OBJECTIVE

To compare and assess the evidence from randomized controlled trials on the efficacy and tolerability of valproic acid and phenytoin in status epilepticus.

METHODS

There were 2 trials retrieved by means of computerized data search. The data was extracted with an intention to treat principle. The treatment effect was measured as odd's ratio between valproic acid and phenytoin.

RESULTS

A total of 168 patients were included in the 2 trials. There was no significant heterogeneity found between trials (Q value= 0.656, df 1.0, P value = 0.069). The combined odd's ratio for the responder rate was 0.501 in favor of valproic acid, with 95% confidence interval of 0.238 to 1.054. Cardiac and respiratory side effects were observed more in phenytoin while liver dysfunction was common in valproic acid.

CONCLUSION

Valproic acid is an effective and well tolerated medication for status epilepticus than phenytoin.

Efficacy ; Tolerability

OBJECTIVES

To determine the risk factors in patients with asymptomatic intracranial stenosis evaluated by magnetic resonance angiography.

METHODS

All admitted or out-patients≥ 19 years old with evidence of stenosis or occlusion of any intracranial
vessels proven by magnetic resonance angiography (MRA) were enrolled in the study. The degree of stenosis was graded as mild, moderate, severe and occluded. For the risk factor evaluation, charts were reviewed.

RESULTS

Among the 486 patients who underwent magnetic resonance angiography, only 41 patients (8.4%) had asymptomatic intracranial stenoses. Twenty three patients were included in the study. The mean age was 72.6 years old, predominantly female. Majority of the study population were hypertensive (78.3%). Family history of hypertension and diabetes mellitus were predominant. Forty eight percent (11/23) had multiple vessel stenoses. Increasing age and increased body mass index were seen in multiple vessel disease which was statistically significant with p value of 0.043. The longer the duration of hypertension and diabetes, the more intracranial vessels were involved. Elevated fasting blood sugar, family history of hypertension and diabetes were seen in single vessel disease. LDL cholesterol was slightly elevated in all three groups. History of myocardial infarction was seen in multiple vessel disease.

CONCLUSION

Advancing age and increased body mass index maybe risk factors for multiple intracranial vessel disease. Other risk factors which seemed to contribute to asymptomatic intracranial stenosis were female gender, hypertension, family history of hypertension, diabetes and LDL cholesterol. Intracranial stenosis involved the intracranial internal carotid and posterior cerebral arteries.

Human ; Intracranial Stenosis ; Magnetic Resonance Angiography ; Asymptomatic Intracranial Stenosis

INTRODUCTION: Olfactory esthesioneuroblastoma also known as olfactory neuroblastoma or esthesioneuroblastoma is an uncommon neuroectodermal tumor that originates from the olfactory sensory epithelium in the upper nasal fossa at the level of the cribriform plate. It represents up to 5% of malignant tumors of the nasal cavity and 20-30% of its metastasis involves the CNS.

CASE REPORT: We present a case of a 42-year-old female who presented with an eleven (11)-year history of the evolution and recurrence of a nasal mass which initially presented as recurrent nasal congestion. Until she presented with profuse epastaxis where she was worked up and MRI of the brain showed a nasal mass extending to bilateral frontal lobes (the official report was unavailable). She underwent maxillofacial surgery and frontal craniotomy with removal of the maxillary and dural masses. Histopathology reported metastatic esthesioneuroblastoma. There was recurrence of a mass in the left submandibular area followed by another mass in the right maxillary area and a third mass in the right submandibular area. She was advised excision of the mass but was lost to follow up. She was admitted for generalized tonic-clonic seizure.

DISCUSSION: The case presented started with a mass in the nasal cavity which has spread to the cranial cavity. Differentials for nasal cavity lesions should include more common malignancies of the nasal cavity such as squamous cell carcinoma, adenocystic carcinoma, and adenoid carcinomas. Definite diagnosis is obtained through histopathology. No standardized treatment protocol is available at the time of this writing. This is followed by radiotherapy for primary low- to moderate-grade lesions with the addition of chemotherapy for patients with advanced, recurrent or metastatic disease (i.e. cyclophosphamide and vincristine). The 5-year survival rate of ENB is 45% for surgery and radiotherapy. Prognosis depends on the stage and grade of the disease.

SUMMARY: When we are presented with a history of nasal obstruction or epistaxis, the differential diagnosis should always include a mass lesion in the nasal cavity. Among the mass lesions, though not so common, esthesioneuroblastoma should always be ruled out. Early diagnosis and early intervention may delay or arrest the progression of the tumor.

 

Human ; Female ; Adult (a Person 19-44 Years Of Age) ; Humans ; Female ; Adult ; Esthesioneuroblastoma, Olfactory ; Nasal Cavity ; Nasal Obstruction ; Vincristine ; Epistaxis ; Survival Rate ; Carcinoma, Adenoid Cystic ; Adenoids ; Ethmoid Bone ; Diagnosis, Differential ; Early Intervention (education) ; Lost To Follow-up ; Magnetic Resonance Imaging ; Prognosis ; Cyclophosphamide ; Brain ; Carcinoma, Squamous Cell ; Frontal Lobe ; Clinical Protocols ; Early Diagnosis ; Craniotomy ; Surgery, Oral ; Writing ; Seizures

INTRODUCTION: Stroke is the third leading cause of death worldwide. Intracranial hemorrhage (ICH) is the third most common type of stroke following ischemic and subarachnoid hemorrhage. Spontaneous intracerebral hemorrhage (SICH) causes 10-15% of first-ever stroke, with a 30-day mortality rate of 35-52%, half of the deaths occurring in the first two (2) days.3 It is associated with a higher mortality rate than either ischemic stroke or subarachnoid hemorrhage (SAH) with only 38% of the patients surviving after one (1) year. The sudden occurrence of an intracranial hemorrhage destroys and displaces brain tissue and can induce an increase in intracranial pressure (ICP). The progression of mass effect after ICH occurred at two (2) distinct points: within two (2) days, related to hematoma enlargement and in the 2nd - 3rd weeks, associated with increased edema. Increased ICP and decreased cerebral perfusion pressure (CPP) gave rise to typical changes in the doppler waveforms obtained by transcranial insonation (i.e. a decrease in diastolic flow velocity and an increase in the PI). Results showed that TCD-PI has the potential to assess mass effect and track ICP changes. In the local setting where many of the hospitals do not have an available intracranial pressure monitoring device, the use of a transcranial doppler will be an economical and practical alternative to detect elevations in ICP, aggressive measures can be instituted immediately and progression of symptoms will be prevented.

OBJECTIVE: The study aimed to utilize TCD-pulsatility index (TCD-PI) as a predictor of the neurological outcome among patients who had spontaneous intracerebral hemorrhage in a tertiary hospital.

METHODS: The study included patients 18-70 years old who sustained acute, supratentorial, non-traumatic, spontaneous intracerebral hemorrhage (Appendix 1) involving the middle cerebral artery as evidenced by neuroimaging. The volume of hematoma should be more than 30 ml or less than 70 ml using the Kothari method. RESULTS: A total of six (6) patients were included in the study. The ages of patients ranged from 39 - 68 years old with a mean age of 53.3 years. Fifty percent (50%) of the patients were males; 100% of the patients are hypertensive; 50% were diabetic; 83.3% of the patients were dyslipidemic, majority (66.6%) are are smokers and alcoholic beverage drinkers; majority of the patients (83.3%) had hematoma on the left basal ganglia, the volumes of hematoma of the study population ranged from 30ml to 65ml, majority of which (83.3%) are between 30-40m by Kothari formula. Results showed that individuals with elevated pulsatility indexes have 13 times greater odds of neurological deterioration compared to patients with normal pulsatility index and this is statistically significant (p = 0.0027).

CONCLUSION: Having shown that elevated TCD-PI created a trend toward deteriorating neurological outcome, its usefulness in the Neuro-ICU and in particular, for patients who have sustained intracerebral hemorrhage, TCD sonography holds a lot of promise. Being non-invasive, portable and cost-effective, it could give the intensivist an idea of an impending elevation of intracranial pressure, aggressive measures could be instituted and possible deterioration of neurological function would be prevented.

Human ; Male ; Humans ; Intracranial Pressure ; Middle Cerebral Artery ; Subarachnoid Hemorrhage ; Stroke ; Tertiary Care Centers ; Brain Ischemia ; Smokers ; Cause Of Death ; Cerebral Hemorrhage ; Intracranial Hemorrhages ; Cerebrovascular Circulation ; Hematoma ; Neuroimaging ; Brain ; Edema ; Diabetes Mellitus ; Basal Ganglia ; Alcoholic Beverages ; Intensive Care Units

Spinal arachnoidicis is a disease characterized by inflammation and scarring of the arachnoid membrane of the spinal cord. There are no data on the actual population-based prevalence and incidence of arachnoiditis in any country, in any of its form. The etiology is complex. Spinal anesthesia has been implicated as one of the causes. Our case is a 59 year old male who presented with obstructive symptoms such as hesitancy, incomplete voiding, weak urinary stream and straining. He was diagnosed with benign prostatic hypertrophy and unde1went transurethral resection of the prostate. After which, patient complained of back pain, perineal paresthesia, numbness spreading over the buttocks down to the soles of both feet, difficulty ambulation, bladder and bowel dysfunction, which were consistent with cauda equine syndrome. MRI of the lumbosacral spine revealed focal enhancement at the canal ofL4-L5 level.

Human ; Male ; Middle Aged: 45-64 Yrs Old ; Anesthesia, Spinal ; Arachnoiditis ; Prostatic Hyperplasia ; Paresthesia ; Spinal Cord