Neurosciences Center

Riyadh, Saudi Arabia

Neurosciences Center

Riyadh, Saudi Arabia
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Satyarthee G.,Neurosciences Center | Moscote-Salazar L.,RED LATINO Latin American Trauma and Intensive Neuro care Organization
Journal of Pediatric Neurosciences | Year: 2016

Ependymoma tends to occur commonly along either on ventricular surfaces of the brain or central canal of the spinal cord. Rarely, ependymoma can develop in the cerebral cortex without attachment to the ventricular structures. However, such occurrence in the purely extra-axial compartment in the falcine region mimicking falcine meningioma is exceedingly rare. The detailed search of primary falcine ependymoma (PEFE) in Medline and PubMed yielded only five isolated case reports. All cases occurred in patient older than 17 years of age; however, our case was a 9-year-old girl. PEFE tends to occur more commonly in male with a male to female ratio of 3:2, with the mean age of 28.8 years (range 17-43 years), lesion had intra-operatively had solid consistency in all cases. All cases were subjected to surgical resection followed by adjuvant radiotherapy; however, in addition, one case also received chemotherapy, with an average follow-up period of 9 months, however, missing in one case. The mean size of the tumor was 5.25 cm (range 1.8-7.2 cm). The authors present a unique case of PEFE in a 9-year-old girl with 8.6 cm ×6 cm ×5.4 cm-sized giant primary falcine ependymoma, managed surgically successfully. To the best of the authors' knowledge, the current case is the first case of pediatric extra-axial falcine ependymoma occurring within the first decade of life in the western literature, showing rapid evolution over 1 month's period into a giant size. Brief pathogenesis, clinical feature, and management along with the pertinent literature are reviewed briefly. © 2017 Journal of Pediatric Neurosciences | Published by Wolters Kluwer - Medknow.

The Central nervous system can be affected in extrapulmonary tuberculosis. The intracranial tuberculoma occurrence is a rare entity occurrence; most often occur in the form of discrete small multiple lesions. Rarely a large sized tuberculoma is observed with mass effects and usually managed surgically to provide rapid relief of mass effect, histopathological confirmation of diagnosis, reduction of pathological mass thereby increasing efficacy of medical therapy. Author reports an extremely rare case of giant tuberculoma occurring in a pediatric patient, which was managed with antituberculous medication along with cerebral decongestant. The patient was also advised surgical therapy in view of giant size of tuberculoma associated with significant mass effect; however, the parents were unwilling for any form of surgical intervention and finally choose to continue medical treatment alone. After 6 months of antitubercular medical therapy, magnetic resonance imaging brain showed completely vanishing of lesion and also amelioration of mass effect with marked subsidence of perilesional edema correlated very well with marked improvement in the clinical status. He received antituberculous therapy for 24 months. To the best knowledge of authors, the current case represents first case of its kind in the pediatric age group with giant intracerebral tuberculoma responding favorably with medication. Management of such rare case and pertinent literature is reviewed briefly. © 2017 Journal of Pediatric Neurosciences Published by Wolters Kluwer- Medknow.

Aggarwal P.,SBILab | Gupta A.,SBILab | Garg A.,Neurosciences Center
2015 IEEE Global Conference on Signal and Information Processing, GlobalSIP 2015 | Year: 2015

In this paper, we propose a novel voxel-based method for joint estimation of underlying activity signal and hemodynamic response function (HRF) in functional magnetic resonance imaging (fMRI). In the proposed two stage iterative framework, fused-least absolute shrinkage and selection operator (Fused LASSO) penalty is utilized for activity detection and HRF estimation. Conditions of smoothness and sparsity are imposed on HRF for its estimation. The validity of the proposed method is demonstrated on both synthetic and real fMRI data. © 2015 IEEE.

Satyarthee G.D.,Neurosciences Center | Sharma B.S.,Neurosciences Center
Journal of Pediatric Neurosciences | Year: 2015

Orbital emphysema is usually considered as self-limiting condition, rarely carries a risk of vision loss as catastrophic consequences due to occlusion of the central retinal artery. It can occur as a consequence of head trauma associated with fracture of the orbit, previous surgery, infection or exposure to high-pressure air jet. Authors report an interesting 7-year-old girl who presented with proptosis of left eye, associated with swelling of eyelids of both eyes. Computerized tomography scan head and orbit revealed orbital emphysema in the left eye with fracture of medial wall of left orbit and fracture of orbit roof with small pneumocephalus over left basifrontal region. Fortunately, she responded well to conservative therapy. Current article reminds uncommon condition to prevent potential visual loss, describing briefly management options.

Satyarthee G.D.,Neurosciences Center | Mahapatra A.K.,AIIMS
Journal of Pediatric Neurosciences | Year: 2015

Authors report a rare case of supratentorial glioblastoma multiforme in a 13-year-old boy, who had headache, vomiting and left sided hemiparesis for last 6 months. On evaluation by primary physician he was labeled as hydrocephalus in view of enlarged head with papilledema on fundoscopic evaluation and no imaging was carried out. On current admission, magnetic resonance imaging brain revealed a large heterogeneous mass lesion involving right frontoparietal region associated with massive perilesional edema causing significant mass effect. He underwent right fronto-temporal craniotomy and intraoperatively erosion of parietal bone was observed, unassociated with any extradural deposit of tumor. After surgery, he noticed improvement in headache along with hemiparesis. Primary calvarial erosion in glioblastoma is extremely rare, and there is paucity of literature as evident from the few case reports reported previously and all occurred in elderly, so current case is the first pediatric case having primary calvarial erosion. Management of such case and pertinent literature is briefly discussed.

Sinha S.,Neurosciences Center | Siddiqui K.A.,Neurosciences Center
Neurosciences | Year: 2011

Defining intractable epilepsy is essential not only to identify up to 40% of patients refractory to pharmacological management, but also to facilitate selection and comparison of such patients for research purposes. The ideal definition still eludes us. Multiple factors including number of antiepileptic drug (AED) failures, seizure frequency and duration of unresponsiveness, etiology, and epilepsy syndromes are considered in formulating the definition of pharmaco-resistant epilepsy. Most definitions used in the literature agree on the number of AED failures, which seem to be 2 or 3, however, the seizure frequency and time factor are varied. The International League Against Epilepsy proposed a definition of drugresistant epilepsy as a failure of adequate trials of 2 tolerated and appropriately chosen and used AED schedules. This for now, could provide an operational definition for clinical and research settings. However, with emergence of new data and novel treatments the criteria for intractability may change.

Orief T.,Neurosciences Center | Orz Y.,Neurosciences Center | Attia W.,Neurosciences Center | Almusrea K.,Neurosciences Center
World Neurosurgery | Year: 2012

Objective: The aim of this study is to describe six cases with spontaneous resorption of sequestrated intervertebral disc herniation observed using magnetic resonance imaging. In addition, the possible mechanisms, predictive factors of spontaneous disappearance of the sequestrated disc herniation, and the proper surgical timing were discussed and reviewed in literature. Methods: All the studied cases experienced acute radicular pain due to sequestrated intervertebral disc herniation; they refused surgery and were treated conservatively, and they were followed up neurologically and radiologically in the outpatient clinic in regular visits. Results: The studied cases included five cases with lumbar disc herniation (three at level L4-5 and two at level L5-S1) and one case with cervical disc herniation at level C5-6. All patients recovered from their radicular pain within 3 to 6 weeks, and it was correlated with resorption of their sequestrated intervertebral disc herniation as documented in their follow-up magnetic resonance imaging at 4 to 9 months. Conclusions: We found that sequestrated disc herniation has potential for regression, which can be clearly demonstrated by magnetic resonance imaging, because of having higher water content, and therefore, may regress through both dehydration and inflammation-mediated resorption. We suggest conservative treatment in the initial course of the sequestrated type of disc herniation for at least 2 months before recommending surgical intervention unless severe neurologic deterioration takes place. © 2012 Elsevier Inc. All rights reserved.

Orief T.,Neurosciences Center | Bin-Nafisah S.,Neurosciences Center | Almusrea K.,Neurosciences Center | Alfawareh M.,Neurosciences Center
Asian Spine Journal | Year: 2011

The preferred treatment of a type II odontoid fracture is anterior odontoid screw fixation to preserve the cervical spine range of movement. This case report describes an unusual complication of guidewire breakage during anterior odontoid cannulated screw fixation for a 52-year-old patient who presented with a type II odontoid fracture after a motor vehicle accident. The distal segment of the guidewire was bent over the tip of the cannulated odontoid screw and broke off during guidewire withdrawal. The three months follow-up computed tomography examination of the cervical spine showed acceptable screw placement, good odontoid process alignment with incomplete fusion, and no migration of the fractured segment of the guidewire. It is recommended that the guidewire be withdrawn once the cannulated screw is passed through the fractured site into the odontoid process and a new guidewire be used in each surgical procedure instead of been reused to avoid metal stress fatigue that can result in easy breakage. © 2011 by Korean Society of Spine Surgery.

Mahmoud A.A.H.,Neurosciences Center | Rizk T.,Neurosciences Center | El-Bakri N.K.,Research and Scientific Publication Center | Riaz M.,Research and Scientific Publication Center | And 2 more authors.
Epilepsia | Year: 2011

Purpose: We ran this study to assess the incidence of nephrolithiasis in a group of children on topiramate (TPM) therapy for at least 1 year. Methods: In this retrospective observational surveillance study, we reviewed the medical charts of children on TPM for at least 1 year seen at the pediatric neurology department during the period from 2005 to 2010 at King Fahad Medical City. Children with a normal baseline ultrasound report were included. Follow-up ultrasound reports after at least 1 year were collected. However, patients with any evidence of chronic illness or medications that may affect the kidney functions in addition to those who are not compliant with the prescribed dose were excluded. Family history of renal stones, symptoms suggestive of urologic disorders, and comorbidities were recorded. Key Findings: Medical charts of 96 children on TPM with a mean age of 6.9 (±3.8) years were reviewed; 52 (54.2%) of the children were male. The follow-up ultrasound showed that five children (5.2%) had developed kidney stones. The occurrence of kidney stones was found in four female patients (80%) versus one male (20%) (p > 0.05). Significance: Long-term use of TPM may result in increased incidence of asymptomatic kidney stones in the pediatric population. Hence, routine baseline and follow-up ultrasound of the urinary system should be recommended during the use of TPM in children. © 2011 International League Against Epilepsy.

Gupta N.,Neurosciences Center | Rath G.P.,Neurosciences Center | Prabhakar H.,Neurosciences Center | Dash H.H.,Neurosciences Center
Journal of Neurosurgical Anesthesiology | Year: 2013

Background: Smooth recovery from anesthesia is desirable in children undergoing surgery for spinal dysraphism who are nursed in prone position during the postoperative period. Dexmedetomidine may be beneficial in these children owing to its sedative, anxiolytic, and opioid-sparing properties with minimal respiratory depression. Methods: Thirty-six children with spinal dysraphism at lumbosacral area, aged 8 to 12 years, undergoing corrective surgery were randomized to receive either dexmedetomidine or volume-matched saline (placebo) after positioned prone until beginning of skin closure. Inspired concentration of sevoflurane was changed to keep the bispectral index score between 45 and 55. Perioperative hemodynamics, intraoperative fentanyl and sevoflurane consumption, and postoperative recovery profile and fentanyl consumption was observed by blinded observers. Postoperative pain, emergence agitation (EA), and discharge readiness from postanesthesia care unit was evaluated using the modified objective pain score, agitation Cole score, and modified Aldrete score, respectively. Fentanyl 0.5-1 μg/kg was administered for pain (objective pain score ≥4) or severe EA (agitation Cole score ≥4) lasting for >5 minutes. Results: The 2 groups did not differ significantly with respect to demographics, duration of anesthesia, emergence, and extubation times. The intraoperative consumption of sevoflurane and fentanyl was significantly less in dexmedetomidine group (0.2±0.1 vs. 0.3±0.1 mL/min, P<0.0001 and 2.3±0.5 vs. 3.1±0.6 μg/kg, P=0.0001, respectively), along with a lower mean heart rate (P<0.001). The mean systolic blood pressure (P=0.98) and incidence of bradycardia and hypotension was comparable in between the 2 groups. Postoperatively, the children in dexmedetomidine group had significantly lower pain scores (P<0.0001), agitation scores (P<0.0001), and time to achieve full modified Aldrete score [0 (0 to 10) vs. 10 (0 to 20) min, P=0.001]. The postoperative consumption of fentanyl was significantly less in dexmedetomidine group [0 (0 to 1.04) vs. 0.88 (0 to 3) μg/kg, P=0.003], along with a longer time of first analgesic requirement [600 (5 to 2100) vs. 5 (5 to 185) min, P=0.0001]. The mean heart rate and systolic blood pressure were higher in placebo group (P<0.001), whereas no difference was observed in respiratory rate (P=0.73) and arterial oxygen saturation (P=0.36). The number of patients with postoperative nausea and vomiting was significantly lower in dexmedetomidine group [2 (11.1%) vs. 9 (50%), P=0.03]. Conclusions: Intraoperative use of dexmedetomidine in children undergoing spinal surgery results in a favorable recovery profile with reduced postoperative pain and EA, without adverse perioperative hemodynamic effects. Copyright © 2013 by Lippincott Williams & Wilkins.

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