Cranial Nerve Damage Research Articles

Meningiomas in the Central Skull Base:From the Perspective of Endoscopic Transnasal Surgery

Recent advancements in endoscopic transnasal surgery(ETS)have expanded the application of this technique to meningiomas in the central skull base area, offering a less invasive alternative with a potentially lower physical burden on patients than conventional microscopic skull base surgery. Notably, while ETS allows surgeons to reach tumors without traversing the brain and nerves, thus theoretically reducing the risk of cranial nerve damage, it requires a high level of proficiency to avoid inadequate resection and tumor recurrence. In this article, we discuss the various surgical considerations, including preoperative imaging, surgical setting, nasal cavity expansion, skull base opening, tumor removal, and skull base reconstruction, as general procedures for specific meningiomas. We further describe the concept and details of our multi-layer fascial closure technique for dural repair in ETS, underlining the importance of skilled dural reconstruction in preventing postoperative complications. In conclusion, while ETS for skull base meningiomas presents a promising and less invasive treatment option, its success relies heavily on the surgeon's experience and understanding of the skull base anatomy, stressing the need for careful approach selection.

Therapeutic effect and psychological impact of aspirin plus edaravone on patients with cerebral infarction.

Cerebral infarction (CI) is characterized by a high prevalence, disability, and mortality. Timely or improper treatment greatly affects patient prognosis. To explore the drug efficacy of aspirin plus edaravone and to explore their effect on quality of life (QOL), anxiety and depression in CI patients. We retrospectively analyzed the records of 124 CI patients treated between June 2019 and February 2021 who were assigned to an observation group (OG) (combination therapy of aspirin and edaravone, 65 patients) or a control group (CG) (aspirin monotherapy, 59 patients). The therapeutic effects, pre- and posttreatment National Institutes of Health Stroke Scale (NIHSS) scores, activities of daily living, degree of cognitive impairment, protein levels of glial fibrillary acidic protein (GFAP), neuron-specific enolase (NSE) and S-100B, occurrence of adverse reactions, and serum high-sensitivity C-reactive protein (hs-CRP), interleukin (IL)-6 and tumor necrosis factor (TNF)-α were evaluated, detected and compared between the two groups. Finally, posttreatment QOL, anxiety, and depression were assessed by the Medical Outcomes Study 36- Item Short Form Health Survey Scale, Self-rating Depression Scale (SDS), and Self-rating Anxiety Scale (SAS), respectively. Compared with the CG, the OG had markedly better therapeutic effects, greater improvements in activities of daily living, and better alleviation in cognitive dysfunction after treatment, as well as lower posttreatment NIHSS scores and serum NSE, GFAP, S-100B, hs-CRP, IL-6, and TNF-α levels; the OG was similar to the CG in terms of adverse reactions but was better than the CG in terms of posttreatment QOL; and the OG also had lower SDS and SAS scores than the CG after treatment. Aspirin plus edaravone had a good curative effect on CI. It can reverse cranial nerve damage in patients, improve neurological function and prognosis, and alleviate inflammation, anxiety, and depression; thus, it is considered safe and worthy of clinical application.

The analysis of serum lipids profile in Guillain-Barre syndrome.

Guillain-Barre syndrome (GBS) is an immune-mediated inflammatory peripheral neuropathy. This study aimed to conduct a systematic analysis of the serum lipids profile in GBS. We measured the serum lipids profile in 85 GBS patients and compared it with that of 85 healthy controls matched for age and sex. Additionally, we analyzed the correlation between lipids and the severity, subtypes, precursor infections, clinical outcomes, clinical symptoms, immunotherapy, and other laboratory markers of GBS. Compared to the healthy controls, GBS exhibited significantly elevated levels of Apolipoprotein B (APOB), Apolipoprotein C2 (APOC2), Apolipoprotein C3 (APOC3), Apolipoprotein E (APOE), triglycerides (TG), and residual cholesterol (RC). Conversely, Apolipoprotein A1 (APOA1), Apolipoprotein A2 (APOA2), and high-density lipoprotein (HDL) were substantially lower in GBS. Severe GBS displayed noticeably higher levels of APOC3 and total cholesterol (TC) compared to those with mild disease. Regarding different clinical outcomes, readmitted GBS demonstrated higher RC expression than those who were not readmitted. Moreover, GBS who tested positive for neuro-virus antibody IGG in cerebrospinal fluid (CSF) exhibited heightened expression of APOC3 in comparison to those who tested negative. GBS with cranial nerve damage showed significantly reduced expression of HDL and APOA1 than those without such damage. Additionally, GBS experiencing limb pain demonstrated markedly decreased HDL expression. Patients showed a significant reduction in TC after intravenous immunoglobulin therapy. We observed a significant positive correlation between lipids and inflammatory markers, including TNF-α, IL-1β, erythrocyte sedimentation rate (ESR), white blood cells, monocytes, and neutrophils in GBS. Notably, APOA1 exhibited a negative correlation with ESR. Furthermore, our findings suggest a potential association between lipids and the immune status of GBS. The research demonstrated a strong connection between lipids and the severity, subtypes, clinical outcomes, precursor infections, clinical symptoms, immunotherapy, inflammation, and immune status of GBS. This implies that a low-fat diet or the use of lipid-lowering medications may potentially serve as an approach for managing GBS, offering a fresh viewpoint for clinical treatment of this condition.

Fluid Resuscitation in Patients With Traumatic Brain Injury: A Comprehensive Review.

Patients with traumatic brain injury (TBI) or head trauma present challenges for emergency physicians and neurosurgeons. Traumatic brain injury is currently a community health issue. For the best possible care, it is crucial to understand the various helpful therapy techniques in the pre-operative and pre-hospital phases. The initial rapid infusion of large volumes of mannitol and a hypertonic crystalloid solution to restore blood pressure and blood volume is the current standard of care for people with combined hemorrhagic shock (HS) and traumatic brain injury. The selection and administration of fluids to trauma and traumatic brain injury patients may be especially helpful in preventing subsequent ischemic brain damage because of the hemodynamic stabilizing effects of these fluids in hypovolemic shock. Traumatic brain injury is an essential factor that may lead to disability and death in a patient. Traumatic brain damage can develop either as a direct result of the trauma or as a result of the initial harm. Significant neurologic problems, such as cranial nerve damage, dementia, seizures, and Alzheimer's disease, can develop after a traumatic brain injury. The comorbidity of the victims may also be significantly increased by additional psychiatric problems such as psychological diseases and other behavioral and cognitive sequels. We review the history of modern fluid therapy, complications after traumatic brain injury, and the use of fluid treatment for decompressive craniectomy and traumatic brain injury.

Serum and CSF brain damage markers NFL and GFAP correlate with tick-borne encephalitis disease severity - a multicenter study on Lithuanian and Swedish patients.

Our aim was to examine the correlation between biomarkers of neuronal and glial cell damage and severity of disease in patients with tick-borne encephalitis. One hundred and fifteen patients with tick-borne encephalitis diagnosed in Lithuania and Sweden were prospectively included, and CSF and serum samples obtained shortly after hospitalization. Using pre-defined criteria, cases were classified as mild, moderate, or severe TBE. Additionally, the presence of spinal nerve paralysis (myelitis) and/or cranial nerve affection were noted. Concentrations of brain cell biomarkers glial fibrillary acidic protein (GFAP), YKL40, S-100B, neurogranin, neurofilament light (NFL), and tau were analyzed in CSF, and in addition, NFL, GFAP and S-100B levels were measured in serum. The Jonckheere Terpstra test was used for group comparisons of continuous variables and Spearman's partial correlation test to adjust for age. CSF and serum concentrations of GFAP and NFL correlated with disease severity, independent of age, and with presence of nerve paralysis. The markers neurogranin, YKL40, tau and S-100B in CSF and S-100B in serum were detected, but their concentrations did not correlate with disease severity. Neuronal cell damage and astroglial cell activation with increased NFL and GFAP in CSF and serum were associated with a more severe disease, independent of age. Increased GFAP and NFL concentrations in CSF and NFL in serum were also indicative of spinal and/or cranial nerve damage. NFL and GFAP are promising prognostic biomarkers in TBE, and future studies should focus on determining the association between these biomarkers and long-term sequelae.

Three Cases of Lower Cranial Nerve Palsies Due to Reactivation of Varicella-Zoster Virus

Varicella zoster virus (VZV) establishes latency in ganglionic neurons, and reactivation of VZV can produce a broad spectrum of neurological disorders involving these neurons, including lower cranial nerve palsies. It is rare for reactivation of VZV to manifest as lower cranial nerve palsies alone. We report three cases of VZV reactivation that presented with lower cranial nerve palsies. Case 1: A 52-year-old woman presented to our department with the complaints of right earache and dysphagia. Examination revealed no abnormal findings, except for right vocal cord palsy and oropharyngeal palsy. Cervicothoracic CT and head MRI did not show any abnormalities. Based on these findings and the results of blood tests, we suspected cranial nerve palsy due to reactivation of VZV and initiated the patient on antiviral drug and steroid treatment. Case 2: A 69-year-old woman visited our hospital with a 6-day history of pharyngeal pain and dysphagia. Laryngoscopy at another hospital revealed left vocal fold paralysis and saliva residue in the hypopharynx. As in Case 1, after closer examination, cranial nerve damage due to reactivation of VZV was suspected, and treatment was initiated. Case 3: An 82-year-old man presented with a 5-day history of throat pain and dysphagia. Based on the presence of a unilateral mucous membrane rash and severe pharyngeal pain, the patient was diagnosed as having pharyngolaryngitis caused by reactivation of VZV, and was started on antiviral medication. From the time of the initial examination, he had persistent hiccups and difficulty in sleeping. After treatment, the hiccups disappeared along with disappearance of the mucous membrane rash.

Aumento da frequência de pneumonia em cães com meningioma em rombencéfalo ventral

ABSTRACT: Intracranial tumors occurring in specific brain regions, such as the cerebellopontine angle, may be associated with cranial nerve dysfunction and dysphagia in humans and animals. Although dysphagia is a known risk factor for pneumonia, only postoperative pneumonia has been investigated in veterinary medicine. This study aimed to describe the clinical and pathological features of dogs with untreated intracranial meningiomas and concomitant pneumonia. Data from post-mortem examination registries from 2011 to 2021 were used (n=23). The frequency of pneumonia and other characteristics were compared between dogs with meningiomas in the ventral rhombencephalon region (VR group; n=13) and those with meningiomas in other intracranial sites (OIS group; n=10). The frequency of pneumonia was higher in the VR group than in the OIS group (n=5 vs. n=0; P=0.039). Plaque-like lesions were also more common in the VR group than in the OIS group (P=0.012). Dogs with concomitant pneumonia had cerebellopontine angle (n=3) and basilar meningiomas (n=2), mainly plaque-like lesions extending to or from other brain areas. In dogs with concomitant pneumonia, meningiomas had invasive (n=5) and compressive (n=3) growth behaviors and nerve roots involved in the swallowing process were frequently affected. Microscopically, these meningiomas were classified as atypical (n=4) and meningiomas (n=1). The reported clinical signs included anorexia (n=3), adipsia (n=1), and dysphagia (n=1). Our findings suggest untreated dogs with ventral rhombencephalon meningiomas may develop cranial nerve damage and aspiration pneumonia.

Complication Rate After Carotid Endarterectomy Comparing Patch Angioplasty and Primary Closure: Long-Term Outcome

Objective: In patients with symptomatic or asymptomatic severe internal carotid artery stenosis, carotid endarterectomy (CEA) has been shown to reduce risk for stroke. The optimal surgical technique remains subject of debate. In the latest European Society of Vascular Surgery (ESVS) guidelines on the management of atherosclerotic carotid disease, routine patching is preferred to routine primary closure. However, there are no RCT’s evaluating selective patching strategies. This follow-up study aimed to assess long term complication rate and restenosis after carotid endarterectomy with selective patching. Methods: Two hundred thirteen consecutive carotid endarterectomies over a 3-year period from January 5th 2011 to December 19th 2013 were prospectively analyzed in a follow-up study over 5 years (mean 4.6, range 3.17-6.17). Patient population consisted of 141 procedures on males and 72 on females with mean age 73 years at the time of surgery (standard deviation (SD) 8.57, range 53-95). There was a follow-up of 89%. Postoperative risk factors were assessed such as hypertension, diabetes mellitus, coronary artery disease and smoking. Postoperative symptoms of cranial nerve injury, transient ischemic events, cerebrovascular events and mortality were evaluated. Duplex ultrasound was performed by a radiologist blinded to the operative technique to evaluate patency of the carotid artery after carotid endarterectomy. Results: Primary closure was used in 110 operations, and patch angioplasty in 103 procedures (Dacron patch). Primary closure was performed when the carotid artery had a diameter above 5 mm, when there was a high carotid bifurcation or when the contralateral carotid artery was occluded. There were no significant differences among groups' baseline characteristics at the time of surgery. Primary closure was performed significantly more in male patients (P= .02). Overall complication rate was 3.76% postoperatively (1.8% after primary closure, 5.8% after patch angioplasty) and after 5 years 5.29% (2.0% after primary closure, 9.1% after patch angioplasty). There are no significant differences in results between the two groups (P= .09 and P= .05). In four cases patients experienced symptoms of cranial nerve damage postoperatively, two in each group. In one of the two cases in each group, the patient fully recovered and the other had persistent complaints (P-value= 1). None of the patients experienced amaurosis fugax during the 5-year follow up period. In five cases a patient had an ipsilateral cerebrovascular thrombosis in the group after patch angioplasty compared to zero in the primary closure group (P-value= .02). In the group of primary closure there was a mortality of 26 patients (23.6%) compared to 26 (25.2%) patients after patch angioplasty (P-value = .70). One was caused by cerebral hyperperfusion syndrome within one month postoperative after patch angioplasty and none were caused by an ipsilateral ischemic stroke. Objective duplex ultrasound showed no significant difference comparing restenosis in both groups (P-value= .43). In twelve cases patients showed a restenosis between 50-70% (6 primary closure and 6 patch angioplasty), none of the patients had high grade restenosis of more than 70%. Patient characteristics did not show a significant effect on long term outcomes. There was a correlation between postoperative use of antihypertensive medication and long-term stroke (P-value= .006), restenosis (P-value= .01) and mortality (P-value= .003). Conclusion: After long-term follow-up we found primary closure and patch angioplasty to be equivalent with respect to complication rate and restenosis when used in selected cases. Best medical treatment and especially the use of antihypertensive medication should be emphasized.

CAROTID ENDARTERECTOMY WITH REGIONAL ANESTHESIA IN OUR EXPERIENCE

Aim: Carotid endarterectomy (CEA) is a common revascularization option for carotid atherosclerosis. Regional anesthesia for CEA has become a preferred anesthesia technique in lots of centers. In this study, we present our experience with CEAs under regional anesthesia.
 Material and Methods: From 2019 to 2022, 271 patients who underwent CEA with regional anesthesia in two centers were included. Retrospectively, patient data, demographical characteristics, comorbidities, and radiological imaging features were enrolled by searching the hospital information system. The primary endpoint was to describe the outcomes.
 Results: Of the 271 participants, 202 were male and 69 were female. The male-to-female ratio is 74.5. The average age was 65.3±10,2. General anesthesia was maintained for two patients due to inadequate patient collaboration. The average operation time was 52±8.9 minutes. The mean X-clamp time was 14±2.5 minutes and the patient stayed in the intensive care unit for an average of 14±2 hours. The most common postoperative complication was bleeding (n=8). No cranial nerve damage was observed. There was no procedural death. Patients were discharged within an average of 4 days.
 Conclusion: Regional anesthesia can be safely performed for CEA. Considering patient preference and compliance, regional anesthesia is the first option for CEA operations in our routine.
 Keywords: carotid artery stenosis, carotid endarterectomy, regional anesthesia

AN UNUSUAL PRESENTATION OF A PULSATILE NECK MASS

AN UNUSUAL PRESENTATION OF A PULSATILE NECK MASS

Central nervous system lesion associated with the novel coronavirus infection COVID-19 in the practice of an occupational pathologist

One of the most important complications of the novel coronavirus infection (COVID-19) is damage to the nervous system. From the pathogenesis perspective, neurological disorders in COVID-19 can be caused by a “cytokine storm”, hypoxemia, homeostasis disorders (critical illness-related encephalopathy), SARS-CoV-2 neurotropism and neurovirulence (isolated cranial nerve damage, focal and diffuse CNS lesions), as well as the combined effect of these factors. COVID-19 also affects the course of chronic neurological diseases. The range of neurological disorders in COVID-19 is wide: from cranial mononeuropathy, clinically manifested by anosmia or ageusia/dysgeusia, to Guillain-Barré syndrome and severe lesions of the brain and spinal cord in the form of acute hemorrhagic necrotizing encephalopathy and myelopathy. The novel coronavirus infection in healthcare workers can be considered an occupational disease if the infection occurred during the performance of their duties. The presented clinical case describes one of the possible serious complications of COVID-19 - damage to the central nervous system (encephalopathy) in a healthcare worker. The article presents the principles and results of a medical examination conducted in order to establish a causal relationship between the disease and professional activities. The need for a multidisciplinary approach to the diagnosis of manifestations, and treatment of COVID-19 and its complications with the mandatory participation of a neurologist is emphasized.

Vascular and Vasogenic Manifestations of Systemic ANCA-Associated Vasculitis with Renal Involvement in Non-Contrast Brain MRI in Patients with Acute Disease Onset.

Background. Data concerning central nervous system (CNS) alterations in ANCA-associated vasculitis with renal involvement (AAVR) are sparse. The study aimed to assess vascular and vasogenic brain alterations in patients with acute onset of AAVR and the applicability of non-contrast magnetic resonance imaging (MRI) techniques in this diagnosis. Methods. Thirty-eight patients with acute onset of AAVR were included in the study. BVAS/WG, c-ANCA, p-ANCA, renal function and perfusion, neurological assessment, and brain MRI were performed. Results. Cerebral vascular alternating narrowing and dilatation (VAND) was detected in 42.1% of patients, and the black-blood was significantly more diagnostic than the TOF technique (p < 0.001). VAND occurrence was independently associated with the concentration of p-ANCA. The vasogenic white matter lesions (VWML) were found in 94.4% of patients, and in their detection, SWAN was significantly better than the FLAIR technique (p = 0.002). The number of VWML correlated with age and cranial nerve damage. Hemosiderin deposits were found in 21.6% of patients and were associated with a gait impairment and paresthesia. Conclusions. Vascular and vasogenic alterations in the CNS are frequent in patients with acute onset of systemic ANCA-associated vasculitis with renal involvement. Non-contrast MRI is useful in the diagnosis of brain vasculitis.

Acupuncture for abducens nerve palsy after radiochemotherapy: a CARE-compliant case report

BackgroundDelayed abducens nerve palsy after chemoradiotherapy for nasopharyngeal carcinoma (NPC) is often accompanied by ocular ischemia and cranial nerve damage, thereby increasing the risk of conventional strabismus surgery. Therefore, patients often prefer conservative treatment. Herein we report a case of acupuncture for delayed abducens nerve palsy after chemoradiotherapy for NPC. Case presentationA 39-year-old patient who previously received chemotherapy and radiotherapy for NPC developed a unilateral abducens nerve palsy with numbness in the face and stiffness in the neck muscles after six years. Based on magnetic resonance imaging (MRI), medical history, and physical examination, he was diagnosed with abducens nerve palsy after chemoradiotherapy. The acupuncture treatment regimen was mainly based on periocular electroacupuncture, supplemented with wheat grain moxibustion and warming needle moxibustion, which were performed three times a week. After one month with a total of 17 acupuncture sessions, the patient's affected eye abduction function recovered completely. Facial sensory abnormalities and neck stiffness also improved significantly. Follow-up at two months reported no recurrence. ConclusionAcupuncture may be a conservative treatment option for patients with abducens nerve palsy after chemoradiotherapy.

COVID-19 in a medical worker and issues of examination of the relationship between disease and occupation

One of the most important complications of the novel coronavirus infection is damage to the nervous system. From the point of view of pathogenesis, neurological disorders in COVID-19 can be caused by a "cytokine storm", hypoxemia, homeostasis disorders (encephalopathy of critical conditions), neurotropy and neurovirulence of SARS-CoV-2 (isolated cranial nerve damage, focal and diffuse central nervous system lesions), as well as mixed effects of these factors. COVID-19 also affects the course of chronic neurological diseases. The range of neurological disorders in COVID-19 is wide: from cranial mononeuropathy, clinically manifested by anosmia and ageusia/dysgeusia, to acute Guillain-Barré inflammatory polyneuropathy and severe lesions of the brain and spinal cord in the form of acute hemorrhagic necrotizing encephalopathy and myelopathy. The new coronavirus infection can be regarded as an occupational disease in medical workers if the infection occurred while they were performing their professional duties. In the presented clinical case, one of the possible serious complications of the coronavirus infection is described, i.e. lesion of the central nervous system (encephalopathy) in a medical worker. The article presents the principles and results of a medical examination conducted in order to establish a causal relationship of the disease and professional activity. The need for a multidisciplinary approach to the diagnosis and treatment of COVID-19 and its complications with the mandatory participation of a neurologist is emphasized.

The prediction effects of thyroid function in the severity of Guillain-Barré syndrome

Guillain-Barré syndrome (GBS), an acquired immune-mediated inflammatory disorder affecting the peripheral nervous system (PNS), is usually complicated with autoimmune diseases including thyroid diseases. Herein, we explored roles of thyroid function and thyroid autoantibodies in the disease severity and its short-term prognosis of GBS. In addition, we further investigated the predictive value of thyroid function for GBS respiratory insufficiency. We retrospectively analyzed the clinical data of 219 GBS patients. According to the thyroid function, the enrolled subjects were divided into 2 groups, that is, patients with abnormal thyroid function (case group) and those with normal thyroid function (control group). The clinical characteristics, disease severity, and short-term prognosis of the patients in 2 groups were compared. In addition, we also divided the 219 GBS patients into mechanical ventilation (MV) group and non-MV group according to whether MV was performed within 1week after admission. The clinical characteristics, disease severity, short-term prognosis, Erasmus GBS respiratory insufficiency score (EGRIS), and the thyroid function were compared in the two groups. We found that GBS patients with abnormal thyroid function had longer duration of hospitalization, higher frequency of cranial nerve damage, and higher incidence of weakened tendon reflexes. Medical Research Council (MRC) scores on admission, at nadir, and at discharge were lower, and Hughes Functional Grading Scale (HFGS) scores on admission and at discharge were higher in GBS patients with abnormal thyroid function group. More patients in the abnormal thyroid function group had myelin, axonal, and myelin-axonal injuries. In the MV group, the time from onset to admission, MRC scores on admission, and the levels of free triiodothyronine (FT3) were lower; the levels of thyroglobulin antibody (TgAb) and EGRIS were significantly higher than those in the non-MV group. The combination of EGRIS and FT3 serum levels to predict GBS patients with MV, the area under the curve (AUC) was 0.905 (95% CI: 0.861 to 0.948, P < 0.05), sensitivity was 88.9%, and specificity was 84.7%. Our results suggest that the serum FT3 levels are negatively correlated with disease severity; the serum FT3 might be a biomarker for the incidence and severity of GBS. Both EGRIS and serum FT3 have a predictive value for the occurrence of acute respiratory insufficiency in GBS patients, and the combination of these two indicators can more accurately predict the risk of acute respiratory insufficiency in GBS patients.

Facial palsy and diplopia revealing idiopathic intracranial hypertension in a child

Idiopathic intracranial hypertension is rare in the pediatric population. It’s characterized by increased intracranial pressure in the absence of any evident underlying neurologic disease. Abducens nerve palsy is the most common cranial nerve deficit related to that condition. The association of sixth and seventh cranial nerve damage is uncommon. In this report, we describe the case of an 8-year-old girl who presented with headache, diplopia and peripheral facial palsy related to idiopathic intracranial hypertension

Management anesthesia in carotid artery aneurysm caused by a Behcet’s disease: A case report

Objective: Arterial manifestations of Behcet’s disease are challenging and can lead to fatal complications. One of the causes of carotid aneurysm is Behcet’s disease. Extracranial internal carotid artery aneurysms are rare. This aneurysm is rare but important because it is associated with a high risk of neur thromboembolic events, cranial nerve damage, and rupture. Method: We describe a 19-year-old man with a history of Behcet’s disease who presented with a gradual enlargement of the right neck mass with shortness of breath when he is supine. Result: This report examines the challenges of treating carotid aneurysms by spreading to the mediastinum in a patient with Behcet’s disease. Conclusion: It is important to pay attention to the need for awake intubation by expanding to the mediastinum.

Spine Pathologies in Osteogenesis Imperfecta: A Review

Background. The scientific and clinical interest in the problems of osteogenesis imperfecta (OI) has grown in the last decade. However, the analysis of various variants of spinal pathologies in OI received insufficient attention.&#x0D; The study aimed to analyze the current literature on various variants of the spinal pathology in patients with OI. OI is a phenotypically and genetically heterogeneous group of hereditary bone dysplasias. The spine pathology in OI is represented by scoliosis, kyphoscoliosis, anomalies of the craniovertebral junction, instability of the segments and fractures of the vertebral bodies, spondylolysis, and spondylolisthesis. Scoliosis and kyphoscoliosis are the most common forms of spinal pathology. In severe forms and at age 6 years, the prevalence of scoliosis can reach 89%. The exact mechanism of scoliosis formation in patients with OI is complex and incompletely defined. Anomalies of the craniovertebral junction are recorded in 37% of patients with OI and are determined in all four types of OI. Clinical manifestations of the craniocervical junction pathology can vary from asymptomatic to compression of the brainstem, restriction of cerebrospinal fluid circulation, leading to hydrocephalus, syringomyelia, and cranial nerve damage. The pathology of the lumbosacral spine is represented by spondylolysis and spondylolisthesis generally in the L5S1 segment in 5.3%10.9% of cases. The clinical significance and natural course of spondylolysis and spondylolisthesis in patients with OI are not fully defined in the literature, and the information on surgical indications and methods is available only in rare case reports. The changes in the axial skeleton in OI can lead to significant functional disability, pain, and potentially life-threatening complications, such as radicular neurological deficit, decrease in the ventilation capacity of the lungs, and cardiorespiratory complications. The overall severity of OI remains the best criterion for predicting the development of secondary spinal pathology. Given the generalization and heterogeneity of OI, an individual and multidisciplinary approach is necessary when diagnosing and planning the treatment strategy for this group of patients.

Early results of carotid endarterectomy and risk factors for in-hospital stroke

Aim: Carotid endarterectomy (CEA), which is performed to prevent the development of cerebrovascular events (CVE) due to carotid artery disease (CAD), is currently the most effective treatment. Perioperative adverse clinical conditions may develop due to patient factors, technique or other reasons. Perioperative stroke is the cause of mortality and morbidity that can develop within 30 days postoperatively. The aim of this study is to present the early results of patients who underwent CEA and investigate the factors affecting the development of early stroke. Material and Methods: Patients who underwent CEA between 2013-2020 were retrospectively analyzed. 529 patients were evaluated. A total of 550 endarterectomy procedures were performed in 529 patients. Demographic data, presence of symptoms, contralateral carotid artery stenosis, anesthetic method, operation technique, postoperative stroke, mortality were recorded from the hospital database. Results: The analyses were based on the results of 550 endarterectomy. The mean age of the patients was 67.0±8.4 years. While 164 (29.8%) of the patients were symptomatic, concomitant contralateral carotid artery stenosis was detected in 138 (25.1%) patients. Considering early postoperative adverse effects, there was no cranial nerve damage, while reoperation for bleeding was necessary in 27 (4.9%) patients. Postoperative ischemic stroke occurred in 20 (3.6%) patients. Mortality occurred in eight (1.5%) patients. Gender, rate of DM, HL, CRF or current CAD did not differ in patients with and without postoperative stroke. The patients with postoperative stroke tended to more frequently have contralateral ICA stenosis but the groups did not differ significantly (p=0.117). In early stroke development after CEA, the presence of pre-procedural symptoms was a significant factor (p&lt;0.001). According to the multivariate analysis preoperative presence of symptoms increased risk by 6.41 (95% CI: 2.22-18.54, p=0.001). Conclusion: Carotid artery revascularization is a safe and effective treatment modality for the prevention of ischemic CVE with low mortality and morbidity rate. Being symptomatic is a significant risk factor for the development of stroke in the early period. It may be useful to group the symptoms and evaluate the extent to which each symptom affects the development of stroke in prospective randomized studies.

Idiopathic hypertrophic cranial pachymeningitis successfully treated with dexamethasone – a case report

Introduction : Idiopathic hypertrophic cranial pachymeningitis (IHCP) is a rare pathological entity which is diagnosed after the exclusion of secondary reasons. Most frequently, IHCP is related to rheumatological diseases such as rheumatic arthritis, sarcoidosis, anti-neutrophil cytoplasmic antibody-associated vasculitis, and IgG4-related disorders. The inflammatory process concerns dura mater and manifests with symptoms of cranial nerve damage or compression. Case description : A 59-year-old Caucasian man presented with transitional episodes of tinnitus and an unspecific headache. Imaging studies (magnetic resonance imaging – MRI) demonstrated a thickened dura mater. Lymphoma was suspected due to an abnormal flow cytometric analysis of a cerebrospinal fluid (CSF) sample. Hematological diagnostics including bone marrow biopsy, whole body computed tomography (CT) and digestion tract examination were performed leading to the exclusion of hematological malignancy. The patient underwent surgery, and a specimen from the lesion was obtained. On this basis, intracranial idiopathic hypertrophic pachymeningitis was diagnosed. First line treatment strategy was introduced with corticosteroids with a gradual dose reduction. After the 48-month follow-up, we observed an alleviation of symptoms with a gradual significant decrease in the thickening of dura matter with almost complete resolution. Conclusions : Idiopathic hypertrophic pachymeningitis should be considered in the differential diagnosis of a thickened dura mater. Administration of steroids appears reasonable as a first line treatment of IHCP.