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SNI Digital, Innovations and Learning, an association with the Hose Neurosurgery Lab and Baghdad Iraq are pleased to present. The 22nd SNI and SNI Digital Baghdad Neurosurgery Online Meeting held
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on March 23, 2024, the meeting originator and coordinator of Sammer Hose of the Universities of Baghdad and Cincinnati.
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The subject of this meeting is Pediatric Neurosurgery, Global Pediatric Neurosurgery Experience and Cases from Argentina, Iraq and Nicaragua. The meeting organizer and moderator is Jorge Lassruff,
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Emeritus Professor Pediatric
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Neurosurgery at the UCLA Medical Center in Los Angeles, California
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This presentation will be on the subject of a clinical scale for the setting sun sign in pediatric hydrocephalus. It will be given by Professor Abdul Hadi al-Khalali, who is the emeritus head, the
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Department of Neurosurgery and Baghdad University in Iraq. So now we go to the dean of the Iraqi neurosurgery, Dr. Al-Halili, who I was asking exactly how to pronounce your name. It's Al-Halili
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Yes, absolutely. When I write letters to him, I say, Dear HK, because I don't know exactly where the age goes and the eye goes, but Dr. Al-Halili is an honor for us. I mean, we have learned a
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lot from you in past, in past presentations, please go ahead with your smart and intelligent assessment of the Pareno sign, very valuable for pediatricians Thank you so much.
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So this is the clinical scale for setting sunshine, which was developed over the years when we used to see so many cases of hydrocephalus in our country.
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And the clinical measure measurement scales provide quantitative,
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excuse me, sorry.
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A quantitative means of evaluation of the patient's status. It's very important to evaluate the current status of the patient in many diseases. And also it will monitor the progress during treatment.
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And as you know very well, we have the coma scale of Glasgow,
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and we have the Carnavus key scale, and we have the Rankin scale for cerebrovascular diseases, and then we have recently
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published by personal communication assessing with the scale for the thyroid exophthalmos.
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But nothing for the assessment and the grading
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of
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the setting sun sign in the case of agrocephalus. Why the name of this? Because it comes from the setting sun, gradually it goes down, so this represents the iris as it goes down. Normally, the
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upper lid, as you know, very well covers the upper part of the iris, and no stick layer as showing above the iris.
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This is in chate children and adult.
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But in settings and signs, vertical gaze paralysis and the retraction of the upper lid was clear as showing above the iris.
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Setting some sign is seen in hydrocephalus, which is the common expose, which we see, and perinosis syndrome and kernichtrus, some normal infants, they have it until the age of eight months or
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maybe one year, and then disappears. Pineal tumors, midibri and vascular lesions, metabolic disease like nimapic and encephalitis. Grading for setting sunshine was improved, which improvised,
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which is simple, applied and dependable and this scale is important in evaluating the current status of the settings on sign and monitoring and follow-up. So the matricular system in hydrocephalus
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will expand the aqueducts of mantra and then produces this vertical paralysis by the distension and affecting the vertical gaze of an aberration, which is a medium of non-paciculus and interstitial
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nucleus at the posterior commissure So this is the aqueduct there, in here, of course. And then these are the centers which are controlling the up gaze. The scale is a five grades, grade 1, 2,
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3, 4, 5. And then grade 1 is the lower part of the iris is covered with the lid. So something like that, it's not the upper lid covering the upper third, it is the lower lid covering the lower
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third
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and then grade two, the lower lid of the The edge of the lower lid is touching the lower edge of the pupil.
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So it's getting worse and this clear eyes showing more on the top. And then grade three, half of the iris is covered, maybe more than half or less slightly, less than half is showing like this
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baby here.
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And grade four, only the tip of the top of the eye of the pupil is showing.
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So that's even worse than the first case, the previous one, grade three. And then in grade five, you have only the tip of the iris is showing.
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So with this, you can't really assess in the progress of the patient with hydrocephalus. And then it will help you in grading, evaluating the degree, monitoring, and also sometimes it helps you
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and when the shunt is blocked. And that's the beginning of the setting sun sign will get worse. And thank you so much.
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Thank you. Thank you very much.
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This is an interesting research subject, particularly for, I mean, we are used to work in
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settings with all the possible
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technology like CAT scan immediately, patient scans with a supposed. CAT scan called neurosurgeon, neurosurgeon fight with anesthesiologist and get the room and
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boom and goes with that. But often happens that many of our patients, particularly when there is tuberculous meningitis, there is
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a high increase ofirocephalus in the world in that band of sub-Saharan Africa expanding to our Latin America and touch in the bottom of Erencia whereirocephalus
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is not caused only on genital metaman formation, but particularly by tuberculous meningitis. And that's why there are so many pediatric neurosurgeons going in the past two, 18, you know, because
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of the high incidence of tuberculous meningitis there. And that can give you a sense of
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urgency, how urgent you just have to be. And of course, this is a prospective work. Now, if you have a great one, okay, you can wait. If you have a grade three of the Pareno sign, you need to
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really stop doing what you're doing and put an external ventricular drain. So the simplicity of your presentation can be extremely useful for those working in less
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easy conditions to work. Yeah, so thank you I don't know if anybody has
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any other questions.
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Can I ask a question? Oh, please. So I wanted to know if you have found a correlation between the grading of the setting sun sign at the and the amount of hydrocephalus that the patient had in your
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experience with your patients. Yes, it is related, yeah. The worse the hydrocephalus, the more increased the track pressure is the worse of
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the setting sun sign, yeah. And it always correlates, or usually, I mean, I don't know, we can't talk about always in medicine, but - Can't say. No, always is.
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Almost, always, yeah. Almost, that's right. And I, Cassie,
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Cassie's younger, almost always, which is for what in itself, okay. So, we'll, yeah. No more questions, Dr. Osmano. I think Heidi did, that's a very interesting analysis idea I think is
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very useful. We hope you enjoyed these presentations.
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professional.
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