Cerebral Computed Tomography Scan Research Articles

Characterizing Cerebral Imaging and Electroclinical Features of Five Pseudohypoparathyroidism Cases Presenting with Epileptic Seizures.

Objective To characterize the cerebral imaging and electroclinical features and investigate their etiological contributions to seizures in pseudoparathyroidism (PHP). Methods The clinical symptoms, biochemical imaging by magnetic resonance imaging (MRI) and computed tomography (CT) tests, and electroencephalogram (EEG) manifestations of five PHP patients with seizures were retrospectively collected and analyzed. Results Physical examination showed an average stature in cases 2~4 and short stature in cases 1 and 5. X-ray tests suggested ectopic calcification in four patients. The seizures in four cases were effectively controlled with antiseizure medicines (ASMs). Cerebral CT scans showed extensive brain calcifications in the bilateral basal ganglia (all five cases), cerebellum (cases 1, 3, and 5), thalamus (case 4), and cerebral cortex. Cerebral MRI showed short T1 signals mainly in the basal ganglia. EEG records revealed focal EEG abnormalities, including abnormal slow waves and epileptiform discharges, mainly over the temporal and frontal lobes. The brain areas with focal EEG abnormalities and calcification did not always coincide. Conclusion The seizures in PHP can be focal to bilateral tonic–clonic. ASMs are effective in epilepsy combined with PHP. Intracranial calcification is not a reliable etiological cause of epilepsy in PHP patients.

Extremely high levels of central nervous system involvement in miliary tuberculosis

BackgroundMiliary tuberculosis (TB) is one of the severest manifestations of TB that can be lethal when concomitant with the central nervous system (CNS) involvement. Bacteriological, biochemical and radiological methods for find CNS comorbidity in miliary TB was evaluated in this study.MethodsConsecutive miliary TB adults were retrospectively enrolled from two designated TB hospitals in China. The capacities of examinations of cerebrospinal fluid (CSF), cerebral computed tomography (CT) and magnetic resonance imaging (MRI) for diagnosis of CNS involvement were assessed.ResultsAssessment of CNS involvement with a lumbar puncture and/or neuroimaging was undertaken in 282 out of 392 of acute miliary TB. Of these 282 patients, 87.59% (247/282) had CNS involvement. Cerebral contrast-enhanced MRI (96.05%, 170/177) and MRI (93.15%, 204/219) yielded significantly higher sensitivities over CSF examination (71.92%, 146/203, P < 0.001) and CT (34.69%, 17/49, P < 0.001). The sensitivity of CSF examination was superior to CT scan (P < 0.001). Although 59.65% (134/225) miliary TB patients acquired bacteriological evidence with sputum examination, the positivity was only 8.82% (21/238) for CSF examination by conventional and molecular tests.ConclusionAlmost all miliary TB had CNS involvement and MRI demonstrated outstanding potential over other methods. Therefore, a routinely screening of CNS TB should be strongly suggested in miliary TB and MRI could be used as the initial approach in resources rich settings.

Ewing’s Sarcoma of the Cranial Vault Revealed by Macrocrania

Ewing’s sarcomas are a heterogeneous group of aggressive tumors affecting mostly children and young adults. They account for 10% of primary malignancies of the bones and 3% of all malignancies in children. They mainly affect the long bones, pelvis, and ribs. Cranial vault localization is extremely rare and indeed account for less than 1% of all localizations in the body. We are reporting the unusual case of a 3-year-old child who presented to our unit with a macrocrania which had been evolving for 2 months prior to his admission, associated with sporadic vomiting and a right frontal swelling that was gradually installed. The cerebral computed tomography scan showed a right frontoparietal lytic tissular process, heterogeneously enhanced after injection of contrast material; with dural invasion and intraparenchymal extension. The child was biopsied and the pathological examination concluded Ewing’s sarcoma. The evolution was fatal with the passing of the child 2 weeks after the biopsy.

Estimating Organ Doses from Pediatric Cerebral Computed Tomography Using the WAZA-ARI Web-Based Calculator

Background: The use of computed tomography (CT) device has increased in the past few decades in Japan. Dose optimization is strongly required in pediatric CT examinations, since there is concern that an unreasonably excessive medical radiation exposure might increase the risk of brain cancer and leukemia. To accelerate the process of dose optimization, continual assessment of the dose levels in actual hospitals and medical facilities is necessary. This study presents organ dose estimation using pediatric cerebral CT scans in the Kyushu region, Japan in 2012 and the web-based calculator, WAZA-ARI (https://waza-ari.nirs.qst.go.jp). Materials and Methods: We collected actual patient information and CT scan parameters from hospitals and medical facilities with more than 200 beds that perform pediatric CT in the Kyushu region, Japan through a questionnaire survey. To estimate the actual organ dose (brain dose, bone marrow dose, thyroid dose, lens dose), we divided the pediatric population into five age groups (0, 1, 5, 10, 15) based on body size, and inputted CT scan parameters into WAZA- ARI. Results and Discussion: Organ doses for each age group were obtained using WAZA-ARI. The brain dose, thyroid dose, and lens dose were the highest in the Age 0 group among the age groups, and the bone marrow and thyroid doses tended to decrease with increasing age groups. All organ doses showed differences among facilities, and this tendency was remarkable in the young group, especially in the Age 0 group. This study confirmed a difference of more than 10- fold in organ doses depending on the facility and CT scan parameters, even when the same CT device was used in the same age group. Conclusion: This study indicated that organ doses varied widely by age group, and also suggested that CT scan parameters are not optimized for children in some hospitals and medical facilities.

Femoral Vein Pulsatility: What Does It Mean?

In this report, the clinical evolution of a 72-year-old patient transferred to the surgical intensive care unit after cardiac surgery is described. The presence of a pulsatile Doppler signal of the common femoral vein was noted after surgery. On postoperative day 5, diuretics in addition to a combination of inhaled epoprostenol and milrinone were associated with normalization of femoral vein pulsatility. The observations seen in peripheral venous flow reinforce the hypothesis that pulsatility of the common femoral vein represents an associated echocardiographic sign of right ventricular dysfunction and may be used to monitor systemic venous congestion. Pulsatility in the venous system may be improved by reducing volume overload and improving right ventricular function.

Ceguera cortical y amnesia global transitoria luego de arteriografía con iopamidol en miembro superior

Los medios de contraste iodados pueden presentar diferentes efectos adversos, siendo los más frecuentes daño renal y reacciones de hipersensibilidad. La ceguera cortical y amnesia global transitoria son complicaciones neurológicas raras descritas tras la administración de medios de contraste. Reportamos el caso de un paciente de 63 años, hipertenso que acude por cianosis, frialdad del segundo y tercer dedo de mano izquierda. Es sometido a arteriografía de miembro superior, usando 50 mL de iopamidol e inmediatamente desarrolla cefalea occipital asociada a visión borrosa bilateral que progresa rápidamente a ceguera; la tomografía cerebral reveló hiperdensidades subaracnoideas occipitales, sin efecto de masa. A las dieciocho horas del evento, el paciente presenta amnesia anterógrada con persistencia de amaurosis. Su tomografía cerebral de control no muestra trastornos focales. El paciente cursa con evolución favorable, la amaurosis bilateral y la cefalea ceden a las treinta horas del evento y es dado de alta sin mayores eventualidades a los diez días.

Assessment of cerebrovascular disease with computed tomography in COVID-19 patients: correlation of a novel specific visual score with increased mortality risk

PurposeCerebrovascular disease (CVD) is considered a major risk factor for fatal outcome in COVID-19. We aimed to evaluate the possible association between computed tomography (CT) signs of chronic CVD and mortality in infected patients.Materials and methodsWe performed a double-blind retrospective evaluation of the cerebral CT scans of 83 COVID-19 patients looking for CT signs of chronic CVD. We developed a rapid visual score, named CVD-CT, which summarized the possible presence of parietal calcifications and dolichosis, with or without ectasia, of intracranial arteries, areas of chronic infarction and leukoaraiosis. Statistical analysis was carried out with weighted Cohen’s K test for inter-reader agreement and logistic regression to evaluate the association of in-hospital mortality with CVD-CT, chest X-ray (CXR) severity score (Radiographic Assessment of Lung Edema-RALE) for radiological assessment of pulmonary disease, sex and age.ResultsCVD-CT (odds ratio 1.6, 95% C.I. 1.2-2.1, p = 0.001) was associated with increased risk of mortality. RALE showed an almost significant association (odds ratio 1.05, 95% C.I. 1-1.1, p 0.06), whereas age and sex did not.ConclusionCVD-CT is associated with risk of mortality in COVID-19 patients. The presence of CT signs of chronic CVD may be correlated to a condition of fragility of the circulatory system, which constitutes a key risk factor for death in infected patients.

An Unusual Variant of Lemierre’s Syndrome with Multiple Abscesses and Hepatic Vein Thrombosis

Introduction: Lemierre’s syndrome is an uncommon, life-threatening disease that develops as a severe complication of oropharyngeal infection. However, this syndrome has also been reported during anaerobic septicemia, originating from diverse sources of infection, such as the gastrointestinal system. The diagnosis of this syndrome remains challenging, and is often prompted by the detection of Fusobacterium necrophorum in blood culture, rather than with clinical signs or symptoms. Case Presentation: A previously healthy 38-year-old woman was hospitalized for a 6-day history of fever, watery diarrhea, and vomiting. Physical examination of the patient showed fever, pharyngitis, and diffuse abdominal tenderness. Laboratory investigations revealed elevated inflammatory markers, and two blood cultures revealed Fusobacterium necrophorum. An abdominal ultrasound showed a liver abscess and hepatic vein thrombosis. The thoracoabdominal and cerebral computed tomography scan confirmed the results of the abdominal ultrasound. It additionally revealed bilateral lung nodules and a parietal brain abscess. The patient’s general condition and her laboratory test results, improved after receiving treatment with ceftriaxone and metronidazole. She received antibiotics for three months, without anticoagulation therapy. Repeated computed tomography scans showed a resolution of the liver, pulmonary, and brain abscesses, as well as the recanalization of the hepatic vein. Conclusions: Lemierre’s syndrome emerges as a result of septic illness and liver abscesses in case of gastrointestinal symptoms despite the lack of common presentation.

Diagnosis, Management, and Outcome in 9 Children with Unilateral Posterior Synostotic Plagiocephaly

Posterior synostotic plagiocephaly represents a rare challenging type of craniosynostosis, often misdiagnosed as a simple posterior positional plagiocephaly. Underdiagnosed forms may result in delayed diagnosis and neurosurgical management, with potential ophthalmologic, cognitive, and aesthetic sequelae in children. Here we retrospectively analyzed data of 9 posterior synostotic plagiocephaly infants treated in our center over a 10-year period (January 2000-December 2009). Patients averaged 10 months of age, and there was a clear male predominance (8 males/1 female). Cerebral computed tomography scan was performed in all patients, and the abnormal suture was located at the right side in 7 cases (77.77%). Ipsilateral occipitomastoid bulge and occipital flattening were found in all cases (100%). Posterior ear displacement was found in 7 cases (77.77%), and there was minimal facial asymmetry in 4 cases (44.44%). The ophthalmoscopic examination found a papillary edema grade 1 in 2 cases and grade 2 in 4 cases. There were no deaths or reoperation in our series. All of our patients underwent a neurosurgical correction, with total ophthalmic recovery in all patients with preoperative papillae edema. Eight patients had an early satisfactory aesthetic aspect. Long-term follow-up in treated children found a normal childhood, with no major school dysfunctions and normal social integration. Interesting findings in our series were male gender predominance and predilection of the right-side synostotic lambdoid suture. We think that early correct diagnosis and appropriate neurosurgical treatment may prevent potential complications such as neurocognitive and aesthetic sequelae in children with posterior synostotic plagiocephaly.

Incidence of early intra-cranial bleeding and ischaemia in adult veno-arterial extracorporeal membrane oxygenation and extracorporeal cardiopulmonary resuscitation patients: a retrospective analysis of risk factors.

Cerebral complications in veno-arterial extracorporeal membrane oxygenation are known to have a strong impact on mortality and morbidity. Aim of this study is to investigate the early incidence, risk factors and in-hospital mortality of intra-cranial ischaemia and haemorrhage in adults undergoing veno-arterial extracorporeal membrane oxygenation treatment. This study is a single-centre retrospective analysis on adult patients undergoing veno-arterial extracorporeal membrane oxygenation for different indications. The inclusion criterion included patients with early routine cerebral computed tomography imaging during extracorporeal membrane oxygenation, with no clinical evidence of cerebral pathology prior to cannulation. Cerebral complications were grouped by aetiology and the territories of the brain's supplying arteries. One hundred eighty-seven adult patients with a total of 190 veno-arterial extracorporeal membrane oxygenation treatments were included. A total of 16.3% (n = 31) had evidence of either cerebral ischaemia (11.1%) or haemorrhage (5.8%); one patient suffered from both. Cerebral computed tomography scans were performed early in median on the first day after extracorporeal membrane oxygenation cannulation; in-hospital mortality of intra-cranial ischaemia and haemorrhage was 71.4% and 45.5%, respectively. Associated with an increased risk for ischaemic lesions were cannulation of the ascending aorta, higher age, presence of an autoimmune disease and cardiac surgery prior to veno-arterial extracorporeal membrane oxygenation. An association with haemorrhagic lesions was found for a lower blood PaCO2 at 2 hours, lower blood flow through the extracorporeal membrane oxygenation device at 2 hours, higher international normalized ratio and constantly higher activated partial thromboplastin time values as well as higher mean arterial pressures until haemorrhagic lesions were evident. Cerebral complications are frequent in patients on veno-arterial extracorporeal membrane oxygenation and may be clinically silent events. Careful monitoring with routine neuroimaging seems to be the most appropriate diagnostic approach at present. Intra-cranial ischaemia occurs more frequent than haemorrhage and is associated with cannulation of the aorta ascendens.

Association between ELP4 rs986527 polymorphism and the occurrence and development of intracranial arachnoid cyst.

ObjectiveThe association between ELP4 rs986527 polymorphism and the occurrence and development of intracranial arachnoid cyst was studied in this paper.MethodsEighty‐five patients diagnosed with intracranial arachnoid cysts by cerebral computed tomography scan were selected. Sixty‐three healthy volunteers for medical examination in hospitals served as controls. The cognition, depressive symptoms, and the likelihood of headache, dizziness, head trauma history, dementia, depression, and epilepsy were assessed. ELP4 genotypes and its allele frequency were determined by PCR, endonuclease restriction analysis, and gel electrophoresis.ResultsELP4 rs986527 had three genotypes: TT, TC, and CC. The intracranial arachnoid cyst group showed no statistically significant difference in genotype frequencies compared with healthy controls. There was no significant correlation between ELP4 rs986527 polymorphism and location of intracranial arachnoid cyst. TC and C genotype frequencies were associated with a higher incidence of clinical symptoms than TT genotype frequencies, and C allele frequencies were associated with a significantly higher incidence of clinical symptoms compared with T allele frequencies. There was no significant difference in TNF‐α and IL‐1β levels between TT/TC/CC genotypes before treatment. After treatment, the levels of TNF‐α and IL‐1β were significantly decreased in different genotypes, and the decrease in CC was the greatest. The frequency of TT and TC genotypes was higher than that of CC genotypes.ConclusionELP4 rs986527 polymorphism affected the incidence of clinical symptoms and the levels of TNF‐α and IL‐1β in patients with intracranial arachnoid cysts.

Direct Oral Anticoagulant Treatment and Mild Traumatic Brain Injury: Risk of Early and Delayed Bleeding and the Severity of Injuries Compared with Vitamin K Antagonists.

The risk of intracranial hemorrhage (ICH) in patients taking direct oral anticoagulants (DOACs) after mild traumatic brain injury (MTBI) is unclear. To assess the differences in the risk of developing early, delayed, and comprehensive bleeding after MTBI among patients treated with DOACs as compared with those treated with vitamin K antagonists (VKAs). All MTBI patients taking oral anticoagulants in our emergency department between June 2017 and August 2018 were included. All patients on oral anticoagulants underwent immediate cerebral computed tomography (CT) and a second CT scan after 24h of clinical observation. There were 451 patients enrolled: 268 were on VKAs and 183 on DOACs. Of the DOAC-treated patients, 7.7% (14/183) presented overall intracranial bleeding, compared with 14.9% (40/268) of VKA-treated patients (p=0.026). Early bleeding was present in 5.5% (10/183) of DOAC-treated patients and in 11.6% (31/268) of VKA-treated patients (p=0.030). Multivariable analysis showed that VKA therapy (odds ratio [OR] 2.327), high-energy impact (OR 11.229), amnesia (OR 2.814), loss of consciousness (OR 5.286), Glasgow Coma Scale score<15 (OR 4.719), and the presence of lesion above the clavicles (OR 2.742) were associated with significantly higher risk of global ICH. A nomogram was constructed to predict ICH using these six variables. Discrimination of the nomogram revealed good predictive abilities (area under the receiver operating characteristic curve: 0.817). DOAC-treated patients seem to have lower risk of posttraumatic intracranial bleeding compared with VKA-treated patients.

Neurolinguistic analysis of a case of phonological alexia in Arabic language

Cases of phonological alexia have been widely studied in various occidental languages, but to our knowledge no case has been reported in Arabic language. We report a neurolinguistic analysis of a single case of phonological alexia in Arabic. AL, 48-year-old, right-handed man, who is a teacher of Arabic, at the age of 35 presented with hemiplegia and severe aphasia. A Cerebral Computed Tomography scan showed a wide left hemispheric infarct. As a result, he developed Broca’s aphasia and alexia. A neurolinguistic analysis of reading was evaluated using the Arabic Dyslexia-Dysgraphia Battery which consists of a corpus of 331 words with different parts of speech and reading task of non-words. The patient had much more difficulty reading non-words than words (90% of errors versus 37%). This is the classical dissociation that characterizes phonological alexia. Keywords: Arabic; Phonological; Alexia

Acute Stroke Treatment in Patients with Basilar Artery Occlusion: A Single-Center Observational Study

Background: Acute ischemic stroke (AIS) due to basilar artery occlusion (BAO) represents 1–4% of all ischemic strokes. BAO results in strokes associated with a high risk of a poor functional outcome and, in 86–95% of the untreated cases, it results in death because of the vital cerebral structures involved. Diagnosis can be delayed because of the variability in presenting symptoms, and acute treatment is often attempted even beyond 6 h from symptoms onset because of the high risk of a fatal prognosis. Objective: In this observational study, we retrospectively analyzed patients with AIS due to BAO referred to the stroke center of the University Hospital of Messina. We aimed to assess prognostic factors and to evaluate the association between clinical outcome and posterior circulation Alberta Stroke Program Early CT Score (pc-ASPECTS) and collateral status. Method: BAO was confirmed by cerebral computed tomography (CT) angiography or cerebral angiography. All patients underwent CT scan and magnetic resonance imaging (MRI). We assessed the pc-ASPECTS on diffusion-weighted imaging (DWI) MR images and the Posterior Circulation Collateral Score (PC-CS) for every patient. Functional outcome was assessed at 3 months using the modified Rankin Scale (mRS). Results: The study population consisted of 27 patients; 16 males and 11 females. The mean age was 66 (±14) years. We observed a favorable outcome (mRS 0–3) in 40.7% of cases, 25.9% reached mRS 0–2, and 29.6% had a poor clinical outcome (mRS 4–5). Patient survival was 70.4%, whereas 8 patients died (29.6%). In 7 patients, pc-ASPECTS was ≥7. According to the PC-CS, 33.3% had moderate collaterals and 63.0% had good collateral status prior to receiving the treatment. Favorable outcome was significantly associated with age, NIHSS score at admission, pc-ASPECTS, hypercholesterolemia, and female sex but not with the other risk factors. Conclusions: In our study, we found that younger age, low NIHSS score at admission, and high pc-ASPECTS, but not onset to treatment time, are associated with a favorable clinical outcome. Transferred patients did not have a significantly poorer outcome. These findings confirm that acute stroke treatment improves clinical outcome in BAO patients, in spite of a delayed diagnosis and an extended therapeutic window, considering lesion volume and localization in DWI MRI.

Findings of Cerebral Computerized Tomography Scan in Epileptic Children Hospitalized in Ahvaz Golestan Hospital

Findings of Cerebral Computerized Tomography Scan in Epileptic Children Hospitalized in Ahvaz Golestan Hospital

Interpretation of Brain CT Scans in the Field by Critical Care Physicians in a Mobile Stroke Unit.

ABSTRACTBACKGROUND AND PURPOSEIn acute stroke, thromboembolism or spontaneous hemorrhage abruptly reduces blood flow to a part of the brain. To limit necrosis, rapid radiological identification of the pathological mechanism must be conducted to allow the initiation of targeted treatment. The aim of the Norwegian Acute Stroke Prehospital Project is to determine if anesthesiologists, trained in prehospital critical care, may accurately assess cerebral computed tomography (CT) scans in a mobile stroke unit (MSU).METHODSIn this pilot study, 13 anesthesiologists assessed unselected acute stroke patients with a cerebral CT scan in an MSU. The scans were simultaneously available by teleradiology at the receiving hospital and the on‐call radiologist. CT scan interpretation was focused on the radiological diagnosis of acute stroke and contraindications for thrombolysis. The aim of this study was to find inter‐rater agreement between the pre‐ and in‐hospital radiological assessments. A neuroradiologist evaluated all CT scans retrospectively. Statistical analysis of inter‐rater agreement was analyzed with Cohen's kappa.RESULTSFifty‐one cerebral CT scans from the MSU were included. Inter‐rater agreement between prehospital anesthesiologists and the in‐hospital on‐call radiologists was excellent in finding radiological selection for thrombolysis (kappa .87). Prehospital CT scans were conducted in median 10 minutes (7 and 14 minutes) in the MSU, and median 39 minutes (31 and 48 minutes) before arrival at the receiving hospital.CONCLUSIONThis pilot study shows that anesthesiologists trained in prehospital critical care may effectively assess cerebral CT scans in an MSU, and determine if there are radiological contraindications for thrombolysis.

Posterior Reversible Encephalopathy Syndrome Due To Carcinoid Crisis Complicating Transarterial Chemoembolization for Metastatic Carcinoid Tumour

Posterior Reversible Encephalopathy Syndrome Due To Carcinoid Crisis Complicating Transarterial Chemoembolization for Metastatic Carcinoid Tumour

Low-Dose Versus High-Dose Tranexamic Acid Reduces the Risk of Nonischemic Seizures After Cardiac Surgery With Cardiopulmonary Bypass

The incidence of postoperative nonischemic seizures associated with the use of tranexamic acid (TXA) and the possibility of prevention with a low-dose regimen of TXA were evaluated. Retrospective study. Tertiary care university hospital. A total of 12,195 patients who underwent cardiac surgical procedures under cardiopulmonary bypass (CPB) were evaluated. The files of every clinical seizure case diagnosed in the surgical intensive care unit between April 2006 and April 2014 were reviewed. Patients who experienced a postoperative seizure underwent a cerebral computed tomography scan to exclude an ischemic lesion. Dosage and type of antifibrinolytic used and surgery characteristics were retrieved from perfusion files. Low-dose TXA was defined as 1,000-mg bolus, 400-mg/h infusion, and 500 mg in CPB priming. High-dose TXA was defined as 30-mg/kg bolus, 15 mg/kg/h, and 2 mg/kg in CPB priming. No seizure was observed in the 886 patients who did not receive antifibrinolytics. A total of 98 clinical seizures (0.8%) were recorded in the intensive care unit, and ischemic cause was excluded in the majority of them after computed tomography scan results were reviewed (91patients [93%]). Low-dose TXA was associated with fewer seizures than was high-dose TXA (46 of 7,452 cases [0.70%] v 34 of 2,190 cases [1.55%], respectively; p < 0.0001). Open-chamber cardiac surgery also was linked to a higher incidence of seizures compared with revascularization (80 of 6,662 [1.20%] and 11 of 5,533 [0.20%], respectively; p < 0.0001). Lower doses of TXA were associated with a lower incidence of nonischemic seizures compared with higher doses of the drug.

Postoperative Care of Patients with High-grade Glioma: Is There a Real Need for the Neurocritical ICU and Early CT Scan?

Pressure on economic resources now requires a careful rationalization of services. For adult patients with supratentorial gliomas, there is no consensus on the real need for care in a postoperative neurocritical intensive care unit (NICU) and on the timing of a postsurgical computed tomography (CT) scan. In this retrospective nonrandomized study, we assessed if and when there is a real need for NICU and if an early CT scan could be justified in the absence of neurologic worsening. Of 264 patients, 21 were admitted to the NICU after the procedure as planned before the surgery for their clinical features (Karnofsky performance status < 70, American Society of Anesthesiologists score > 2, or Charlson Comorbidity Index > 5). The mean stay in the NICU was 19.7 hours. One of these patients had developed a postoperative hematoma that was subsequently removed, and died afterward. The other 243 patients were followed clinically after the procedure: 219 underwent a cerebral CT scan 24 hours after the procedure and were discharged in good condition. The other 24 patients had a cerebral CT scan within 24 hours after the procedure. The early CT showed the presence of a local edema in five cases and a hematoma surgically treated with a subsequent admission to the NICU in two cases. Considering our data, we suggest that NICU should not always be used after craniotomy for supratentorial gliomas. Clinical observation was sufficient to predict early postoperative complications. A CT scan before 24 hours after surgery is not recommended in the absence of clinical worsening.

Bilateral Divergent Shoulder's Fracture Dislocation Case in an Ischemic Stroke Patient.

Introduction:The literature review revealed that nowadays only about 15 cases of bilateral shoulder dislocation associated with the fracture of the upper end of the humerus have been published. The triad of lesional mechanism designated by the triple syndrome E composed of epilepsy, electrocution, and external trauma was the circumstances noted in which these fractures dislocations occur with migration of the two humeral heads either forward or backward.Case Report:An architect of 36-year-old, right-handed, was admitted in emergency department for loss of knowledge of progressive installation. At admission the blood pressure, pulse, and temperature were normal. There was a right hemiparesis predominantly in brachiofacial side and an aphasia. After intensive resuscitation measures, the cerebral computed tomography scan revealed a left temporoparietal hypodensity area affecting the middle cerebral artery superficial territory with a mass effect compatible with acute ischemic stroke. During the hospitalization, episodes of generalized tonic-clonic convulsions appeared with a fever at 39°C and a leukocytosis at 35 thousand on the 5th day. These convulsions caused on the right shoulder an anterior dislocation under coracoid, associated with a fracture of the greater tubercle and on the left shoulder, posterior dislocation with much displaced comminuted articular proximal humeral fracture. We did reduction by external maneuvers for the right shoulder and open reduction with internal fixation by anatomical plate of left shoulder lesions. In the immediate aftermath of surgery, he presented episodes of agitation which led to the dismantling of the left shoulder fixation. He was evacuated to the North Country where an ablation of the left shoulder material and stabilization by locked plate were carried out. The sequelae were marked by the occurrence of an osteomyelitis with osteolysis of the entire upper right humerus extremity. It will require an inverted prosthesis.Conclusion:The surgical treatment must be done by a solid assembly and consultation with neurologists and anesthetists is essential. This multidisciplinary management could prevent any convulsive postoperative seizures that would risk sacrificing all therapeutic efforts.