Objective: To assess the angiographic profile and in hospital outcomes of primary percutaneous coronary intervention among young patients presenting with acute ST Elevation Myocardial Infarction and underwent primary PCI. Methods: The retrospective observational study was conducted at Shahid Gangalal National Heart Centre (SGNHC), Kathmandu, from july 2020 to June 2021, and included acute ST-Elevation Myocardial Infarction patients underwent primary percutaneous coronary intervention (PCI). Data was collected on demographic, angiographic, and in-hospital outcomes. Patients <45 years were considered young. Data was analysed using SPSS 21. Results: Total 104 patients met the inclusion criteria. Mean age of presentation was 40.16 ± 4.42 years. Over three-fourth of the patients were male 80 (76.9%). Smoking was the most prevalent risk factor with 61 (58.6%) patients followed by hypertension 35 (33.6%) and dyslipidemia 23 (22.1%). Single Vessel Disease (SVD) was the most common finding seen in 62 patients (59.6%) and Left Anterior Descending Artery (LAD) was the most commonly involved artery seen in approximately three fourth patients 80 (76.9%) followed by RCA 61 (58.6%) and LCX 15(14.4%). Left Main Coronary Artery is involved in 3 patients (2.9%). 6 (5.8%) patients suffered from cardiogenic shock either at admission or during hospital stay. Total In hospital mortality was seen in 3 (2.9%) patients. Conclusions: Among young patients (<45 years old) with STEMI who underwent PPCI in underdeveloped country majority are males and smoking is the most prevalent risk factor. Single vessel disease and LAD involvement is the most common angiographic finding and they have favorable in-hospital outcome.

A 24-year-old gentleman presented to us with complaints of occasional headache for 2 years. Magnetic resonance imaging showed enhancing supra sellar mass with nonenhancing cystic components, extending superiorly up to the body of bilateral lateral ventricle, laterally displacing septum pellucidum, and compressing the third ventricle with obstructive hydrocephalus. Hormone profile depicted adrenocorticotropic hormone <5.00 pg/mL, growth hormone 1.32 ng/mL, insulin-like growth factor-1 <3.0 ng/mL. The patient underwent surgical resection. Histological finding was suggestive of ganglioglioma World Health Organization grade I. Customized immunohistochemistry panel was advised and revealed positive CD 56, NSE, and GFAP immunohistochemical stains. Gangliogliomas are less frequent neoplastic lesions confined to only a handful of case reports and studies. Accounting less than 2% of intracranial neoplasms, these lesions primarily affect those in the first 3 decades of their life. As ubiquitous it is in nature, we hereby present a case of ganglioglioma in a young adult male arising from septum pellucidum.

Background: Craniopharyngioma, an epithelial tumor believed to arise from the remnants of Rathke’s pouch, portray approximately 1.2%-4.4% of all intracranial tumors. Due to its inherent domain in the skull base and its liaison with indispensable neurovascular structure, it has still remained an intimidating contest despite an improved dexterity among the neurosurgeons and refinement in neurosurgical gadgetry.Surgical corridor to come down in favor for is elected by the position of optic chiasm, extension of tumor and development of ACoM or ACA (A1). Methods: A retrospective series study was conducted at Annapurna Neurological Institute and Allied Sciences between January 2016 and August 2021. A total of 20 patients who underwent surgery for histopathologically proven craniopharyngioma was enrolled. Majority of the surgery was performed via a pterional approach while two cases were addressed with a supra ciliary approach and one with a trans nasal trans septal transsphenoidal approach. Result: The age of presentation among our study group ranged from 5 years to 46 years with a mean age of 28.2 years.The most frequent mode of presentation was headache associated with visual disturbances (visual acuity and visual field). Histopathological analysis disclosed an admantinomatous variant 15 cases and a papillary type in 5 cases. The use of Ommaya reservoir in few selective cases was escorted by the cystic ingredient of the lesion. An endeavor to aggressive surgical approach was accomplished, amidst, excision of tumor was subtotal in 9 %, near total in 36 % and gross total in 45 %. Diabetes insipidus was seen in 36%. We had to endure a case of mortality, who lamentably had a massive sub-arachnoid hemorrhage with a colossal PCA territory infarction on arrival. Post operatively, the mass effect evolved on account of PCA territory infarction. Conclusion: The magnitude of resection of the tumor is affected by the extension of tumor, consistency of the lesion and position of optic chiasm. Even with an extensive resection, the prospect of recurrence is inordinately high.

Abstract“I will not permit considerations of age, disease or disability, creed, ethnic origin, gender, nationality, political affiliation, race, sexual orientation, social standing or any other factor to intervene between my duty and my patient.” Obliged by the aforementioned oath, no medical practitioner shall sit in a moral judgment on any patient but will treat their illness to the best of their ability whatever the circumstances. A clear concord was yet to be authorized after the World Health Organization (WHO) declared the global pandemic of severe acute respiratory syndrome coronavirus 2infection. As a diagnostic modality, WHO recommended real-time reverse transcription–polymerase chain reaction (RT-PCR) as a reliable test; however, its availability in a deprived nation like ours became a major restraining factor. Despite an asset of having high specificity, RT-PCR for coronavirus disease 2019has its own liability of having low sensitivity. Henceforth, as time passed by, the validity of the rapid diagnostic tests was put into question. In later months, a few centers around our periphery started conducting RT-PCR, but the time taken to obtain the result was long-drawn-out process and the patient who needed urgent neurosurgical intervention at Annapurna Neurological Institute and Allied Sciences had to wait. We would like to share our expedition through peaks and valleys of managing 215 patients during the vicious circle of lockdown and global pandemic.

Hypertension is the most prevalent determinant condition embarking on the development of spontaneous intracerebral hemorrhage. Usually, the presentation is a unilateral hematoma. Spontaneous bilateral intracerebral hemorrhage is an How to cite this article: Kayastha J, Rajbhandari P, Gurung P, Shrestha B, Dabadi S, Pant B. Unusual case of spontaneous bilateral basal ganglia bleed.