Chronic Subdural Hematoma Associated with Fahr Syndrome: A Clinical Association or Just a Simple Coincidence?

The Fahr syndrome (FS) is a rare degenerative neurological disorder (its prevalence is <0.5%). FS is distinguished by the presence of abnormal bilateral intracranial calcifications with a predilection for the basal ganglia, also presented by movement disorders such as parkinsonism, paresis, and speech disorders. Chronic subdural hematoma (CSH), which is typically the result of mild head trauma, is a regularly encountered condition in elderly. A 63-year-old man has referred to our clinic from another hospital with a history of mild head trauma approximately a month ago. At the time of admission, the patient's Glasgow Coma Scale point was 15 points. In the history, there was only mild ataxia and right-sided hemiparesis. The laboratory examination revealed no electrolytes level abnormalities and normal endocrinal test examinations. Computed tomography revealed bilateral calcifications of basal ganglia, dentate nuclei which were misinterpreted as intracerebral contusion; with CSH of left temporal and parietal region. The hematoma was evacuated by burr-hole drainage. The patient was discharged 5 days after the surgery. The pathophysiology of FS is still unrevealed. There are some suggestions such as secondary to local disturbance of blood-brain barrier or a calcium neuronal metabolism disorder. However, on the other hand, local blood-brain barrier disturbance would also take part in CSH pathology. We hypostasized that patients with the history of FS, who had mild head traumas, might prone to subdural collections. On the other hand, FS and CSH coexistence is very unusual. Neurosurgeons might keep in mind FS when bilateral calcifications are seen in a patient.

Sphingomonas Paucimobilis: A Rare Infectious Agent Found in Cerebrospinal Fluid.

Sphingomonas paucimobilis (S. paucimobilis) is a gram negative bacillus. It has existed in soil, drinking water and plants. It has been isolated from distilled water tanks, respirators, and hemodialysis devices at the hospital setting. Patients with chronic disorders or immune suppression may be susceptible to infections with it. This microorganism has also been reported to infect healthy persons. Both nosocomial and community-acquired infections have been reported. So far, a variety of infections have been reported, including sepsis, septic pulmonary embolism, septic arthritis, peritonitis, and endophthalmitis. Only 2 cases of meningitis have been reported so far in the literature. So far, no previous reports of culture proliferation have been reported in patients with external ventricular drains, as was the case in our patient. Therefore, our case is the first to have S. paucimobilis proliferation in cerebrospinal fluid culture during intensive care unit stay for an external ventricular drain.

The therapeutic value of proanthocyanidin in experimental cerebral vasospasm following subarachnoid hemorrhage.

AIM: We aimed to examine the basilar artery in an experimental subarachnoid hemorrhage (SAH) model both from the ultrastructural and radiological aspects and tried to evaluate the benefit of proanthocyanidin (PC), an antioxidant matter, in reducing vasospasm. MATERIAL AND METHODS: A total of 21 male New Zealand rabbits were divided into three groups after performing angiography. Group I: Control group, Group II: Subarachnoid hemorrhage group, Group III: Subarachnoid hemorrhage and Proanthocyanidin group (100 mg/kg/ day). Rabbits were sacrificed on the 5th day after angiography. A segment of the basilar artery, 4 mm in length, was prepared for ultrastructural examination. RESULTS: There was no ultrastructural or radiological abnormality in the basilar artery in Group 1. In the basilar artery digital subtraction angiography (DSA) of Group 2, a statistically significant decrease in basilar artery calibration was found (p < 0.05). There was no damage in the endothelium, subendothelium, tunica media and adventitia of the basilar artery ultrastructurally but a statistically significant narrowing in lumen diameter was seen. There was also no difference in basilar artery calibration in the DSA of Group 3 (p > 0.05). No damage was seen in the basilar artery ultrastructurally. CONCLUSION: Proanthocyanidin with its strong antioxidant effect and possible vasomotor action can significantly attenuate SAH-induced vasospasm.