Introduction Spinal intramedullary dermoid is very rare, accounting for <1% of intraspinal tumors. It can be congenital or acquired. They usually present in 2nd or 3rd decade of life in adults. It may or may not associated with spinal dysraphism. It is asymptomatic in most cases, manifest acutely if it ruptures. Long segment involvement of spinal intramedullary tumor in adult without the history of trauma makes this case unique. Fat suppression imaging helps to distinguish adipose tissue from lesions causing hematomyelia in patients presented with intramedullary hyperintensity in both T1 & T2 sequences of MRI spine. Case presentation We report here a rare case of 30 years old male who presented to us with sudden urinary retention followed by rapidly progressive quadriparesis and paresthesia in his right arm. In MRI, spinal intramedullary tumor was noted from medulla till D5 vertebra. We performed subtotal excision of tumor and sample sent for histopathology which proved it to be intramedullary spinal dermoid cyst. Conclusion Long segment involvement of spinal intramedullary dermoid cyst in adult without history of trauma makes this case different. Fat suppression imaging must be done in patients with intramedullary hyperintensity in both T1 and T2 sequences of MRI spine. Early diagnosis and appropriate management will be helpful in reducing morbidity.

Objective: To determine the outcome of endoscopic discectomyin patients with lumbar prolapsed intervertebral disc in terms of back pain and leg pain using the visual analogue scale.Material and Methods: Descriptive case series, was conducted at, PINS, LGH Lahore for 6 months. 15 patients were included through non probability consecutive sampling that fulfilled inclusion criteria. All patients’ low back pain and leg pain was documented using visual analogue scale before and after 2 months of surgery.On the basis of VAS we calculated % age improvement of low back pain and leg pain after endoscopic discectomy, while ≥ 5 scale improvement was considered clinically significant.Results: Patients mean age was 44.46 years. Among them, 9 (60%) were males and 6(40%) were females. On average, the basal metabolic index (Kg/m2) was 29.29 However, the BMI of females was 31.76 and male was 27.65 Kg/m2. On average, the duration of symptoms was 8.05 months. On average, the Straight Leg Raise was 24.7o at the time of treatment. A decreased sensation was observed in L5 of 3 (20%) and in S1 of 4 (26.67%) participants. Whereas Absent sensation was observed in L5 of 3(20%) and in S1 of 5 (33.33%). Mean preoperative back pain and as well as leg pain was 7.05 that improved to 0.41 and 0.86 4 weeks post operatively.Conclusion: Endoscopic discectomy is equally effective in alleviating the symptoms without notable difference in surgical outcome.

Objective: To determine the outcome of surgical intervention in the form of laminoplasty in the patients with multilevel cervical myelopathy. Material and Methods: Descriptive case series, was conducted at NS-I, PINS, Lahore for 6 months. The patients were included through non probability consecutive sampling that fulfilled inclusion criteria. All of the patients were assessed using JOA score before and after 2 months of surgery. General characteristics, including age, gender, other medical conditions and other risk factors were assessed prior to surgery. The total number of 35 patients was included with expected JOA percentage recovery rate of 75% + 21% after the procedure. Results: In this study 35 total patients were enrolled. The mean age was 55.68 + 9.92 years. Total number of male patients were 23 (65.71), while the female was 12 (34.29). The mean duration of degenerative cervical myelopathy was 3.90 + 1.3 months. The mean pre op value of JOA score was 7.08 + 2.7 (4 – 10) for the patients. The mean post op score was 13.00 + 2.30 (9 – 17). The mean recovery value calculated at two month interval was 62.12 + 17.39 (38.46 – 100). Statistically, there was a significant difference of outcome of pre and post op value of JOA scores i.e., p value = 0.00. Conclusion: Our study determined that, the open door laminoplasty is an effective and reliable technique with good outcome in the treatment of multi-level degenerative cervical spine myelopathy patients.

Background: Pneumocephalus is defined as presence of intracranial gas. It can be at any site in the cranium; isolated or at different sites simultaneously. Quantity of gas along with extent of mass effect caused by it & severity of clinical symptoms will determine the modality of treatment; i.e. conservative or surgical. Among many etiologies trauma is one, which is one of the most common cause as in our case. Multiple foci of gas scattered within the subarachnoid space, especially in the cisterns seen on CT scan of brain has been described as “Air bubble sign”, indicating of subdural tension PNC. Here we have presented our case with review of management of such condition, especially conservative. Case: A case of 55yrs male with history of road traffic accident was referred from another hospital. CT scan of Brain done in previous center showed diffuse PNC scattered throughout the subarachnoid space. The patient was managed conservatively and successive repeat CT scan showed gradual to complete resorption of gas and simultaneous clinical improvement of the patient. Conclusion: “Air bubble sign” described as a sign of tension PNC can be managed conservatively in absence of significant clinical symptoms and may not only be associated with subdural tension PNC. The modality of treatment of PNC as well for tension PNC should be tailored according to the patient’s clinical status.

contusions managed conservatively. Material and Methods:  A prospective observational study was carried out in, Punjab Institute of Neurosciences, Lahore. A total of 97 patients, from 15-65 years, who were diagnosed with cerebral contusions and being managed conservatively were enrolled from July 2019 to December 2019. They were followed-up for 12 – 18 months. Results:  A total of 23% patients developed early post-traumatic seizures (PTS) and 11% of patients developed late post-traumatic seizures with mild to moderate brain injury.6% of patients with early PTS used antiepileptic drugs (AED) for at least three months during follow up and 7% with late PTS used AED. 8% of patients developed late PTS without any early PTS. The results of our study show that among 23% early PTS and 11% late PTS only 3 % actually required to use AED for at least 6months. To prevent this, 3% of the population 44% were using AED supplementary. Conclusion:  In our study, the incidence of early and late PTS is comparable to the other studies. The non-judicious use of the anti-epileptic drug is common in our country which leads to an increase in the risk of drug resistance and cost-intensive for poor patients in developing countries as prophylactic and excessive use of anti-epileptics does not affect the PTE.