Spinal dural arteriovenous fistula masquerading as a herniated disc: illustrative case.

BACKGROUND: Spinal dural arteriovenous fistula (SDAVF) is a rare disorder with an unknown etiology. Often, the clinical presentation and imaging findings are misleading, causing this condition to be mistaken for other entities, such as demyelinating or degenerative spinal lesions. OBSERVATIONS: The authors report a challenging case of SDAVF in which the patient's symptoms were initially thought to be attributable to a herniated disc based on his imaging studies at another institution. He sought the authors for a second opinion, which yielded a confirmed diagnosis of SDAVF. Due to his rapidly progressive neurological manifestations, he underwent a surgical division of the fistula using intraoperative video angiography via indocyanine green injections. His symptoms progressively improved over a 3-month period. He regained full sphincter control by 4 months, which gave him a better recovery than seen in other patients with SDAVFs, who do not generally fully regain sphincter control. LESSONS: SDAVF is a critical spinal vascular pathology that should not be overlooked in the differential diagnosis of any patient presenting with signs of progressive myelopathy. Despite its associated vague initial clinical symptoms, SDAVF typically, but not always, demonstrates a characteristic imaging appearance on magnetic resonance (MR) imaging studies; therefore, MR angiography is still required for definitive diagnosis. Surgical treatment for SDAVF is almost always definitive and curative.

An untapped window of opportunity for glioma: targeting therapy-induced senescence prior to recurrence.

High-grade gliomas are primary brain tumors that are incredibly refractory long-term to surgery and chemoradiation, with no proven durable salvage therapies for patients that have failed conventional treatments. Post-treatment, the latent glioma and its microenvironment are characterized by a senescent-like state of mitotic arrest and a senescence-associated secretory phenotype (SASP) induced by prior chemoradiation. Although senescence was once thought to be irreversible, recent evidence has demonstrated that cells may escape this state and re-enter the cell cycle, contributing to tumor recurrence. Moreover, senescent tumor cells could spur the growth of their non-senescent counterparts, thereby accelerating recurrence. In this review, we highlight emerging evidence supporting the use of senolytic agents to ablate latent, senescent-like cells that could contribute to tumor recurrence. We also discuss how senescent cell clearance can decrease the SASP within the tumor microenvironment thereby reducing tumor aggressiveness at recurrence. Finally, senolytics could improve the long-term sequelae of prior therapy on cognition and bone marrow function. We critically review the senolytic drugs currently under preclinical and clinical investigation and the potential challenges that may be associated with deploying senolytics against latent glioma. In conclusion, senescence in glioma and the microenvironment are critical and potential targets for delaying or preventing tumor recurrence and improving patient functional outcomes through senotherapeutics.

Intraventricular sizeable colloid cyst with atypical radiological features: A case report and evidence-based review.

Colloid cysts are benign intracranial lesions, typically located in the anterior portion of the third ventricle near the interventricular foramina of Monro. The cysts usually consist of an epithelial lining filled with viscous gelatinous material of various components. Colloid cysts are generally asymptomatic, but once symptomatic, they can present in a variety of ways, including headaches, vomiting, visual and memory problems, and vertigo. Colloid cysts present classically on imaging as a well-delineated hyperattenuating lesion on unenhanced radiological modalities. Herein, we report a case of a patient who presented with hydrocephalus caused by a sizeable colloid cyst which demonstrated atypical imaging findings in the form of hypodensity on CT and hyperintensity on T2WI, making them difficult to identify and easy to miss. Although this atypical imaging appearance is uncommon with yet unknown true incidence, it is prudent to be aware of it because early management of colloid cysts has a favorable outcome, in contrast to untreated cysts that are associated with higher rates of morbidity and mortality. Additionally, we provide a comprehensive, evidence-based review of the medical entity of intracranial colloid cysts with highlights of current postulated pathological theories and management algorithms.

Pediatric nurses' knowledge and practices of nasogastric tube placement and verification: A cross-sectional study.

OBJECTIVES: The study assesses pediatric nurses' knowledge and routine practices in relation to nasogastric tube (NGT) placement and verification procedure. By investigating these aspects, the study seeks to contribute to the enhancement of patient safety and the improvement of pediatric nursing care in the context of NGT procedures by ensuring accurate NGT placement and minimizing complications in pediatric patients. The study assesses pediatric nurses' knowledge and practices of inserting and confirming the placement of NGTs among pediatric patients in the Asir Province, Saudi Arabia. METHODS: In this multihospital cross-sectional study, a total of 130 pediatric nurses participated. The study used a validated questionnaire comprising two parts: one focusing on the demographic data of the pediatric nurses and the other assessing their knowledge and practices regarding NGT placement and verification. The collected data were analyzed using descriptive statistics and linear regression tests in the SPSS software. The research question addressed in this study was to determine the knowledge and practice levels of pediatric nurses in relation to NGT placement and verification. RESULTS: This study included 130 registered pediatric nurses, of whom more than half had unsatisfactory knowledge (53.1%) and incompetent practices (58.5%) related to NGT insertion. Linear regression associated with perceived nurses' practices scores explained that knowledge score, years of experience, educational qualification, and training courses had a high-frequency positive effect on the practice score, with P < 0.01. Linear regression associated with perceived nurses' knowledge scores explained that educational qualification, practice score, and training courses had a high-frequency positive effect on the knowledge score, with P < 0.01. CONCLUSIONS: The study found that pediatric nurses' knowledge and practices regarding NGT were inadequate. These results highlight the importance of implementing continuous educational programs to improve care practices pertaining to nasogastric tubes and enhance patient safety and quality of care.

Beta-propeller protein-associated neurodegeneration: A clinical update with a case report.

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Neurocysticercosis presenting as a locked-in lateral ventricle: A case report and evidence-based review.

Human neurocysticercosis is one of the most prevalent parasitic infestations of the central nervous system. It is considered the most frequent underlying etiology of acquired epilepsy in endemic areas in Central and South America, East Europe, Africa, and Asia, with over 50 million people affected globally. Ventricular involvement is a severe form of neurocysticercosis commonly manifests as arachnoiditis, raised intracranial pressure, or hydrocephalus, secondary to CSF flow obstruction of the ventricular system by cysts of Taenia solium, hence requiring prompt, aggressive intervention to alleviate the increased intracranial pressure to prevent imminent lethal complications. Ventricular neurocysticercosis can involve any brain ventricle but with a paramount preference for the fourth ventricle, causing non-communicating hydrocephalus and symmetric ventriculomegaly. However, in this clinical report, we present an uncommon case of trapped (locked-in) lateral ventricle caused by an isolated cysticercus trapped at the ipsilateral foramen of Monro, which is an atypical location for neurocysticercosis, adding more challenges to diagnosis and during the process of surgical extraction. We additionally provide a comprehensive, evidence-based review of the clinical course and management options relevant to the entity of ventricular neurocysticercosis, besides recent relevant clinical updates.

Glioblastoma masquerading as a cystic brain lesion: A case report and evidence-based review.

INTRODUCTION AND IMPORTANCE: In adults, glioblastomas account for approximately 12-15 % of primary intracranial neoplasms. In current standard-of-care treatment, glioblastomas have a 5-year survival rate of ~7.5 % and a median survival of ~15 months. Glioblastoma exhibits a highly variable imaging appearance, but the thick and irregular ring enhancement surrounding a necrotic core with infiltrative growth is the most prevalent imaging pattern. Glioblastoma with a cystic component (also known as cystic glioblastoma) is a rare presentation that can be misleading and often mistaken for other cystic brain lesions. CASE PRESENTATION: In this report, we present a case of a 43-year-old woman who presented to the emergency department with a 2-month history of progressive neurologic manifestations that was attributed to a right-sided cystic brain lesion detected on routine imaging studies, which was later characterized as a cystic glioblastoma based on specific imaging and molecular studies. CLINICAL DISCUSSION: We highlight the importance of combining radiological and molecular modalities with clinical suspicion for a better characterization of cystic brain lesions and including glioblastoma in the list of potential diagnoses. Furthermore, we provide a comprehensive, evidence-based review of the entity of cystic glioblastoma and how the existence of the cystic component might affect the management and the overall prognosis. CONCLUSION: Several characteristics make cystic glioblastoma unique. However, it is also capable of mimicking other benign cystic brain lesions, delaying definitive diagnosis and hence the most appropriate management plan.

Hemolytic uremic syndrome with central nervous system manifestations, a case report and literature review.

Hemolytic uremic syndrome (HUS) is a multisystem disorder generally seen in children and young adults, manifesting with the symptomatic triad of thrombocytopenia, hemolytic anemia, and acute kidney injury. These symptoms are often preceded by a prodrome of bloody diarrhea, vomiting, fever, and weakness. HUS is an exceedingly rare entity, with less than 1.5 per 100,000 people affected annually. HUS with central nervous system (CNS) manifestations constitutes approximately 20%-50% of cases and often presents with seizures, altered level of consciousness, and brainstem symptoms. CNS involvement in HUS is a major cause of acute morbidity and mortality; therefore, timely diagnosis and treatment are crucial in the management of these cases. Neuroimaging plays a critical role in the diagnosis; however, it might be very challenging in a large number of cases because studies that report the typical neuroradiologic features of brain injury in cases with HUS are not commonly available. Herein, we demonstrate in a case-based approach, the importance of combining clinical suspicion with different radiologic modalities to better characterize HUS cases with CNS involvement, as well as demonstrate how the early start of meticulous supportive therapy can lead to a favorable outcome even when severe brain involvement is evident on acute imaging studies. Furthermore, we provide an illustrated overview of the current theories that explain the neurologic involvement in HUS, as well as the commonly affected brain areas and how this entity can be radiologically differentiated from other potential diagnoses.

Meningioangiomatosis with Skull Erosion.

Meningioangiomatosis (MA) is a rare, poorly studied brain hamartomatous lesion, the etiology of which is not fully elucidated. It typically involves the leptomeninges, extending to the underlying cortex, characterized by small vessel proliferation, perivascular cuffing, and scattered calcifications. Given its close proximity to, or direct involvement of, the cerebral cortex, MA lesions typically manifest in younger patients as recurrent episodes of refractory seizures, comprising approximately 0.6% of operated-on intractable epileptic lesions. Due to the absence of characteristic radiological features, MA lesions constitute a significant radiological challenge, making them easy to miss or misinterpret. Although MA lesions are rarely reported with still-unknown etiology, it is prudent to be aware of these lesions for prompt diagnosis and management to avoid morbidity and mortality associated with delayed diagnosis and treatment. We present a case of a young patient with a first-time seizure caused by a right parieto-occipital MA lesion that was successfully excised via an awake craniotomy, achieving 100% seizure control.

Spinal schistosomiasis masquerading as an intramedullary tumor.

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P21 Overexpression Promotes Cell Death and Induces Senescence in Human Glioblastoma.

High-grade gliomas are the most common and aggressive adult primary brain tumors with a median survival of only 12-15 months. Current standard therapy consists of maximal safe surgical resection followed by DNA-damaging agents, such as irradiation and chemotherapy that can delay but not prevent inevitable recurrence. Some have interpreted glioma recurrence as evidence of glioma stem cells which persist in a relatively quiescent state after irradiation and chemotherapy, before the ultimate cell cycle re-entry and glioma recurrence. Conversely, latent cancer cells with a therapy-induced senescent phenotype have been shown to escape senescence, giving rise to more aggressive stem-like tumor cells than those present in the original tumor. Therefore, approaches are needed to either eliminate or keep these glioma initiating cells in a senescent state for a longer time to prolong survival. In our current study, we demonstrate that the radiation-induced cell cycle inhibitor P21 can provide a powerful route to induce cell death in short-term explants of PDXs derived from three molecularly diverse human gliomas. Additionally, cells not killed by P21 overexpression were maintained in a stable senescent state for longer than control cells. Collectively, these data suggest that P21 activation may provide an attractive therapeutic target to improve therapeutic outcomes.

The Necessity of Routine Pre-operative Group and Save Testing for Emergency Appendectomies.

Background Pre-surgical group and save (G&S) tests are routine but can result in unnecessary expense and theatre delays. The objective of this study was to assess the necessity of G&S testing prior to appendectomy and evaluate the cost implications. Methods This retrospective study analysed the records of 200 patients with appendicitis who underwent emergency appendectomies at a busy general surgery department between March 2021 to August 2022. The study adhered to local clinical governance unit protocol and the Strengthening the Reporting of Cohort Studies in Surgery (STROCCS) guidelines. Patients who had elective appendectomies or other emergency procedures were excluded. Data was collected on age, gender, number of samples and requirement for perioperative transfusion. Comparisons were drawn between patients who underwent laparoscopic, open or converted emergency appendectomies. Results Of the sample population, (median age 32, 55.5% male), 93.5% had valid preoperative G&S tests. None required perioperative blood transfusions. 26% of the patients only required one sample for a valid G&S due to having previous sample in the lab; 55% required two samples; 7% needed a third sample because one initial sample was rejected; and 5.5% required four samples because the initial two samples were rejected. The total cost of these samples was estimated to be £3,500.14. Conclusion Emergency appendectomy poses minimal risk of resulting in the need for blood transfusions. Reevaluating the need for routine preoperative G&S testing and adopting a risk-benefit analysis approach could have a financial benefit for the NHS.