From The Editor’s Desk I - PIH · practice Medicine were published as case reports or as letters...

Issue 1, Vol 1, Jan 2017

www.pihpng.com | [email protected] | +675 7998 8000 Ext 247 | ©PIH 2017

I t gives us great pleasure at PIH to launch, in the New Year, our E-Journal for the

clinical fraternity which will soon be followed by the E-Newsletter for the medical

fraternity and the public.

We invite your contribution.

In an era of a surfeit of information arriving and clogging your inbox, we hope to at-

tract your attention, and retain your interest, by presenting visual images, accompa-

nied by a short and pithy commentary. Contributors are requested to kindly adhere

to this pattern.

Documentation and presentation/publication of good clinical work, and the lessons learned from it, is the founda-

tion of all medical knowledge and medical progress.

In these days, when one gets overwhelmed seeing huge papers, with multi-authors, reporting RCTs (Randomised

Control Trials) and Meta –analyses let us not forget that some seminal reports in Medicine that changed the way we

practice Medicine were published as case reports or as letters to an editor!

Dr. Venkita. S. Suresh,

Medical Director

From The Editor’s Desk

INTRACRANIAL ANEURYSMS | Clinical Report | Dr Jaiyesh

A 74-year-old patient was admitted recently to PIH with severe, throbbing

headache, heaviness of speech and a dizzy spell after which he had collapsed

while talking during a meeting, the loss of consciousness lasting a few seconds.

Past history of CAD, diagnosed 20 years ago, and was on Aspirin, a statin and

Valsartan.

BP 144-156/90-85. GCS-15/15. E4 V5 M6.

No neck stiffness,

No motor or sensory deficit

MRI showed Subarachnoid Haemorrhage. CT Angiography: Ruptured Berry aneurysm of Anterior Communi-

cating Artery. ECG: Infero-lateral T inversion. Echo: Concentric LVH and Hypokinesia of entire septum. Good

Systolic function, Grade II Diastolic dysfunction, RVH and Dilated Left Atrium. Carotid Doppler: Atheromatous

plaque at bifurcation of Common Carotid artery.

Issue 1, Vol 1, Jan 2017 2


Saccular cerebral aneurysms, also known as “Berry aneurysms” are

rounded outpouchings that arise from the arterial bifurcation points. Saccular

aneurysms are true aneurysms; meaning they are dilatations of a vascular lu-

men due to weakness of all vessel wall layers.

Most intracranial aneurysms result from hemodynamically induced degenera-

tive vascular disease, most common being Hypertension.

Saccular aneurysms usually arise in the Circle of Willis vessels, 30 to 35% of

which occur in the Anterior Communicating (ACOM) artery.

A ruptured aneurysm is the most common cause of non-traumatic subarachnoid haemorrhage. A patient with

a ruptured aneurysm will usually describe his/her symptoms as “the worst headache of my life”. Plain CT

scan of the brain is usually the initial diagnostic modality requested for and this will clearly demonstrate the

presence or absence of SAH.

Digital subtraction angiography (DSA) is the gold standard imaging modality for investigating suspected aneu-

rysms. This will best characterize the aneurysm as to exact location, size and direction or orientation of the

aneurysm, which will help the surgeon or interventionist decide what the best approach is to treat this aneu-

rysm.

Saccular Aneurysm in the ACOM artery Saccular Aneurysm in the ACOM artery,

broad-based neck of the aneurysm

INTRACRANIAL ANEURYSMS - Dr Blanch

He was successfully medically managed to relieve headache, raised ICT and prevent vasospasm of the feeding

artery to the aneurysm. He was stabilized and made fit to fly abroad for intervention, surgical or radiological.

PIH plans to shortly arrange neuro-surgical facilities in–house.

Dr. Jaiyesh Kumar,

Intensivist and Cardiologist, PIH

Issue 1, Vol 1, Jan 2017 3


A s the year of 2016 comes to a close, reflecting on the past 11months we have

seen PIH go from strength to strength. We have achieved many a milestone, in terms

of adding new specialties, new equipment and inducting fresh clinical talent. This

has been possible due to the concerted efforts of everyone at PIH and proper direc-

tions from the management.

Communications has always been an integral part of any development and the

means of knowledge sharing. At PIH we are taking it a step further by starting our E-

Journal and Newsletter. I congratulate our Medical Director, Dr Suresh and his team

for bringing this valuable contribution.

These E- Publications will enable us to share the prized medical knowledge gleaned from surgical and clinical episodes and take home lessons, for the Health Care community. I wish the endeavor great success and would like everyone to contribute to this knowledge sharing platform.

Colonel Sandeep S Shaligram

From The CEO’s Desk

It is important to note that there is an alternative treatment to surgery which is endovascular coil emboliza-

tion. This is a minimally invasive, non-surgical treatment of saccular aneurysms.

I believe the patient should be informed of the alternative therapeutic approach in treating aneurysms. Hav-

ing said this, not all aneurysms can be coiled and not all aneurysms can be operated on.

A team approach, including the neurologist, neurosurgeon and neuro-radiologist, is the best approach when

dealing with intracranial aneurysms. The patient should be informed of all possible therapeutic approaches

including risk and outcome possibilities.

Patient education is the key.

DR. ALFONSO BLANCH

Consultant Radiologist, PIH

“Teat” Formation indicating point of

rupture

Berry Aneursym in the ACOM artery directed ante-

riorly and inferiorly with “ TEAT” Formation

From The Editor’s Desk I - PIH · practice Medicine were published as case reports or as letters...

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Transcript of From The Editor’s Desk I - PIH · practice Medicine were published as case reports or as letters...