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Occipital condylar fractures (OCFs) are rare fractures encountered after trauma. Most of these get missed on plain radiographs. A high degree of suspicion prompts one to diagnose it with computed tomographic scan. Isolated hypoglossal nerve palsy is one of the manifestations. Management depends on the type of fracture. Overall prognosis is good.

Object The aim of this study was to analyze the correlation of hypodensity in extradural hematomas on CT with the clinical profile in pediatric patients. This is the only study available in this age group. Methods This was a prospective study conducted over a period of 3 years in which all children 18 years old or younger with a diagnosis of cranial extradural hematoma were included. The patients were allocated to 2 groups: those with mixed-density clots (17 cases) and those with classically hyperdense clots (52 cases). A comparative analysis between the 2 groups was conducted. Results Patients with mixed-density clots presented earlier to the hospital, had poor Glasgow Coma Scale scores at admission, exhibited large clot volumes, had a high incidence of active bleeding at surgery, and had increased morbidity and mortality as compared with the patients with hyperdense extradural hematomas. Conclusions Early recognition and rapid evacuation of the mixed-density clot with restoration of hemostasis may result in a decline in morbidity and death in children with this entity.

Sellar and suprasellar tuberculomas are rare. Patients with these lesions usually experience headache, vomiting, and hypofunction of pituitary gland; imaging reveals an enhancing sellar-suprasellar mass. We report 2 rare cases of sellar-suprasellar tuberculomas in children aged 8 and 6 years. One child presented with features of headache and vomiting, and the other presented with posterior pituitary dysfunction. In both cases, imaging revealed sellar-suprasellar masses. Both cases were multidrug-resistant tuberculomas. We discuss sellar-suprasellar tuberculomas, a rare form of neurotuberculosis in the background of an overall increase in multidrug-resistant tuberculosis, especially in children.

Aim To analyze the analysis of recurrence rates of single versus double burr holes in patients with subacute and chronic subdural hematomas. Material and methods The study was a prospective randomized controlled trial on patients with subacute and chronic subdural hematomas. Collections with membranes or septae were excluded from the study. A written consent was taken from the patient or patient party after explaining the procedure. A total of 254 patients were enrolled in the study over a period of 18-months in the Department of Neurosurgery, Sheri-Kashmir-Institute of Medical Sciences, Srinagar, Kashmir. Results Recurrence rates in single and double-burr-hole groups were 6.15% and 4.83% respectively, which was not statistically significant. Conclusion Most of the subdural hematomas can be dealt by single burr-hole drainage.

Traumatic pseudoaneurysm of the middle meningeal artery is rare and is associated with high mortality. Skull fracture is usually an associated feature of this entity. An elderly male was brought to our hospital in a stage of coma. The details of ictus were not known. The Glasgow coma scale score was 9/15. Examination revealed a pseudo-aneurysm arising from the posterior branch of the left middle meningeal artery which was excised. The case is presented for its rarity and its characteristic radiology. Traumatic pseudoaneurysm of middle meningeal artery is rare. It is important to recognize this treatable entity.

Aim To study the clinicopathological aspects of primary CNS lymphoma in immunocompetent patients. Material and methods Sixteen patients with primary CNS lymphoma were analyzed for their clinico-pathological characteristics and followed-up for the treatment and subsequent management in Neurosurgery, and Medical and Radiation Oncology. Results The fronto-parietal region was the commonest location of CNS lymphoma; four cases of cerebellar lymphoma were seen. Our patients were relatively young with a mean age of 48 years and an age range of 35-60 years. Females outnumbered males with a ratio of 2.7:1. The commonest presentation was focal neurological-deficits and features of raised intracranial pressure. All the patients histologically had diffuse large B-cell lymphoma. Radiologically, most presented as disc-enhancing lesions. Two patients had multiple lesions. Most of the patients (10) died within a mean of 4.4 months (range 2 weeks-16 months). Conclusion Primary CNS lymphoma is seen in immunocompetent patients as well. Relapse is common after treatment and the overall prognosis is unfavorable.

Background We endeavored to analyze patients of subacute and chronic subdural hematomas studied in a 4-year period at the Sher-i-Kashmir Institute of Medical Sciences, Kashmir, India. Methods The study was a retrospective analysis of 1181 patients of subdural hematomas. Demographic characteristics, clinico-radiologic features, operative modalities, and outcome were studied. Acute subdural hematomas were excluded from the study. Results The mean age was 60.4 ± 12.4 and males outnumbered females. Chronic subdural collections were more common than subacute subdural hematomas and left side predominated. Two burr holes with closed-system drainage was used in most patients. Incidence of postoperative seizures is very low. Overall recurrence rates were low; however, multilocular hematomas had the highest incidence of recurrence. Morbidity and mortality were 7.53% and 2.96%, respectively. Preoperative neurologic grade correlated with outcome. Conclusions Subdural hematomas are common in elderly males. Preoperative neurologic grade dictates the outcome. Multilocular hematomas have a higher chance of recurrence. Craniotomy should be reserved for recurrent hematomas, and there may be a scope of craniotomy for multilocular chronic subdural hematomas at the outset. Antiepileptic prophylaxis is not routinely recommended.

Brain tumors in children represent the second most frequent tumors in this age group after hematologic malignancies. We highlight the demographic pattern after retrospective analysis of brain tumors in children from geographically and ethnically distinct Kashmir Valley managed in our center between 2000 and 2009. We had a total of 248 pediatric patients with brain tumors. The parameters analyzed were age, gender, location of tumors and histopathological subtypes as well as WHO grade of tumor. We also did a comparison between the frequencies of common varieties of tumor in the first and second 5-year periods. We found that 111 tumors (44.75%) were supratentorial, and 137 (55.25%) were infratentorial. The male-to-female ratio was 1.4:1. The proportions of low-grade and high-grade tumors were 60 and 40%, respectively. The most common tumor in our series was astrocytoma. The most common tumors in the supratentorial and infratentorial compartments were craniopharyngioma and medulloblastoma, respectively. Our experience reflects a different demographic profile of pediatric brain tumors as compared with other regions of the world.

Epidural hematomas which are located at the vertex are rarely seen and form a small percentage of total epidural hematomas. Tearing in the superior sagittal sinus is the usual cause of an epidural hematoma located in the vertex. The clinical features of this entity are non-specific; hence, localization of the lesion is difficult. We report an adult who was hit by a motorcycle and was initially discharged from the hospital as a case of concussional head injury. He returned back with raised intracranial pressure symptoms, so a CT scan was done but was misinterpreted, and he reported one week later with bilateral abducent nerve palsy. Magnetic resonance imaging confirmed vertex EDH for which he was operated.These hematomas are seen rarely and can be interpreted as an artifact. Its recognition is important because it has an excellent prognosis. We concluded that all head injury patients should get high axial cuts on the CT scan, and any degree of suspicion should prompt a neurosurgeon to investigate further with coronal CT scan or MRI.