World Neurosurg
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Case Reports
Ruptured Vertebral Artery Dissecting Aneurysm in a Patient with Recurrent Bacterial Meningitis.
Intracranial mycotic aneurysms are uncommon. They can occur due to extravascular extension or intravascular seeding of the vessel wall. They often result in subarachnoid hemorrhage with poor prognosis. We present a rare case of subarachnoid hemorrhage due to vertebral artery dissection with aproximal anterior inferior cerebellar artery (AICA)-posterior inferior cerebellar artery common trunk mycotic aneurysm after an episode of bacterial meningitis. ⋯ Bacterial meningitis can lead to inflammatory injury of the intracranial vessels with resultant aneurysm formation. New enhancement of the vessel wall indicates that patients are at risk of developing mycotic aneurysms; therefore close observation with repeated vascular imaging is necessary.
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Anatomic compression of the optic nerve secondary to a dolichoectatic cerebrovascular compression is a rare clinical entity. Because of the limited number of published cases and variable clinical presentation, the natural history remains ambiguous and no consensus exists regarding management. In addition, there is an ongoing debate regarding whether a dolichoectatic cerebral blood vessel can actually cause optic neuropathy, or it merely represents an incidental finding. As a result, it is thought that a diagnosis of compressive optic neuropathy from an adjacent dolichoectatic internal carotid artery (ICA) should be considered only after other possible etiologies are excluded. Although this might seem straightforward, the clinical scenario becomes complex if the patient is also found to have additional incidental pituitary lesions. Such coexistence has not been reported previously in the literature. ⋯ The compression of the optic nerve by dolichoectatic ICA is commonly thought to be a diagnosis of exclusion. However, the presence of a coexisting pathology should not prompt the exclusion in every case and a case-based approach is highly recommended to correctly manage this rare clinical condition.
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This is a case report of a 2-year-old male who presented with walking disability and sphincter incontinence since birth. His mother has diabetes mellitus. The patient had a normal mental function, and his lower extremities were hypoplastic and akinetic. ⋯ CauReS is a rare congenital disorder in which there is abnormal fetal development of the lower spine and hypoplasia of the lower extremities. Neurosurgically, there are no clear guidelines to follow for patients with CauReS. Sometimes, surgical spinal cord untethering may be indicated in some selected patients to improve neurologic function.
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Ectopic intracranial schwannomas (those that do not arise from a named cranial nerve) are rare. They account for <2% of surgically resected central nervous system schwannomas. ⋯ This is the first reported case of a giant juvenile ectopic schwannoma within the temporal bone.
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The Brain Trauma Foundation (BTF) recommends intracranial pressure (ICP) monitoring for all salvageable patients with an abnormal computed tomography (CT) scan and a Glasgow Coma Scale <9. Studies have shown that compliance with this recommendation is low. We sought to obtain contemporary national rates of ICP monitor placement in patients with severe traumatic brain injury (TBI). ⋯ The rate of ICP monitoring in patients with severe TBI who meet BTF criteria is low and increased only slightly from 2013 to 2017.