RESUMO
Brain stone is an umbrella term for benign intracerebral calcifications and may be associated with various diagnoses. The surgical decision should be made on a case-by-case basis. Sometimes, conservative management should be considered, irrespective of the underlying pathology. We present a critical case with a brain stone treated conservatively. A 17-year-old female patient was admitted to our department with a headache. The neurological examination revealed no abnormal findings. Cranial CT and MRI scans showed a contrast-enhanced, highly calcified lesion located deep in the white matter at the level of the left centrum semiovale. Surgery was found unnecessary. The patient presented no neurologic deficits or symptoms during the three-year follow-up period. In this case, the differential diagnosis included arteriovenous malformations (AVMs), cavernomas, calcifying pseudoneoplasms of the neuroaxis (CAPNON), etc. The localization of the lesion, expression of the symptoms, and potential outcomes of a possible surgery should be carefully estimated before making the final decision. In summary, conservative treatment should also be considered for critically located, benign calcified lesions, irrespective of pathology, unless they cause intense neurologic symptoms or deficits.
RESUMO
The Coronavirus 2019 (COVID-19) pandemic has affected over 700 million people worldwide and caused nearly 7 million deaths. Vaccines currently developed or in development are the most effective tools for curbing the pandemic and mitigating its impacts. In Turkey, inoculation with the Pfizer-BioNTech COVID-19 vaccine (BNT162b2, also known as tozinameran) has been approved. We report a 56-year-old female patient with underlying essential hypertension who experienced intracranial hemorrhage after receiving her first dose of tozinameran. The patient underwent immediate surgical evacuation of the hematoma, during which a left middle cerebral artery bifurcation aneurysm was macroscopically identified and clipped. The patient was pronounced deceased on the second postoperative day. This is the second case of intracranial hemorrhage following tozinameran administration caused by a ruptured middle cerebral artery bifurcation aneurysm. Upon analyzing the case, there might be a connection between the vaccine's potential immune-triggering effect on hemodynamic patterns and the rupture of the previously unknown cerebral aneurysm. However, these severe complications do not justify avoiding vaccines; further studies are needed. This study emphasizes the need for increased vigilance in patients with underlying systemic comorbidities who have recently been vaccinated and to share our insights into the potential relationship between tozinameran and intracranial hemorrhage.
RESUMO
OBJECTIVE: Glutamate antagonists are very attractive drugs in laboratory works to protect neural tissue against ischemia. In this work, the effects of magnesium, MK-801 and combination of magnesium and MK-801 on blood-brain barrier (BBB) and brain edema after experimentally induced traumatic brain injury are evaluated. METHODS: A standard closed head injury was induced on the rats by a controlled impact device using a 450-g free falling mass from a height of 2 m onto a metallic disc fixed to the intact skull. One of the following was injected to animals intraperitoneally 30 minutes after injury: saline, magnesium, MK-801 and magnesium plus MK-801. To quantify the brain edema, the specific gravity of the brain tissue was determined. To demonstrate the alteration of the BBB permeability, Evans blue dye was used as a tracer. RESULTS: In all treatment groups, the specific gravity of brain tissue values was significantly higher compared with the control group. Evans blue dye content in the brain tissue was significantly reduced in all three treatment groups with respect to the control group. There was no significant difference of effect between the groups of magnesium alone and MK-801 alone when compared with each other and when compared with their combination. CONCLUSION: The present data demonstrate that treatment with magnesium, MK-801 and combination of magnesium and MK-801 can reduce formation of brain edema and can help restore BBB permeability after experimental diffuse brain injury.
