The five preferences for post-traumatic SAH

Acute traumatic brain injury is a worldwide public health crisis. Post-traumatic subarachnoid hemorrhage (SAH) is a finding that is present at a frequency of 40% according to data from American TCDB (1,2). Among the mechanisms that have been implicated as causes of post-traumatic SAH is the cortical bleeding through the subarachnoid space. It is estimated that the incidence of post-traumatic SAH is 11% to 60% in patients with traumatic brain injury. The brain CT is considered a technique with good sensitivity, economical and available in many hospitals worldwide. We have reviewed the literature and found some imaging characteristics of post-traumatic subarachnoid hemorrhage. We have called “the five preferences for post-traumatic SAH”

Safety and efficacy of mini doppler in recurrent pituitary tumours: Report of 12 cases

Background: Pituitary surgery is the most common surgery used to remove pituitary tumours. The use of mini doppler in surgical removal of an endonasal pituitary tumour has shown good short-term clinical outcomes and few complications in patients. Cavernous sinus invasion limits the surgical excision and still a challenge of gross total resection.   Objective: The main objective of this study is to evaluate the outcome of surgical removal of an endonasal pituitary tumour using mini doppler.    Method: A total of 12 patients were studied retrospectively from 2012 to 2018 in a single institution (Private hospital) in Dhaka, Bangladesh. The male and female ratio was 7:5. Results: 92% of cases of the total number of patients had satisfactory removal/ neurological improvement/hormonal improvement. Among 12 cases, 8 cases had transient diabetes insipidus and one patient had CSF leak.    Conclusion: The intraoperative Doppler is a useful tool to localize the carotids, which provides safer resection of endonasal pituitary tumours. Thus, it is very safe and effective for laterosellar resection of recurrent pituitary tumours and for cavernous sinus invasions

Large armored bridging over fractured vertebra with intraspinal tumor mimicking bony mass caused by migrated fragments of burst cervical vertebra presenting with severe cervical myelopathy

Vertebral body may get displaced anterior or posteror with elements of rotation. However, burst cervical spine vertebral fracture may migrate anteriorly and posteriorly simultaneously. However anterior displaced fragment forming armor like mass is very rare. Similarly, the posteriorly propelled fragments migrating caudally and posterolaterally producing a large osseous mass inside spinal canal mimicking bony tumour causing severe cervical canal stenosis and presenting with marked myelopathy is extremely rare. To the best knowledge of authors, association of such traumatic dual pathology represents first of its kind in western literature, who was neglected early medical advice and presenting with marked compressive cervical myelopathy. She underwent successful surgical decompression with gradual recovery of spastic limb weakness and recovery of sensation. Authors also highlights the importance of early resuscitation and adequate maintainace of mean arterial pressure following acute spinal cord injury. Pertinent literature is briefly reviewed

Primary giant myxoma of the temporal bone with major intracranial extension: Presenting with hearing impairment and ear polyp

Myxomas are mesenchymal origin, benign tumor, constituting approximately half of the benign cardiac tumors. Occasionally, it may also occurs at other locations, though the intracranial location of a myxoma is considered exceptionally rare. Only isolated few cases of intracranial myxoma are reported in the literature, almost all were locally confined within the originating bone. The extensive Pubmed and Medline search yielded only eight cases of primary myxoma arising in the temporal bone with extension into intracranial compartment. However intracranial extension is limited as early detection, however, Osterdock et al reported a case also arising from temporal bone with extensive intracranial extension. Author report an interesting case of intracranial myxoma in 27- year- old- male, involving the temporal bone associated with extensive bony erosion and also extending into infratemporal fossa, mastoid, and frontoparietal region and a polypoidal mass protruding into external ear. To the best of knowledge of authors, temporal myxoma presenting with external ear polypoidal mass, which underwent successful surgical excision is not reported and represent first case in the world literature

Roles and rules of Syngo iFLOW in neuroendovascular procedures

The authors present 2 patients who underwent neuroendovascular procedures in syngo iFLOW produced that use the dynamic of fluid in several types of intracranial pathologies. As part of a combined CT/angiography suite, iFLOW offered the major advantage of immediate detection or exclusion of intracranial complication without patient transfer. The study of fluid dynamics constitutes a cornerstone for the evaluation of various intracranial vascular pathologies. These applications include the isolation of cerebral aneurysms by embolization and clipping, embolisation of malformations, as well the evaluation of vasooclussive diseases. The emergence of techniques such as syngo iFLOW, which give a comprehensive picture of angiography, constitute a element that can to contribute to the decision of conduct clinics. Siemens has developed a novel based system which is able to reconstruct in achieving angiography techniques colors define intracranial flow characteristics in a single image. With this technique, is possible to obtain a comprehensive picture of cerebral angiography

A proposal for a new pial arteriovenous fistulas grading scale for neuroendovascular procedures and literature review

Pial arteriovenous fistulas are an unusual type of cerebrovascular lesion. The vascular supply of this type of injury comes from cortical and pial vessels which are not located in the dura leaflets. With the aim to make a grading scale for this type of injury, we conducted a literature search using the keywords "pial arteriovenous fistulas", "embolization" associated with "outcome". Angiographic and imagenological characteristics typically found in pial arteriovenous fistulas were taken and was developed a preliminary classification system that must be validated in future studies. Pial arteriovenous fistulas are associated with a poor natural history and the establishment of an individualized therapeutic strategy can provide a good prognosis. The endovascular management of these lesions is safe and effective

Odontogenic Pain as the Principal Presentation of Vertebral Artery Pseudoaneurysm; a Case Report

Dissection of the vertebral artery is an important but rare cause of cerebrovascular accidents. Here we report a 48-year-old man with toothache since 4 days before who presented to the emergency department with neck pain and final diagnosis of dissecting right vertebral artery pseudoaneurysm. To our knowledge, this maybe the first report of odontogenic pain as the first manifestation of vertebral artery pseudoaneurysm in the literatures

Tibial nerve schwanoma: short review of surgical management

Schwannoma is a benign, solitary nerve sheath tumour and accounting for about 5% of soft tissue tumours. It can occur along the peripheral nervous system in any part of body. It presents as a painless, swelling. We report an adult male presented with tibial nerve schwanoma underwent successful surgical excision. However, differentiation with neurofibroma is very important as surgical planning and prognosis is quite different. In lower limb usually incidence of neurofibroma is higher in contrast of upper limb. Pertinent literature and management are briefly discussed

Conus medullaris dermoid tumour: Uncommon presentation of conus medullaris dermoid as an exophytic mass lesion

Authors report an extremely uncommon case dorsally exophytic conus dermoid in a three- years old boy, who underwent meningocele repair locate at lumbosacral region at an age of one month. The boy presented with low backache and difficulty in passing urine. Magnetic resonance imaging evaluation of spine revealed presence of a large exophytic mass located dorsally in the conus and the features suggestive of dermoid. He underwent surgical intervention during surgery lesion was dorsally exophytic containing cheesy material with hairs, excision of dermoid along capsule was carried our successfully. Pertinent literature and management of exophytic conus dermoid is discussed briefly