Haemorrhagic transformation of malignant middle cerebral artery infarction after thrombolysis

Haemorrhagic transformation of malignant middle cerebral artery infarction (MCI) after thrombolysis is a devastating form of stroke. For this reason, decompressive craniectomy has been en vogue for select patients with results suggesting relevant improvement in mortality albeit largely a trade-off for unfavourable outcome particularly in the >60 years old group.A 49-years-old man was referred after developing generalized tonic-clonic seizures and left hemiparesis following thrombolysis for right MCI. Repeat CT brain scan showed haemorrhagic transformation of the right MCI. He underwent craniotomy, clot evacuation and insertion of an intracranial pressure monitor but warranted a second operation to remove the bone flap, subtemporal decompression due to failed medical management at controlling the intracranial pressure. And ICP bolt was positioned on the contralateral side.He was discharged eight weeks following admission with GCS 11/15.The increasing practice of thrombolysis has introduced new insights into the treatment of malignant MCI including the option of a prophylactic decompressive craniectomy. However, evidence for such practice is currently under investigation. Haemorrhagic transformation of MCI after thrombolysis should now be considered a surgical disease in this climate with dual indication for early decompression in select patients

Dorsal thoracic arachnoid web – Confounders of a rare entity in the developing setting

Dorsal thoracic arachnoid webs constitute a rare clinical entity due to a thickening in the arachnoid membrane at that level with resultant compression of the spinal cord and myelopathic features. Obstruction to cerebrospinal fluid flow can lead to syringomyelia, which may assume variable positions relative to the web. Dorsal arachnoid webs are more predominant in the thoracic spine and are diagnosed by the pathognomonic ‘scalpel sign’ on spinal magnetic resonance imaging. Early intervention prevents clinical deterioration. On the other hand, failure to recognize this rare entity can result in progressively compromised ambulatory capacity which translates into loss of income and economic burden with dire social consequences

Antithrombotic therapy of Cerebral cavernous malformations /

Cavernous malformations are recognized as the most common vascular anomalies in the brain, that often lead to hemorrhage with neurological symptoms. Usually the treatment is surgical removal or stereotactic radiotherapy. We present a case of a slow-flow vascular anomaly located in the cavernous sinus with recurrent partial thrombotic areas. Inspired by treatment of peripheral venous anomalies antithrombotic therapy was initiated instead of surgery or stereotactic radiotherapy. This led to complete spontaneous resolution of the lesion and normalization of symptoms within nine months. The patient never showed any symptoms over a period of eight years while continuing antithrombotic therapy. Based on this case this therapy may be a reasonable approach to treat intracerebral venous anomalies

Embryonal tumour with multi-layered rosettes a case based review of the literature

The World Health organization updated the classification of central nervous system tumours in 2016 with more emphasis placed on molecular signature. This has led to widespread adaptation of more targeted therapy in neurosurgery.Primitive Neuroectodermal Tumour has been subdivided leading to the emergence of epidermal tumor with multi-layered rosettes as a separate entity.Neurosurgical centres in developing countries rely on assistance from more resource endowed institutions to make this diagnosis. Despite such collaborations, epidermal tumor with multi-layered rosettes remains a rare diagnosis with no universally accepted standard of treatment approach. The disease has a rapidly progressing character and portends a sinister prognosis despite multimodal therapy

Four continuous covariates (age in years, hospital stay in days, duration of surgery in minutes, body mass index) were available.

<p>The description of the continuous covariates (number of observations, number of missing observations, mean, standard deviation and range) was split into the surgery date cohorts. P-values of the Mann-Whitney test for a difference of the means between the cohorts are printed in the first column.</p

The categorical variables are shown (sex, location of the tumor, WHO grade, embolization prior to surgery, paresis prior to surgery, paresis post-surgery, paresis until 3 months after discharge).

<p>The P-values for chi-squared tests comparing the distributions between the two surgery date cohorts are depicted in the first column.</p

BMI with incidence of meningioma and PE.

<p>The legend for BMI is on the left side of the panel. The number of PE corresponding to each age-group and the incidence of meningioma in percent is quantified on the right side. All three factors increased with age until the sixth decade and decreased with advanced age (>70 years).</p

PE associated factors.

<p>The comparison of cases with PE and cases without PE showed that PE is significantly associated with skull base meningioma (p = 0.01), prolonged hospital stay (p = 0.01 difference = 2.87 days) and higher BMI (p = 0.03 difference = 4.05 kg/m²).</p

Unadjusted results for the whole data set (change from cohort A to cohort B): Risk differences (RD) and odds ratios (OR) with 95% confidence intervals are given.

<p>The p-value is a likelihood ratio p-value and thus identical for both comparison measures. The numbers needed to treat (NNT) were based on the estimated risk difference.</p

Adjusted odds ratio results for changes from cohort A to cohort B (all tumor locations).

<p>Adjusted odds ratio results for changes from cohort A to cohort B (all tumor locations).</p