Pilocytic Midbrain Astrocytoma Presenting with Fresh Bleed after Twenty-one-years Survival Following First Surgery: A Unique Case of Longest Brainstem Glioma Survival

Brainstem glioma usually carries a poor prognosis and prolonged survival is very infrequent. In a detailed Pubmed, Medline search for prolonged survival, authors could got a longest survival only up to seventeen years, reported by Umehara et al, who was subjected to gamma knife therapy and got symptomatic, MRI brain reveled large tumor growth during pregnancy necessitating emergency surgery and histopathological diagnosis was pilocytic astrocytoma. Authors report an interesting case of midbrain glioma diagnosed 21 years back, who underwent gross resection in the year 1993, histopathology was pilocytic astrocytoma, WHO grade I, and received gamma knife surgery for residual subsequently and he presented with sudden onset left sided hemiplegia on the current admission. The cranial MRI imaging revealed an infarct involving right hemi midbrain, contrast MRI brain revealed no residual glioma. To the best knowledge of authors such prolonged survival is not reported with a case of brainstem glioma survived twenty- one years with non residual tumor on the last imaging study represents first case of its kind in the western literature and probably developed hemiplegia due to bleed, highlighting bleed as delayed complication following gamma knife therapy for cranial tumor

Cognitive Improvement After Endovascular Treatment in a Case of Intracranial Dural Fistula With Concomitant Dementia

Dural fistulas associated with dementia are rarely reported and, among these, intracranial dural fistulas constitute an infrequent etiology. Moreover, dementia associated with dural fistulas occurs due to venous hypertension leading to ischemic neuronal dysfunction. This case report describes a male patient exhibiting unusual features of dementia with a concomitant dural fistula compromising the superior sagittal sinus. The fistula was completely occluded via endovascular embolization. Two months after the interventional therapy, clinical assessment revealed complete improvement of executive functions. Afterward, the patient returned to his daily activities without impairment

Monitoring of Intracranial Pressure in Patients with Severe Traumatic Brain Injury: Review

Traumatic brain injury is a very heterogeneous entity that emerges over time. The neuromonitoring is critical for the prevention of secondary alterations, such as ischemia and hypoxia, which appear days after a primary injury. Neurosurgeons must understand that the phenomena are secondary to the primary lesion. Advances in multimodal neuromonitoring techniques have allowed evaluation of brain metabolism as well as other physiological parameters, including intracranial pressure, cerebral perfusion pressure, cerebral blood flow, brain temperature, blood pressure, and partial pressure of oxygen in brain tissue

Late-onset Development of Tachylalia Following a Closed Traumatic Craniocerebral Injury Associated with Bitemporal Gliosis

Tachylalia is defined as extremely rapid output of speech. A case of delayed development of tachylalia 4 years following sustaining a closed craniocerebral injury is reported. We suggest that the management of communication disorders should always be considered as a part of treatment and rehabilitation of traumatic head injury. In a detailed PubMed and Medline search for late-onset tachylalia, development following traumatic craniocerebral injury did not yield even a single report in the literature. The multidisciplinary approach in management of such rare event is highly crucial