Post-traumatic cerebellar infarction due to vertebral artery foramina fracture: Case report

Posttraumatic cerebral infarction is an uncommon cause of morbidity and mortality and many studies have highlighted that trauma needs to considered as causative factor for cerebellar infarction. We present a case of cerebellar infarction in a 35 year old young patient secondary to vertebral fracture involving the vertebral foramen and vertebral artery injury. CT scan cervical spine showed C2-3 fracture on left side with fracture extending into the left vertebral foramen. A CT scan angiogram could not be performed because of poor neurological status. Possibly the infarction was due to left vertebral artery injury. Without surgical intervention prognosis of these patients remain poor. Prognosis of patients with traumatic cerebellar infarction depends on the neurological status of the patient, intrinsic parenchymal damage and more importantly extrinsic compression of the brainstem by the edematous cerebellar hemispheres

Acute spontaneous subdural hematomaas unusual complication after tooth extraction

Background: Intracranial bleeding has been reported in the literature associated with tooth extraction. Coagulation disorders are often associated with complications after dental extraction. In this case report, we describe a case of spontaneously intracranial subdural hematoma possible after tooth extraction.Case description: The patient was a 26-y-old female without any underlying diseases. A computerized tomography scan showed a subdural hematoma 48 hours after the dental extraction. She was managed with a burr hole, good postoperative evolution and discharged to home.Conclusion: Although rare, the presence of headache with signs of alarm after the extraction of a tooth, we must discard intracranial abnormalities. To the best of our knowledge this is the first report in the literature of a spontaneously intracranial subdural hematoma possible after tooth extraction

Unilateral traumatic hemorrhage of the basal ganglion and bihemisferic cerebral infarction

Among the various injuries caused by the cerebral tramatic lesion are trau- matic brain contusions. Hemorrhagic contusions of the basal ganglia are unusual. Different injuries such as cranial fractures, epidural hemorrhage, subdural hematoma, subarachnoid hemorrhage among others may be associated with brain contusions. In some cases traumatic brain injury arises. We present a case of a patient with unilateral cerebral contusion associated with bihemispheric cerebral infarction

An international based survey about preferences in neurosurgical irrigation fluids in neurotrauma procedures

Background: Traumatic brain injury surgery is the most frequently performed by neurosurgeons. The use of 0.9% saline solution (normal saline) irrigation and other solutions during neurosurgical procedures has been considered a cause of neural tissue injury. The normal saline has been used for many years, but at cellular level it may cause harmful changes. The emergence of new solutions, such as artificial cerebrospinal fluid and Ringer's lactate, seem to produce less damage effects on brain tissue. The aim of this study is to evaluate the trends in use of irrigation solutions in traumatic brain injury surgeries.Materials and Methods: This study was conducted through a web-based survey sent to 40 neurosurgeons worldwide.Results: Over the period of the study data was collected from the 40 physicians and the 100% of the respondents used any type of irrigation solution during neurosurgery.Conclusion: The use of normal saline in brain surgery is a widespread practice worldwide, despite the negative effects on neural tissue as it may contribute to further damage. The conception of new irrigation solutions for neurosurgery, especially in traumatic brain injury, may be a useful alternative for future studies and to expand our knowledge on this topic

Giant Subgaleal cerebrospinal fluid leakage: An unusual complication of chronic subdural hematoma surgery

We report a rare case of chronic subdural hematoma complicated with a Giant subgaleal cerebrospinal fluid leakage. Physical examination was performed with no alteration in mental status and no focal neurological disorder. The subdural hematoma was drained and two weeks later, patient was admitted to our hospital with a giant scalp swelling. Physical examination revealed a left parietal subcutaneous collection. The patient was reoperated with a correction in the fistula, he presented a satisfactory postoperative evolution. To our knowledge, this is the first report in literature of a chronic subdural hematoma with a complicated giant subgaleal cerebrospinal fluid leakage

Detection of lesions in the optic nerve with magnetic resonance imaging using a 3D convolutional neural network

Deep learning; Multiple sclerosis, Optic nerveAprendizaje profundo; Esclerosis múltiple; Nervio ópticoAprenentatge profund; Esclerosi múltiple; Nervi òpticBackground Optic neuritis (ON) is one of the first manifestations of multiple sclerosis, a disabling disease with rising prevalence. Detecting optic nerve lesions could be a relevant diagnostic marker in patients with multiple sclerosis. Objectives We aim to create an automated, interpretable method for optic nerve lesion detection from MRI scans. Materials and Methods We present a 3D convolutional neural network (CNN) model that learns to detect optic nerve lesions based on T2-weighted fat-saturated MRI scans. We validated our system on two different datasets (N = 107 and 62) and interpreted the behaviour of the model using saliency maps. Results The model showed good performance (68.11% balanced accuracy) that generalizes to unseen data (64.11%). The developed network focuses its attention to the areas that correspond to lesions in the optic nerve. Conclusions The method shows robustness and, when using only a single imaging sequence, its performance is not far from diagnosis by trained radiologists with the same constraint. Given its speed and performance, the developed methodology could serve as a first step to develop methods that could be translated into a clinical setting.This project was developed as a part of Gerard Martí-Juan ECTRIMS Research Fellowship Program 2021–2022. This study was partially supported by the Projects (PI18/00823, PI19/00950), from the Fondo de Investigación Sanitaria (FIS), Instituto de Salud Carlos III

Extracranial internal carotid artery aneurysm: Case illustration

Extracranial internal carotid artery aneurysms (EICAA) are uncommon lesion. These aneurysms can be classified as true or false aneurysms, atherosclerotic, dysplastic, infectious, posttraumatic and iatrogenic aneurysms. The most common presentation is central neurologic dysfunction, either a stroke or a transient ischemic attack. The rupture of these aneurysms can lead to severely impairment and can affect the quality of life of the patients or even may lead to death. Management of these lesions is required in most cases to prevent complications, however there is no treatment guideline or expert consensus for the management. We present a case of an unusual EICAA, associated with kinking of the affected vessel and review the literature

What the Neurosurgeon needs to know about Cerebral Developmental Venous anomalies

Venous Angiomas or Developmental venous anomalies (DVA) are extreme variations of normal transmedullary veins that are necessary for the drainage of white and gray matter, also are one type of cerebrovascular malformation (CVM), sharing category with capillary telangiectesias, cavernous malformations (CM), and arteriovenous malformations (AVM), each of which may also be associated with a DVA. DVA are the most commonly encountered CVM, accounting for up to 60% of all CVM. We present a review of the literatura

Transoral osteosynthesis for C1 fractures: two cases report

The upper cervical spine fractures are rare and often fatal injuries so immediately with the traumatic event. Due to the amplitude of the spinal canal in the upper cervical region, only 16% of the survivors exhibit neurological compromise, so they can go unnoticed for emergency care. CI injuries are rare. We report two cases in relation to our experience in the management of this injury through transoral

An international based survey on perioperative use of tranexamic acid in neurotrauma

Background: Tranexamic acid is used to reduce bleeding, easy to use, affordable and relatively safe. There are few studies on the use of tranexamic acid in trauma and especially in neurosurgery. There is no published study on the trend the use of tranexamic acid in neurotrauma surgery among international doctors. The aim of this study was to evaluate the current practice for use of tranexamic acid during neurotrauma surgery. Materials and Methods: A 11-question electronic survey was sent to 25 practicing physicians worldwide. Basic demographic information and estimated rates of use of tranexamic acid during neurotrauma surgery. Results: Twenty five physicians responded to our survey. Very Few trusts (12%) use tranexamic acid during neurotraumasurgery. Conclusion: Further studies are required to establish guidelines in neurosurgery and neurotrauma, especially. The use of this medicine potentially helps improve patient care with head injury and save lives