Delhi man makes full recovery in over two years; survives six surgeries, rare skull bone TB

A 53yearold man who was admitted to a Delhi hospital in a semicomatose state following a brain haemorrhage has recovered and returned to an independent life after a twoandahalfyear medical ordeal involving nine hospitalisations and six surgeriesDoctors at Fortis Hospital Shalimar Bagh said the patients treatment became particularly challenging after he developed tuberculosis of the skull bone an exceptionally rare complication following brain surgeryThe patient was brought to the emergency department after suddenly losing consciousness due to a spontaneous brain haemorrhage that caused severe swelling inside the brain His condition was further complicated by a bleeding disorder low platelet levels and the use of Ecosprin for a heart condition making emergency surgery highly riskyDelhi doctors performed an emergency decompressive brain surgery to remove the blood clot Since the brain had swollen extensively a portion of the skull was temporarily left open to relieve pressure and prevent permanent brain damageHe subsequently required prolonged ventilator support and a tracheostomy and remained in intensive care for nearly a month before regaining consciousness and recovering enough to be discharged according to the hospitalHis recovery however was complicated by seizures following which doctors performed another surgery to replace the skull bone The patients own skull bone which had been preserved in a bone bank was used for the procedureSoon afterwards another blood clot developed beneath the replaced skull bone necessitating an immediate repeat brain surgery doctors saidSeveral months later the patient developed discharge from the surgical wound Investigations revealed tuberculosis of the skull bone an exceptionally uncommon condition rarely seen after brain surgery according to the hospitalThe infected bone was removed and prolonged antituberculosis treatment was started During the course of treatment doctors also diagnosed tuberculosis involving the brain and spineThe patient subsequently suffered repeated neurological weakness and recurrent infections requiring multiple hospital admissions He also sustained a thighbone fracture following a fallIn a multidisciplinary procedure doctors repaired the fracture while simultaneously reconstructing the skull with a customdesigned PEEK Polyether Ether Ketone cranial implant a patientspecific artificial skull implant created using detailed imaging the hospital saidTowards the end of the treatment the patient developed optic neuritis as a complication of antituberculosis medication resulting in partial loss of vision The condition was detected early treatment was modified and rehabilitation was continued under medical supervision according to the hospitalOver nearly twoandahalf years specialists from neurosurgery orthopaedics infectious diseases critical care cardiology pulmonology nephrology urology ophthalmology endocrinology gastroenterology and rehabilitation medicine were involved in his careDr Sonal Gupta principal director and HOD Neuro and Spine Surgery Fortis Hospital Shalimar Bagh said the biggest challenge was not only performing emergency brain surgery on a patient at high risk of bleeding but also managing the complications that followed over the next twoandahalf yearsThe development of tuberculosis involving the skull bone after brain surgery is exceptionally uncommon Gupta said adding that managing it alongside brain and spine tuberculosis repeated surgeries neurological complications and treatmentrelated side effects required constant reassessment and coordination between specialtiesGupta said infection of cranioplasty bone flaps has an overall incidence of around 56 per cent but most such infections are bacterial while only a few cases of tuberculosis infection of the bone flap have been reported in medical literatureThe patients recovery and return to an independent life highlighted the importance of timely intervention evidencebased decisionmaking and continuity of care she saidThis story has been sourced from a third party syndicated feed agencies Midday accepts no responsibility or liability for its dependability trustworthiness reliability and data of the text Midday managementmiddaycom reserves the sole right to alter delete or remove without notice the content in its absolute discretion for any reason whatsoever