Physician work–life balance has gained significant attention in the last few years as the rates of burnout among physicians have increased. Burnout is defined as a state of mental and physical exhaustion caused by one’s professional life.1 It leads to exhaustion, cynicism, and adversely affected work productivity, patient outcomes, and interpersonal relationships. Although work–life balance applies to all professions, physicians find it especially hard to achieve, with almost half of U.S. surgeons being unsatisfied with their work–life dynamic.2 The decision to pursuemedicine as a career comeswith an inherent understanding that patients will always be a priority. The work–life imbalance begins during residency, where 60% of residents and fellows report experiencing significant work stress.2 Eventually, very few learn to cope and only one out of every five neurosurgeons can achieve a goodwork–life balance.Women physicians have higher rates of attrition as compared with men. This article aims to highlight the issue, increase self-awareness, and provide strategies to cope and have a better work–life relationship (►Table 1).
{"title":"Work–Life Balance for the Modern Neurosurgeon: Her/His Perspective","authors":"A. Prabhune, Harsh Deora, M. Tripathi","doi":"10.1055/s-0043-57250","DOIUrl":"https://doi.org/10.1055/s-0043-57250","url":null,"abstract":"Physician work–life balance has gained significant attention in the last few years as the rates of burnout among physicians have increased. Burnout is defined as a state of mental and physical exhaustion caused by one’s professional life.1 It leads to exhaustion, cynicism, and adversely affected work productivity, patient outcomes, and interpersonal relationships. Although work–life balance applies to all professions, physicians find it especially hard to achieve, with almost half of U.S. surgeons being unsatisfied with their work–life dynamic.2 The decision to pursuemedicine as a career comeswith an inherent understanding that patients will always be a priority. The work–life imbalance begins during residency, where 60% of residents and fellows report experiencing significant work stress.2 Eventually, very few learn to cope and only one out of every five neurosurgeons can achieve a goodwork–life balance.Women physicians have higher rates of attrition as compared with men. This article aims to highlight the issue, increase self-awareness, and provide strategies to cope and have a better work–life relationship (►Table 1).","PeriodicalId":43198,"journal":{"name":"Indian Journal of Neurotrauma","volume":null,"pages":null},"PeriodicalIF":0.2,"publicationDate":"2023-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85738685","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
, Traumatic brain injury can be complicated by edema and mass effect resulting in elevation of the intracranial pressure (ICP), reduction in cerebral perfusion pressure, and global ischemia. 1 The use of osmotic agents (mannitol and hypertonic saline) is recommended to lower the ICP and to improve cerebral blood fl ow to hypoperfused brain regions in patients with traumatic brain injury. 2 Mannitol has traditionally been used as nonsurgical treatment options to control intracranial hypertension, tissue shifts, and ultimately herniation in these patients. 1,3 – 5 A 16-year-old girl sustained traumatic brain injury after being hit by a two-wheeler. She presented to the emergency department (cid:1) 6hours after the incident. She had a history of loss of consciousness for 20minutes, multiple episodes of vomiting, and left ear bleed. There was no history of seizures. On neurological examination, she was opening eyes to call, disoriented, and localizing to pain (E3V4M5). Pupils were bilaterally equal and reacting to light. There were no focal neurological de fi cits. General and systemic examination was unremarkable. A computed tomography (CT) scan of the brain showed thin right fronto-temporo-parietal acute subdural hematoma with mass effect andminimal midlineshift; in addition, therewas a thin temporal extradural hematoma (EDH) of theleft side also ( ► Fig. 1A ). The patient was started on antiedema measures and prophylactic antiepileptics. She regained consciousness thenextdayafteradmissionbutwascomplainingofpersistent
{"title":"Expansion of Contralateral Extradural Hematoma following Mannitol Therapy","authors":"A. Agrawal, G. Rao","doi":"10.1055/s-0043-1768172","DOIUrl":"https://doi.org/10.1055/s-0043-1768172","url":null,"abstract":", Traumatic brain injury can be complicated by edema and mass effect resulting in elevation of the intracranial pressure (ICP), reduction in cerebral perfusion pressure, and global ischemia. 1 The use of osmotic agents (mannitol and hypertonic saline) is recommended to lower the ICP and to improve cerebral blood fl ow to hypoperfused brain regions in patients with traumatic brain injury. 2 Mannitol has traditionally been used as nonsurgical treatment options to control intracranial hypertension, tissue shifts, and ultimately herniation in these patients. 1,3 – 5 A 16-year-old girl sustained traumatic brain injury after being hit by a two-wheeler. She presented to the emergency department (cid:1) 6hours after the incident. She had a history of loss of consciousness for 20minutes, multiple episodes of vomiting, and left ear bleed. There was no history of seizures. On neurological examination, she was opening eyes to call, disoriented, and localizing to pain (E3V4M5). Pupils were bilaterally equal and reacting to light. There were no focal neurological de fi cits. General and systemic examination was unremarkable. A computed tomography (CT) scan of the brain showed thin right fronto-temporo-parietal acute subdural hematoma with mass effect andminimal midlineshift; in addition, therewas a thin temporal extradural hematoma (EDH) of theleft side also ( ► Fig. 1A ). The patient was started on antiedema measures and prophylactic antiepileptics. She regained consciousness thenextdayafteradmissionbutwascomplainingofpersistent","PeriodicalId":43198,"journal":{"name":"Indian Journal of Neurotrauma","volume":null,"pages":null},"PeriodicalIF":0.2,"publicationDate":"2023-05-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79587505","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A. Reddy, N. Panda, Rajeev Chauhan, Shalvi Mahajan, S. Mohindra
Abstract Head fixation devices are frequently used to immobilize the position of the head in neurosurgery. We report a rare complication of a four-pin Sugita device causing epidural hematoma (EDH) in a young adult male undergoing transcranial excision of a craniopharyngioma manifesting intraoperatively as an intractable tense brain. Decreased bone mineral density secondary to the metabolic consequences of craniopharyngioma could have increased the susceptibility to breach of the bony cortex. The index case highlights the essential role of a preoperative computed tomography (CT) scan review for the thickness of the cranial vault and the identification of weaker zones in high-risk groups.
{"title":"Pin Site Epidural Hematoma Masquerading as Intractable Brain Swelling: A Diagnostic Dilemma","authors":"A. Reddy, N. Panda, Rajeev Chauhan, Shalvi Mahajan, S. Mohindra","doi":"10.1055/s-0043-1768173","DOIUrl":"https://doi.org/10.1055/s-0043-1768173","url":null,"abstract":"Abstract Head fixation devices are frequently used to immobilize the position of the head in neurosurgery. We report a rare complication of a four-pin Sugita device causing epidural hematoma (EDH) in a young adult male undergoing transcranial excision of a craniopharyngioma manifesting intraoperatively as an intractable tense brain. Decreased bone mineral density secondary to the metabolic consequences of craniopharyngioma could have increased the susceptibility to breach of the bony cortex. The index case highlights the essential role of a preoperative computed tomography (CT) scan review for the thickness of the cranial vault and the identification of weaker zones in high-risk groups.","PeriodicalId":43198,"journal":{"name":"Indian Journal of Neurotrauma","volume":null,"pages":null},"PeriodicalIF":0.2,"publicationDate":"2023-05-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77638592","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Tariq Janjua, Fotis G. Souslian, L. Moscote-Salazar
The effects of prolonged immobilization in the critical patient have been well described. Patients on mechanical ventilation and patients receiving extracorporeal membrane oxygenation therapy have been presented as evidence of the feasibility of implementation of early mobilization protocols. Prolonged immobilization of critically ill patients has been associated with intensive care unit-acquired weakness syndrome, increased mortality, at the cognitive level, impact on quality, and cost increase among other considerations. Early mobilization emphasizes strategies to stimulate motor, sensory, and proprioceptive levels in the context of critically ill patients. Early mobility intervention in critically ill patients begins in the fi rst days of stay in the unit and requires a scheduled combination of passive and active activities. The presence of an external ventriculostomy device is not a contraindication for mobilization. 1,2 It helps as above with the progression and improvement in the outcome. The dislodgement and risk of fracture of external ventricular drainage (EVD) are major concerns. Here, we brie fl y go over the technical aspect of EVD placement and how to safely mobilize the patient.
{"title":"Mobilization of Patients with External Ventriculostomy Drains: Pro and Cons","authors":"Tariq Janjua, Fotis G. Souslian, L. Moscote-Salazar","doi":"10.1055/s-0043-1768055","DOIUrl":"https://doi.org/10.1055/s-0043-1768055","url":null,"abstract":"The effects of prolonged immobilization in the critical patient have been well described. Patients on mechanical ventilation and patients receiving extracorporeal membrane oxygenation therapy have been presented as evidence of the feasibility of implementation of early mobilization protocols. Prolonged immobilization of critically ill patients has been associated with intensive care unit-acquired weakness syndrome, increased mortality, at the cognitive level, impact on quality, and cost increase among other considerations. Early mobilization emphasizes strategies to stimulate motor, sensory, and proprioceptive levels in the context of critically ill patients. Early mobility intervention in critically ill patients begins in the fi rst days of stay in the unit and requires a scheduled combination of passive and active activities. The presence of an external ventriculostomy device is not a contraindication for mobilization. 1,2 It helps as above with the progression and improvement in the outcome. The dislodgement and risk of fracture of external ventricular drainage (EVD) are major concerns. Here, we brie fl y go over the technical aspect of EVD placement and how to safely mobilize the patient.","PeriodicalId":43198,"journal":{"name":"Indian Journal of Neurotrauma","volume":null,"pages":null},"PeriodicalIF":0.2,"publicationDate":"2023-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76825309","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Ganesh Swaminathan, A. Abraham, T. Mani, M. Joseph
Abstract Objective We study the clinical relevance of classifying traumatic brain injury (TBI) into moderate and mild categories based on the Glasgow Coma Scale (GCS) score at admission with respect to the treatment intensity and 6-month mortality and morbidity rates. Methods Analysis of patients from a prospectively maintained database admitted at a level I trauma center from 2013 to 2019 with an admission GCS score between 9 and 15 and a minimum follow-up of 6 months post-TBI was done to study the treatment intensity and 6-month morbidity and mortality rates for each GCS score from 9 to 15. Results In all, 2,060 patients met the study criteria, of which 1,684 were males (81.7%). Road traffic accident was the most common cause of TBI (83.7%). There was a significant linear increase in the proportion of patients who had good outcomes with increasing GCS scores from 9 to 15 ( p ≤ 0.001). When the variables in each GCS score were compared with a GCS score of 15, there was an increase in the odds ratio of mortality and poor outcome with decreasing GCS scores ( p ≤ 0.001). Patients with a lower admission GCS score required more intense treatment in the form of surgery and ventilation ( p ≤ 0.00001). There was a higher incidence of pupillary asymmetry in patients with lower GCS scores ( p ≤ 0.00001). Conclusions The classification of TBI patients into moderate and mild based on the GCS score at admission is not of any practical value, and TBI patients may be more usefully classified based on the admission GCS score into severe and not severe groups.
{"title":"Revisiting the Classification of Moderate and Mild Traumatic Brain Injury Based on the Admission Glasgow Coma Scale Score","authors":"Ganesh Swaminathan, A. Abraham, T. Mani, M. Joseph","doi":"10.1055/s-0043-1768170","DOIUrl":"https://doi.org/10.1055/s-0043-1768170","url":null,"abstract":"Abstract Objective We study the clinical relevance of classifying traumatic brain injury (TBI) into moderate and mild categories based on the Glasgow Coma Scale (GCS) score at admission with respect to the treatment intensity and 6-month mortality and morbidity rates. Methods Analysis of patients from a prospectively maintained database admitted at a level I trauma center from 2013 to 2019 with an admission GCS score between 9 and 15 and a minimum follow-up of 6 months post-TBI was done to study the treatment intensity and 6-month morbidity and mortality rates for each GCS score from 9 to 15. Results In all, 2,060 patients met the study criteria, of which 1,684 were males (81.7%). Road traffic accident was the most common cause of TBI (83.7%). There was a significant linear increase in the proportion of patients who had good outcomes with increasing GCS scores from 9 to 15 ( p ≤ 0.001). When the variables in each GCS score were compared with a GCS score of 15, there was an increase in the odds ratio of mortality and poor outcome with decreasing GCS scores ( p ≤ 0.001). Patients with a lower admission GCS score required more intense treatment in the form of surgery and ventilation ( p ≤ 0.00001). There was a higher incidence of pupillary asymmetry in patients with lower GCS scores ( p ≤ 0.00001). Conclusions The classification of TBI patients into moderate and mild based on the GCS score at admission is not of any practical value, and TBI patients may be more usefully classified based on the admission GCS score into severe and not severe groups.","PeriodicalId":43198,"journal":{"name":"Indian Journal of Neurotrauma","volume":null,"pages":null},"PeriodicalIF":0.2,"publicationDate":"2023-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78386346","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Neurological Wake-Up Test for Severe Neurotrauma Patients","authors":"Tariq Janjua, L. Moscote-Salazar","doi":"10.1055/s-0043-1768054","DOIUrl":"https://doi.org/10.1055/s-0043-1768054","url":null,"abstract":"","PeriodicalId":43198,"journal":{"name":"Indian Journal of Neurotrauma","volume":null,"pages":null},"PeriodicalIF":0.2,"publicationDate":"2023-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88631889","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
L. Moscote-Salazar, W. Florez-Perdomo, Tariq Janjua
Uncertainty inprinciple entails thepresence ofdoubt. This can lead to the inabilityofdelayeddecisionmaking. Toanobserver, thiswill lead to skepticismandunwillingness toworkwith the process. Ultimately if the process continues, it will lead to mistrust and a dysfunctional working environment. William Osler was one of thefirst to recognizehow uncertainty plays a role in our medical practice. His statement “One special advantage of the skeptical attitude of mind is that a man is never vexed to find that after all, he has been in the wrong”1 helps with the concept he proposed in the practice of medicine. But despite the uncertainty that surrounds medicine, the history of the disease creates challenges around the individuality of each patient. This challenge is present in the practice of neurocritical care. Acute neurological criseswere considered to be part of the black box of complex brain derangements. Over time, with extensive advancement of neurological sciences with tools like neuroimaging, neuromonitoring, surgical procedures, and protocols, the black box is more open now. The practice still has uncertainties, especially with new and complex diseases like coronavirus disease 2019 and the introduction of complex therapies including extensive use of different monoclonal antibodies. Patients with the acute neurological crisis have a multisystem presentation.2 The uncertainty of when an acute pulmonary injury happens with an acute brain crisis is always there.3 Which one is the primary and which one is the key aspect at the time of examination? The neurological examination of these patients can be unreliable due to multiple factors including sedation requirement for ventilator stability to surgical stability to avoid hemorrhagic conversion. The recognition of the presence of this uncertainty is important in neurocritical care. The goal should be to work on facts and change the management based on the response of the therapeutics that are used under the umbrella of the best clinical practice.
{"title":"Uncertainty in Neurocritical Care: Recognizing Its Relevance for Clinical Decision Making","authors":"L. Moscote-Salazar, W. Florez-Perdomo, Tariq Janjua","doi":"10.1055/s-0043-1768056","DOIUrl":"https://doi.org/10.1055/s-0043-1768056","url":null,"abstract":"Uncertainty inprinciple entails thepresence ofdoubt. This can lead to the inabilityofdelayeddecisionmaking. Toanobserver, thiswill lead to skepticismandunwillingness toworkwith the process. Ultimately if the process continues, it will lead to mistrust and a dysfunctional working environment. William Osler was one of thefirst to recognizehow uncertainty plays a role in our medical practice. His statement “One special advantage of the skeptical attitude of mind is that a man is never vexed to find that after all, he has been in the wrong”1 helps with the concept he proposed in the practice of medicine. But despite the uncertainty that surrounds medicine, the history of the disease creates challenges around the individuality of each patient. This challenge is present in the practice of neurocritical care. Acute neurological criseswere considered to be part of the black box of complex brain derangements. Over time, with extensive advancement of neurological sciences with tools like neuroimaging, neuromonitoring, surgical procedures, and protocols, the black box is more open now. The practice still has uncertainties, especially with new and complex diseases like coronavirus disease 2019 and the introduction of complex therapies including extensive use of different monoclonal antibodies. Patients with the acute neurological crisis have a multisystem presentation.2 The uncertainty of when an acute pulmonary injury happens with an acute brain crisis is always there.3 Which one is the primary and which one is the key aspect at the time of examination? The neurological examination of these patients can be unreliable due to multiple factors including sedation requirement for ventilator stability to surgical stability to avoid hemorrhagic conversion. The recognition of the presence of this uncertainty is important in neurocritical care. The goal should be to work on facts and change the management based on the response of the therapeutics that are used under the umbrella of the best clinical practice.","PeriodicalId":43198,"journal":{"name":"Indian Journal of Neurotrauma","volume":null,"pages":null},"PeriodicalIF":0.2,"publicationDate":"2023-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78804328","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Sandeep Kumar, Shailesh Thanvi, H. Beniwal, Sharad Thanvi, Shelly Singh
Abstract Background Penetrating brain injury (PBI) can be caused by several objects ranging from knives to chopsticks. However, an assault with hand drill while working in a factory is a peculiar accident. Because of its rarity and lack of standard protocol management, the management of PBI is complex. Case Presentation We presented a case of a 26-year-old male with alleged history of insertion of eight nails from a hand drill machine from right side of head while working in a factory accompanied by loss of consciousness and history of vomiting. Computer tomography demonstrated that nails passed through the right parietal bone and reached up to contralateral hemisphere and posterior cranial fossa. Removal of nails and hematoma evacuation was done timely that led the patient to have a good postoperative recovery. Conclusion In this case report, we discussed the successful management of a very rare penetrating head injury with a hand drill machine. The goal of this case report is to demonstrate the general management principles in PBI that can improve the patient outcome.
{"title":"Management of Eight Hand Drill Nails Induced Penetrating Brain Injury","authors":"Sandeep Kumar, Shailesh Thanvi, H. Beniwal, Sharad Thanvi, Shelly Singh","doi":"10.1055/s-0043-1762598","DOIUrl":"https://doi.org/10.1055/s-0043-1762598","url":null,"abstract":"Abstract Background Penetrating brain injury (PBI) can be caused by several objects ranging from knives to chopsticks. However, an assault with hand drill while working in a factory is a peculiar accident. Because of its rarity and lack of standard protocol management, the management of PBI is complex. Case Presentation We presented a case of a 26-year-old male with alleged history of insertion of eight nails from a hand drill machine from right side of head while working in a factory accompanied by loss of consciousness and history of vomiting. Computer tomography demonstrated that nails passed through the right parietal bone and reached up to contralateral hemisphere and posterior cranial fossa. Removal of nails and hematoma evacuation was done timely that led the patient to have a good postoperative recovery. Conclusion In this case report, we discussed the successful management of a very rare penetrating head injury with a hand drill machine. The goal of this case report is to demonstrate the general management principles in PBI that can improve the patient outcome.","PeriodicalId":43198,"journal":{"name":"Indian Journal of Neurotrauma","volume":null,"pages":null},"PeriodicalIF":0.2,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77237408","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
L. Moscote-Salazar, W. Florez-Perdomo, Tariq Janjua
Abstract Daily sedation interruption or sedation vacation is a strategy for neurological evaluation, respiratory mechanics, cardiac stability, and eventual weaning to extubation. However, its application has safety aspects such as pulmonary, cardiac, and neurological complications. A protocol-driven sedation vacation in the medical intensive care helps with the reduction in the intensive care length of stay and increase in ventilator-free days. 1,2 The same approach can be used in neurointensive care with alterations based upon the neurocritical care progression.
{"title":"Sedation Vacation in Neurocritical Care: A Proposal Algorithm","authors":"L. Moscote-Salazar, W. Florez-Perdomo, Tariq Janjua","doi":"10.1055/s-0043-1762599","DOIUrl":"https://doi.org/10.1055/s-0043-1762599","url":null,"abstract":"Abstract Daily sedation interruption or sedation vacation is a strategy for neurological evaluation, respiratory mechanics, cardiac stability, and eventual weaning to extubation. However, its application has safety aspects such as pulmonary, cardiac, and neurological complications. A protocol-driven sedation vacation in the medical intensive care helps with the reduction in the intensive care length of stay and increase in ventilator-free days. 1,2 The same approach can be used in neurointensive care with alterations based upon the neurocritical care progression.","PeriodicalId":43198,"journal":{"name":"Indian Journal of Neurotrauma","volume":null,"pages":null},"PeriodicalIF":0.2,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80560706","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Roger Mulumba Ilunga, L. Barry, Mouhamadou Moustapha Ndongo, Yakhya Cisse, Hugues Ghislain Atakla, D. Wague, M. Faye, M. Ba
Abstract The authors report the case of a 10-year-old child who was admitted to the emergency room with a penetrating lumbar spinal injury caused by an iron rod, which occurred accidentally during a recreational activity. The clinical presentation was a ponytail syndrome with paraparesis and cerebrospinal fluid discharge from the lumbar penetration point of the iron rod. The lumbar X-ray and computed tomography (CT) scan performed in the emergency room revealed the iron rod penetrating the spinal canal through the lamina of the L3 vertebra on the left, requiring urgent surgical management, consisting of laminectomy of L3 allowing the removal of the iron rod and repair of the dura mater without any damage to the roots of the cauda equina. The evolution was favorable with complete motor recovery at 3 months follow-up.
{"title":"Penetrating Iron Rod Wound of the Lumbar Spine Causing Cauda Equina Syndrome in a Child: Case Report and Review of the Literature","authors":"Roger Mulumba Ilunga, L. Barry, Mouhamadou Moustapha Ndongo, Yakhya Cisse, Hugues Ghislain Atakla, D. Wague, M. Faye, M. Ba","doi":"10.1055/s-0042-1760450","DOIUrl":"https://doi.org/10.1055/s-0042-1760450","url":null,"abstract":"Abstract The authors report the case of a 10-year-old child who was admitted to the emergency room with a penetrating lumbar spinal injury caused by an iron rod, which occurred accidentally during a recreational activity. The clinical presentation was a ponytail syndrome with paraparesis and cerebrospinal fluid discharge from the lumbar penetration point of the iron rod. The lumbar X-ray and computed tomography (CT) scan performed in the emergency room revealed the iron rod penetrating the spinal canal through the lamina of the L3 vertebra on the left, requiring urgent surgical management, consisting of laminectomy of L3 allowing the removal of the iron rod and repair of the dura mater without any damage to the roots of the cauda equina. The evolution was favorable with complete motor recovery at 3 months follow-up.","PeriodicalId":43198,"journal":{"name":"Indian Journal of Neurotrauma","volume":null,"pages":null},"PeriodicalIF":0.2,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90605379","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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