Traumatic Carotid Cavernous Fistula Resulting in Symptoms in the Ipsilateral Eye: A Case Report.

Post-traumatic unilateral carotid cavernous fistula (CCF) with ipsilateral symptoms is a rare occurrence, so its diagnosis frequently gets overlooked for other more common conditions. Timely imaging with digital subtraction angiography (DSA) and appropriate vascular intervention is essential in preventing potentially serious sequelae in such cases. We describe a case of post-traumatic CCF in a 42-year-old man who experienced intermittent headaches and right eye redness, proptosis, and watery discharge for three months following the incident. He was diagnosed with a right CCF based on DSA. Timely endovascular embolization with the coiling method resulted in obvious relief of the ocular symptoms and an improved prognosis. This article offers a description of our patient, a brief discussion of the existing literature, the challenges of diagnosing such cases, and a variety of therapy options.

Decline in subarachnoid haemorrhage volumes associated with the first wave of the COVID-19 pandemic.

BACKGROUND: During the COVID-19 pandemic, decreased volumes of stroke admissions and mechanical thrombectomy were reported. The study's objective was to examine whether subarachnoid haemorrhage (SAH) hospitalisations and ruptured aneurysm coiling interventions demonstrated similar declines. METHODS: We conducted a cross-sectional, retrospective, observational study across 6 continents, 37 countries and 140 comprehensive stroke centres. Patients with the diagnosis of SAH, aneurysmal SAH, ruptured aneurysm coiling interventions and COVID-19 were identified by prospective aneurysm databases or by International Classification of Diseases, 10th Revision, codes. The 3-month cumulative volume, monthly volumes for SAH hospitalisations and ruptured aneurysm coiling procedures were compared for the period before (1 year and immediately before) and during the pandemic, defined as 1 March-31 May 2020. The prior 1-year control period (1 March-31 May 2019) was obtained to account for seasonal variation. FINDINGS: There was a significant decline in SAH hospitalisations, with 2044 admissions in the 3 months immediately before and 1585 admissions during the pandemic, representing a relative decline of 22.5% (95% CI -24.3% to -20.7%, p<0.0001). Embolisation of ruptured aneurysms declined with 1170-1035 procedures, respectively, representing an 11.5% (95%CI -13.5% to -9.8%, p=0.002) relative drop. Subgroup analysis was noted for aneurysmal SAH hospitalisation decline from 834 to 626 hospitalisations, a 24.9% relative decline (95% CI -28.0% to -22.1%, p<0.0001). A relative increase in ruptured aneurysm coiling was noted in low coiling volume hospitals of 41.1% (95% CI 32.3% to 50.6%, p=0.008) despite a decrease in SAH admissions in this tertile. INTERPRETATION: There was a relative decrease in the volume of SAH hospitalisations, aneurysmal SAH hospitalisations and ruptured aneurysm embolisations during the COVID-19 pandemic. These findings in SAH are consistent with a decrease in other emergencies, such as stroke and myocardial infarction.

Dynamics of water conveying zinc oxide through divergent-convergent channels with the effect of nanoparticles shape when Joule dissipation are significant.

AIM OF STUDY: The shape effects of nanoparticles are very significant in fluid flow and heat transfer. In this paper, we discuss the effects of nanoparticles shape in nanofluid flow between divergent-convergent channels theoretically. In this present study, various shapes of nanoparticles, namely sphere, column and lamina in zinc oxide-water nanofluid are used. The effect of the magnetic field and joule dissipation are also considered. RESEARCH METHODOLOGY: The system of nonlinear partial differential equations (PDEs) is converted into ordinary differential equations (ODES). The analytical solutions are successfully obtained and compared with numerical solutions. The Homotopy perturbation method and NDsolve method are used to compare analytical and numerical results respectively. CONCLUSION: The results show that the lamina shape nanoparticles have higher performance in temperature disturbance and rate of heat transfer as compared to other shapes of nanoparticles.

Shape Effect of Nanosize Particles on Magnetohydrodynamic Nanofluid Flow and Heat Transfer over a Stretching Sheet with Entropy Generation.

Magnetohydrodynamic nanofluid technologies are emerging in several areas including pharmacology, medicine and lubrication (smart tribology). The present study discusses the heat transfer and entropy generation of magnetohydrodynamic (MHD) Ag-water nanofluid flow over a stretching sheet with the effect of nanoparticles shape. Three different geometries of nanoparticles-sphere, blade and lamina-are considered. The problem is modeled in the form of momentum, energy and entropy equations. The homotopy analysis method (HAM) is used to find the analytical solution of momentum, energy and entropy equations. The variations of velocity profile, temperature profile, Nusselt number and entropy generation with the influences of physical parameters are discussed in graphical form. The results show that the performance of lamina-shaped nanoparticles is better in temperature distribution, heat transfer and enhancement of the entropy generation.

Aneurysmal Subarachnoid Hemorrhage: Outcome of Aneurysm Clipping Versus Coiling in Anterior Circulation Aneurysm.

OBJECTIVE: To compare the neurological outcome of microsurgical clipping versus coiling in patients with anterior circulation aneurysm. STUDY DESIGN: Comparative study. PLACE AND DURATION OF STUDY: Department of Neurosurgery, Lahore General Hospital, Lahore, from January 2010 to December 2013. METHODOLOGY: Patients aged 14 - 60 years, with ruptured cerebral aneurysm of anterior circulation and World Federation of Neurosurgical Society (WFNS) grades 1, 2 and 3 were included. Patients more than 60 years, medically unfit patient and posterior circulation aneurysms and WFNS grades 4 and 5 were excluded. Aneurysm sac obliteration was done in randomized manner with microsurgical clipping or coiling. Postoperatively, the patients were assessed and followed-up upto one year for outcome parameters on the bases of WFNS grade and Modified Ranking Scale (mRS) as favourable (mRS ≤2 ) and unfavourable (mRS > 2). RESULTS: Among 140 subjects selected for study, 70 were included in group A, i.e. coiling and other 70 were in group B, i.e. clipping. The median age of patients in group A was 52.5 ± 10 years and in group B was 51.00 ± 10 years. Overall, 56 (40%) males, 28 (60%) males in each group; and 84 (60%) females, 42 (60%) in each group were included. The male to female ratio in this study was 1:1.5. In group A, i.e. coiling, 27 (38.6%) patients had no disability (grades 1 and 2), 25 (35.7%) were slightly disabled (grade 3) and 18 (25.7%) had moderate disability (grade 4); whereas in group B, i.e. clipping group 23 (32.9%) patients had no disability (grades 1 and 2), 23 (32.9%) were slightly disabled (grade 3) and 24 (34.3%) had moderate disability (grade 4). At one year follow-up, in group A, favourable outcome was achieved in 56 (80%) of patients compared to 48 (68.6%) in group B; whilst, 14 (20%) patients in group Aand 22 (33.1%) in group B showed unfavourable outcome. Although mortality rate was higher in clipping (n=3, 4.3%) as compared to coiling (n=1, 1.4%), but was not statistically significant (p = 0.310). CONCLUSION: Endovascular coiling of anterior circulation aneurysms is safe and as effective and successful as aneurysm clipping and is less invasive also.