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BACKGROUND The aim of the study was to investigate the therapeutics effects, complications and factors associated with prognosis of patients with severe Traumatic Brain Injury (TBI) in whom decompressive craniectomy (DC) was performed. METHODS A retrospective study was conducted between 2015 and 2019 and included patients with severe TBI who underwent decompressive craniectomy. The parameters assessed were clinical state using the Glasgow Coma Score (GCS), CT Scan findings, details of DC, complications, factors associated with mortality and neurological outcome upon discharge from hospital using Glasgow Outcome Scale (GOS). RESULTS A total of 83 patients were included in the study. The mean age of the patients was 32 ± 14 years. There were 68 (81.9%) males and 15 (18.1%) females. Most common cause for injury was road traffic accident (62%). The average Glasgow coma score at admission was 7 ± 3.44 (53%). Complications included contralateral hematoma (4.8%), external cerebral herniation (28.9%), seizures (6.0%), hydrocephalus (8.4%), postoperative infection (30.1%) etc. CONCLUSIONS Decompressive craniectomy is an important procedure to save the life of patients with severe TBI. However some complications associated with the procedure have to be kept in mind before using it in a generalised manner. Low GCS at admission, development of hydrocephalus and old age were factors associated with poor outcome.

BACKGROUND Neural tube defects (NTDs) are one of the most common birth defects affecting the Central Nervous System (CNS) and is often associated with complex birth defects compatible with survival.1 NTD is a general term for a congenital malformation of the central nervous system (CNS) occurring secondary to lack of closure of the neural tube and has a worldwide incidence of 1.0 to 10.0 per 1,000 births. Congenital malformations of spine and spinal cord are collectively termed as spinal dysraphism. It includes a heterogenous group of anomalies resulting from incomplete midline closure of osseous, mesenchymal and nervous tissue.2 Most of these conditions are diagnosed at or soon after birth, but some are diagnosed late in childhood or in adulthood because of absence of clinical manifestations. We wanted to evaluate the causative factors, clinical features, management and postoperative complications of children with meningomyelocoele. METHODS This is a retrospective study and all children having meningomyelocoele born between April 2014 to May 2016 were included in the study. Clinical features, maternal educational status, size and location of the defect, operative details such as time to surgery and its relation to postoperative morbidity and mortality were recorded. RESULTS A total of 36 patients were evaluated in the study period. There were 20 (55.6%) males and 16 (44.4%) females. Most common location of MMC was in lumbar (83.3%) and followed by thoracolumbar (16.7%) regions. None of the mothers received folate supplementation. Hydrocephalus (n = 18), pelvicalyceal ectasia (n = 3), pes equinovarus (n = 7), Chiari II malformation (n = 4)), pelvicalyceal ectasia (n = 3), hip dysplasias (n = 2), accounted for additional anomalies. Short term complications following surgery were bladder dysfunction in 8 patients (22.2%), 7 patients (19.4%) had seizures, 6 patients (16.7%) had bacterial meningitis and 3 patients (8.3%) had severe hydrocephalus and 4 patients (11.1%) had ventriculitis. CONCLUSIONS Operating on patients with meningomyelocoele with in 72 hrs. of birth reduces complications, hospital stay and antibiotic usage.

Background The underlying neurobiological mechanism for abnormal functional connectivity in schizophrenia (SCZ) remains unknown. This project investigated whether glutamate and GABA, 2 metabolites that contribute to excitatory and inhibitory functions, may influence functional connectivity in SCZ. Methods Resting-state functional magnetic resonance imaging and proton magnetic resonance spectroscopy were acquired from 58 SCZ patients and 61 healthy controls (HC). Seed-based connectivity maps were extracted between the anterior cingulate cortex (ACC) spectroscopic voxel and all other brain voxels. Magnetic resonance spectroscopy (MRS) spectra were processed to quantify glutamate and GABA levels. Regression analysis was performed to describe relationships between functional connectivity and glutamate and GABA levels. Results Reduced ACC functional connectivity in SCZ was found in regions associated with several neural networks including the default mode network (DMN) compared to HC. In the HC, positive correlations were found between glutamate and both ACC-right inferior frontal gyrus functional connectivity and ACC-bilateral superior temporal gyrus functional connectivity. A negative correlation between GABA and ACC-left posterior cingulate functional connectivity was also observed in HC. These same relationships were not statistically significant in SCZ. Conclusions The present investigation is one of the first studies to examine links between functional connectivity and glutamate and GABA levels in SCZ. Results indicate that glutamate and GABA play an important role in the functional connectivity modulation in the healthy brain. The absence of glutamate and GABA correlations in areas where SCZ showed significantly reduced functional connectivity may suggest that this chemical-functional relationship is disrupted in SCZ.

BACKGROUND Depressed fracture is common following head injury and its management is controversial. These are often associated with considerable morbidity and mortality. This study aims to evaluate various aspects including outcome of depressed skull fractures. MATERIALS AND METHODS 100 patients of depressed skull fractures were admitted in MLB Medical College, Jhansi over a period of three years from June 2014 to June 2017. These patients were evaluated with respect to age, sex, mode of injury, sites of injury, Glasgow coma score (GCS) at the time of admission, early and late epilepsy, focal neurological deficit, CT scan findings, infection and treatment. RESULTS There were 68 males and 32 females. 15-30 years (32%) was the most commonly affected group. RTA (50%) was the most common cause followed by fall (25%) and physical assault (25%). Most common site of fracture was in parietal region (55%). GCS was 13-15 in 80% patients. Fracture was compound type in 82% and simple in 18%. Favourable outcome was achieved in 98% patients especially in those with better presenting GCS. CONCLUSION Most patients with early and proper treatment of depressed fractures have favourable outcome. Good GCS score at admission correlated with better outcome.

The fornix is a white matter tract carrying the fibers connecting the hippocampus and the hypothalamus, two essential stress-regulatory structures of the brain. We tested the hypothesis that allostatic load (AL), derived from a battery of peripheral biomarkers indexing the cumulative effects of stress, is associated with abnormalities in brain white matter microstructure, especially the fornix, and that higher AL may help explain the white matter abnormalities in schizophrenia.Using 13 predefined biomarkers, we tested AL in 44 schizophrenic patients and 33 healthy controls. Diffusion tensor imaging was used to obtain fractional anisotropy (FA) values of the fornix and other white matter tracts.AL scores were significantly elevated in patients compared with controls (F(3,77) = 7.87, p = .006). AL was significantly and inversely correlated with FA of fornix in both controls (r = -.58, p = .001) and patients (r = -.36, p = .023). Several nominally significant (p.05 but did not survive Bonferroni correction for multiple comparison) correlations were also observed between AL and FA of other white matter tracts in schizophrenic patients. However, the fornix was the only tract exhibiting a correlation with AL in both groups.These results provide initial evidence that allostatic processes are linked to fornix microstructure in clinical participants.

Among the intracranial hematomas, chronic subdural hematomas (CSDH) are the most benign with a mortality rate of 0.5-4.0%. The elderly and alcoholics are commonly affected by CSDH. Even though high percentage of CSDH patients improves after the evacuation, there are some unexpected potential complications altering the postoperative course with neurological deterioration. Poor outcome in postoperative period is due to complications like failure of brain to re-expand, recurrence of hematoma and tension pneumocephalus. We present a case report with multiple intraparenchymal hemorrhages in various locations like brainstem, cerebral and cerebellar peduncles, right cerebellar hemisphere, right thalamus, right capsulo-ganglionic region, right corona radiata and cerebral hemispheres after CSDH evacuation. Awareness of this potential problem and the immediate use of imaging if the patient does not awake from anesthesia or if he develops new onset focal neurological deficits, are the most important concerns to the early diagnosis of this rare complication.

Patients with schizophrenia show decreased processing speed on neuropsychological testing and decreased white matter integrity as measured by diffusion tensor imaging, two traits shown to be both heritable and genetically associated indicating that there may be genes that influence both traits as well as schizophrenia disease risk. The potassium channel gene family is a reasonable candidate to harbor such a gene given the prominent role potassium channels play in the central nervous system in signal transduction, particularly in myelinated axons. We genotyped members of the large potassium channel gene family focusing on putatively functional single nucleotide polymorphisms (SNPs) in a population of 363 controls, 194 patients with schizophrenia spectrum disorder (SSD) and 28 patients with affective disorders with psychotic features who completed imaging and neuropsychological testing. We then performed three association analyses using three phenotypes - processing speed, whole-brain white matter fractional anisotropy (FA) and schizophrenia spectrum diagnosis. We extracted SNPs showing an association at a nominal P value of

Schizophrenia, a devastating psychiatric illness with onset in the late teens to early 20s, is thought to involve disrupted brain connectivity. Functional and structural disconnections of cortical networks may underlie various cognitive deficits, including a substantial reduction in the speed of information processing in schizophrenia patients compared with controls. Myelinated white matter supports the speed of electrical signal transmission in the brain. To examine possible neuroanatomical sources of cognitive deficits, we used a comprehensive diffusion-weighted imaging (DWI) protocol and characterized the white matter diffusion signals using diffusion kurtosis imaging (DKI) and permeability-diffusivity imaging (PDI) in patients (n = 74), their nonill siblings (n = 41), and healthy controls (n = 113). Diffusion parameters that showed significant patient-control differences also explained the patient-control differences in processing speed. This association was also found for the nonill siblings of the patients. The association was specific to processing-speed abnormality but not specific to working memory abnormality or psychiatric symptoms. Our findings show that advanced diffusion MRI in white matter may capture microstructural connectivity patterns and mechanisms that govern the association between a core neurocognitive measure-processing speed-and neurobiological deficits in schizophrenia that are detectable with in vivo brain scans. These non-Gaussian diffusion white matter metrics are promising surrogate imaging markers for modeling cognitive deficits and perhaps, guiding treatment development in schizophrenia.

Large-scale consortium efforts such as Enhancing Neuro Imaging Genetics through Meta Analysis (ENIGMA) and other collaborative efforts show that combining statistical data from multiple independent studies can boost statistical power and achieve more accurate estimates of effect sizes, contributing to more reliable and reproducible research. A meta-analysis would pool effects from studies conducted in a similar manner, yet to date, no such harmonized protocol exists for resting state fMRI (rsfMRI) data. Here, we propose an initial pipeline for multi-site rsfMRI analysis to allow research groups around the world to analyze scans in a harmonized way, and to perform coordinated statistical tests. The challenge lies in the fact that resting state fMRI measurements collected by researchers over the last decade vary widely, with variable quality and differing spatial or temporal signal-to-noise ratio (tSNR). An effective harmonization must provide optimal measures for all quality data. Here we used rsfMRI data from twenty-two independent studies with approximately fifty corresponding T1-weighted and rsfMRI datasets each, to (A) review and aggregate the state of existing rsfMRI data, (B) demonstrate utility of principal component analysis (PCA)-based de noising and (C) develop a deformable ENIGMA EPI template based on the representative anatomy that incorporates spatial distortion patterns from various protocols and populations.

Negative symptoms represent a distinct component of psychopathology in schizophrenia (SCZ) and are a stable construct over time. Although impaired frontostriatal connectivity has been frequently described in SCZ, its link with negative symptoms has not been carefully studied. We tested the hypothesis that frontostriatal connectivity at rest may be associated with the severity of negative symptoms in SCZ. Resting state functional connectivity (rsFC) data from 95 mostly medicated patients with SCZ and 139 healthy controls (HCs) were acquired. Negative symptoms were assessed using the Brief Negative Symptom Scale. The study analyzed voxel-wise rsFC between 9 frontal “seed regions” and the entire striatum, with the intention to reduce potential biases introduced by predefining any single frontal or striatal region. SCZ showed significantly reduced rsFC between the striatum and the right medial and lateral orbitofrontal cortex (OFC), lateral prefrontal cortex, and rostral anterior cingulate cortex compared with HCs. Further, rsFC between the striatum and the right medial OFC was significantly associated with negative symptom severity. The involved striatal regions were primarily at the ventral putamen. Our results support reduced frontostriatal functional connectivity in SCZ and implicate striatal connectivity with the right medial OFC in negative symptoms. This task-independent resting functional magnetic resonance imaging study showed that medial OFC–striatum functional connectivity is reduced in SCZ and associated with severity of negative symptoms. This finding supports a significant association between frontostriatal connectivity and negative symptoms and thus may provide a potential circuitry-level biomarker to study the neurobiological mechanisms of negative symptoms.

Background Altered brain connectivity is implicated in the development and clinical burden of schizophrenia. Relative to matched controls, schizophrenia patients show (1) a global and regional reduction in the integrity of the brain's white matter (WM), assessed using diffusion tensor imaging (DTI) fractional anisotropy (FA), and (2) accelerated age-related decline in FA values. In the largest mega-analysis to date, we tested if differences in the trajectories of WM tract development influenced patient–control differences in FA. We also assessed if specific tracts showed exacerbated decline with aging. Methods Three cohorts of schizophrenia patients (total n = 177) and controls (total n = 249; age = 18-61 years) were ascertained with three 3T Siemens MRI scanners. Whole-brain and regional FA values were extracted using ENIGMA-DTI protocols. Statistics were evaluated using mega- and meta-analyses to detect effects of diagnosis and age-by-diagnosis interactions. Results In mega-analysis of whole-brain averaged FA, schizophrenia patients had lower FA (P = 10−11) and faster age-related decline in FA (P = 0.02) compared with controls. Tract-specific heterochronicity measures, that is, abnormal rates of adolescent maturation and aging explained approximately 50% of the regional variance effects of diagnosis and age-by-diagnosis interaction in patients. Interactive, three-dimensional visualization of the results is available at www.enigma-viewer.org. Conclusion WM tracts that mature later in life appeared more sensitive to the pathophysiology of schizophrenia and were more susceptible to faster age-related decline in FA values. Hum Brain Mapp, 2016. © 2016 Wiley Periodicals, Inc.

Introduction Diffusion weighted imaging (DWI) methods can noninvasively ascertain cerebral microstructure by examining pattern and directions of water diffusion in the brain. We calculated heritability for DWI parameters in cerebral white (WM) and gray matter (GM) to study the genetic contribution to the diffusion signals across tissue boundaries. Methods Using Old Order Amish (OOA) population isolate with large family pedigrees and high environmental homogeneity, we compared the heritability of measures derived from three representative DWI methods targeting the corpus callosum WM and cingulate gyrus GM: diffusion tensor imaging (DTI), the permeability-diffusivity (PD) model, and the neurite orientation dispersion and density imaging (NODDI) model. These successively more complex models represent the diffusion signal modeling using one, two, and three diffusion compartments, respectively. Results We replicated the high heritability of the DTI-based fractional anisotropy (h2 = 0.67) and radial diffusivity (h2 = 0.72) in WM. High heritability in both WM and GM tissues were observed for the permeability-diffusivity index from the PD model (h2 = 0.64 and 0.84), and the neurite density from the NODDI model (h2 = 0.70 and 0.55). The orientation dispersion index from the NODDI model was only significantly heritable in GM (h2 = 0.68). Conclusion DWI measures from multicompartmental models were significantly heritable in WM and GM. DWI can offer valuable phenotypes for genetic research; and genes thus identified may reveal mechanisms contributing to mental and neurological disorders in which diffusion imaging anomalies are consistently found. Hum Brain Mapp, 2015. © 2015 Wiley Periodicals, Inc.

Human immunodeficiency virus (HIV) enters the brain early after infecting humans and may remain in the central nervous system despite successful antiretroviral treatment. Many neuroimaging techniques were used to study HIV+ patients with or without opportunistic infections. These techniques assessed abnormalities in brain structures (using computed tomography, structural magnetic resonance imaging (MRI), diffusion MRI) and function (using functional MRI at rest or during a task, and perfusion MRI with or without a contrast agent). In addition, single-photon emission computed tomography with various tracers (e.g., thallium-201, Tc99-HMPAO) and positron emission tomography with various agents (e.g., [18F]-dexoyglucose, [11C]-PiB, and [11C]-TSPO tracers), were applied to study opportunistic infections or HIV-associated neurocognitive disorders. Neuroimaging provides diagnoses and biomarkers to quantitate the severity of brain injury or to monitor treatment effects, and may yield insights into the pathophysiology of HIV infection. As the majority of antiretroviral-stable HIV+ patients are living longer, age-related comorbid disorders (e.g., additional neuroinflammation, cerebrovascular disorders, or other dementias) will need to be considered. Other highly prevalent conditions, such as substance use disorders, psychiatric illnesses, and the long-term effects of combined antiretroviral therapy, all may lead to additional brain injury. Neuroimaging studies could provide knowledge regarding how these comorbid conditions impact the HIV-infected brain. Lastly, specific molecular imaging agents may be needed to assess the central nervous system viral reservoir.

BACKGROUND: We measured and compared heritability estimates for measures of functional brain connectivity extracted using the Enhancing Neuroimaging Genetics through Meta-Analysis (ENIGMA) rsfMRI analysis pipeline in two cohorts: the GOBS (Genetics of Brain Structure) cohort and the HCP (the Human Connectome Project) cohort. These two cohorts were assessed using conventional (GOBS) and advanced (HCP) rsfMRI protocols, offering a test case for harmonization of rsfMRI phenotypes, and to determine measures that show consistent heritability for in-depth genome-wide analysis. METHODS: The GOBS cohort consisted of 334 Mexican-American individuals (124M/210F, average age=47.9±13.2 years) from 29 extended pedigrees (average family size=9 people; range 5–32). The GOBS rsfMRI data was collected using a 7.5-minute acquisition sequence (spatial resolution=1.72×1.72×3 mm(3)). The HCP cohort consisted of 518 twins and family members (240M/278F; average age=28.7± 3.7 years). rsfMRI data was collected using 28.8-minute sequence (spatial resolution=2×2×2 mm(3)). We used the single-modality ENIGMA rsfMRI preprocessing pipeline to estimate heritability values for measures from eight major functional networks, using (1) seed-based connectivity and (2) dual regression approaches. RESULTS: We observed significant heritability (h(2)=0.2–0.4, p

Big data initiatives such as the Enhancing NeuroImaging Genetics through Meta-Analysis consortium (ENIGMA), combine data collected by independent studies worldwide to achieve more generalizable estimates of effect sizes and more reliable and reproducible outcomes. Such efforts require harmonized image analyses protocols to extract phenotypes consistently. This harmonization is particularly challenging for resting state fMRI due to the wide variability of acquisition protocols and scanner platforms; this leads to site-to-site variance in quality, resolution and temporal signal-to-noise ratio (tSNR). An effective harmonization should provide optimal measures for data of different qualities. We developed a multi-site rsfMRI analysis pipeline to allow research groups around the world to process rsfMRI scans in a harmonized way, to extract consistent and quantitative measurements of connectivity and to perform coordinated statistical tests. We used the single-modality ENIGMA rsfMRI preprocessing pipeline based on model-free Marchenko-Pastur PCA based denoising to verify and replicate resting state network heritability estimates. We analyzed two independent cohorts, GOBS (Genetics of Brain Structure) and HCP (the Human Connectome Project), which collected data using conventional and connectomics oriented fMRI protocols, respectively. We used seed-based connectivity and dual-regression approaches to show that the rsfMRI signal is consistently heritable across twenty major functional network measures. Heritability values of 20–40% were observed across both cohorts.

Background: Resting-state functional dysconnectivity is commonly reported in schizophrenia (SCZ) but the underlying neurobiological mechanism remains unknown. Altered excitatory and inhibitory function may play a role but has never been examined. This project investigated the relationship between glutamate and GABA levels assessed with proton MRS and functional connectivity in SCZ.

This paper delineates the layout and the detailed design of a single input multiple output (SIMO) gearbox for a strip leveller machine. The leveller machine is used to flatten out and level the coiled sheets for finding applications in various industries. Roller leveling is essentially a bending process. The out of flat part, sheet or plate is deformed by a series of alternating bends created by passing the sheet, or plate between upper and lower sets of leveling rollers. The power is transmitted to the rollers from the motor via a gearbox and the outputs of the gearbox are connected to the rollers through spindle shafts with the help of universal joints. The large angle of these universal joints affects its efficiency and thereby decreases its life. Hence this angle is to be reduced and one way of achieving this is by compacting the gearbox. The size is drastically reduced by constructing the layout of the gears in such a way, that the space between the outer surface of the gear and the shaft is utilized by arranging the gears in several lateral and longitudinal planes. The main aim of the paper is to describe this innovative layout and its design verification.

Colloid cyst in the third ventricle is a common entity, whereas a variant of it, namely xanthogranulomatous, is quite rare. The closest imaging differential diagnosis is a purely third ventricular craniopharyngioma. We herein describe a case of xanthogranulomatous colloid cyst presenting with hydrocephalus.

Schizophrenia is associated with abnormalities in the structure and functioning of white matter, but the underlying neuropathology is unclear. We hypothesized that increased tryptophan degradation in the kynurenine pathway could be associated with white matter microstructure and biochemistry, potentially contributing to white matter abnormalities in schizophrenia. To test this, fasting plasma samples were obtained from 37 schizophrenia patients and 38 healthy controls and levels of total tryptophan and its metabolite kynurenine were assessed. The ratio of kynurenine to tryptophan was used as an index of tryptophan catabolic activity in this pathway. White matter structure and function were assessed by diffusion tensor imaging (DTI) and (1)H magnetic resonance spectroscopy (MRS). Tryptophan levels were significantly lower (p

The presence of arsenic (As) in water is of great public concern. Arsenic exists in three common valence states viz., As(0) metalloid arsenic, As(III) (arsenite) and As(V) (arsenate). Arsenite [As(III)] is the most toxic form among arsenicals which, predominates in anaerobic conditions, generally in flooded soils and in the water with high BOD. Experiments were conducted to investigate the effect of As(III) on the mycorrhization in vetiver (Vetiveria zizanioides (L.) Nash) grass in hydroponics. Studies showed significant alteration in the mycorrhizal colonization in the roots of vetiver exposed to higher concentrations of As(III) starting from 1.0, 2.0, 3.0, 4.0 to 5.0 mg/L prepared in 5% Hoagland nutrient solution without addition of phosphate ions. Considerable reduction in the mycorrhizal intensity (M) was observed in all the treatment sets as compared to the control suggesting a negative impact of the As(III) on the mycorrhizal association. Simultaneously, the study also showed that, As(III) is toxic to the vetiver plants having mycorrhizal association however plants with non-mycorrhizal (cleansed) roots were found to be able to survive for a longer period exposed to As(III).

Tentorial meningiomas (TM), comprising approximately 3–6% of all intracranial meningiomas, are complex entities with an intricate relationship to surrounding structures and require multiple surgical approaches. In the present study, the rationale for deciding the approaches for TMs and the perioperative management dilemmas were evaluated. Thirty-seven patients (28 primary [supratentorial (2), infratentorial (20) and both (6)] and nine complex [cerebellopontine (CP) angle (5) and petroclival (4)] TM) underwent surgery using the occipital transtentorial, supracerebellar infratentorial, subtemporal transtentorial, bioccipital suboccipital, midline suboccipital, retrosigmoid, and combined pre and retrosigmoid approaches. The extent of excision was categorized according to Simpson’s grade. Simpson’s grade of excision was I in six, II in 11, III in nine and IV in 11 patients, respectively. Follow-up assessment (2 months to 9 years) in 27 patients (72.9%) showed that 23 patients returned to their previous activity level with either no or minimal symptoms, three returned to previous activity level with major cranial nerve palsy, and one patient required permanent assistance. One patient had recurrence and four others underwent resurgery for residual tumor. Two patients with petroclival lesions died due to aspiration pneumonitis and meningitis, respectively; one with CP angle TM presented in a poor general condition and expired following emergency ventriculoperitoneal shunt and subsequent definite surgery. Pseudomeningocele, cerebrospinal fluid leak, and cranial nerve palsy were the major morbidities. Classifying TM into medial and lateral, supra and infratentorial groups helps in deciding an appropriate and safe approach. Meticulously preserving venous sinuses is important since the risk of venous infarction cannot be predicted even with radiological good venous collaterization and apparent venous sinus blockade by tumor. Laterally situated tumors carry a better prognosis when compared to the medially situated ones. Leaving a small residual tumor in an effort to preserve important neurovascular structures does not obviate the expectation of a good long-term prognosis with minimal morbidity and low recurrence rates.

A 52‑year‑old female presented with slowly progressive left lower limb polyradiculopathy. MRI of the lumbar region revealed an extradural dumbbell mass at L3 vertebral level, isointense on T1W and hyperintense on T2W images with homogenous contrast enhancement and extending into paraspinal region through left L3/4 foramen. L2 to L 4 left hemilaminectomy and excision of intraspinal part of tumor was performed. Histopathological examination revealed presence of cavernous hemangioma. This case is reported because of its rarity, unusual dumbbell shape of lesion and difficulty in making a preoperative diagnosis without a coexisting bone lesion.

We present a male child with primary Ewing′s sarcoma arising from ethmoid sinuses with intradural and extracranial extension (bilateral nasal cavities, orbits, and maxillary sinuses). This is a rare condition. He presented with recurrent episodes of epistaxis for 2 years, sudden onset rapidly progressive bilateral proptosis, with painful restriction of extraocular movements, and decreased visual acuity for 4 days. Sudden complete loss of vision following admission demanded emergency tumor decompression.

Aim To identify patients at risk for developing pressure ulcer among hospitalized patients and the prevalence of pressure ulcer in this group. Patients and method A prospective study included 100 patients from medical and surgical wards. Data were collected on admission, and subjects were followed up at regular intervals. The Waterlow pressure ulcer risk assessment tool was completed and patients were stratified "as not at risk," "at risk", "high risk", and "very high risk". Subjects were then monitored for 2 weeks and the actual incidence of pressure ulcer formation was analyzed in the various risk groups. Results Of 100 patients studied, 20% were at risk, 10% were assessed at high risk, and 7% were classified as at very high risk for developing a pressure ulcer. Necessary preventive measures were taken (posture change, specialized beds/mattresses, nursing care, nutritional input, etc) for those patients at risk of development of pressure ulcer. Four of 7 patients (57.1%) who were at very high-risk developed pressure ulcer as compared with 2 of 10 patients (20%) categorized in the high-risk category within a period of 2 weeks. No patient who was classified as not at risk on the Waterlow pressure ulcer risk assessment tool developed a pressure ulcer within the observation period. Conclusion Pressure ulcers developed in identified risk groups despite adequate available preventive measure being taken to prevent their development. It is of extreme importance to identify patients at risk for the development of pressure ulcers so that preventive measures can be instituted to reduce the incidence of hospital-acquired pressure ulcers.

Aim: Spontaneous intracranial hemorrhage (SICH) in children is relatively less common as compared to adults, and there are limited studies addressing this issue in children. In this study, we analyze the etiology, clinical features, treatment options and outcome assessment in this population. Material and Methods: Fifty consecutive patients of spontaneous intracerebral bleed, aged 18 years and below, were retrospectively analyzed based on medical records and radiographic images. Status of the patient at the final follow-up after discharge was considered as the outcome. Results: Age of patients ranged from 2 months to 17 years with higher predilection in males (M:F = 3:2). Presenting features were symptoms of raised intracranial pressure (70.0%), deterioration in sensorium (50.0%), limb weakness (36.0%) and seizures (28%). Arteriovenous malformation (AVM) was the most common cause of hemorrhage, and was found in 22 patients (44%), followed by cerebral aneurysm in 17 cases (34%), moyamoya disease in 3 cases (6%), and intracranial tumor, hematological disorders and unknown cause (possible vasculitis) were each found in 2 patients (4%). Treatment modalities consisted of: excision of AVM, aneurysm clipping, embolization, superficial temporal artery to middle cerebral artery bypass, tumor excision, hematoma evacuation and conservative management. Thirty-five patients (74%) had good outcome and 13 patients had poor outcome (26%). Conclusions: Aneurysm is an important cause of SICH, alongside AVM, which is the leading cause. Thorough investigation is necessary to elucidate the cause of bleed, which may otherwise be missed. Cerebellar bleed and late presentation were found to be associated with poor outcome. Age was not found to be associated with outcome.

The significance of pain in wound healing is much neglected because of biases against pain management in general, a lack of knowledge of available analgesics, and difficulties associated with pain measurement. To assess pain in patients suffering from acute and chronic wounds, a 1-day descriptive study was conducted involving 50 patients, 26 with acute wounds and 24 with chronic wounds, served by the wound clinic of a university hospital. Patients responded to questions regarding onset, location, type, and intensity of pain using the Visual Analog and Visual Reporting Scales and to statements about aggravating and relieving factors and overall impact on their quality of life using a 5-point scale where 5 = totally agree and 1 = completely disagree. Results showed pain was commonly mild to moderate (41 patients, 88%), located in and around wound (43 patients, 93.5%), occurred most frequently during dressing change (30 patients, 65%), and was relieved by medications (39 patients, 84.8%) and positioning (17 patients, 37%). The most commonly affected quality of life variables were physical activity (40 patients, 87% of patients) and social functioning (23 patients, 50%). Controlling wound pain can play a major role in improving patient quality of life.

A hypertensive patient with clinical and laboratory features of normal pressure hydrocephalus (NPH) but with evidence of bilateral multiple cerebral infarcts on computed tomography (CT) did not benefit from shunting. In six reported cases of hypertensive cerebrovascular disease with NPH, the result of shunting was not predictable and was generally disappointing. Laboratory criteria to predict which cases of NPH will benefit from shunting remain controversial. The chances of improvement after shunting are slight when there is CT evidence of bilateral multiple cerebral infarcts, even though other clinical and laboratory data might suggest NPH.