in adults and the elderly with CSE.</p> <p><strong>Methods:</strong> We conducted a hospital-based cross-sectional study. A total of 193 participants with a diagnosis of CSE were enrolled in the study. The means area under the receiver operating characteristic curve (AUC) was compared to distinguish between the score performances.</p> <p><strong>Results:</strong> The average age of the respondents was 46.15 ± 20.25 years; 138 (69.8%) of them were adults, and 55 (30.2%) were elderly. In our study, in-hospital mortality was 30 (15.5%). In adults, on comparison STESS with the cutoff value of ≥3 has an AUC of 0.712 (95 percent CI =0.60–0.83), whereas ESME-EAL with the cutoff value of ≥40 has an AUC of 0.912 (95 percent CI =0.86–0.97), and in the elderly, STESS has an AUC of 0.613 (95 percent CI =0.43–0.80), and ESME-EAL has AUC of 0.848 (95% CI =0.74–0.80).</p> <p><strong>Conclusions:</strong> The EMSE-EAL-40 score is superior to the STESS-3 for predicting in-hospital mortality in both adults and the elderly with CSE. EMSE-EAL can be easily applied in resource-poor sectors with constrained diagnostic facilities.</p> Archana Verma, Alok Kumar, Manoj Kumar Verma Copyright (c) 2022 Nepalese Society of Neurosurgeons (NESON) http://creativecommons.org/licenses/by-nc/4.0 https://www.nepjol.info/index.php/NJN/article/view/41968 Tue, 15 Mar 2022 00:00:00 +0000 Experience with Atorvastatin in Conservative Management of Chronic Subdural Hematoma with Brief Review of Literature https://www.nepjol.info/index.php/NJN/article/view/41114 <p>Chronic subdural hematoma (CSDH) is one of the most common neurosurgical procedure done in any neurosurgical unit worldwide. The majority of CSDH are operated upon and there are very few studies regarding its conservative management. Mannitol, Steroids, Tranexemic acid, middle meningeal artery embolization and Angiotensin Converting Enzyme inhibitors are some options to treat CSDH conservatively. Atorvastatin is one of the newer and novel drugs that has been used effectively to medically treat CSDH.</p> <p>This is a retrospective study of 20 cases of CSDH that were managed conservatively with atorvastatin between 2015 to 2021.</p> <p>A total of 20 (7.5%) cases were included in the study period (January 2015 – January 2021). Glasgow Coma Score (GCS)/ Markwalder score (MS), mode of injury if any, age, sex, symptoms and neurological findings, co-morbidities, anti-platelet use, radiological finding of midline shift at admission and outcome with Glasgow outcome score (GOS) at the end of two months after treatment recorded. Atorvastatin in dose of 20 mg daily was given for maximum of two months with repeat CT/MRI scans done at 2 months. Repeat scan was done at 2 weeks and at 2 months and all of them showed complete resolution of the CSDH radiologically.&nbsp; The Glasgow outcome score showed good improvement in all the cases although there was mild confusion in five of the elderly which can be attributed to age related behavior changes.</p> <p>We conclude that atorvastatin can be used safely in not only elderly but also in younger subjects.</p> Yam Bahadur Roka, Mohan Karki, Arati Dahal Chettri Copyright (c) 2022 Nepalese Society of Neurosurgeons (NESON) http://creativecommons.org/licenses/by-nc/4.0 https://www.nepjol.info/index.php/NJN/article/view/41114 Tue, 15 Mar 2022 00:00:00 +0000 Non epileptic attack disorder, Psychiatric co morbidities and their outcomes: NEAD & Psychiatric Comorbidity https://www.nepjol.info/index.php/NJN/article/view/41064 <p><strong>Background</strong>: NEAD is a common presentation in epilepsy clinics and is often misdiagnosed. This study was therefore planned to understand the prevalence of psychiatric co morbidities in patients diagnosed as NEAD and to study the outcome of both the conditions over 6 months with pharmacotherapy and supportive psychotherapy.</p> <p><strong>Material &amp; Method:</strong> 71 patients of NEAD were enrolled and assessed on SCID 1 to diagnose psychiatric co morbidity with rating of severity of anxiety &amp; depression on HDRS &amp; HARS.</p> <p>Patients were divided into Groups A &amp; B depending on the presence or absence of existing co-morbid psychopathology respectively and were followed up over 6 months to assess outcomes. Psychiatric medication was given to Group A patients and both groups received supportive psychotherapy on follow up.</p> <p><strong>Results:</strong> Group A had 50 patients with psychiatric co morbidity and Group B included 21 patients.&nbsp; Depressive disorders were common psychopathology and follow up at 3&amp; 6 months revealed a reduction in the total mean scores of HARS and HDRS from baseline. Outcome of NEAD at the end of 6 months revealed 100% reduction in 28% and 50% reduction in 15 – 16% of both group patients.</p> <p><strong>Conclusions:</strong> There are very few Indian studies on short or long term outcomes of NEAD and there is a need to create awareness among the treating physicians regarding the impact of associated psychiatric co morbidities which would affect the prognosis of NEAD.</p> Neena Sawant, Maithili Umate Copyright (c) 2022 Nepalese Society of Neurosurgeons (NESON) http://creativecommons.org/licenses/by-nc/4.0 https://www.nepjol.info/index.php/NJN/article/view/41064 Tue, 15 Mar 2022 00:00:00 +0000 Radiological comparison of the biomechanical characteristics of short segment posterior instrumentation (Moss- Miami system), with and without transverse connector, in unstable thoraco-lumbar fracture https://www.nepjol.info/index.php/NJN/article/view/38548 <p>Introduction: Wedge compression fracture was most common type of fracture (66.6 %) and first Lumbar vertebra (L1) was the most common fracture site (38 %). The choice of surgical approach and instrumentation depends on fracture type, injury level and degree of neural injury. This paper evaluated efficacy of transpedicular screw fixation by Moss Miami instrumentation with transverse connector for surgical treatment in traumatic unstable thoraco-lumbar fractures.</p> <p>Materials and Method: Fifty-five cases were prospectively studied over three years.&nbsp; Comparison was done between two groups- Group 1 without transverse connector and Group 2 with transverse connector. Radiologically evaluation was done in both groups pre-operatively, tenth day, six weeks and six months interval. All X-rays were assessed by lateral and dynamic antero- posterior views for measuring kyphotic (cobb’s) angle and inter-rod angle.</p> <p>Results: In both groups post-operative Mean Cobb’s angle level were increased and remained same until 6months. Variation in Group 2 with transverse connector was slightly higher in initial period (i.e.) after 10 days and then it remains minimal from 6 weeks to 6 months. But in Group 1 without transverse connector the change in angle variation was minimal which worsen over 6 weeks and it continues to remain worse at 6 months, suggestive of parallelogram effect.</p> <p>Conclusion: Transverse connector does play role in preventing parallelogram effect of implants and provides additional stability to the construct. This is first study done in vivo which is done to study the role of transverse connector and evaluate any parallelogram effect in spinal instrumentation.</p> <p><strong>Key words</strong></p> <p>Transverse connector, Thoraco-lumbar fracture, parallelogram effect</p> Anand Doshi, Prashant Khandelwal, Sejal Metha, Sudhir Sudumbrekar Copyright (c) 2022 Nepalese Society of Neurosurgeons (NESON) http://creativecommons.org/licenses/by-nc/4.0 https://www.nepjol.info/index.php/NJN/article/view/38548 Wed, 16 Mar 2022 00:00:00 +0000 Risk factors for Deliberate Self Harm in Bipolar Affective Disorder patients presenting to Tertiary care center- A cross-sectional study https://www.nepjol.info/index.php/NJN/article/view/40505 <p><strong>Abstract:-</strong></p> <p><strong>Background:</strong> Deliberate Self Harm (DSH) is a complex event, associated with psychosomatic, biological, social factors and psychiatric disorders. Current literature shows that, there is rise in DSH in psychiatric disorders and it has been recognised as major public health problem in India. So, objective of this study was to assess the underlying risk factors for DSH in patients with Bipolar Affective Disorder (BPAD).</p> <p><strong>Methods:</strong></p> <p>This cross-sectional study was conducted on 150 patients diagnosed with BPAD as per International Classification of Diseases; tenth revision (ICD-10). Semi-structured socio-demographic proforma was used to record basic profile. Deliberate self harm inventory (DSHI) was administered to assess the type of DSH. Young Mania Rating scale and Beck Depression Inventory were used to assess severity of symptoms.</p> <p><strong>Results:</strong></p> <p>Prevalence of DSH in present study was 33%. In socio-demographic profile, younger age group, lower education levels and being single were significant risk factors for DSH (p- value &lt;.001, .016 and &lt;.001 respectively) and among clinical variables, early years of disorder, severe mania, moderate and severe depressive episode in presence of medium to high suicidal intent, family history of mood disorders and co-morbid substance use and medical disorder were significant risk factors for DSH in BPAD with statistical significance (p&lt;.0001).</p> <p><strong>Conclusion:</strong></p> <p>DSH is considered to be the significant predictor of suicide. BPAD is associated with high risk of DSH, which can be present in either depressive or manic episode. Patients with BPAD in early years of illness, should be evaluated thoroughly for risk factors, so that DSH risk can be minimised</p> Fakirappa B Ganiger, Manisha Sharma, Somashekhar Bijjal Copyright (c) 2022 Nepalese Society of Neurosurgeons (NESON) http://creativecommons.org/licenses/by-nc/4.0 https://www.nepjol.info/index.php/NJN/article/view/40505 Tue, 15 Mar 2022 00:00:00 +0000 Ex-vivo preservation technique of autologous bone flap in resource limited settings: Retrospective analysis of outcome based on single institute of Nepal https://www.nepjol.info/index.php/NJN/article/view/40675 <p><strong>Objective</strong>:&nbsp;Ex-vivo preservation of autologous bone flap for cranioplasty involves various techniques but there are no fixed guidelines as preservation time, temperature ,technique differs. It was&nbsp;&nbsp;preserved submerging in the mixture of 10% betadine and 80 % ethyl alcohol solution in an airtight container in &nbsp;refrigerator at constant temperature of 0 ﹾ&nbsp;C and was autoclaved 1 hour before reimplantation. The Primary objective of the study is to analyze &nbsp;Surgical site infection (SSI) ,secondary &nbsp;its association with dependent variables age,sex,mode of injury, number of procedure performed .</p> <p><strong>Materials and methods</strong>: This is a retrospective study conducted in Nepal Mediciti hospital &nbsp;from September 2017 to November 2019 .Data of all patients who underwent cranioplasty was reviewed from medical record and&nbsp;U/L autologous bone cranioplasty preserved with this technique were included and other were excluded from the study.The primary outcome&nbsp;SSI&nbsp;was classified according to guidelines of the centers of disease control(CDC) and stablished with organism isolated in the culture.</p> <p><strong>Results</strong>: Only 66 out of 78 cranioplasty was included in this study .The majority was male 83.3%.The mean age was 37.16(standard deviation [SD]±14.58).The SSI was 7.5% and was associated with number of procedures performed (p0.08).RTA was major cause of cranioplasty in 60.61%.</p> <p><strong>Conclusion</strong>: Ex-vivo preservation of autologous bone flap for cranioplasty with this technique is safe to be applied in resource limited settings as it can produce similar results as &nbsp;other techniques.</p> <p>&nbsp;</p> <p>&nbsp;</p> <p>&nbsp;</p> Sumit Joshi, Prakash Paudel, Prasanna Karki, Dambar Bikram Shah, Gopal Raman Sharma Copyright (c) 2022 Nepalese Society of Neurosurgeons (NESON) http://creativecommons.org/licenses/by-nc/4.0 https://www.nepjol.info/index.php/NJN/article/view/40675 Tue, 15 Mar 2022 00:00:00 +0000 Textiloma Misdiagnosed as Paraspinal Abscess During the Period of COVID-19 Pandemic: Case Report https://www.nepjol.info/index.php/NJN/article/view/42462 <blockquote> <p>Retained surgical sponge and consequent foreign body reaction is a well-documented complication. In the current literature, the phenomenon has many names such as textiloma, gossypiboma, gauzoma, and muslinoma. While it is one of the widely reported topics, only a few cases are reported by neurosurgeons. Herewith we present a case of textiloma in Turkey who had repeated surgical interventions at various hospitals during the COVID-19 pandemic, possibly due to breakdown of preventive measures against retention of surgical sponge.</p> </blockquote> Murat Özcan Yay, Sinan Sağıroğlu, Mehmet Turgut Copyright (c) 2022 Nepalese Society of Neurosurgeons (NESON) http://creativecommons.org/licenses/by-nc/4.0 https://www.nepjol.info/index.php/NJN/article/view/42462 Tue, 15 Mar 2022 00:00:00 +0000