Context:Vertex epidural hematoma (VEDH) is uncommon. A high index of suspicion is required to suspect and diagnose this condition, and the surgical management is a challenge to neurosurgeons. There are only isolated case reports or small series of VEDH in the literature.Aims:We have tried to analyze a large series of VEDH seen in our institute.Settings and Design:Retrospective observational study.Subjects and Methods:This is an analysis of case records of patients with VEDH during 17 years period from 1995 to 2012.Statistical Analysis Used:Nil.Results:Twenty nine cases of VEDH encountered over a period of 17 years have been analyzed, including 26 males and 3 females. Majority were due to road accidents. Headache, papilledema and lower limb weakness have been the major presenting features in these cases. The diagnosis was by direct coronal computerized tomography (CT) scan in most of them. Majority were managed conservatively with observation and serial imaging. Four patients who had large VEDH with altered sensorium were managed surgically. The source of bleeding was mainly from superior sagittal sinus.Conclusions:VEDH has to be suspected when a patient presents with impact over the vertex and features of raised intracranial pressure. Direct coronal CT or magnetic resonance imaging is useful in the diagnosis. Surgery is required when the patient develops progressive deterioration in sensorium and/or with the hematoma volume more than 30 ml. The present series of 29 cases is the largest reported so far.

Primitive neuroectodermal tumours (PNET) are aggressive childhood malignancies and offer a significant challenge to treatment. A two years old female child presented with weakness both lower limbs. Preoperative MRI of the spine and paravertebral regionIso – hyper intense posterior placed extradural lesion, non contrast enhancing from D11-L2 levels with cord compression D9 to L3 laminectomy done. Granulation tissue found from D11 to L2. with cord compression. The granulation tissue removed in toto. The pathological findings were consistent with PNET. Post operative neurological improvement was minimal. Cranial screening ruled out any intracranialtumour. Hence a diagnosis of primary spinal PNET was made. A review of the literature shows that only 19 cases of primary intraspinal PNETs have been reported to date and the present case extradural in location. Primary intraspinal PNETs are rare tumors and carry a poor prognosis.

Objective Strategies to improve traumatic brain injury (TBI) outcomes in India are ill defined. The objective of this study was to examine baseline prehospital (PH) factors associated with outcomes from the Andhra Pradesh Traumatic Brain Injury Project. Methods We conducted a prospective observational cohort study of adult patients with TBI admitted to the primary referral hospital. Modes of injury, prehospital care and transport, and factors associated with increased in-hospital mortality were evaluated. Poisson regression with robust error variance and adjusted attributable risk percent estimates determined factors associated with outcomes. Results A total of 447 adults (38% with mild TBI, 30% with moderate TBI, and 32% with severe TBI; 81% men) with isolated TBI (89%) from road traffic accidents (48.1%) or falls (46.5%) were enrolled. Of the patients, 45.7% were transported by ambulance, 61% had scalp/facial bleeding, 11% had respiratory distress, and 7% had cervical spine stabilization. Of these, 25.3% died and 34% had unfavorable outcomes. Among 335 direct admits, 45% traveled more than 50 km and nearly 20% traveled more than 100 km. Bleeding was associated with higher mortality (adjusted relative risk [aRR], 1.56; 95% confidence interval [CI], 1.05–2.31) and unfavorable outcome (aRR, 1.60; 95% CI, 1.18–2.17). Of the patients, 45 (31%) with severe TBI received PH airway management prior to definitive treatment, and respiratory distress was associated with unfavorable discharge outcomes (aRR, 1.23; 95% CI, 1.00–1.51). Conclusions Patients with TBI often received treatment far away from injury, bypassing closer hospitals. Scalp/facial bleeding was common and associated with unfavorable outcomes. Ambulance use was infrequent, and few patients received PH airway management, hemorrhage control, or cervical spine stabilization when needed.