Predictors of aneurysmal rebleed before definitive surgical or endovascular management.

BACKGROUND: Aneurysmal rebleed is the most dreaded complication following subarachnoid hemorrhage. Being a cause of devastating outcome, the stratification of risk factors can be used to prioritize patients, especially at high volume centers. METHOD: A total of 99 patients with aneurysmal rebleed were analyzed in this study both prospectively and retrospectively from August 2010 to July 2014. In the control group, 100 patients were selected randomly from the patient registry. A total of 25 variables from the demographic, historical, clinical and radiological data were compared and analyzed by univariate and multivariate logistic regression analysis. RESULTS: Significant independent predictors of aneurysm rebleed were the presence of known hypertension (p = 0.023), diastolic blood pressure of >90 mmHg on admission (p = 0.008); presence of loss of consciousness (p = 0.013) or seizures (p = 0.002) at first ictus; history of warning headaches (p = 0.005); higher Fisher grade (p < 0.001); presence of multiple aneurysms (p = 0.021); irregular aneurysm surface (0.002). CONCLUSIONS: Identification of high risk factors can help in stratifying patients in the high risk group. The risk stratification strategy with early intervention can prevent rebleeds. This in turn may translate into better outcomes of patients with intracranial aneurysms.

"Os" omovertebrale variants prove it to be a misnomer.

There are only a few case reports comprising exclusively of os omovertebrale. Here, we discuss various types, varied clinical presentations, associated abnormalities, and management strategies of this abnormality. We retrospectively analyzed three patients with os omovertebrale and their clinical presentation, and also reviewed the limited available literature. Patients were evaluated clinically and radiologically to diagnose this abnormality as well as the associated abnormalities. Two patients were operated for neurological deficits attributed to this deformity. It is quite common to miss this abnormality when it is of osseocartilaginous or fibrous type, especially when it is asymptomatic and not associated with Sprengel's scapula. By analyzing our patients and other reported cases, we have proposed a classification system. In addition, we discuss varied clinical presentations and their practical application. Os omovertebrale is a rare abnormality. It should be kept in mind and managed when encountered in clinical practice. The classification and clinicoradiological correlations described here can be useful to individualize management issues.

Insula in epilepsy - "untying the gordian knot": A systematic review.

PURPOSE: Despite significant advances in epileptology, there are still many uncertainties about the role of the insula in epilepsy. Until recently, most insular onset seizures were wrongly attributed to the temporal lobe. Further, there are no standardised approaches to the diagnosis and treatment of insular onset seizures. This systematic review gathers the available information about insular epilepsy and synthesizes current knowledge as a basis for future research. METHOD: Adhering to the PRISMA guidelines, studies were meticulously extracted from the PubMed database. The empirical data pertaining to the semiology of insular seizures, insular networks in epilepsy, techniques of mapping the insula, and the surgical intricacies of non-lesional insular epilepsy were reviewed from published studies. The corpus of information available was then subjected to a process of concise summarization and astute synthesis. RESULTS: Out of 235 studies identified for full-text review, 86 studies were included in the systematic review. The insula emerges as a brain region with a number of functional subdivisions. The semiology of insular seizures is diverse and depends on the involvement of particular subdivisions. The semiological heterogeneity of insular seizures is explained by the extensive connectivity of the insula and its subdivisions with all four lobes of the brain, deep grey matter structures, and remote brainstem areas. The mainstay of the diagnosis of seizure onset in the insula is stereoelectroencephalography (SEEG). The surgical resection of the insular epileptogenic zone (when possible) is the most effective treatment. Open surgery on the insula is challenging but magnetic resonance-guided laser interstitial thermal therapy (MRgLITT) also holds promise. CONCLUSION: The physiological and functional roles of the insula in epilepsy have remained obfuscated. The dearth of precisely defined diagnostic and therapeutic protocols acts as an impediment to scientific advancement. This review could potentially facilitate forthcoming research endeavours by establishing a foundational framework for uniform data collection protocols, thereby enhancing the feasibility of comparing findings across future studies and promoting progress in this domain.

Impairments in Quality of Life and Cognitive Functions in Long-term Survivors of Glioblastoma.

BACKGROUND: The incidence of long-term survival in glioblastoma (GBM), i.e., >3 years, ranges from 3% to 5%. Although extensive research is performed in novel therapies for prolonging survival, there is a scarcity of research focusing on the impact of tumor and treatment on cognitive, psychological, and social status of survivors. This study is an attempt to look into this poorly addressed important issue. MATERIALS AND METHODS: Nine patients (six adults and three children) with GBM who had survived >3 years were included in the study. The quality of life (QOL) functions were assessed with the World Health Organization QOL Questionnaire BREF questionnaire. The neuropsychological assessment was done using the National Institute of Mental Health and Neurosciences neuropsychology battery for adults and children. The scores were compared with normative data. RESULTS: The physical and psychological health-related QOL of long-term GBM survivors were affected considerably due to fatigue, poor quality of sleep, inability to concentrate, presence of depression, financial burden with impaired personal and social relationships (P < 0.05). Different domains of cognitions such as motor speed (P = 0.0173), mental speed (P = 0.0022), sustained attention (P = 0.0001), long-term memory (P = 0.0431), mental flexibility (P < 0.05), and planning and executive functions (P < 0.05) were significantly impaired affecting personal, social, and professional lives. CONCLUSION: The health-related QOL and cognition are significantly impaired in GBM long-term survivors. As the incidence of long-term survival is very less, there is a need for larger multicenter studies to come up with definitive results, which in turn can help in formatting the rehabilitative and support programs for these patients.

Calvarial defects in the region of the lambdoid suture in neurofibromatosis type-1 patients.

Rare type of calvarial defects seen in patients with neurofibromatosis type-1 (NF1) is presented. The issues of pathogenesis and management are discussed. Two cases of NF1 with skull defects in the region of the lambdoid suture are reported. The possible etiological basis and nature of these type of defects and management issues are discussed. The calvarial skull defects in the lambdoid suture region are rare defects in NF1 patients. The possible reason of the progressive nature of these type of lesions can be the cerebrospinal fluid pulsations behaving like "growing skull fractures," especially when not associated with structural lesions. It leads to progressive enlargement of the small congenital defects in the region of the lambdoid suture and abnormal susceptibility of bones for resorption. For these defects, conservative management is suggested due to its progressive nature and high chances of operative treatment failure.