Delayed symptomatic cerebral vasospasm following vestibular schwannoma resection: illustrative case.

BACKGROUND: Symptomatic cerebral vasospasm following posterior fossa extraaxial tumor resection is a rare phenomenon, with only 13 cases previously reported in the literature. The condition appears similar to vasospasm following supratentorial tumor resection, intraaxial posterior fossa tumor resection, and aneurysmal subarachnoid hemorrhage (aSAH). The majority of patients were not evaluated for vasospasm prior to symptom onset, leading to a delay in diagnosis. OBSERVATIONS: The authors present their experience in a 56-year-old female who developed delayed cerebral vasospasm after excision of a solid-cystic vestibular schwannoma. Routine postoperative brain computed tomography showed evidence of subarachnoid hemorrhage in the basal cisterns. She was discharged on the 9th postoperative day. On the 11th day after tumor excision, she developed left hemiparesis, dysarthria, and dysphagia and was readmitted. Angiography confirmed bilateral diffuse cerebral vasospasm. The patient responded to standard hyperdynamic therapy used for vasospasm secondary to aSAH. LESSONS: Symptomatic distant cerebral vasospasm after posterior fossa extraaxial tumor excision is a rare but challenging complication with a very high morbidity rate in reported cases. A high index of suspicion is required for early diagnosis and prompt management for a favorable outcome.

Post covid cerebral phaeohyphomycosis by Rhinocladiella mackenziei: An unusual association.

Cerebral phaeohyphomycosis (CP) is a rare but a highly morbid fungal infection of the central nervous system caused by the fungi belonging to the order Chaetothyriales, which includes Cladophialophora bantiana, Exophiala dermatitidis, Rhinocladiella mackenziei (RM) etc. This disease is associated with poor clinical outcomes, with reported mortality of over 80%. We present the case of a 65-year gentleman who developed CP secondary to RM infection following COVID-19 and the associated challenges in his medical and surgical management.

Bilateral blindness following flow diverter placement in a giant thrombosed cavernous carotid aneurysm: illustrative case.

BACKGROUND: The best treatment option for giant intracranial aneurysms (GIAs) is still debated. The authors report a case of a giant thrombosed cavernous carotid artery (CCA) aneurysm for which two sessions of flow diverter (FD) placement failed, leading to bilateral blindness. OBSERVATIONS: A 66-year-old man presented to an outside center with a history of rapid-onset right-sided retro-orbital pain, visual deterioration, and restricted eye movements associated with headache, vomiting, and diminished sensations on the right side of the face. He was diagnosed with an unruptured thrombosed giant CCA aneurysm and was treated twice with unsuccessful FDs. At follow-up, he developed blindness in both eyes. After 1.5 years, he presented to the authors' institution with headache, vomiting, and epistaxis, for which he underwent high-flow external carotid artery-M2 segment of the middle cerebral artery bypass grafting using the radial artery as a conduit and ligation of the internal carotid artery in the neck without any added neurological deficits. LESSONS: This dreadful complication of bilateral blindness after being treated with repeated unsuccessful FDs has not been reported in the literature. It could have been avoided if microsurgery had been the primary modality of treatment.