Epidemiological and Computed Tomography Aspects of Facial Trauma at Kira Hospital in Bujumbura

Background: Maxillofacial trauma affects young adults more. The injury assessment is difficult to establish in low-income countries because of the imaging means, particularly the scanner, which is poorly available and less financially accessible. The aim of this study is to describe the epidemiological profile and the various tomodensitometric aspects of traumatic lesions of the face in patients received in the Radiology department of Kira Hospital. Patients and methods: This is a descriptive retrospective study involving 104 patients of all ages over a period of 2 years from December 2018 to November 2019 in the medical imaging department of KIRA HOSPITAL. We included in our study any patient having undergone a CT scan of the head and presenting at least one lesion of the facial mass, whether associated with other cranioencephalic lesions. Results: Among the 384 patients received for head trauma, 104 patients (27.1% of cases) presented facial damage. The average age of our patients was 32.02 years with extremes of 8 months and 79 years. In our study, 87 of the patients (83.6%) were male. The road accident was the circumstance in which facial trauma occurred in 79 patients (76% of cases). These injuries were accompanied by at least one bone fracture in 97 patients (93.3%). Patients with fractures of more than 3 facial bones accounted for 40.2% of cases and those with fractures of 2 to 3 bones accounted for 44.6% of cases. The midface was the site of the fracture in 85 patients (87.6% of cases). Orbital wall fractures were noted in 57 patients (58.8% of cases) and the jawbone was the site of a fracture in 50 patients (51.5% of cases). In the vault, the fractures involved the extra-facial frontal bone (36.1% of cases) and temporal bone (18.6% of cases). Cerebral contusion was noted in 41.2% of patients and pneumoencephaly in 15.5% of patients. Extradural hematoma was present in 16 patients and subdural hematoma affected 13 patients. Conclusion: Computed tomography is a diagnostic tool of choice in facial trauma patients. Most of these young patients present with multiple fractures localizing to the mid-level of the face with concomitant involvement of the brain.

Giant Tuberculomas Suggesting a Malignant Brain Tumor: About Two Cases

Tuberculoma is a common condition in developing countries. In some cases, it may mimic a glial lesion, making differential diagnosis challenging. The authors report two cases of giant tuberculoma in young patients aged 14 and 16. A literature review was conducted on these cases. Both patients underwent partial excision. Histology concluded tuberculoma. Anti-tubercular treatment was implemented. The evolution one year later was marked by the persistence of neurological disorders, although they had improved.

Intracranial Calcified Extradural Hematoma about a Case

Introduction: Extradural hematoma is a common pathology in our department. The natural history of small-volume hematoma is usually towards resorption. In rare cases, the hematoma calcifies and compresses the brain. We report an extradural hematoma in a 15-year-old boy who had a road traffic accident on February 2011. The brain CT-scan performed the following day revealed a small right frontal extradural hematoma. During hospitalization, he had a fever of 40 degrees with convulsions and the blood culture isolated the coagulase-negative staphylococci and Group D streptococci. When his conscience was restored, hemiparesis and dysarthria were observed. The control brain CT-scan performed 2 weeks after the trauma showed early resorption of the hematoma. Two months after the trauma, the brain CT-scan showed calcification of the hematoma. He underwent surgery in April 2011 to remove the calcification. The sequels were hemiparesis and posttraumatic epilepsy. Conclusion: The evolution of a small non-operated extradural hematoma can be done towards calcification thus requiring surgery.

Hyponatremia in the acute phase of spinal cord trauma: Review

Hyponatremia is a common electrolyte disturbance usually observed in neurosurgical patients undergoing surgical management of traumatic, as well as, nontraumatic intracranial pathology. The spinal cord trauma is also associated with occasional development of such hyponatremia;it usually occurs within the first two-weeks of the injury. Hyponatremia can lead to alterations of consciousness, convulsions, coma, cardiac arrhythmias and on rare occasions, death. Authors present a practical oriented review of the literature.

The Significance of Hypoalbumineamia and Hypoproteinemia in Patients with Stroke

Objective: To determine if there is any significant association between stroke and both hypoalbuminema and hypoproteinemia. Patients and Methods: Total serum proteins “T.S.P.” and serum albumin were measured for 65 patients with stroke who were admitted to the medical and neurological wards at Baghdad Teaching Hospital in the Medical City from November 2003 to October 2004. Careful history was obtained and proper clinical examinations were done. Serum albumin, T.S.P., blood sugar, renal function, liver function and general urine examination “G.U.E.” were tested within 48 - 72 hours of the start of patient symptoms. These patients with hepatic and renal dysfunction and those with diabetes mellitus were excluded. The results were compared with the results obtained from control group, which consisted of 40 persons of matched age and sex. By application pf chi square test “X” to see the association of serum albumin with cigarette smoking, age, hypertension and the presence of carotid bruit. Results: The mean serum level of T.S.P. and serum albumin of those with stroke was 6.42 ± 0.322 g/dl, 3.26 ± 0.251 g/dl respectively, which was significantly lower than T.S.P. and serum albumin of the control “mean = 7.8 ± 0.257 g/dl, 4.73 ± 0.206 g/dl respectively” [P X2 = 25.14, P X2 = 15.57, P Conclusion: Hypoalbuminemia and hypoproteinemia are significantly associated with stroke.

Intentional Penetrating Craniocerebral Injury Caused by a Nail: Clinical Presentation and Management of Three Cases

The authors report on their experience in the medical and surgical management of three cases of penetrating craniocerebral injuries caused by a nail. In all three cases, it was an aggression. Two of the three patients were male. The cranial locations affected were respectively left parietal, right temporal and right frontal. The Glasgow coma score (GCS) was between 9 and 13. None of the patients had a motor deficit. A plain skull radiographs was performed for each patient. All patients underwent surgery and all received antibiotic therapy and tetanus vaccination. In two cases, post-operative outcome was simple. Recovery was complete without sequelae. The patient with a GCS of 9 died the day after surgery.

Spontaneous Disappearance of a Ruptured Intracranial Aneurysm

The spontaneous disappearance of a ruptured intracranial aneurysm is unusual and its mechanism remains incompletely understood. However, several hypotheses are put forward and are mostly found in Virchow’s triad. We report the case of a man who suffered subarachnoid hemorrhage by rupture of a blister aneurysm of the P1 segment of the left posterior cerebral artery. A control arteriography performed one week after the rupture showed a disappearance of the aneurysm and a significant vasospasm of the carrier artery. Angiograms performed at 3 weeks and 3 months confirmed this disappearance of the aneurysm and a return to normal artery size. Clinically the patient was doing well. Therefore his aneurysm was spontaneously declared cured. Several studies are needed to clarify the natural history of spontaneously thrombosed aneurysms and elucidate their occurrence mechanism in order to improve the management of intracranial aneurysmal pathology.

Cranio-cervical bone hyperpneumatization: An overview and illustrative case

The pneumatization of regions such as the apex of the temporal crag, the mastoid cells and the perilaberytic region is considered physiological in adults. The process of craniocervical pneumatization in unhealthy adults derives from a dysfunction at the level of the eustachian tube, which provides a valve effect causing an increase in pressure at the level of the middle ear, forcing the entry of air into the dome of the skull through the opening of the occipitomastoidal suture. The process of standard pneumatization of the temporal bones, begins in the final weeks preceding birth, characterized by a decrease in the embryonic mesenchyme at the antrum level and progresses through childhood until adolescence, when the stone portion at the level of the rock is pneumatized;Normal variants have been reported, such as pneumatization that extends from the temporal scale to behind the sigmoid sinus. With regard to the process of hyperneumatization, several etiologies have been proposed that a congenital process versus an acquired process to develop this condition should be compared. The present illustrative case is a seventy-three years old male presented to the outpatient clinic with chronic recurrent occipital headache, already investigated by general practitioner for elevated blood pressure which was excluded. We had checked him to exclude the cervical spinal origin of the occipital headache which was then excluded too. This case scenario demonstrates the debate about how to deal with such cases and thus the review will bring the attention of those who take care of such radiological findings to keep in mind the possible causes and complications according to the reported cases till now. We concluded that the hyperpneumatization of the craniocervical junction is an uncommon radiological finding that is usually asymptomatic although it can entail serious complications in some instances, especially when it enlarges progressively, which may be due to an acquired process. Thus, craniocervical hyperpneumatization deserves highlighting for the managing team to gain fluent treatment and better patient outcome.

Preoperative embolization of skull-base tumors: Indications, utility, and concerns

Skull-base tumors are generally difficult to access compared with many other cranial lesions. Usually surgery remains the gold standard treatment for the majority of these tumors. However, in many cases, surgical resection is a challenge because the disease usually is already in the advanced stage by the time of diagnosis. Additionally, there are hypervascular lesions which cause excessive loss of blood, then results in multiple blood transfusions and prolonged operative time, increases the risk of neural injury and prevents complete excision. In order to reduce blood loss intraoperatively, many alternatives were available with the neurosurgical armamentarium, such as head elevation, intravenous use of tranexamic acid, total intravenous anesthesia and even preoperative embolization of tumors. However, preoperative embolization carries variable results, potentially aggravating edema and increasing tumor size. To ascertain the current status and the up-to-date indications, an evaluation of the therapeutic role of preoperative embolization was performed in the current study.

Acute intra-operative brain swelling managed effectively with emergency basal cisternostomy: A case report

The cisternostomy is a novel technique for the management of intracranial hypertension. Intracranial hypertension is the most frequent cause of mortality in patients with acute brain injury. The availability of a less aggressive technique compared to decompressive craniectomy is an advantage for neurosurgeons. We presented a case that demonstrates the successful use of this technique.

Intracranial ricocheted-bullet injuries: An overview and illustrative case

The impact of a bullet by firearm is a mortal entity that in recent years has been on the rise due to the increase in crime,confrontations,among other acts of violence.Brain injuries by firearm account for 33.3% of all fatal injuries from this type of weapon.This resulted in a significant number of disabilities with its burden cost at a global level.The types of bullet injuries to the head include:penetrating (inlet without outlet),perforating (through and through),tangential (not enter the skull,causing coupe injury),ricochet (intracranial bouncing of bullet) and careening (rare.enter skull but not brain,runs in the subdural space).There are several situations that can occur once the bullet enters the body or into the intracranial cavity.Unmatched association of the bullet trajectory with the final position of the bullet within the body raise the suspicion for additional phenomena involvement,this can be explained by either internal bullet ricochet or internal bullet migration.The former usually represents an active movement and the latter is a passive movement.Intracranial ricocheting of bullets forms up to 25% of all penetrating bullet injuries to the skull.Such bullets types are commonly tumbling and have an unpredictable trajectory.The surgical management for intracranial bullet injury developed over decades from the time of Harvey Cushing and the World War I till the present.Now,the accepted intervention ranges from simple wound care to a proper surgery that includes hematoma evacuation,removal of only accessible bone fragments and foreign bodies,dural repair and wound debridement with or without decompressive craniectomy.Also.intracranial pressure monitoring is generally indicated.We reported a thirty-three years old male.victim of homicidal bullet injury to the head.presented with Glasgow Coma Scale score of 8 (best eye response:2.best motor response:4,best verbal response:2),upon examination a right parietal (near vertex) inlet without outlet was found.The poor prognostic factors in this patient included bi-hemispheric involvement,associated acute subdural hematoma with interhemispheric extension,ricochet type of injury and effacement of sulci.Intracranial ricocheted-bullet injury is a special entity of bullet injury to the head with its particular ballistics and management that deserve highlighting by the trauma team to gain fluent treatment and better outcome.

Congenital Depressed Skull Fracture Lifting with Suction Cup: A Therapeutic Alternative to Surgery

Congenital skull fractures of newborn are rare and create medico-legal problems. Their management is controversial. Between surgery considered too aggressive and uncertain conservative attitude, reduction by suction cup or breast pump is an alternative. The authors report their experience through a case of successful resolution of a congenital depressed skull fracture using a suction cup in a newborn at 13 day of life followed by a literature review. This technique avoids the usual complications of surgery and reduces the anxiety of parents related to surgery. It also avoids the anxiety of having a newborn with a recessed skull and a conservative attitude with uncertain outcome.

Brainstem Tuberculoma Reactivated during Pregnancy and Postpartum

Pregnancy, which is responsible for the decline in immunity, and the immediate postpartum period can lead to reactivation or worsening of tuberculosis. We report a case of a patient who consulted for neurological disorders in the context of a deterioration in general condition. The CT scan revealed a brainstem lesion which was successfully treated like a tuberculosis. However, reactivation has been observed in the postpartum period of a pregnancy contracted during anti-tuberculosis treatment. Further clinical improvement has been achieved with anti-tuberculosis treatment. Pregnancy and the immediate postpartum had led to a transient decline in immunity in part by decreasing in the inflammatory activity of type 1 helper T cells so that the fetus, which is a foreign body, was accepted by the maternal body. This decline in immunity during pregnancy and the immediate postpartum period due to immune reconstitution had been responsible for a high degree of vulnerability, usually characterized by a significant exacerbation of tuberculosis symptoms and an unfavorable course of disease.

The use of non-living animals as simulation models for cranial neurosurgical procedures: a literature review

Simulation plays a pivotal role in neurosurgical training by allowing trainees to develop the requisite expertise to enhance patient safety.Several models have been used for simulation purposes.Non-living animal models offer a range of benefits,including affordability,availability,biological texture,and a comparable similarity to human anatomy.In this paper,we review the available literature on the use of non-living animals in neurosurgical simulation training.We aim to answer the following questions:(1)what animals have been used so far,(2)what neurosurgical approaches have been simulated,(3)what were the trainee tasks,and(4)what was the experience of the authors with these models.A search of the PubMed Medline database was performed to identify studies that examined the use of non-living animals in cranial neurosurgical simulation between 1990 and 2020.Our initial search yielded a total of 70 results.After careful screening,we included 22 articles for qualitative analysis.We compared the reports in terms of the(1)animal used,(2)type of surgery,and(3)trainee tasks.All articles were published between 2003 and 2019.These simulations were performed on three types of animals,namely sheep,cow,and swine.All authors designed specific,task-oriented approaches and concluded that the models used were adequate for replicating the surgical approaches.Simulation on non-living animal heads has recently gained popularity in the field of neurosurgical training.Non-living animal models are an increasingly attractive option for cranial neurosurgical simulation training.These models enable the acquisition and refinement of surgical skills,with the added benefits of accessibility and cost-effectiveness.To date,16 different microneurosurgical cranial approaches have been replicated on three non-living animal models,including sheep,cows,and swine.This review summarizes the experience reported with the use of non-living animal models as alternative laboratory tools for cranial neurosurgical training,with particular attention to the set of tasks that could be performed on them.

Epidural spinal cord compression as initial clinical presentation of an acute myeloid leukaemia: case report and literature review

Epidural localization of myeloid leukaemia is rarely reported.Spinal cord compression as an initial presentation of acute myeloid leukaemia is extremely rare.This is a report of a 17-year-old black boy who presented to emergency department with neurological symptoms of spinal cord compression.Imaging modalities showed multiple soft tissue masses in the epidural space.After surgical treatment,histopathological examination of the epidural mass showed myeloid leukaemia cells infiltration.Literature review on Medline and 'scholar Google' database was done.The characteristics and management of extra-medullary leukaemia are discussed.Granulocytic sarcoma,myeloid sarcoma or chloroma with acute myeloid leukaemia should be considered as part of epidural spinal cord compression.Therefore surgery is indicated on an emergent basis.