Background Prognosis of traumatic brain injury (TBI) significantly depends on the incidence of progressive hemorrhagic injury (PHI). The present study was conducted to assess whether D-dimer/fibrinogen ratio can predict PHI among the patients with TBI. Materials and Methods A total of 150 patients were included in this retrospective study; among them 72 had PHI and 78 did not have PHI. Demographic, clinical, radiological, and laboratory parameters including plasma D-dimer and plasma fibrinogen levels and subsequently D-dimer/fibrinogen ratio were evaluated. Independent t -test, Mann-Whitney U test, chi-square test, Fisher's exact test, and multivariate logistic regression were used for statistical analysis. Results Age, injury time, first computed tomography time, Glasgow Coma Scale scores, unreactive pupils, abnormal cisterns, midline shift above 5 mm, skull base fracture, epidural hematoma, subdural hematoma, intraventricular hemorrhage, cerebral hematoma, brain contusion, plasma D-dimer concentration, plasma fibrinogen concentration, and D-dimer/fibrinogen ratio vary significantly between PHI and non-PHI groups ( p < 0.05). Multivariate logistic regression showed that the Glasgow Coma Scale score (odds ratio [OR], 0.531; 95% confidence interval [CI], 0.436-0.648; p = 0.004) and D-dimer/fibrinogen ratio (OR, 3.784; 95% CI, 2.086-6.867; p = 0.027) were the two independent predictors for PHI. Conclusion D-dimer/fibrinogen ratio is a useful parameter in predicting the incidence of PHI among the patients with TBI.

Introduction. Posterior fossa tumours (PFTs) frequently present with ophthalmic complaints. The literature is mainly focused on PFTs affecting the pediatric age group, and the post-treatment visual outcomes (VOs) are scarcely reported. Objective. To evaluate the VOs at 6 months following the index surgery in patients with PFTs. Materials and methods. This retrospective study involved 50 patients of all age groups who underwent surgical resection of PFTs in the Department of Neurosurgery. The patients with PFTs, except those with low-grade tumours, received concurrent chemo-radiotherapy. Pre- and postoperative (6 months after the index surgery) ophthalmic examinations were done and compared. VOs included colour vision, night vision, visual acuity (VA), pupillary function (size, reactivity), papilledema grade, splinter haemorrhage, retinal venous dilatation, strabismus (esotropia and hypertropia), and nystagmus. Results. The patients were mainly aged 1–10 years (22%) with slight female predominance (52%). The most common PFTs were brainstem glioma and pilocytic astrocytoma (each 18%). At 6 months, there was no significant change in colour and night vision, pupil size and reactivity, splinter haemorrhage, and hypertropia (all p-values>0.05). A significantly lesser proportion of patients had moderate VA (p-value=0.013), retinal venous dilatation (p-value=0.001), and grade 1 (p-value=0.005) as well as grade 4 papilledema (p-value=0.041). Moreover, a significantly greater proportion of patients had grade 0 papilledema (p-value<0.0001). While the incidence of nystagmus and esotropia increased significantly (both p-values<0.0001). Conclusion. At 6 months, the majority of the patients had good VOs, including significant improvement in moderate VA, papilledema, and retinal venous dilatation. While nystagmus and esotropia increased significantly.

Objective In patients with mild traumatic brain injuries (mTBIs), with Glasgow Coma Scale (GCS) scores of 13 to 15, isolated subdural hematomas (iSDHs) are identified as a prevalent category of intracranial hemorrhage. The primary objective of our research was to investigate the relationship between the characteristics of iSDHs, as revealed through computed tomography (CT) scans on patient admission, and the consequent necessity for neurosurgical intervention. Materials and Methods This was a 1-year study, employing a prospective observational design at our institution. We enrolled adult trauma patients diagnosed with mTBIs and concurrent iSDHs, intent on documenting the hemorrhages' quantitative parameters such as maximum length and thickness, among other related variables. The eventual execution of neurosurgical procedures constituted our primary outcome, aiming to establish a decisive correlation between CT scan metrics of iSDHs upon admission and the imperative for subsequent surgical intervention. Results A total of 50 patients were included in our study: 14 patients received a neurosurgical intervention and 36 patients did not. The neurosurgical intervention group had a mean maximum SDH length and thickness that were 38 mm longer and 9.6 mm thicker than those of the non-neurosurgical intervention group (p < 0.001 for both). Conclusion In this study, we evaluated the odds of a neurosurgical intervention based on hemorrhage characteristics on CT, in patients with an iSDH and mTBI. Once validated in a second population, these data can be used to evaluate the necessity of interhospital transfers and to better inform patients and families of the risk of future neurosurgical intervention and prognosis.

Background : The present study has been conducted to assess whether hypocalcemia can be used as a prognostic factor in the outcome of traumatic brain injury. Materials And Methods : This prospective study was done on 100 patients with moderate to severe traumatic brain injury. Serum calcium levels of patients had a Glasgow coma scale of 3–13 points following traumatic brain injury, with demonstrable intracranial lesions in cranial computed tomography were included. Student's t test, chi square test and Fisher's exact test were used for comparative analysis. Logistic regression and receiving operative curves analysis analysis were also done to assess the risk factors. Results: Statistically significant difference were found in the Ca2+levels on the 3rd day of admission between the patients with GOS ≤3 and the patients with GOS>3 (P=0.029).The best level of higher sensitivity (86.27%) and specificity (68.66%) of hypocalcaemia on 3rd 2+ day was the Ca2+ value of 1.14 mmol/L. Conclusion: The serum Ca levels on day 3 could be useful for the prediction of mortality and disability in patients with moderate to severe traumatic brain injury.

Objective  There are a large number of prospective studies that use diffusion tensor imaging (DTI) to show the relationship between intracranial tumors and white matter (WM) fibers. We studied the role of DTI in supratentorial intra-axial (ST-IA) tumors of the brain in deciding the surgical approach with maximal resection and minimal or no deficit and in predicting the histological characterization of the tumor and the neurological outcome. Methods  A total of 91 cases of ST-IA tumors were included in our study. The neurological status of the patients was assessed preoperatively, and the tumor volume and DTI pattern were noted radiologically. Surgical plan was decided by the senior consultants of the neurosurgery department taking into consideration the findings of tractography and magnetic resonance imaging. The neurological status and the extent of resection were evaluated postoperatively, and the correlation between histopathology with DTI was studied. Results  Of the 91 patients, 25 had high-grade glioma (HGG), 60 had low-grade glioma (LGG), and 6 were metastatic lesions. Gross total excisions were done mostly in patients with DTI showing displaced fibers and subtotal/partial resections were done mostly in disrupted/infiltrated tracts, which was statistically significant. The correlation between histopathology and tractography revealed that intact/displaced tracts were seen mostly in LGG (79%), whereas 86% of HGG showed disrupted/infiltrated fibers; both were statistically significant. Conclusion  Preoperative DTI in ST-IA brain tumors is an important tool for deciding the appropriate surgical approach for maximal safe resection, thus improving the post-op neurological outcome in patients. It also helps in predicting the tumor histology while also serving as an important prognostication indicator.

Background and Objective: Considering large number of studies available for use of DTI in intracranial tumors showing their relationship with WM bres, we studied the role of preoperative and post op DTI in ST-IA brain tumors in eloquent areas in prognosticating the patient and predicting neurological outcome. Total 54 Methods: cases of ST-IA tumours in eloquent areas were included in study. Detailed neurological examination and DTI was done before surgery and FA values were noted. Surgical plan was decided by senior consultants of Neurosurgery department with ndings of DTI and MRI, in consideration. Neurologic examination with repeat DTI was done postoperatively and Correlation in change of FA values with neurological status was evaluated. In total 54 patients, 36 had displaced Results: bres with FA value ranged from 0.378 to 0.515, mean of 0.462 and 18 had inltrated/disrupted fascicles with FA value ranged from 0.161 to 0.368, mean of 0.253 in preoperative DTI. At follow up 28 patients with displaced bres improved clinically and in repeat DTI 93% of patients showed rise in FA values ranged from 0.416 to 0.683 with mean 0.539 which was statistically signicant.In18 patients with inltrated/disrupted bres 13 had no clinical improvement at follow up with fall in FA values in 84% patients with FA values ranged from 0.153 to 0.382 and mean of 0.235, which was also statistically signicant. DTI (pre and Conclusions: postoperative) in ST-IA brain tumours in Eloquent Areas helps in predicting neurological outcome after surgery as well as an important prognostication indicator.

Aim: To study the proportion of selective micronutrient and macronutrient deciency in traumatic brain injury. Material And Methods: A prospective observational Study performed at department of neurosurgery, SMS medical college, Jaipur.200 traumatic head injury patient of age 15 to 80 years admitted at neurosurgery trauma ICU with post resuscitation Glasgow coma scale (GCS) score of 3 to 8 (severe traumatic brain injury) were included in the study.“Malnutrition Universal Screening Tool” (MUST) was used to assess the nutritional status of all subjects and it was classied as: no risk, moderate risk and high risk of malnutrition when MUST score was 0, 1 and ≥ 2respectively. Severity of TBI was classied into mild, moderate, and severe based on Glasgow Coma Scale (GCS) when it ≥13, 9 -12 and ≤ 8 respectively. Serum electrolytes were measured at time of admission in emergency before starting intravenous uid and repeated at 24 hours after resuscitation and Serum electrolytes (serum sodium, potassium) were repeated at 24 hours after resuscitation and along with calcium, phosphate, B12. Results: Mild, moderate and severe TBI was revealed in 26%, 30.5% and 43.5% of the subjects respectively. All the nutrients intake viz. energy (kcal/d), protein (gm/d), CHO (gm/d) and fat (gm/d) was found to be signicantly less among the TBI subjects. Macronutrients inadequacy viz. energy (kcal/d), protein (gm/d), CHO (gm/d) and ber (gm/d) inadequacy was reported among 93.5%, 69%, 4.5% and 71.5% of the subjects respectively. Conclusion: Nutrition assessment upon admission of TBI patients could be a vital factor in identifying patients with malnutrition, and prevention from nutrition-related complications.

Background: Traumatic brain injury (TBI) is the leading cause of death in trauma patients in various parts of the world including India. Coagulation cascade is affected in TBI. The severity of coagulopathy correlates with degree of primary injuries thus affecting the prognosis of geriatric patients. Since the prognosis of isolated TBI can be a challenge to predict at times. AIM: we wanted to study the potential of international normalized ratio (INR) test, prothrombin test (PT), platelet count as a prognostic tool in isolated TBI. Methods: INR, PT, platelet count reflects the coagulation status. In most trauma cases, it is a routine test as well. We collected the INR, PT, platelet count value at admission of 200 isolated geriatric TBI cases over a period of three months. Then, patients were followed-up and their outcome at three months from admission is scored using Glasgow outcome scale (GOS). The relationship of INR, PT, platelet count with GOS was studied.Results: From our limited study, we found that INR of 1.52, PT 17 sec or more and platelet count less than 1.10 lac predicts poor prognosis in cases of isolated geriatric TBI.Conclusions: It is important to early diagnose and early manage the coagulation abnormalities in isolated geriatric head injury patients.

Ischemic stroke of basal ganglia after head trauma is rare in children younger than 18 months and accounts for less than 2% of all ischemic strokes in childhood. The clinical history of these lesions is particularly favorable because they are usually small and facial-brachial-crural hemiparesis is typical of this pathology that regresses over a period of time. The most effective therapeutic approach appears to be a conservative one, although the best treatment regimen is still not well defined. It is necessary to exclude conditions such as heart disease, coagulopathies, and acute traumatic arterial dissections. The authors present a rare case of bilateral basal ganglia infarct in an 18-month-old child following head trauma managed conservatively with good recovery.

Miliary mottling is most commonly seen in tuberculosis. Clinical features of tuberculosis mimic many other lung diseases. Here we report a 40 yr old male with clinical features suggestive of tuberculosis, miliary mottling on skiagram chest and granulomatous hepatitis on histopathology. Case was finally diagnosed as sarcoidosis on liver biopsy and improved on oral corticosteroid.