Journal of Chittagong Medical College Teachers' Association
Background: Tuberculosis (TB) is one of the commonest infectious diseases in the developing count... more Background: Tuberculosis (TB) is one of the commonest infectious diseases in the developing countries like Bangladesh. Tubercular Meningitis (TBM) is a common sequel of TB involving the Central Nervous System (CNS) and is one of the leading causes of mortality and morbidity. Syringomyelia following TBM as late or early complication of TB is very rare. Case Description: We report a case of syrigomyelia in a 32 years old lady as a sequel, following treatment for tubercular meningitis after 8 years of successful treatment of tubercular meningitis with a full course of Anti tubercular drugs. She developed gradual weakness of her both lower limbs along with tingling and numbness and bladder incontinence for 5 months before presentation. MRI of Brain and Spine revealed syringomyelia from upper cervical region down to lower dorsal region. Syringostomy at D7 level was done initially but with not much significant improvement. Rather over a period of time she deteriorated and became bed ridde...
This article is an open access article distributed under the terms and conditions of the Creative... more This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY
Posterior Reversible Encephalopathy Syndrome (PRES) is a clinical but mostly radiological diagnos... more Posterior Reversible Encephalopathy Syndrome (PRES) is a clinical but mostly radiological diagnosis with a wide variety of etiologies that is commonly underdiagnosed and missed due to the complete reversibility of its course. The pathophysiology lies in the raised blood pressure that disrupts the internal autoregulation within brain. Ours is a patient who presented as such, is a diagnosed case of B-thalassemia major. One previous author reported of PRES in gravid women with abnormal blood picture which being a rarity interested us in reporting this case [1]. Diagnosis now is more MR based but treatment yet remains elusive and mostly symptomatic.
Abstarct Objective Gliomas, the most frequent primary brain tumors, have various grades, among wh... more Abstarct Objective Gliomas, the most frequent primary brain tumors, have various grades, among which grade II, III, and IV are diffusely infiltrating astrocytomas. As therapeutic approaches and outcome differ considerably, depending on the grade of these tumors, prediction is important regarding outcome. Magnetic resonance spectroscopy (MRS) can be of help in understanding of the biochemical changes of pathological state to study, monitor, predict grading and outcome of gliomas. Materials and Methods All the 30 patients in the study with intracranial diffusely infiltrating astrocytoma had MRS study using 1.5 Tesla MR scanner. The study population was divided into three groups on the basis of the grades of the tumor according to histopathology. Mean height of choline (Ch), N-acetyl aspartate (NAA), creatine (Cr) peak, and choline/creatine (Ch/Cr) ratio was documented. Mean value of each variable among three grades was analyzed and compared with analysis of variance (ANOVA) test (F-te...
Bangladesh Medical Research Council Bulletin, 2013
Spontaneous intracerebral hemorrhage (ICH) comprises 10-15% of all strokes and has a higher risk ... more Spontaneous intracerebral hemorrhage (ICH) comprises 10-15% of all strokes and has a higher risk of morbidity and mortality (40-45%). A simple and widely valid clinical grading scale, the Intracerebral Hemorrhage Score (ICH score) was developed to predict to outcome of spontaneous ICH. The aim of the present study was to assess the relation between the ICH score and the surgical outcome of ICH by Glasgow Outcome Scale (GOS) at the 30th post ictus day in our perspective. This prospective study was done during the period of April 2009 to October 2010 in Department of Neurosurgery, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka. Forty three cases were enrolled by set inclusion and exclusion criteria. Intracerebral Hemorrhage Score was calculated during admission and the surgical outcome of ICH was determined by GOS by face to face or telephone interview using structured questionnaire on their 30th post ictus day. Correlation between the ICH score and the surgical outcome of...
Objective: Objective of the study was to estimate the economic burden of head injury (HI) patient... more Objective: Objective of the study was to estimate the economic burden of head injury (HI) patients attending a tertiary level hospital. This study also tried to determine the socio-demographic characteristics, to estimate direct and indirect cost incurred by the head injury patients and to assess economic burden by different types of accidents causing head injury. Methods:The study was a cross-sectional descriptive study carried out to estimate the economic burden of head injury patients attending a tertiary level hospital during the period from January to June 2010, conducted at the neurosurgery department of Dhaka Medical College Hospital (DMCH). All the conscious head injury patients of both sexes, treated in Neurosurgery department of DMCH, willing to participate in the study were included in the study. Convenience type of non-probability sampling technique was followed and sample size of this study was 110. Face to face interview was conducted with the patient and / or attendan...
Background: Vascular injuries occur in approximately 25% of all penetrating neck traumas, with ca... more Background: Vascular injuries occur in approximately 25% of all penetrating neck traumas, with carotid artery injuries being particularly lethal. Penetrating neck injuries are potentially fatal. Vascular injuries occur in approximately 25% of cases, which can lead to the formation of arteriovenous fistulas. Case Description: The authors present a case of delayed open surgery to repair a carotid-jugular fistula that resulted in an unprecedented complication, as well as a brief review of the condition’s diagnosis and treatment options. Conclusion: This case report suggests us that, penetrating neck injuries should be thoroughly evaluated for arteriovenous fistulae. To avoid complications, common carotid-jugular fistulas must be treated as soon as possible. Postoperative complications can be effectively managed with prompt action.
Chronic subdural haematoma (CSH) is a well-known disease entity; however, calcifi ed CSH (CCSH) i... more Chronic subdural haematoma (CSH) is a well-known disease entity; however, calcifi ed CSH (CCSH) is quite rare. Here the authors report on a 65-year-old man who developed gradual left hemiparesis and had gradually deteriorating level of consciousness for 1 month. CT scan revealed a huge right-sided CCSH. He underwent surgery and the CCSH was excised totally. The patient recovered well and was able to do his daily activities by himself. Surgical treatment for CCSH results in good neurological outcome.
Among the pediatric brain tumors, medulloblastoma (MB) is the most common solid variety and entir... more Among the pediatric brain tumors, medulloblastoma (MB) is the most common solid variety and entirely occur in the posterior fossa with tendency to seed into CSF spaces. Despite innovations in technological developments and understanding of tumor biology, modern imaging facilities, advances in surgical practices, and newer chemotherapeutic and radiation techniques, this malignant type of tumor continues to be a formidable entity. Even though, the outcome in terms of survival rate is better than any time before, the overall result is still disappointing. With advances in management strategy, chances of survival with good quality of life have been amplified, where newer targeted therapies and rehabilitation plays an immense role. While the adverse effects of surgery and adjuvant therapies are still on play, researchers are trying ceaselessly to minimize those to give maximum wellbeing to these unfortunate children.
Chronic subdural haematoma (CSH) is a well-known disease entity; however, calcified CSH (CCSH) is... more Chronic subdural haematoma (CSH) is a well-known disease entity; however, calcified CSH (CCSH) is quite rare. Here the authors report on a 65-year-old man who developed gradual left hemiparesis and had gradually deteriorating level of consciousness for 1 month. CT scan revealed a huge right-sided CCSH. He underwent surgery and the CCSH was excised totally. The patient recovered well and was able to do his daily activities by himself. Surgical treatment for CCSH results in good neurological outcome.
Neurosurgery is an ever developing discipline. So many new technological adjuncts have been added... more Neurosurgery is an ever developing discipline. So many new technological adjuncts have been added and are being added. Neuronavigation is such a modern adjunct that has helped and is helping neurosurgeons and patients to have better surgery and outcome. This adjunct helps the neurosurgeon in determining or defining target areas, functional and anatomical high risk zones, landmark areas and trajectories. A brief review on basics of neuronavigation and its role in neurosurgery is discussed.
Neurenteric cysts are rare congenital lesions of benign nature that can be encountered at any lev... more Neurenteric cysts are rare congenital lesions of benign nature that can be encountered at any level of the neuraxis, starting from the cranium down to coccyx. Rewarding outcome can be achieved with early diagnosis and complete removal of these benign lesions. Here, we report a case of a huge neurenteric cyst in an 11-year-old boy at the ventral craniocervical junction, a rarely reported entity with literature review. In this article, we focus on the clinical presentation, pathogenesis, radiological findings, surgery, and surgical outcome of this benign lesion, as we succeeded to have gratifying result following surgery in our instance.
Some lesions in the brain are difficult to approach through a single common route / trajectory. F... more Some lesions in the brain are difficult to approach through a single common route / trajectory. For those, dual approach combined together may ensure easier safe removal with better outcome as we had lesions like left petroclival meningioma & large craniopharyngioma. Methods Two patients, one left petroclival meningioma and one suprasellar craniopharyngioma with intraventricular extension underwent surgery with dual approach at the Neurosurgery department, BSMMU. After detailed clinical and radiological evaluation, the left petroclival meningioma patient was planned for a combined pre and post sigmoid petrosectomy and retromastoid retrosigmoid route. These were accomplished in two stages, three months apart. The craniopharyngioma patient with intraventricular extension underwent surgery through pterional transsylvian and frontal anterior trans-callosal approach in a single sitting. Bang. J Neurosurgery 2020; 10(1): 111-118
Trigeminal Neuralgia (TGN) is a disease frequently encountered by the neurologists and neurosurge... more Trigeminal Neuralgia (TGN) is a disease frequently encountered by the neurologists and neurosurgeons. The typical pain of TGN is lancinating in nature in one side of face along the distribution of Trigeminal nerve. Pain is sharp shooting and periodic in nature, aggravated by various factors, like eating, talking, laughing. A typical trigeminal neuralgia is caused by compression to the Root exit zone (REZ) by superior cerebellar artery (SCA), aberrant loop of Antero inferior cerebellar artery (AICA), dolichobasilar artery or a large sized vein. However facial pain mimicking TGN may occur by a tumor, plaque of Multiple sclerosis or may be idiopathic. So this is very important to know the cause of TGN/ facial pain for planning of specific treatment. Most of the patients remain pain free by medical management by using Carbamazepine, oxycarbazepine, Pregabalin, Gabapentin, Clonazepam etc. But medically refractory TGN can be treated by Microvascular decompression (MVD) with significantly ...
Chiari malformations (CM) are a set of enigmatic congenital anomalies, owing to their complex pat... more Chiari malformations (CM) are a set of enigmatic congenital anomalies, owing to their complex pathology, varied presentations and management dilemma. Because of the daunting nature of this disease, a universal definitive treatment protocol is yet to be established. Diverse surgical procedures are in practice with various philosophies, aiming to resolve different sections of the pathologies of this disorder, either singly or in combination. However, outcomes are quite variable. Though not a well-recognized and commonly practiced paradigm of managing CM, different techniques of cranioplasty for CM has been described by many authors with variable rates of success. Cranioplasty for Chiari has been found to be helpful in different circumstances with the objective to address different predicaments. Initially, it has been exercised as one of the modalities to manage some particular situations, mostly in cases to solve complications following surgery. Now in some centers, different types of methods of cranioplasty are practiced routinely to treat particular set of Chiari patients with specifically set criteria and some have shown success in those certain scenarios. In this chapter, different methods of cranioplasty for Chiari malformation by different authors, strategies behind the techniques and their results are described in brief. "Stealth cranioplasty", a technique devised by our team is also portrayed.
After hospitalization, an urgent CT scan of brain did, which revealed massive hematoma occupying ... more After hospitalization, an urgent CT scan of brain did, which revealed massive hematoma occupying the right sylvian fissure and adjacent parietal lobe (Figure 1). MRI of brain showed T1WI heterogeneously hyper intense lesion present within the right sylvian cistern and adjacent temporo-parietal area. The lesion had multiple intrinsic flow voids in T2WI (Figure 2). Due to initial presentation as intracranial hemorrhage and presence of multiple flow voids in T2WI, a CT angiogram of cerebral vessels was done to sort out the pattern of vascular pathology. CT angiogram showed a saccular
Chiari malformation (CM) and its management are long debated enigmas for neurosurgeons. Many surg... more Chiari malformation (CM) and its management are long debated enigmas for neurosurgeons. Many surgical procedures have been innovated and are in practice for this perplexing and daunting entity to give the patients a satisfactory remedy. But, a unanimously accepted surgical procedure is still lacking to achieve gratifying result. We tried to develop a novel technique, which we call the "stealth cranioplasty (SCP)," to help the adult Chiari malformation type 1 (CM1) patients. In this chapter, the philosophy behind developing the technique of "stealth cranioplasty" by reconstruction of posterior fossa (PF) by cranioplasty with pre-shaped titanium mesh is described. Different stages, difficulties, and modifications of the journey toward the present day status are also elaborated graphically.
Chronic periapical abscess drains through a sinus tract either intraorally or extraorally. Howeve... more Chronic periapical abscess drains through a sinus tract either intraorally or extraorally. However, intraoral drainage is more common than extraoral in both dentitions. Nevertheless, the simultaneous presentation of extraoral and intraoral sinus tract is very rarely reported in primary dentition. This case report discussed the management of a girl aged 7 years with a chronic periapical abscess of tooth no. 85 with both non-healing extraoral and intraoral sinus tract having multiple stomata. Non-vital pulpectomy using calcium hydroxide paste intracanal dressing was performed initially until 2 weeks without remarkable healing; then antibiotic dressing consisting of a mixture of ciprofloxacin, metronidazole and clindamycin was placed as an intracanal medicament for 1 week, which shows uneventful healing of both intraoral and extraoral sinus tract. This case report clearly indicates about how history, correct diagnosis and appropriate treatment of endodontic infection associated with si...
Journal of Chittagong Medical College Teachers' Association
Background: Tuberculosis (TB) is one of the commonest infectious diseases in the developing count... more Background: Tuberculosis (TB) is one of the commonest infectious diseases in the developing countries like Bangladesh. Tubercular Meningitis (TBM) is a common sequel of TB involving the Central Nervous System (CNS) and is one of the leading causes of mortality and morbidity. Syringomyelia following TBM as late or early complication of TB is very rare. Case Description: We report a case of syrigomyelia in a 32 years old lady as a sequel, following treatment for tubercular meningitis after 8 years of successful treatment of tubercular meningitis with a full course of Anti tubercular drugs. She developed gradual weakness of her both lower limbs along with tingling and numbness and bladder incontinence for 5 months before presentation. MRI of Brain and Spine revealed syringomyelia from upper cervical region down to lower dorsal region. Syringostomy at D7 level was done initially but with not much significant improvement. Rather over a period of time she deteriorated and became bed ridde...
This article is an open access article distributed under the terms and conditions of the Creative... more This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY
Posterior Reversible Encephalopathy Syndrome (PRES) is a clinical but mostly radiological diagnos... more Posterior Reversible Encephalopathy Syndrome (PRES) is a clinical but mostly radiological diagnosis with a wide variety of etiologies that is commonly underdiagnosed and missed due to the complete reversibility of its course. The pathophysiology lies in the raised blood pressure that disrupts the internal autoregulation within brain. Ours is a patient who presented as such, is a diagnosed case of B-thalassemia major. One previous author reported of PRES in gravid women with abnormal blood picture which being a rarity interested us in reporting this case [1]. Diagnosis now is more MR based but treatment yet remains elusive and mostly symptomatic.
Abstarct Objective Gliomas, the most frequent primary brain tumors, have various grades, among wh... more Abstarct Objective Gliomas, the most frequent primary brain tumors, have various grades, among which grade II, III, and IV are diffusely infiltrating astrocytomas. As therapeutic approaches and outcome differ considerably, depending on the grade of these tumors, prediction is important regarding outcome. Magnetic resonance spectroscopy (MRS) can be of help in understanding of the biochemical changes of pathological state to study, monitor, predict grading and outcome of gliomas. Materials and Methods All the 30 patients in the study with intracranial diffusely infiltrating astrocytoma had MRS study using 1.5 Tesla MR scanner. The study population was divided into three groups on the basis of the grades of the tumor according to histopathology. Mean height of choline (Ch), N-acetyl aspartate (NAA), creatine (Cr) peak, and choline/creatine (Ch/Cr) ratio was documented. Mean value of each variable among three grades was analyzed and compared with analysis of variance (ANOVA) test (F-te...
Bangladesh Medical Research Council Bulletin, 2013
Spontaneous intracerebral hemorrhage (ICH) comprises 10-15% of all strokes and has a higher risk ... more Spontaneous intracerebral hemorrhage (ICH) comprises 10-15% of all strokes and has a higher risk of morbidity and mortality (40-45%). A simple and widely valid clinical grading scale, the Intracerebral Hemorrhage Score (ICH score) was developed to predict to outcome of spontaneous ICH. The aim of the present study was to assess the relation between the ICH score and the surgical outcome of ICH by Glasgow Outcome Scale (GOS) at the 30th post ictus day in our perspective. This prospective study was done during the period of April 2009 to October 2010 in Department of Neurosurgery, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka. Forty three cases were enrolled by set inclusion and exclusion criteria. Intracerebral Hemorrhage Score was calculated during admission and the surgical outcome of ICH was determined by GOS by face to face or telephone interview using structured questionnaire on their 30th post ictus day. Correlation between the ICH score and the surgical outcome of...
Objective: Objective of the study was to estimate the economic burden of head injury (HI) patient... more Objective: Objective of the study was to estimate the economic burden of head injury (HI) patients attending a tertiary level hospital. This study also tried to determine the socio-demographic characteristics, to estimate direct and indirect cost incurred by the head injury patients and to assess economic burden by different types of accidents causing head injury. Methods:The study was a cross-sectional descriptive study carried out to estimate the economic burden of head injury patients attending a tertiary level hospital during the period from January to June 2010, conducted at the neurosurgery department of Dhaka Medical College Hospital (DMCH). All the conscious head injury patients of both sexes, treated in Neurosurgery department of DMCH, willing to participate in the study were included in the study. Convenience type of non-probability sampling technique was followed and sample size of this study was 110. Face to face interview was conducted with the patient and / or attendan...
Background: Vascular injuries occur in approximately 25% of all penetrating neck traumas, with ca... more Background: Vascular injuries occur in approximately 25% of all penetrating neck traumas, with carotid artery injuries being particularly lethal. Penetrating neck injuries are potentially fatal. Vascular injuries occur in approximately 25% of cases, which can lead to the formation of arteriovenous fistulas. Case Description: The authors present a case of delayed open surgery to repair a carotid-jugular fistula that resulted in an unprecedented complication, as well as a brief review of the condition’s diagnosis and treatment options. Conclusion: This case report suggests us that, penetrating neck injuries should be thoroughly evaluated for arteriovenous fistulae. To avoid complications, common carotid-jugular fistulas must be treated as soon as possible. Postoperative complications can be effectively managed with prompt action.
Chronic subdural haematoma (CSH) is a well-known disease entity; however, calcifi ed CSH (CCSH) i... more Chronic subdural haematoma (CSH) is a well-known disease entity; however, calcifi ed CSH (CCSH) is quite rare. Here the authors report on a 65-year-old man who developed gradual left hemiparesis and had gradually deteriorating level of consciousness for 1 month. CT scan revealed a huge right-sided CCSH. He underwent surgery and the CCSH was excised totally. The patient recovered well and was able to do his daily activities by himself. Surgical treatment for CCSH results in good neurological outcome.
Among the pediatric brain tumors, medulloblastoma (MB) is the most common solid variety and entir... more Among the pediatric brain tumors, medulloblastoma (MB) is the most common solid variety and entirely occur in the posterior fossa with tendency to seed into CSF spaces. Despite innovations in technological developments and understanding of tumor biology, modern imaging facilities, advances in surgical practices, and newer chemotherapeutic and radiation techniques, this malignant type of tumor continues to be a formidable entity. Even though, the outcome in terms of survival rate is better than any time before, the overall result is still disappointing. With advances in management strategy, chances of survival with good quality of life have been amplified, where newer targeted therapies and rehabilitation plays an immense role. While the adverse effects of surgery and adjuvant therapies are still on play, researchers are trying ceaselessly to minimize those to give maximum wellbeing to these unfortunate children.
Chronic subdural haematoma (CSH) is a well-known disease entity; however, calcified CSH (CCSH) is... more Chronic subdural haematoma (CSH) is a well-known disease entity; however, calcified CSH (CCSH) is quite rare. Here the authors report on a 65-year-old man who developed gradual left hemiparesis and had gradually deteriorating level of consciousness for 1 month. CT scan revealed a huge right-sided CCSH. He underwent surgery and the CCSH was excised totally. The patient recovered well and was able to do his daily activities by himself. Surgical treatment for CCSH results in good neurological outcome.
Neurosurgery is an ever developing discipline. So many new technological adjuncts have been added... more Neurosurgery is an ever developing discipline. So many new technological adjuncts have been added and are being added. Neuronavigation is such a modern adjunct that has helped and is helping neurosurgeons and patients to have better surgery and outcome. This adjunct helps the neurosurgeon in determining or defining target areas, functional and anatomical high risk zones, landmark areas and trajectories. A brief review on basics of neuronavigation and its role in neurosurgery is discussed.
Neurenteric cysts are rare congenital lesions of benign nature that can be encountered at any lev... more Neurenteric cysts are rare congenital lesions of benign nature that can be encountered at any level of the neuraxis, starting from the cranium down to coccyx. Rewarding outcome can be achieved with early diagnosis and complete removal of these benign lesions. Here, we report a case of a huge neurenteric cyst in an 11-year-old boy at the ventral craniocervical junction, a rarely reported entity with literature review. In this article, we focus on the clinical presentation, pathogenesis, radiological findings, surgery, and surgical outcome of this benign lesion, as we succeeded to have gratifying result following surgery in our instance.
Some lesions in the brain are difficult to approach through a single common route / trajectory. F... more Some lesions in the brain are difficult to approach through a single common route / trajectory. For those, dual approach combined together may ensure easier safe removal with better outcome as we had lesions like left petroclival meningioma & large craniopharyngioma. Methods Two patients, one left petroclival meningioma and one suprasellar craniopharyngioma with intraventricular extension underwent surgery with dual approach at the Neurosurgery department, BSMMU. After detailed clinical and radiological evaluation, the left petroclival meningioma patient was planned for a combined pre and post sigmoid petrosectomy and retromastoid retrosigmoid route. These were accomplished in two stages, three months apart. The craniopharyngioma patient with intraventricular extension underwent surgery through pterional transsylvian and frontal anterior trans-callosal approach in a single sitting. Bang. J Neurosurgery 2020; 10(1): 111-118
Trigeminal Neuralgia (TGN) is a disease frequently encountered by the neurologists and neurosurge... more Trigeminal Neuralgia (TGN) is a disease frequently encountered by the neurologists and neurosurgeons. The typical pain of TGN is lancinating in nature in one side of face along the distribution of Trigeminal nerve. Pain is sharp shooting and periodic in nature, aggravated by various factors, like eating, talking, laughing. A typical trigeminal neuralgia is caused by compression to the Root exit zone (REZ) by superior cerebellar artery (SCA), aberrant loop of Antero inferior cerebellar artery (AICA), dolichobasilar artery or a large sized vein. However facial pain mimicking TGN may occur by a tumor, plaque of Multiple sclerosis or may be idiopathic. So this is very important to know the cause of TGN/ facial pain for planning of specific treatment. Most of the patients remain pain free by medical management by using Carbamazepine, oxycarbazepine, Pregabalin, Gabapentin, Clonazepam etc. But medically refractory TGN can be treated by Microvascular decompression (MVD) with significantly ...
Chiari malformations (CM) are a set of enigmatic congenital anomalies, owing to their complex pat... more Chiari malformations (CM) are a set of enigmatic congenital anomalies, owing to their complex pathology, varied presentations and management dilemma. Because of the daunting nature of this disease, a universal definitive treatment protocol is yet to be established. Diverse surgical procedures are in practice with various philosophies, aiming to resolve different sections of the pathologies of this disorder, either singly or in combination. However, outcomes are quite variable. Though not a well-recognized and commonly practiced paradigm of managing CM, different techniques of cranioplasty for CM has been described by many authors with variable rates of success. Cranioplasty for Chiari has been found to be helpful in different circumstances with the objective to address different predicaments. Initially, it has been exercised as one of the modalities to manage some particular situations, mostly in cases to solve complications following surgery. Now in some centers, different types of methods of cranioplasty are practiced routinely to treat particular set of Chiari patients with specifically set criteria and some have shown success in those certain scenarios. In this chapter, different methods of cranioplasty for Chiari malformation by different authors, strategies behind the techniques and their results are described in brief. "Stealth cranioplasty", a technique devised by our team is also portrayed.
After hospitalization, an urgent CT scan of brain did, which revealed massive hematoma occupying ... more After hospitalization, an urgent CT scan of brain did, which revealed massive hematoma occupying the right sylvian fissure and adjacent parietal lobe (Figure 1). MRI of brain showed T1WI heterogeneously hyper intense lesion present within the right sylvian cistern and adjacent temporo-parietal area. The lesion had multiple intrinsic flow voids in T2WI (Figure 2). Due to initial presentation as intracranial hemorrhage and presence of multiple flow voids in T2WI, a CT angiogram of cerebral vessels was done to sort out the pattern of vascular pathology. CT angiogram showed a saccular
Chiari malformation (CM) and its management are long debated enigmas for neurosurgeons. Many surg... more Chiari malformation (CM) and its management are long debated enigmas for neurosurgeons. Many surgical procedures have been innovated and are in practice for this perplexing and daunting entity to give the patients a satisfactory remedy. But, a unanimously accepted surgical procedure is still lacking to achieve gratifying result. We tried to develop a novel technique, which we call the "stealth cranioplasty (SCP)," to help the adult Chiari malformation type 1 (CM1) patients. In this chapter, the philosophy behind developing the technique of "stealth cranioplasty" by reconstruction of posterior fossa (PF) by cranioplasty with pre-shaped titanium mesh is described. Different stages, difficulties, and modifications of the journey toward the present day status are also elaborated graphically.
Chronic periapical abscess drains through a sinus tract either intraorally or extraorally. Howeve... more Chronic periapical abscess drains through a sinus tract either intraorally or extraorally. However, intraoral drainage is more common than extraoral in both dentitions. Nevertheless, the simultaneous presentation of extraoral and intraoral sinus tract is very rarely reported in primary dentition. This case report discussed the management of a girl aged 7 years with a chronic periapical abscess of tooth no. 85 with both non-healing extraoral and intraoral sinus tract having multiple stomata. Non-vital pulpectomy using calcium hydroxide paste intracanal dressing was performed initially until 2 weeks without remarkable healing; then antibiotic dressing consisting of a mixture of ciprofloxacin, metronidazole and clindamycin was placed as an intracanal medicament for 1 week, which shows uneventful healing of both intraoral and extraoral sinus tract. This case report clearly indicates about how history, correct diagnosis and appropriate treatment of endodontic infection associated with si...
Uploads
Papers by Asifur Rahman