Extensive Pneumocephalus Secondary to Petrous Bone Cholesteatoma

Pneumocephalus refers to air inside the cranium; however, otogenic pneumocephalus is rarely reported in the literature. The neurological presentations of pneumocephalus include headache, lethargy, confusion, disorientation, and seizure. Here, we have reported a case of a 42-year-old woman with extensive pneumocephalus and cerebrospinal fluid leak secondary to petrous bone cholesteatoma. She presented to the emergency department with sudden headache and left ear discharge. Physical examination revealed watery otorrhea through a hole in the tympanic membrane. Radiological studies demonstrated extensive soft tissue in the left middle ear and mastoid extending to the internal auditory canal. Free intracranial air was observed, and bony destruction was seen in the cochlea, vestibule, and semicircular canals. The patient was managed surgically via the transotic approach and fully recovered. Although otogenic pneumocephalus is rarely encountered in clinical practice, early diagnosis and urgent management are important to prevent fatal complications.

Critical cerebellar hemorrhage due to pilocytic astrocytoma in a child: A case report

Background: Cerebellar hemorrhage is rare in children, and its cause is usually vascular disorders such as arteriovenous malformations or hematological disorders. Case Description: A previously healthy 10-year-old girl presented with a loss of consciousness following sudden headache and vomiting. A non-contrast brain computed tomography (CT) scan revealed a massive cerebellar hemorrhage with obstructive hydrocephalus; however, subsequent CT angiography (CTA) showed no vascular abnormalities. An emergency craniotomy was performed to evacuate the hematoma, and histological analysis of the specimen obtained from the tissue surrounding the hematoma revealed a pilocytic astrocytoma (PA). Six months after the ictus, her recovery was scored at 2 on the modified Rankin Scale. Conclusion: PA can be a cause of critical cerebellar hemorrhage. In this case of life-threatening massive hematoma, CTA was useful to exclude a major vascular pathology and to save time.

Successful endovascular treatment of a ruptured bihemispheric posterior inferior cerebellar artery aneurysm: illustrative case

BACKGROUND Normal posterior inferior cerebellar artery (PICA) anatomy is highly variable, but bihemispheric PICA crossing the midline to supply the vascular territory of bilateral cerebellar hemisphere is rare. Herein, the authors reported a rare case of ruptured aneurysm that was associated with bihemispheric PICA and successfully treated endovascularly. OBSERVATIONS A 46-year-old woman presented with sudden headache and loss of consciousness because of an intraventricular hemorrhage due to a ruptured aneurysm that was associated with the bihemispheric PICA. Angiography revealed that the aneurysm was located at the bifurcation between the bihemispheric PICA and the bilateral distal PICA. The ruptured aneurysm was successfully occluded using coil embolization, which preserved the parent artery with no procedural-related complication. LESSONS To the best of the authors’ knowledge, this was the first report of a ruptured aneurysm associated with bihemispheric PICA being successfully treated endovascularly. Aneurysm formation may be accelerated by hemodynamic stress and vascular fragility. For neurosurgeons and neurointerventionalists, it is important to understand the anatomical variation of PICA, especially bihemispheric PICA, which is a potential risk factor for a fatal stroke.

Bilateral carotid and vertebral arterial dissection after vaccine for COVID-19: case report

Context: This case report describes a patient with bilateral dissection of the carotid and vertebral arteries after being immunized by the Astrazeneca vaccine against COVID-19. Case report: AVC, female, 55 years old, health professional, without previous illness, received ChAdOx1 nCov-19 AstraZeneca vaccine and evolved after one day with flu-like symptoms, headache, odynophagia, fever, myalgia for 5 days. On the 7th day, she sought hospital service complaining of sudden headache, and numbness in the left upper limb. A non-reactive Sars-Cov-2 RT-PCR test was performed. The patient was released after clinical improvement. She returned after 8 days, being diagnosed with migraine and was treated with sintomatic drugs. After more 7 days, during the neurologist appointment, she reported daily headaches of varying intensity and episodes of unverified fever, with no findings on physical examination. Laboratory tests, brain resonance with cranial and cervical angioresonance, which showed findings of bilateral carotid dissection, involving the supra-bulbar segments of both internal carotid arteries, notably in the right internal carotid artery, as well as degrees of dissection of both vertebral arteries. On admission, antiplatelet aggregation was chosen, with the patient showing good evolution and being discharged after 4 days for outpatient follow-up. Conclusion: The patient has no evident risk factor for arterial dissection. In addition, the post-vaccine adverse reaction and the temporal gap between the application of the vaccine and the development of multiple arterial dissections drew attention. A possible link between the patient’s immune response and vascular endothelial inflammatory reaction is suggested, resulting in multiple arterial dissections.

Clinicopathological case: headache and systemic inflammatory illness—Occam vs Hickam

A 63-year-old woman presented with a sudden headache, which persisted and subsequently changed in character. Over time, constitutional features developed, leading to an unexpected diagnosis. This report documents the clinicopathological conference at the Association of British Neurologists Annual Meeting 2019.

Spontaneous Subarachnoid Hemorrhage Caused by Ruptured Aneurysm of Basilar Trunk Perforator

Background: The morbidity of BAPA is very low. Up to now, the pathogenesis and treatment of BAPA are not uniform. Conventional endovascular embolization and craniotomy seem not to be a good choice. We report a case of spontaneous subarachnoid hemorrhage caused by rupture of perforator aneurysm of basal trunk and successfully discharged after conservative treatment, suggesting that conservative treatment may be superior to surgical intervention.Case presentation: A 65-year-old male patient with sudden headache and dizziness for five days was admitted to our hospital for emergency treatment. Spontaneous subarachnoid hemorrhage was diagnosed by DSA. We finally found that hemorrhage Caused by ruptured aneurysm of basilar Trunk perforator.After conservative treatment for two months,DSA showed that the aneurysm disappeared completely.Conclusions: Aneurysm located at perforator artery of basilar trunk was rare and difficult to treat.Conservative treatment for certain cases with periodic angiography follow-up was recommended in order to prevent from potential iatrogenic effects.

A cross-sectional analysis of 2017 stroke symptoms recognition at the US regional level

Objectives Stroke symptom recognition is critical in reducing time to treatment, but it is not known whether the increased support for stroke education programs during the last several years has led to an improvement in regional stroke symptom recognition levels since they were last assessed in the mid-2010s. Methods We used the most current estimates of recognition from the 2017 National Health Interview Survey to examine regional recognition levels for individual stroke symptoms and correct identification of all five stroke symptoms. Results Recognition of individual stroke symptoms was ≥76% in all regions, but correct identification of all stroke symptoms was lower ranging from 68.8 to 70.2%. Recognition of sudden numbness or weakness of face, arm, or leg, especially on one side (Northeast: 94.9%, Midwest: 95.8%, South: 93.8%, West: 94.5%) was the highest and recognition of sudden headache with no known cause (Northeast: 77.6%, Midwest: 76.4%, South: 77.7%, West: 76.5%) was the lowest for all regions. Discussion We observed similar stroke symptom recognition levels in each US region with little improvement since the mid-2010s. Additional effort should be made to increase recognition of sudden headache with no known cause in US regions with current high prevalence of stroke risk factors.

Pituitary Apoplexy Leading to Cerebral Infarction: A Systematic Review

Background: Cerebral infarction caused by pituitary apoplexy (PA) is rare. To characterize the clinical features of cerebral infarction caused by PA, we performed a systematic review. Summary: The clinical symptoms are mainly sudden headache, hemiplegia, visual impairment, disturbance of consciousness, and ophthalmalgia in patients with cerebral infarction caused by PA. Treatment for this type of infarction is different from treatment for general acute cerebral infarction. Compared to patients who underwent emergency surgery and conservative treatment, patients treated with delayed surgery showed a better prognosis and a lower mortality rate. Compared to patients who underwent craniotomy or conservative treatment, patients who underwent transsphenoidal surgery (TSS) not only improved well but also showed a lower mortality rate. Key Messages: PA rarely causes cerebral infarction, which is a critical condition with a poor prognosis and is more common in men. Delayed surgery and TSS appear to confer a better prognosis in patients with this condition.