Internal carotid artery ectasia: A case report of incidental diagnosis after post-traumatic headache.

Internal carotid artery ectasia (ICAE) is a rare vascular abnormality characterized by dilation and tortuosity of the internal carotid artery (ICA) beyond normal limits. ICAE is typically asymptomatic but can manifest with symptoms such as headache and dizziness. The exact cause of ICAE remains uncertain, but both congenital and acquired factors, including trauma, have been implicated. A 35-year-old female presented to the Emergency Room with severe headache and dizziness following a traumatic injury. Neurological examination revealed no deficits. Computed tomography (CT) scan showed an elongated and prominent right supraclinoid internal carotid artery with mural wall calcification. Subsequent magnetic resonance imaging (MRI) confirmed the diagnosis of internal carotid artery ectasia (ICAE) without significant stenosis or malformation. The patient remained asymptomatic during follow-up visits. Proactive monitoring was advised to detect potential complications at an early stage. This case emphasizes the incidental detection of ICAE in a patient with post-traumatic headache. ICAE is a rare condition with an elusive etiology, and its management depends on factors such as symptom severity and associated risks. Conservative management is often recommended for asymptomatic cases.

Factors Shaping Medical Students' Intentions Toward Neurosurgery: A Cross-Sectional Study.

Background Choosing a medical specialty poses a significant challenge for students, with initial fascinations often evolving during their academic journey. Despite its inherent appeal, neurosurgery faces hesitancy among undergraduate students, potentially due to perceived difficulties and time demands. This study aims to investigate the factors influencing medical students' intentions toward neurosurgery at two institutions in the eastern province of Saudi Arabia. Methodology A cross-sectional study design was employed, utilizing a validated, anonymous questionnaire distributed electronically to medical students and interns in the eastern province of Saudi Arabia. The questionnaire comprised two sections, namely, demographic and academic profiles, and participants' intentions, knowledge, and attitudes toward neurosurgery. Data analysis involved descriptive statistics, and chi-square tests to explore relationships and identify significant predictors. Results Of the participants, 197 (34.1%) expressed interest in neurosurgery, but only 94 (16.3%) had a comprehensive understanding of the field. Motivations included high income, specialty prestige, and positive impact on patients, while stress and work-life balance were common deterring factors. Age and academic years were associated with a gradual decrease in interest, except for initial medical school students. Participants were attracted to innovative technological aspects, while high competition and neurophobia were deterring factors. Conclusions This study provides a comprehensive analysis of determinants influencing medical students' and interns' interest in neurosurgery. Early exposure, clinical training, and personal motivations play significant roles in shaping career preferences. Challenges, such as perceived difficulties and concerns related to work-life balance, need targeted interventions to enhance neurosurgery's attractiveness. Considerations extend beyond technical and academic facets to encompass personal and lifestyle dimensions.

Gliosarcoma in a Young Filipino Woman: A Case Report and Review of the Literature.

BACKGROUND Gliosarcoma (GS) is a rare variant of glioblastoma (GBM), which is typically seen in patients age 40-60 years and located in the supratentorial region. We present an unusual case of GS in a young patient with an unusual presentation, which eventually led to the finding of this neoplasm. CASE REPORT Our patient was a 38-year-old woman originally from the Philippines who was transferred to our institution with an isolated left foot drop that developed over the course of several months. Subsequent neuroimaging revealed an extensive mixed cystic and solid mass in the posterior mesial right frontal lobe. Subtotal surgical resection revealed a multi-lobed tumor with a malignant glioma-like surface component overlying a smooth, well-encapsulated, avascular, sarcoma-like component. Neuropathologic examination of the resected tumor revealed a biphasic histologic pattern of predominantly sarcomatous components with fewer adjacent-area glial components. Post-operatively, the patient was left with a mild worsening of left leg segmental strength. She was referred to our neurooncologist colleagues for adjuvant treatment options. CONCLUSIONS Our case is unique in that it represents a rare neoplasm in a patient whose demographics are atypical for this type of tumor, as well as the unusual presentation of isolated foot drop.

Bilirubin and its oxidation products damage brain white matter.

Brain injury after intracerebral hemorrhage (ICH) occurs in cortex and white matter and may be mediated by blood breakdown products, including hemoglobin and heme. Effects of blood breakdown products, bilirubin and bilirubin oxidation products, have not been widely investigated in adult brain. Here, we first determined the effect of bilirubin and its oxidation products on the structure and function of white matter in vitro using brain slices. Subsequently, we determined whether these compounds have an effect on the structure and function of white matter in vivo. In all, 0.5 mmol/L bilirubin treatment significantly damaged both the function and the structure of myelinated axons but not the unmyelinated axons in brain slices. Toxicity of bilirubin in vitro was prevented by dimethyl sulfoxide. Bilirubin oxidation products (BOXes) may be responsible for the toxicity of bilirubin. In in vivo experiments, unmyelinated axons were found more susceptible to damage from bilirubin injection. These results suggest that unmyelinated axons may have a major role in white-matter damage in vivo. Since bilirubin and BOXes appear in a delayed manner after ICH, preventing their toxic effects may be worth investigating therapeutically. Dimethyl sulfoxide or its structurally related derivatives may have a potential therapeutic value at antagonizing axonal damage after hemorrhagic stroke.