Age and multimorbidities as poor prognostic factors for COVID-19 in hemodialysis: a Lebanese national study.

BACKGROUND: Hemodialysis patients with COVID-19 have been reported to be at higher risk for death than the general population. Several prognostic factors have been identified in the studies from Asian, European or American countries. This is the first national Lebanese study assessing the factors associated with SARS-CoV-2 mortality in hemodialysis patients. METHODS: This is an observational study that included all chronic hemodialysis patients in Lebanon who were tested positive for SARS-CoV-2 from 31st March to 1st November 2020. Data on demographics, comorbidities, admission to hospital and outcome were collected retrospectively from the patients' medical records. A binary logistic regression analysis was performed to assess risk factors for mortality. RESULTS: A total of 231 patients were included. Mean age was 61.46 ± 13.99 years with a sex ratio of 128 males to 103 females. Around half of the patients were diabetics, 79.2% presented with fever. A total of 115 patients were admitted to the hospital, 59% of them within the first day of diagnosis. Hypoxia was the major reason for hospitalization. Death rate was 23.8% after a median duration of 6 (IQR, 2 to 10) days. Adjusted regression analysis showed a higher risk for death among older patients (odds ratio = 1.038; 95% confidence interval: 1.013, 1.065), patients with heart failure (odds ratio = 4.42; 95% confidence interval: 2.06, 9.49), coronary artery disease (odds ratio = 3.27; 95% confidence interval: 1.69, 6.30), multimorbidities (odds ratio = 1.593; 95% confidence interval: 1.247, 2.036), fever (odds ratio = 6.66; 95% confidence interval: 1.94, 27.81), CRP above 100 mg/L (odds ratio = 4.76; 95% confidence interval: 1.48, 15.30), and pneumonia (odds ratio = 19.18; 95% confidence interval: 6.47, 56.83). CONCLUSIONS: This national study identified older age, coronary artery disease, heart failure, multimorbidities, fever and pneumonia as risk factors for death in patients with COVID-19 on chronic hemodialysis. The death rate was comparable to other countries and estimated at 23.8%.

Patient survival and limb salvage after shark attack with major vascular injury: A case report.

Shark attacks are rare unique pathological processes. Some of them represent devastating injuries with a high morbidity and significant mortality. Related published articles are limited. The increased human interaction within the environment of sharks is the cause of rising incidence of such attacks. This study reported a case of level 4 shark injuries (shark-induced trauma scale) in a 33-year-old male patient, who presented with an extensive injury of the right lower limb with the characteristic features of shark bite. At admission the patient was in a state of shock with profuse bleeding that was controlled by tourniquet. The patient was resuscitated according to the advanced trauma life support. Clinical examination showed hard signs of vascular injury with absent pedal pulse, associated neurological deficits and severance at the knee joint. Prompt vascular intervention after resuscitation was performed to manage the major vascular injuries, together with proper washout and debridement of all the necrotic tissues under strong antibiotic coverage to prevent infection. After that, the patient underwent sequenced plastic, orthopedic, and neurological interventions. Strict follow-up was conducted, which showed that the patient was saved and achieved a functioning limb. This study aims to highlight the management of level 4 shark injuries, which are considered serious and challenging with a high fatality rate and a great risk of amputation due to the associated major vascular injuries. Immediate well organized management plan is crucial. Prompt resuscitation and surgical intervention by a highly-skilled medical team are required to improve the chance of patient survival and limb salvage.

Fractionated whole body gamma irradiation modulates the hepatic response in type II diabetes of high fat diet model rats.

HFD animals were exposed to a low rate of different fractionated whole body gamma irradiation doses (0.5, 1 and 2 Gy, three fractions per week for two consecutive months) and the expression of certain genes involved in type 2 diabetes mellitus (T2DM) in livers and brains of HFD Wistar rats was investigated. Additionally, levels of diabetes-related proteins encoded by the studied genes were analyzed. Results indicated that mRNA level of incretin glucagon like peptite-1 receptor (GLP-1R) was augmented in livers and brains exposed to 1 and 2 Gy doses. Moreover, the mitochondrial uncoupling proteins 2 and 3 (UCP2/3) expressions in animals fed on HFD compared to those fed on normal chow diet were significantly increased at all applied doses. GLP-1R and UCP3 protein levels were up regulated in livers. Total protein content increased at 0.5 and 1 Gy gamma irradiation exposure and returned to its normal level at 2 Gy dose. Results could be an indicator of type 2 diabetes delayed development during irradiation exposure and support the importance of GLP-1R as a target gene in radiotherapy against T2DM and its chronic complications. A new hypothesis of brain-liver and intestine interface is speculated by which an increase in the hepatic GLP-1R is influenced by the effect of fractionated whole body gamma irradiation.

Routine cerebrospinal fluid analysis during 'de novo' ventriculoperitoneal shunt insertion: Single Institution Experience.

Background Cerebrospinal fluid (CSF) sampling is performed during ventriculoperitoneal (VP) shunting procedure surgery for early detection of infection. We have performed a retrospective study to determine whether routine intraoperative CSF sampling at new VP shunt insertion has predicted shunt infection or changed subsequent surveillance or management. Method From January 2011 to December 2013, 99 patients underwent first time VP shunt insertion at our hospital. The data collected from Beaumont Hospital Information System and operating theatre logbook. The reviewed data were patient demographics, the clinical condition requiring VP shunt procedure, shunt type, date of VP shunt insertion, date of VP shunt infection or malfunction and laboratory data. Results A first time VP shunt insertion procedure was performed in 99 patients. During the VP shunt insertion procedure, 64 patients had CSF sampling for microbiological analysis. The CSF culture was negative in all samples. All patients were followed up for 12 months. During the follow-up period, a total of 15 patients underwent VP shunt revision. Three of the shunt revisions were secondary to infection. The three infected shunt cases had sterile CSF cultures at the time of insertion. Conclusion There appears to be no correlation between CSF sampling during first time VP shunt insertion and the later development VP shunt infection. This questions the need for routine CSF sampling at the time of insertion. This would be confirmed as a part of future randomised trials.

Distal humerus fractures nonunion with elbow stiffness in working adults: Can triple tension band technique and Lambda Plate(®) be a standby solution?

BACKGROUND: Distal humerus fracture nonunion and associated elbow stiffness are two intermingled orthopaedic challenges for working adults. This prospective study aimed to evaluate the short-term results of the triple tension band and Lambda plate in managing both problems. METHODS: The study included fourteen cases. The mean age was 35.7 ± 8.5 years (range 25-49). Eight cases were males. Initial management was conservative in three cases. Three cases had a history of infected nonunion. Eight cases had initially OTA type C injuries and six cases had type A injuries. All cases had olecranon osteotomy, triple tension band, Lambda plating, and autogenous bone grafting. Five cases had ulnar nerve anterior transposition. Evaluation of the cases was objectively via Mayo Elbow Performance (MEP) score and subjectively through Disabilities of the Arm, Shoulder and Hand (DASH) score. RESULTS: The average follow-up period was 23.7 ± 5.3 months. All cases had a solid bony union in a mean of 16.4 ± 2.1 weeks and the final range of motion averaged 100 ± 19.6°. MEP and DASH scores had significant improvement at the final follow-up periods (P = 0.001). Cases with transposed ulnar nerve had significantly less MEP scores (P = 0.028) and more DASH scores (P = 0.013). CONCLUSIONS: The prescribed technique could be a good alternative to the known traditional methods with the advantages of: good exposure for arthrolysis; rigid and stable internal fixation even with low bone quality or small-sized distal fragments; and secure early rehabilitation.

Suprasellar pilocytic astrocytoma: one national centre's experience.

INTRODUCTION: Pilocytic astrocytomas in the supratentorial compartment make up 20 % of all brain tumours in children with only 5 % of these arising in the suprasellar region. Optic pathway gliomas or suprasellar gliomas are often seen in neurofibromatosis type 1 (NF1) patients. Given their location, suprasellar pilocytic astrocytomas are challenging to manage surgically with high morbidity rates from surgical resection. We assess our cohort of patients with suprasellar pilocytic astrocytoma and document our experience. METHOD: A retrospective review of patients diagnosed with suprasellar glioma between 2000-October 2012. We included patients diagnosed with optic pathway glioma based on radiological features (with or without biopsy) and those who had a biopsy confirming pilocytic astrocytoma. RESULTS: Fifty-three patients included (sporadic tumours 24 and NF1 related 29). Fifteen sporadic and four NF1 patients were biopsied. Twelve sporadic and 13 NF1 patients were initially treated with chemotherapy while only 1 patient had radiotherapy initially. Progression was noted in 58 % of the sporadic group and 24 % of the NF1 group. The only significant factor for progression was NF1 status (p = 0.026). CONCLUSION: Management should be guided by individual patient circumstance. In our cohort, chemotherapy did not significantly improve progression free survival; however, NF1 status significantly correlated with the decreased progression.

ETV as a last resort.

INTRODUCTION: The field of neuroendoscopy is rapidly expanding with increasing indications for endoscopic third ventriculostomy (ETV). DISCUSSION: As a treatment for hydrocephalus, ETV has the advantage of providing a more physiological cerebrospinal fluid diversion without shunt hardware which reduces the risk of recurrent infection and malfunction. The success rate of ETV has been increasing with decreasing morbidity and mortality. CONCLUSION: Originally, ETV was indicated for cases of obstructive hydrocephalus, however the indications are expanding. To highlight this, we present a small series of cases were ETV is not traditionally indicated and was a treatment of last choice.

Stupp-treated glioblastoma accompanied by EBV-positive primary CNS lymphoma.

We describe a patient who within 2 months of undergoing radio-chemotherapy for glioblastoma developed an Epstein-Barr virus-positive primary diffuse large B-cell CNS lymphoma. To our knowledge, this is the first such case reported in the literature showing that new tumefactions following aggressive treatment for glioblastomata might represent secondary malignancies.

Predictive modeling of wide-shallow RC beams shear strength considering stirrups effect using (FEM-ML) approach.

This paper presents an analysis and prediction of the shear strength of wide-shallow reinforced concrete beams, utilizing Finite Element Analysis (FEA) and machine learning techniques. The methodology involves validating a detailed Finite Element Model (FEM) against experimental results, conducting a parametric study, and developing three Machine Learning prediction equations. The FEM captures concrete and steel behaviors, including cracking and crushing for concrete and linear isotropic properties for steel reinforcement. Loading and boundary conditions are defined for accuracy and validated against 13 experimental specimens, exhibiting a maximum 8% and 12% difference in loads and deflections, respectively. A parametric study generates a dataset of 77 wide beam configurations, exploring variations in beam widths, concrete strengths, compression rebars, and shear reinforcement. This dataset is used to develop machine learning models, including "Genetic Programming (GP)", "Evolutionary Polynomial Regression (EPR)", and "Artificial Neural Network (ANN)". Comparative analysis reveals GP and EPR models with over 95% correlation, while the ANN model outperforms with 99% accuracy. Sensitivity analysis underscores the significant influence of concrete strength and beam aspect ratio on shear strength. In conclusion, the study demonstrates the potential of FEA and machine learning models to predict shear strength in wide-shallow reinforced concrete beams, providing valuable insights for architectural design and engineering practices and emphasizing the role of concrete strength and beam geometry in shear behavior.

A prospective randomised study to compare the utility and outcomes of subdural and subperiosteal drains for the treatment of chronic subdural haematoma.

BACKGROUND: The usage of a drain following evacuation of a chronic subdural haematoma (CSDH) is known to reduce recurrence. In this study we aim to compare the clinical outcomes and recurrence rate of utilising two different types of drains (subperiosteal and subdural drain) following drainage of a CSDH. METHODS: Prospective randomised single-centre study analysing 50 patients who underwent CSDH treatment. Two types of drains, subperiosteal (SPD) and subdural (SDD), were utilised on consecutive alternate patients following burr-hole craniostomy, with a total of 25 patients in each group. The drains were left in for 48-h duration and then removed. The modified Rankin Scale (mRS) was used for outcome measurement at 3 and 6 months. RESULTS: Data analysis was performed by unpaired t test with Welch's correction. It was observed that none of the patients in either group had haematoma recurrence during a 6-month follow-up, and a significant difference in outcome was noted at 6 months (p = 0.0118) more than at 3 months (p = 0.0493) according to the statistical analysis. Postoperative seizure and inadvertent placement of the subdural drain into the brain parenchyma were the two complications noted in this study. Anticoagulant use prior to the surgery did not affect the outcome in either group. CONCLUSIONS: We conclude there was no recurrence of CSDH utilising the SDD and SPD following burr-hole craniostomy. The mRS measurement at the 6-month follow-up was found to be statistically significant, with better outcomes with utilisation of the SPD. The SPD may thus prove to be more beneficial than the SDD in the treatment of CSDH. A multi-centre study with a larger group of patients is recommended to reinforce the results from our study.

Highly unstable complex C3-type distal femur fracture: can double plating via a modified Olerud extensile approach be a standby solution?

BACKGROUND: Multiplanar complex C3-type unstable distal femoral fractures present many challenges in terms of approach and fixation. This prospective study investigates a possible solution to these problems through double plating with autogenous bone grafting via a modified Olerud extensile approach. MATERIALS AND METHODS: Twelve patients with closed C3-type injuries were included; eight of them were male, and their mean age was 33.5 years (range 22-44 years). Mechanism of injury was road traffic accident (RTA) in nine patients and fall from height in the other three cases. Eight cases were operated during the first week and four cases during the second week after injury. Mean follow-up was 13.7 months (range 11-18 months). RESULTS: Mean radiological healing time was 18.3 weeks (range 12-28 weeks), and all cases had good radiological healing without recorded nonunion or malunion. Clinically, two cases (16.7 %) had excellent results, five cases (41.7 %) had good results, three cases (25 %) had fair results, and two cases (16.7 %) had poor results. No cases developed skin necrosis, deep infection, bone collapse, or implant failure. However, two cases (16.7 %) had limited knee flexion to 90° and required subsequent quadricepsplasty. CONCLUSIONS: Use of this modified highly invasive approach facilitated anatomical reconstruction of C3-type complex distal femoral fractures with lower expected complication rate and acceptable clinical outcome, especially offering good reconstruction of the suprapatellar pouch area. It can be considered as a standby solution for managing these difficult injuries.

Admission Hyperglycemia as a Predictor of COVID-19 Pneumonia, Cytokine Release Syndrome Progression, and Clinical Outcomes in a Tertiary Care Hospital.

Introduction Diabetes and coronavirus disease 2019 (COVID-19) are interrelated. The presence of hyperglycemia per se during COVID-19 infection regardless of diabetes status has been associated with poor prognosis and increased risk of mortality. Objectives The main aim of the current study was to assess the association between admission hyperglycemia and COVID-19 outcomes. Methods This is a retrospective cohort study including 315 patients, mainly employed in the facility, who presented to the emergency department or were admitted with confirmed COVID-19 infection from April 2020 to August 2021. Results The mean age of the studied cohort was 40.2±12.5 years, where 59.68% were males and 37.7% were symptomatic. Older age, male gender, history of diabetes and hypertension, and elevated C-reactive protein (CRP) and lactate dehydrogenase (LDH) levels were associated with a significantly increased risk of developing cytokine release syndrome (CRS). Admission hyperglycemia was significantly associated with poor outcomes. The time to negativity was 9.30±0.1 days for asymptomatic patients; however, it increased significantly according to clinical presentation, presence of comorbidities, and severe outcomes, in patients with cytokine release syndrome. Conclusions Admission hyperglycemia was associated with an increased risk of progression to critical condition in patients hospitalized with COVID-19 independent of the history of diabetes. Therefore, it should not be overlooked but instead should be detected and appropriately treated to improve outcomes. In addition, post-COVID-19 care should be individualized, where severe cases require almost double the time needed by mild cases to convert to negative.

The Impact of Hospitality Work Environment on Employees' Turnover Intentions During COVID-19 Pandemic: The Mediating Role of Work-Family Conflict.

Employees' turnover intentions and work-family conflict as a result of the hospitality work environment are considered the major global challenges confronted by hospitality organizations, especially in the era of COVID-19. This study aims at identifying the impact of the hospitality work environment on work-family conflict (WFC), as well as turnover intentions and examining the potential mediating role of WFC in the relationship between work environment and turnover intentions, during the COVID-19 pandemic in a sample of three- and four-star resorts in Egypt. A total of 413 resorts employees from Egyptian destinations (Sharm El-Sheikh and Hurghada) participated in the study. The findings of the Structural Equation Modeling (SEM) revealed that the hospitality work environment significantly and positively affects employees' turnover intentions and WFC. In the context of the mediating role of WFC, results illustrated that WFC significantly partially mediates the relationship between the hospitality work environment and turnover intentions. Upon these findings, the study suggests that to prevent WFC and eliminate turnover intentions among resorts' employees, an urgent need to create a better work environment is vitally important. limitations and future research directions have been discussed.

Modeling the relationship between perceived service quality, tourist satisfaction, and tourists' behavioral intentions amid COVID-19 pandemic: Evidence of yoga tourists' perspectives.

Purpose: This study aims to investigate the impact of perceived service quality (PSQ) on tourist satisfaction and behavioral intentions and explore the potential mediating role of tourist satisfaction in the relationship between service quality and behavioral intentions in the yoga tourism context during the COVID-19 pandemic. Further, this is to examine to what extent yoga tourist satisfaction directly affects their behavioral intentions. Design/methodology/approach: Based on a review of literature, the study proposes a conceptual model to test four hypothesized relationships among the constructs of perceived service quality, tourist satisfaction, and behavioral intentions. Data was collected by using a self-administrated questionnaire that was developed and directed to a convenience sample of yoga tourists (380 forms). Structural equation modeling (SEM) was employed to determine the relationship between study constructs. Findings: The results of SEM illustrated that all the hypothesized relationships are supported. The findings confirm that yoga tourists' behavioral intentions are significantly affected directly and indirectly (through tourist satisfaction) by perceived service quality. Additionally, tourist satisfaction significantly partially mediates the relationship between PSQ and tourists' behavioral intentions. Research limitations: The subject of this study was yoga tourists staying in yoga retreats/studios in Egyptian destinations (South Sinai Governorate). Future research may focus on other geographical destinations and other influential variables of yoga tourists' satisfaction and behavioral intentions should be investigated. Practical implications: For improving tourists' satisfaction and behavioral intentions, yoga service providers should take care by giving tourists personalized attention, and understanding, fulfilling their specific needs. Health and hygiene practices must be considered during the COVID-19 pandemic. Originality/value: This study is perhaps the first empirical study that examines the relationship between PSQ and tourists' satisfaction and behavioral intentions in the yoga tourism context. A new integrated conceptual model that combined three service quality dimensions, namely, tangibles, intangibles as well as health and hygiene was developed and validated.

Carotenoids: Therapeutic Strategy in the Battle against Viral Emerging Diseases, COVID-19: An Overview.

Carotenoids, a group of phytochemicals, are naturally found in the Plant kingdom, particularly in fruits, vegetables, and algae. There are more than 600 types of carotenoids, some of which are thought to prevent disease, mainly through their antioxidant properties. Carotenoids exhibit several biological and pharmaceutical benefits, such as anti-inflammatory, anti-cancer, and immunity booster properties, particularly as some carotenoids can be converted into vitamin A in the body. However, humans cannot synthesize carotenoids and need to obtain them from their diets or via supplementation. The emerging zoonotic virus severe acute respiratory syndrome coronavirus 2, which causes coronavirus disease 2019 (COVID-19), originated in bats, and was transmitted to humans. COVID-19 continues to cause devastating international health problems worldwide. Therefore, natural preventive therapeutic strategies from bioactive compounds, such as carotenoids, should be appraised for strengthening physiological functions against emerging viruses. This review summarizes the most important carotenoids for human health and enhancing immunity, and their potential role in COVID-19 and its related symptoms. In conclusion, promising roles of carotenoids as treatments against emerging disease and related symptoms are highlighted, most of which have been heavily premeditated in studies conducted on several viral infections, including COVID-19. Further in vitro and in vivo research is required before carotenoids can be considered as potent drugs against such emerging diseases.

Contoured plating for proximal ulna nonunion: an improved technique.

Twenty-one patients having proximal ulna nonunion were treated with contoured plating. The most proximal hole received an intramedullary 6.5-mm cancellous lag screw that extends fixation of the nonunion site. Mean age of the patients was 41.7 years. Average follow-up period was 22 months. Union occurred in 19 cases after a mean of 9.6 weeks. Complications were persistent nonunion in two cases, a stiff elbow in one, hardware prominence in two, and a 1 x 1-cm ulcer over the curve of the plate in one case. The two unsatisfactory results were related to ulnohumeral arthritis. In conclusion, augmentation of the contoured plate with a 6.5-mm intramedullary cancellous lag screw creates a stable construct in treatment of proximal ulna nonunion. It applies axial compression, resists bending forces on the dorsal plate and allows early mobilization after surgery, regardless of the size of the proximal fragment.

Locked plating for femoral fractures in polio patients.

BACKGROUND: Femoral fractures in polio survivors present unique challenges; the bone is often small, deformed, osteoporotic and hypovascularized. Locked compression plating aided in achieving a better construct stability of osteoporotic fractures. METHODS: A total of 13 unilateral femoral fractures in adult polio patients were fixed with locked compression plating in a prospective study. Mean age was 49.8 years (range 34-62). In 6 cases, the small size of the bone matched only narrow plates, and in 6 cases the plate was contoured to fit the cortex. Average follow-up period was 18.4 months (range 12-24). RESULTS: Radiological evidence of union was apparent in 12 cases after 12-20 weeks (mean 16.3). One case was considered ununited after 28 weeks and progressed to union with bone grafting after another 12 weeks. At the end of the follow-up period, 12 patients returned to their prefracture Vignos disability scale, only the case that experienced nonunion showed functional deterioration. CONCLUSION: The locked compression plate withstood fixing femoral fractures in polio patients, addressing the challenges of a smaller, osteoporotic, less vascularized and sometimes deformed femur.

The upshot of Polyphenolic compounds on immunity amid COVID-19 pandemic and other emerging communicable diseases: An appraisal.

Polyphenols are a large family of more than 10,000 naturally occurring compounds, which exert countless pharmacological, biological and physiological benefits for human health including several chronic diseases such as cancer, diabetes, cardiovascular, and neurological diseases. Their role in traditional medicine, such as the use of a wide range of remedial herbs (thyme, oregano, rosemary, sage, mint, basil), has been well and long known for treating common respiratory problems and cold infections. This review reports on the most highlighted polyphenolic compounds present in up to date literature and their specific antiviral perceptive properties that might enhance the body immunity facing COVID-19, and other viral infectious diseases. In fact, several studies and clinical trials increasingly proved the role of polyphenols in controlling numerous human pathogens including SARS and MERS, which are quite similar to COVID-19 through the enhancement of host immune response against viral infections by different biological mechanisms. Thus, polyphenols ought to be considered as a potential and valuable source for designing new drugs that could be used effectively in the combat against COVID-19 and other rigorous diseases.

Resveratrol Modulates the Inflammatory Profile of Immune Responses and Circulating Endothelial Cells' (CECs') Population During Acute Whole Body Gamma Irradiation.

Wistar rats were whole body irradiated with a single dose of 2 Gy post administration with 10 or 100 mg/kg of resveratrol (RSV) intraperitoneally for 30 days. Rats' livers were dissected and processed to analyze immune response profiles of Th1, Th2, Th9, Th17, and Th22 by flow cytometry. In addition, peripheral blood samples were collected and circulating endothelial cells (CECs) were counted as an indicator for endothelial damage. Results demonstrated that resveratrol at 100 mg/kg enhanced liver immunological response influenced by irradiation by inducing Th2 immune response that was revealed by an increase in IL-10 secretion to more than 5,000 pmol/ml post irradiation. Results also indicated that RSV, at a dose of 100 mg/kg, decreased levels of the main pro-inflammatory cytokines such as INF-γ, IL-22, IL-17A, and GM-CSF post irradiation. In addition, the same RSV was bound to upregulate the expression of IL-10 mRNA in isolated Kupffer cells (KCs) and their secretion of IL-10 post irradiation. The result demonstrated that KCs were the central source of this anti-inflammatory response mediated mainly by IL10. These results, proposed for the first time, clearly states that RSV promotes IL-10 mediated immune resolution by Kupffer cells and not by hepatocytes. This implies that KCs have a crucial role in radiotherapy. Additionally, this study showed that RSV had an anti-apoptotic effect through re-increasing the number of CECs, which is implicated in irradiation damage. Result of the current work discloses novel findings about the potential of RSV as a radio-protector agent of a natural origin and suggests novel roles of KCs as a pharmacological target during radiation exposure.

Cerebral Venous Sinus Thrombosis Manifesting as a Recurrent Spontaneous Subdural Hematoma: A Case Report.

BACKGROUND: Diagnosing cerebral sinus venous thrombosis (CSVT) manifested as a spontaneous subdural hematoma (SDH) is challenging due to variability of its clinical features. The neuroradiological investigation is crucial to confirm the diagnosis. The management of SDH secondary to CVST is controversial and not well established. CASE DESCRIPTION: We present a case of an adult man with Down's syndrome who underwent a left-sided craniotomy and evacuation of spontaneous subdural hematoma. Post-surgery magnetic resonance venography (MRV) revealed venous sinus thrombosis in the right transverse sinus with loss of flow signal. He was started on Apixaban two weeks post-surgery. Three months later, the patient re-presented with recurrence of the SDH. His anticoagulation was discontinued, and he underwent craniotomy reopening and evacuation of the recurrent hematoma. The patient returned to his baseline following this procedure. The patient was followed up in the out-patient clinic regularly. Interval brain MRI and MRV performed at six months showed further resolution of the thrombosis of the right sigmoid sinus with restoration of the venous flow. CONCLUSION: The management of SDH complicating CVST remains controversial due to the rarity of its presentation and the hazards associated with the use of anticoagulation.