Pakistan Journal Of Neurological Surgery

Silent Struggles, Resilient Spirits: A Study of Psychosocial Challenges and Quality of Life in Female Brain Tumor Patients at a High-Volume Neuroscience Institute in Pakistan

Hamza Noman — 2025-08-31

Objectives: To determine the psychosocial impact of brain tumours in the female population of Pakistan using the FACT-Br Questionnaire.

Materials and Methods: 108 female patients with diagnosed brain tumours between the ages of 13-75 years were enrolled after informed consent from Punjab Institute of Neurosciences, Lahore. After admission, patients were asked to fill out the FACT-Br questionnaire. Demographic data and symptoms were also recorded.

Results: Out of a total of 108 patients, the mean FACT-Br total score was 96.7 (out of 200). This indicated a significant deterioration in the quality of life and psychosocial well-being.

Conclusion: Our results showed that brain tumours had caused major psychosocial and quality of life impairment in our sample. It is advised, based on our findings, that recognition by physicians of these problems is essential, and effort towards a better QOL outcome is required.

Meningitis in Children Presenting With First-Time Fits And Fever

Naveed Ullah — 2025-08-31

Background: Seizures are among the most common neurological crises that children experience. Medical professionals are concerned that meningitis may be the underlying reason when youngsters experience convulsions and fever. This study aimed to determine the frequency of meningitis in children presenting for the first time with seizures and fever at a tertiary care hospital in Peshawar.

Materials & Methods: This descriptive cross-sectional study was conducted over six months at the Pediatric Medicine Department, Khyber Teaching Hospital, Peshawar. The study used a non-probability consecutive sampling method to select 135 children, ages 1 month to 12 years.

Results: The study included 135 children with a mean age of 7.44 years (SD ± 2.7). Age-wise distribution showed the highest proportion (31.1%) in children aged 11–12 years. Males comprised 41.5%(n = 56), and females 58.5%(n = 79). Meningitis was confirmed in 37%(n = 50) of cases. Fever was documented in 48.1% of cases. There was a statistically significant correlation (p < 0.001) between meningitis and the duration of symptoms, complicated seizures, and fever.

Conclusion: Meningitis is a serious medical issue that should be evaluated by medical professionals in children who are having their first seizures and fever, especially if they are young or have complicated seizure presentations. Meningitis may not show the classic symptoms, but a diagnosis can still be made in some situations.

Correlation Between Neuro-Ortho Clinical Findings and Radiological Patterns in Cervical Spine Trauma

Hafiz Abdul Basir — 2025-08-31

Objective: To evaluate the correlation between neuro-orthopedic clinical findings and radiological imaging patterns in patients presenting with cervical spine trauma at a tertiary care hospital.

Materials and Methods: A prospective observational study was conducted at the Department of Radiology and Orthopedics, Lady Reading Hospital, Peshawar. A total of 354 patients aged 14 years and above with suspected or confirmed cervical spine trauma were enrolled. Detailed clinical neuro-orthopedic examinations were performed using the American Spinal Injury Association (ASIA) scale. All patients underwent CT and MRI cervical spine imaging. Clinical findings were correlated with radiological injury patterns.

Results: The mean age of patients was 37.2 ± 10.8 years, with a male predominance (65.5%). Road traffic accidents were the leading cause of injury (59.3%). The most frequent radiological findings were compression fractures (39.5%) and spinal cord signal changes (14.7%). ASIA grades C and D were most common. A statistically significant moderate positive correlation was observed between spinal cord signal changes on MRI and severity of neurological deficit (r = 0.61, p < 0.001).

Conclusion: There is a strong association between clinical neurological impairment and radiological abnormalities in cervical spine trauma. Incorporating MRI with clinical evaluation improves diagnostic accuracy and assists in prognostication. Multidisciplinary neuro-ortho-radiological assessment is crucial for optimal management of cervical spine injuries.

Correlation Between Preoperative Tumor Volume and Postoperative Neurological Deficit in Brain Tumor Resections

Sajid Razaq — 2025-08-31

Objective: To evaluate the correlation between preoperative tumor volume and the development of early postoperative neurological deficits in patients undergoing brain tumor resections.

Materials and Methods: A prospective observational study was conducted at Lady Reading Hospital, Peshawar, from January to December 2024. A total of 130 patients undergoing elective craniotomy for brain tumor resection were enrolled. Preoperative tumor volume was calculated using contrast-enhanced T1-weighted MRI via manual segmentation. Neurological status was assessed within 72 hours postoperatively. Data were analyzed using SPSS version 26.0, applying independent t-tests, ROC analysis, and logistic regression.

Results: Out of 130 patients, 38 (29.2%) developed new or worsened neurological deficits postoperatively. Patients with deficits had significantly larger mean tumor volumes (61.8 ± 17.2 cm³) compared to those without deficits (42.7 ± 14.5 cm³, p < 0.001). A tumor volume cutoff of 51.5 cm³ predicted deficits with 81.6% sensitivity and 75.3% specificity (AUC = 0.83). Logistic regression confirmed tumor volume as an independent predictor (OR: 2.06; p < 0.01).

Conclusion: Preoperative tumor volume is significantly associated with early postoperative neurological deficits. A volumetric threshold may serve as a valuable tool for surgical risk assessment and patient counseling in brain tumor surgery.

Spectrum of Intracranial Complications in Patients with Dental Abscess

Mansoor Ahmad — 2025-08-31

Objective: To analyze the demographic characteristics, primary dental infections, and spectrum of intracranial complications in patients diagnosed with intracranial infections secondary to dental abscesses.

Materials & Methods: This retrospective observational study reviewed data from 180 patients diagnosed with intracranial complications resulting from dental abscesses at Lady Reading Hospital over 15 months (January 2024 to March 2025). Data collected from electronic medical records included patient demographics, type and location of dental abscess, microbiological findings, and intracranial complications confirmed by CT or MRI. Logistic regression analysis was used to identify risk factors.

Results: The mean age of patients was 45.1 years. The most common primary dental infection was periapical abscess (60%). The most frequent intracranial complication was brain abscess (35%), followed by meningitis (20%) and cavernous sinus thrombosis (25%). Older age, diabetes mellitus, and immunocompromised status were identified as significant risk factors for brain abscess development.

Conclusion: Intracranial complications secondary to dental abscesses represent a significant clinical concern. Early diagnosis and prompt management are crucial to improving patient outcomes. This study highlights the demographic and clinical patterns of these infections, which can aid in risk stratification and timely intervention.

Clinical Outcomes of Transforaminal Full Endoscopic Discectomy in the Management of Upper Lumbar Disc Herniation: A Prospective Study

Muhammad Farooq — 2025-08-31

Objective: This study analyzes the clinical effects and possible adverse events that occur after performing Full Endoscopic Lumbar Spine Surgery (FELSS) through the transforaminal approach when treating upper lumbar disc herniation.

Methods: This prospective study recruited patients with Upper Lumbar Disc Herniation (ULDH) who underwent transforaminal full Endoscopic Lumbar Spine Surgery at the Farooq Endoscopic Spine Institute, Afridi Medical Complex, from February 2020 to January 2023, with a 1-year follow-up. Those patients who have Symptoms refractory to at least six weeks of conservative management, including physiotherapy, analgesics, and epidural steroid injections, were included. Visual analogue scale and Oswestry disability index were the main outcome measures used, along with reporting the complications.

Results: During postoperative months 1, 6, and 12, the patients experienced significant VAS and ODI score enhancements, which reached 1.5 ± 0.6 VAS and 12.5 ± 5.0 ODI (p < 0.001). Of the patients, 83.1% managed to return to work, and daily activities were resumed by 89.2% of the population. Three patients (6.38%) showed drastic improvements as they were pain-free and achieved standing position, while preoperatively they were brought on a wheelchair. The surgical procedures resulted in four complications affecting 2.4% of patients through dural tear, as well as 4.2% developing epidural hematomas.

Conclusion: The transforaminal FELSS surgical method represents a reliable and protected strategy to treat upper lumbar disc herniation while producing considerable positive treatment results. Surgeons can expect better patient recovery when medical treatment occurs soon after symptoms start and the patient has no neurological issues.

Management of Thoracolumbar Spinal Fracture at Tertiary Care Hospitals: A Retrospective Study

Hamed Shir Shinwari — 2025-08-31

Objective: This study aimed to evaluate the fracture types, neurological deficits via the ASIA grading system, and to analyze fracture management strategies, post-fracture and surgical complications, in patients with thoracolumbar fractures.

Materials and Methods: A retrospective observational study was conducted on 114 TLS patients aged 16-75 years with known cases of TLS fracture. Data included demographics, mechanism of injury, radiographic investigations, fracture classifications, ASIA grades, treatment types, and outcomes. Descriptive statistics were used for analysis.

Results: The current study found that the majority of patients were male (64%) and aged 20-29 years (36%). Falls from height were the leading mechanism of injury. AO classification revealed a predominance of A1 (26.3%) and A2 (21.9%) fractures. ASIA A (complete neurological deficits) was found in 35.1% of patients, and ASIA E (no neurological deficit) in 31.6%. Conservative treatment was employed in 55.3% while 44.7% of patients underwent surgery, mostly through a posterior approach. Common complications included spinal cord compression (35.1%), pressure sores (21.9%), and neuropathic pain (13.2%). Overall, 70% of patients showed good recovery.

Conclusion: The study concluded that posterior surgical intervention is preferred, yielding favorable outcomes. Hence, early diagnosis and appropriate interventions are also crucial for minimizing complications and improving prognosis.

Comparative Analysis of MRI DWI/ADC Changes with Clinical Recovery in Stroke Patients

Hafeez Ur Rehman — 2025-08-31

Objective: To determine the relationship between MRI diffusion weighted imaging (DWI), apparent diffusion coefficient (ADC) changes, and clinical recovery in acute ischemic stroke patients.

Materials and Methods: This prospective observational study was conducted at the Radiology Department of Lady Reading Hospital, Peshawar, from January 2025 to June 2025. A total of 234 patients with acute ischemic stroke were included. All patients underwent MRI with DWI and ADC sequences within 24 hours of symptom onset. Clinical severity was assessed using the National Institutes of Health Stroke Scale (NIHSS), and functional recovery was evaluated using the Modified Rankin Scale (mRS) and Barthel Index at discharge and 30-day follow-up. Statistical analysis included Pearson correlation and multivariate regression to assess the association between imaging parameters and clinical outcomes.

Results: DWI reversal on follow-up imaging was observed in 38.6% of patients and was strongly associated with improved functional outcomes (p=0.002). Multivariate analysis confirmed baseline DWI volume, mean ADC value, and NIHSS score as independent predictors of recovery.
Conclusion: DWI lesion size, ADC value, and initial NIHSS score are significant predictors of clinical recovery in acute ischemic stroke patients. Incorporation of MRI-based diffusion imaging in routine stroke assessment improves early prognostication and guides management decisions.

Nerve Conduction Studies: A Diagnostic Tool for Carpal Tunnel Syndrome

Mewat Shah — 2025-08-31

Objectives: Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy, yet the role of nerve conduction studies (NCS) in its diagnosis remains debated. This study aimed to evaluate the diagnostic yield of NCS and its correlation with clinical features in patients with suspected CTS.

Materials & Methods: A retrospective cross-sectional study was conducted on 201 patients referred for NCS with symptoms suggestive of CTS. Demographic characteristics, symptom profiles, physical examination findings (Tinel’s sign, Phalen’s maneuver), and NCS results were reviewed. Diagnostic accuracy measures were calculated, and associations between clinical features and NCS-confirmed CTS were assessed using chi-square tests.
Results: NCS confirmed CTS in 65.2% (n=131) of patients. Bilateral symptoms p=0.007), nocturnal exacerbation ( p<0.001), and a positive Phalen’s maneuver (100 vs. 28; p<0.001) were significantly associated with NCS-confirmed CTS. Severe numbness (p<0.001) and pain (p<0.001) also correlated with positive findings, whereas comorbidities showed no significant association (p=0.396).
Conclusions: NCS demonstrates higher diagnostic value in patients presenting with bilateral symptoms, nocturnal pain, and positive provocative tests, supporting a selective rather than routine approach to its use. However, its limited sensitivity in early-stage disease underscores the importance of combining clinical and electrophysiological assessments. Future longitudinal studies are warranted to determine the predictive role of NCS in treatment outcomes.

Cognitive and Neuropsychiatric Sequelae in Postpartum Women with Preeclampsia: A Prospective Cohort Study

Sadia Ahmad — 2025-08-31

Objective: This study aimed to prospectively evaluate cognitive function and neuropsychiatric outcomes in postpartum women with a history of preeclampsia compared to normotensive controls. It further sought to identify key predictors of cognitive impairment and mood disturbances within this high-risk group.

Materials and Methods: Between January and December 2024, a forward-looking cohort investigation was implemented at a tertiary healthcare institution. A total of 280 postpartum participants were included, comprising 160 women diagnosed with preeclampsia and 120 normotensive counterparts, with both groups balanced in terms of age and parity. Cognitive performance was measured using the Montreal Cognitive Assessment (MoCA), while emotional health was monitored through the Hospital Anxiety and Depression Scale (HADS) and the Edinburgh Postnatal Depression Scale (EPDS) during follow-up visits conducted at 6 and 12 months after childbirth.

Results: At 12 months postpartum, women in the preeclampsia group exhibited significantly lower mean MoCA scores (23.6 vs. 26.1, p<0.001) and a higher prevalence of clinically significant anxiety (38.1% vs. 15.8%) and depression (29.4% vs. 10.8%) than controls. Logistic regression identified severe preeclampsia, low educational status, and elevated EPDS scores as independent predictors of cognitive impairment.

Conclusion: Women with a history of preeclampsia are at increased risk for cognitive and psychiatric sequelae in the postpartum period. These findings underscore the importance of structured neuropsychiatric screening and early intervention in postpartum care for this high-risk population.

Comparative Diagnostic Performance of CT and MRI in Acute Ischemic Stroke: A Retrospective Analysis From A Tertiary Care Center

Amina Iftikhar — 2025-08-31

Objective: This study sought to assess and juxtapose the diagnostic proficiency of non-contrast CT and MRI in acute ischemic stroke, focusing on infarct delineation, hemorrhagic conversion, and posterior circulation involvement.

Materials and Methods: This retrospective observational study was conducted at the Department of Radiology, Lady Reading Hospital, Peshawar. A total of 200 patients aged 18 years or older, presenting with clinical suspicion of AIS, were included. All patients underwent both non-contrast CT and MRI within 24 hours of symptom onset. Imaging was reviewed independently by two experienced neuro-radiologists. Data on infarct detection, infarct volume, posterior circulation involvement, and hemorrhagic transformation were recorded.

Results: MRI detected acute infarcts in 92% of patients, significantly more than CT (66%) (p < 0.001). In posterior circulation strokes, MRI identified 60 cases versus 24 on CT (p < 0.001). Detection of hemorrhagic transformation was similar between modalities (CT: 87.5%, MRI: 85.7%; p = 0.68). MRI showed higher diagnostic accuracy with a sensitivity of 92%, specificity of 87%, and AUC of 0.95, compared to CT (sensitivity: 66%, specificity: 81%, AUC: 0.75). MRI also identified larger infarct volumes (p < 0.01).

Conclusion: MRI provides superior diagnostic performance in acute ischemic stroke, especially for early and posterior circulation infarcts, while CT remains crucial for initial hemorrhage exclusion. A combined approach may enhance diagnostic accuracy and improve outcomes in stroke care.

Controlled Decompression Effects in Patients with Severe Traumatic Brain Injury: A Randomized Controlled Trial

Abdul Hameed Khan — 2025-08-31

Objective: To investigate whether controlled decompression therapy reduces the incidence of comorbidities and enhances recovery in sTBI patients.

Materials and Methods: In a Khyber teaching hospital, sTBI patients aged 18 to 75 years were randomly divided into one of two groups: controlled decompression (CD) surgery (n = 26) and fast decompression surgery (n = 26) in a randomized control experiment. The primary outcome markers were 30-day all-cause mortality and the Extended-Glasgow Outcome-Scale (GOS-E) score at six months. Secondary outcomes included delayed bleeding, posttraumatic brain infarction, and intraoperative brain infarction.

Results: The greatest improvement in six-month GOS-E score was a remarkable reduction in 30-day all-cause mortality in the controlled decompression (CD) group in comparison to the group fast decompression group of the participants (15.3% compared with 24.6%, a P value of -0.042). Additionally, subjects in the group of supervised decompression surgery had lower intraoperative brain edema (19.2% versus 42.3%, p-value 0.033), late bleeding (11.5% versus 30.7%, p-value 0.048), and cerebral infarction after trauma than the rapid decompression group (15.0% versus 22.4%, with a p-value less than 0.001).

Conclusion: Controlled decompression (CD) surgical interventions have been found to significantly uplift the outcomes for individuals with severe traumatic brain injury (sTBI) and reduce the likelihood of related health conditions so but a more comprehensive understanding of the importance of standardized directed decompression surgical intervention in the management of sTBI requires multicenter randomized controlled trials.

A Month in Cross Section: A Case Series of Eleven Sphenoid Wing Meningiomas: A Single Center Experience

Mushtaq — 2025-08-31

Objective: The objective of this work was to present our experience of SWM in a single-center case series of eleven patients in one month.

Materials & Methods: 11 cases of joint global sphenoid wing meningiomas were operated on in September 2022. Patient demographic, clinical, radiology, and perioperative salient features were noted. Post-operative clinical outcome included improvement in visual acuity, neural deficit, and headache. The extent of resection on radiology plus survival was noted as an outcome measure.

Results: Patients aged 28 to 65 years, with 9 females and 2 males, had giant sphenoid wing meningioma. Complete medial sphenoid wing involvement along with neurovascular structures, post operatively, they had visual deterioration; hence, the extent of resection was limited to prevent greater post-operative morbidity. 3/7 undergoing GTR had complete carotid artery encasement, in which full full-thickness MCA infarct was noted in 6 6-hour post-operative scan; they were later converted to a full 16 cm decompressive craniotomy. One survived with hemiparesis and aphasia while two died – male (49y), female (65), both had left craniectomies. STR was done in four patients, with cavernous sinus invasion and internal carotid encasement.

Conclusion: Giant sphenoid meningioma involving the medial sphenoid wing and associated neurovascular structures is surgically challenging and must be treated with STR. If GTR is to be attempted, early CT Brain postoperatively to prevent mortality.

Autonomic Dysreflexia: Gaps in Awareness and Clinical Preparedness Among Healthcare Providers

Muhammad Shoaib — 2025-08-31

Background: Autonomic dysreflexia (AD) is a potentially life-threatening emergency affecting patients with spinal cord injuries at or above T6 level. Despite its severity, healthcare provider knowledge regarding recognition and management remains understudied, particularly in developing healthcare systems.

Objective: To assess awareness and clinical preparedness regarding autonomic dysreflexia among healthcare providers in tertiary care settings in Pakistan.

Materials and Methods: This cross-sectional study utilized a structured questionnaire administered to 127 healthcare professionals (35 consultants, 92 residents) across three tertiary care hospitals in Rawalpindi and Islamabad, Pakistan. The survey assessed knowledge of AD pathophysiology, recognition, and management approaches. Data were analyzed using SPSS version 25.0.

Results: The mean age of participants was 35.7 ± 7.4 years. Only 25.21% of respondents demonstrated adequate knowledge and preparedness for managing AD. Consultants showed significantly higher competency (48.15%) compared to residents (18.18%). Critical knowledge gaps were identified in first-line interventions, including proper patient positioning, identification and removal of noxious stimuli, and blood pressure management strategies.

Conclusion: This study reveals substantial gaps in awareness and clinical preparedness regarding autonomic dysreflexia among healthcare providers in Pakistan. The findings highlight an urgent need for targeted educational interventions, particularly for residents who often serve as first responders in emergencies.

The Comparison of Outcome of Traumatic Brain Injury in Left and Right Hemispheres of The Brain

Bushra Maqsood — 2025-08-31

Objective: Using the Glasgow Coma Scale (GCS) and Glasgow Outcome Scale (GOS), this study compares the clinical presentation, surgical requirements, and functional results of unilateral LH versus RH TBI.

Materials & Methods: Patients with unilateral LH or RH TBI were the subjects of a retrospective observational study. Individuals with bilateral, brainstem, or diffuse axonal injuries were not included. Initial GCS scores, imaging results, surgical procedures, and GOS scores at discharge were among the data gathered. To evaluate the variations in the clinical trajectory between the two groups, a comparison study was conducted.

Results: The findings showed that patients with RH injuries needed surgery more often than those with LH injuries and had substantially lower first GCS scores. Lower GOS scores at discharge were linked to RH injuries, even if the radiological findings were identical. On the other hand, LH injuries could be found more quickly and easily, which frequently resulted in better results and faster medical treatment. RH deficits' mild, frequently nonverbal character may cause a delay in diagnosis and treatment, which could worsen the prognosis.

Conclusion: Hemispheric laterality is important for TBI presentation and results. RH injuries are associated with worse healing, most likely because of delayed diagnosis and care. Understanding these hemisphere-specific variations better could facilitate early detection and direct more efficient, customized treatment plans.

MRI Patterns and Disability Correlation in Multiple Sclerosis: A Prospective Study from a Tertiary Care Center in Pakistan

Qudsia Shah — 2025-08-31

Objective: To evaluate the magnetic resonance imaging (MRI) characteristics of multiple sclerosis (MS) in a tertiary care setting and determine their correlation with clinical disability using the Expanded Disability Status Scale (EDSS).

Materials and Methods: This prospective observational study was conducted at the Department of Radiology, Lady Reading Hospital, Peshawar, over six months. A total of 84 patients diagnosed with MS as per the 2017 revised McDonald criteria were included. Standardized brain and spinal MRI sequences were analyzed for lesion distribution, contrast enhancement, T1 black holes, and spinal cord involvement.

Results: The mean age was 33.2 ± 8.7 years; 72.6% were female. The most common lesions were periventricular (90.5%), followed by juxtacortical (65.5%), infratentorial (41.7%), and spinal cord (38%). T1 black holes were present in 33.3% of cases. EDSS > 4 was seen in 34.5% of patients. Significant associations were observed between EDSS > 4 and the presence of T1 black holes (p = 0.005), spinal cord lesions (p = 0.012), and infratentorial lesions (p = 0.030). Logistic regression identified T1 black holes (OR = 3.4), spinal cord lesions (OR= 2.8), and infratentorial lesions (OR = 2.5) as independent predictors of disability.

Conclusion: MRI lesion topography, particularly T1 black holes, spinal cord, and infratentorial involvement, correlates strongly with functional disability in MS. These imaging features can aid in early risk stratification and guide treatment planning in resource-limited settings.

Clinical and Radiological Evaluation of Pediatric Leukodystrophies: A Prospective Study from a Tertiary Care Center in Pakistan

Muhammad Islam — 2025-08-31

Objective: To evaluate the clinical and magnetic resonance imaging (MRI) characteristics of pediatric patients with leukodystrophies and assess the diagnostic value of MRI in a low-resource setting.

Materials & Methods: This prospective observational study was conducted at the Department of Radiology, Lady Reading Hospital, Peshawar, Pakistan, between January and November 2024. A total of 165 children under 14 years of age with clinically suspected leukodystrophies were included. MRI was performed using a

1.5 Tesla scanner and interpreted independently by two experienced radiologists. Radiological patterns were analyzed and correlated with clinical presentations. Statistical analysis assessed associations between imaging findings and specific symptoms.

Results: Of the 165 patients, the mean age was 5.8 years, with a slight male predominance. Spasticity (74%), developmental delay or regression (65%), and seizures (42%) were the most common clinical presentations. MRI revealed bilateral symmetrical white matter abnormalities in 80% of cases. Metachromatic leukodystrophy showed frontal white matter involvement with U-fiber sparing; adrenoleukodystrophy demonstrated occipital changes with contrast enhancement; and Krabbe disease exhibited a tigroid pattern with thalamic and cerebellar involvement. Contrast enhancement was significantly associated with neuroregression (p = 0.01), while cerebellar atrophy correlated with seizures (p = 0.03).

Conclusion: MRI provides critical diagnostic value for leukodystrophies in pediatric populations, especially in resource-limited environments. Recognizing characteristic imaging patterns facilitates early diagnosis, aiding timely intervention and improving outcomes.

Correlation of Radiological and CSF Patterns in Adults with Meningitis: A Retrospective Analysis from a Tertiary Care Hospital in Peshawar

Adnan Ahmed — 2025-08-31

Objective: This study aimed to assess the correlation between radiological imaging findings and cerebrospinal fluid (CSF) parameters in adult patients with bacterial and tuberculous meningitis, to identify distinct diagnostic patterns that could enhance differentiation and improve clinical management.

Materials and Methods: A total of 97 cases, comprising individuals aged fourteen years and above, were retrospectively examined over a twelve-month timeframe following a confirmed diagnosis of meningitis. Data included clinical presentation, CSF analysis, and imaging findings from MRI and CT scans. Statistical tests, including chi-square, were used to evaluate the association between radiological and CSF patterns.

Results: Tuberculomas were exclusively associated with tuberculous meningitis (p = 0.013), while infarcts were more prevalent in bacterial cases (p = 0.002). Hydrocephalus was observed more frequently in bacterial meningitis, but it was not statistically significant (p = 0.155). CSF profiles highlighted elevated protein levels and lymphocyte dominance in tuberculous cases, contrasting with neutrophilic inflammation and variable glucose levels in bacterial meningitis. The integration of radiological and biochemical data enhanced diagnostic precision.

Conclusion: This study highlights the importance of combining radiological imaging with CSF analysis in diagnosing meningitis. The findings provide valuable insights into local patterns, improving differential diagnosis and patient outcomes. Prospective studies are recommended to validate these findings and refine therapeutic protocols.

Risk Factors for Postoperative Spinal Infections Following Instrumented Spine Surgery: A Case-Control Study of 500 Cases

Muhammad Nawaz Khan — 2025-08-31

Objective: Postoperative spinal infections are a significant complication of instrumented spine surgery, contributing to increased morbidity and healthcare costs. This case-control study aimed to identify the risk factors associated with postoperative infections in patients undergoing instrumented spine surgery.

Materials and Methods: We carried out a retrospective case-control study involving 500 patients who underwent instrumented spine surgery at Lady Reading Hospital, Peshawar, between January 2019 and December 2023. Among them, 50 patients (10%) developed postoperative infections and were categorized as the case group, while the remaining 450 patients without infections formed the control group. Data were collected on sociodemographic characteristics, comorbidities, surgical factors, and postoperative care. To identify independent predictors of disease, we applied multivariate logistic regression analysis. A p-value of less than 0.05 was considered statistically significant.

Results: Diabetes mellitus (OR 3.5, p = 0.01), prolonged surgical time (>3 hours) (OR 3.1, p = 0.02), obesity (OR 2.9, p = 0.03), and insufficient antibiotic prophylaxis (OR 2.6, p = 0.04) were significantly associated with postoperative infections. Extended hospital stay was recorded in patients having post-operative infection or multiple readmissions, and reoperation was high.

Conclusion: Factors like diabetes mellitus, extended duration of surgery, obesity, and Failure to appropriately use prophylactic antibiotics may contribute to an elevated risk of infections following surgery. Recognizing these risk factors early and modifying them can reduce the burden of postoperative infection.

Rare Brachial Plexus Tumor: Case Report and Surgical Management Insights from Pakistan

Mumtaz Ali — 2025-08-31

A 40-year-old male presented with a six-month history of numbness, paresthesia, and progressive flaccid weakness that was localized to the right C5 dermatome. A large, lobulated, and encapsulated mass in the medial aspect of the right axilla was identified via imaging studies. The mass was associated with the superior and middle trunk of the brachial plexus and extended to the supra and infraclavicular fossa. The imaging studies were supported by the nerve conduction studies (NCS), significantly highlighting the involvement of the right upper trunk with signs of denervation. The transclavicular neurosurgical approach was effective in the removal of the tumor while preserving the normal neurological functions. Brachial plexus tumors are rare and often underdiagnosed due to nonspecific symptoms and overlapping features with other neuromuscular conditions. This case highlights the diagnostic value of MRI and nerve conduction studies in identifying tumor characteristics and planning surgery. A transclavicular approach enabled safe excision with preservation of neural function. Postoperative recovery was favorable, with improved motor and sensory function and no recurrence at two months. This case emphasizes the importance of early diagnosis, appropriate surgical technique, and multidisciplinary management in achieving optimal outcomes. This case report highlights the diagnostic and therapeutic challenges associated with brachial plexus tumors due to their complex anatomical location. However, Imaging studies, a multidisciplinary approach, and nerve conduction studies were important in achieving favorable outcomes. The transclavicular neurosurgical approach was meaningful in tumor excision while preserving normal neurological function.

Lateral Intraventricular Epidermoid Cyst: A rare case report

Faiqa Filza Khan — 2025-08-31

Abstract:

Epidermoid cysts originate from ectopic embryonic epithelial cells and are a very common type of benign intracranial tumor. However, the incidence of intraventricular epidermoid cysts is low, and lateral intraventricular epidermoid cysts are even rarer. Here, we present a case of lateral intraventricular epidermoid cyst and review the relevant literature. A 33?year?old male who was presented with complaints of aphasia, vomiting, inability to walk and previous history VP shunt which was blocked on examination. A computed tomography of the brain showed a low?density mass in the lateral ventricle and enlargement of the left ventricle. Cranial magnetic resonance imaging further confirmed that the mass was an epidermoid cyst. The patient underwent microscopic surgical resection combined with endoscopy via the Keen’s point as a tract to reach the ventricle. The mass was satisfactorily removed, and the patient recovered well. Lateral intraventricular epidermoid cysts often present with clinical symptoms due to the invasion of surrounding brain tissue or blockage of the cerebrospinal fluid system. Diagnosis relies on examination by magnetic resonance imaging, and treatment relies on surgical resection. The prognoses of patients are mostly excellent and depend on whether the tumor is resected cleanly or not.

Key Words:

Epidermoid cyst, lateral intraventricular, prognosis, surgery