Endovascular stenting for cerebral venous sinus stenosis secondary to meningioma invasion.

INTRODUCTION: Symptomatic intracranial hypertension (IH) due to venous outflow obstruction secondary to dural venous sinus (DVS) tumoral invasion affects up to 3% of intracranial meningioma patients. The literature regarding endovascular therapies of such patients is limited to a few case reports and a recent single-centre case series. PURPOSE: We describe our single-centre experience of endovascular therapy in patients with clinically symptomatic IH secondary to DVS meningioma invasion. METHODS: We performed a retrospective review of clinical and radiological data of all patients with refractory IH and meningiomas invading the DVS who were referred for possible DVS venoplasty and stenting. Seven endovascular procedures in six female patients were done. Presumed secondarily induced lateral transverse sinus stenosis was also stented in four patients as part of the primary intervention. RESULTS: All patients experienced complete symptomatic resolution at 6-month follow-up. Five patients had no symptom recurrence over a mean follow-up period of 3.5 years. One patient with multiple meningiomas developed recurrent IH 2 years following stenting secondary to in-stent tumour re-invasion. This was re-stented with consequent 6 months post-retreatment symptomatic relief at the time of writing. No procedure-related complications occurred. CONCLUSION: In the setting of DVS stenosis secondary to meningioma invasion, endovascular therapy is a safe and successful therapeutic option with promising mid-term results. The procedure should be considered in cases where complete surgical tumour resection is unlikely or carries a significant risk. If present, secondarily induced stenoses at the lateral ends of the transverse sinuses should also be considered for treatment.

Predominantly Solid Hemangioblastoma Presenting as an Extra-Axial Cerebellopontine Angle Lesion.

Hemangioblastomas (HBs) are typically intra-axial, highly vascular tumors of the central nervous system and account for up to 2.5% of all intracranial tumors and up to 12% of posterior fossa neoplasms. Extra-axial HBs are rarely described in the literature. The radiological appearances of cerebellopontine angle (CPA) extra-axial HB can lead to a diagnostic conundrum as they may mimic the appearance of dural metastasis, vestibular schwannoma, or meningioma. Here, we describe a patient who presented with an extra-axial CPA HB and explore the literature of the condition.

Rare Case of Multiple Intradural Extramedullary Spinal Schwannomas With Intramedullary Extension.

Spinal schwannomas are benign WHO grade I nerve sheath tumors that account for nearly 30% of all spinal neoplasm. Typically, these lesions are intradural extramedullary in location and are composed entirely of well-differentiated eosinophilic Schwann cells. Intramedullary schwannomas, however, are extremely rare due to the lack of Schwan cells in the normal spinal cord and represent 1% of all the spinal schwannoma population. The presence of such an intramedullary component makes diagnosis challenging as imaging features may resemble other intramedullary neoplastic entities. Here, we describe a case of a 56-year-old male patient who presented with an 18-month history of intermittent right-sided mid-thoracic pain secondary to multiple intradural extramedullary spinal schwannoma with intramedullary extensions. We also review the literature pertaining to the condition.

Unusual case of upper gastrointestinal haemorrhage secondary to a ruptured gastroduodenal artery pseudoaneurysm: case presentation and literature review.

Pseudoaneurysm rupture of the gastroduodenal artery (GDA) is life-threatening and can present as an acute upper gastrointestinal haemorrhage. Here, we present a case of upper gastrointestinal haemorrhage arising from a ruptured GDA pseudoaneurysm. A 56-year-old woman presented acutely with haematemesis. She reported ongoing upper epigastric pain for a few weeks. Laboratory evaluation revealed severe microcytic hypochromic anaemia (haemoglobin, 69 g/L; normal, 120-140 g/L) and a mildly raised serum amylase level. Upper gastrointestinal endoscopy revealed dark blood collection between the rugae of the distal stomach. An abdominal CT scan detected a homogeneously enhancing rounded lesion arising from the GDA adjacent to the second part of the duodenum. The median arcuate ligament was causing stenosis of the coeliac axis origin. The diagnosis of haematemesis secondary to a ruptured GDA pseudoaneurysm was confirmed by mesenteric angiography, and aneurysmal embolisation was done. The haemoglobin level stabilised after aneurysmal embolisation.

Unilateral right closed-lip schizencephaly.

Schizencephaly is a rare central nervous system (CNS) malformation secondary to neuronal migration defects. The pathogenesis is complex and is secondary to environmental and genetic factors. Clinically, the majority of patients present with varying degrees of motor and psychological disturbances. Imaging plays a cornerstone in the diagnosis by identifying the characteristic lesional features and recognising other associated abnormalities such as an absent septum pellucidum and corpus callosum dysgenesis. Here, we present a male paediatric case who presented with an interestingly asymptomatic unilateral right closed-lip schizencephaly and review the aetiology, clinical presentation and imaging characteristics of the disease and associated literature.

Palliative Care: Knowledge and Attitude among Saudi Residents, 2016.

Introduction: Palliative care is a medical specialty, which focuses on relieving the suffering and improving the quality of life for patients who are facing life-threatening illnesses and their families. Looking after dying patients is inseparable from our responsibility as physicians. However, dealing with the dying patients is challenging for the majority of physicians. Aim: To document the knowledge and attitudes of palliative care among residents from major specialties, Eastern Province, Saudi Arabia. Methodology: A cross-sectional study was carried out using a self-administered questionnaire to a convenient sample of residents from major specialties from various training centers in Eastern Province, Saudi Arabia, during 2015-2016. A total of 433 residents have been participated in the study. Results: About 46% of the residents showed lack of overall palliative care knowledge, and almost half of them had negative views toward palliative care. Almost 60% of them achieved good score in pain management. The majority of respondents had never received training in palliative medicine (91.7%). It was observed that higher training level has a positive effect on the overall knowledge, including basic concept, pain, and psychiatric symptoms' management. Also, previous exposure to patients who would benefit from palliative care has a direct effect on overall knowledge and attitude scores. Conclusion: The results indicate a low level of knowledge and attitude regarding palliative medicine among sampled residents. Also, it highlights the importance of exposing the residents to palliative medicine field to improve their knowledge and attitude.