Management of postoperative cerebral vasospasm in skull base surgeries: A systematic review of case reports and series.

Background: This study provides a comprehensive overview of the management of postoperative vasospasm after skull base surgeries. This phenomenon is rare but can be of serious sequelae. Methods: Medline, Embase, and PubMed Central were searched, along with examining the references of the included studies. Only case reports and series that reported vasospasm following a skull base pathology were incorporated. Cases with pathologies other than skull base, subarachnoid hemorrhage, aneurysm, and reversible cerebral vasoconstriction syndrome were excluded from the study. Quantitative data were presented as mean (Standard Deviation) or median (range), accordingly, while qualitative data were presented as frequency (percentage). Chi- square test and one-way analysis of variance were used to assess for any association between the different factors and patient outcomes. Results: We had a total of 42 cases extracted from the literature. The mean age was 40.1 (±16.1) with approximately equal males and females (19 [45.2%] and 23 [54.8%], respectively). The time to develop vasospasm after the surgery was 7 days (±3.7). Most of the cases were diagnosed by either angiogram or magnetic resonance angiography. Seventeen of the 42 patients had pituitary adenoma as the pathology. Anterior circulation was nearly affected in all patients. For management, most patients received pharmacological with supportive management. Twenty-three patients had an incomplete recovery as a result of vasospasm. Conclusion: Vasospasm following skull base operations can affect males and females, and most patients in this review were middle-aged adults. The outcome of patients varies; however, most patients did not achieve a full recovery. There was no correlation between any factors and the outcome.

Pathway-Affecting Single Nucleotide Polymorphisms (SNPs) in RPS6KA1 and MBIP Genes are Associated with Breast Cancer Risk.

BACKGROUND: Genetic mutations and polymorphisms play an important role in the transformation of primary cells to malignant cells as it may lead to disturbance of vital pathways regulating cell cycle, DNA damage repair, and apoptosis. In this study, we genotyped single nucleotide polymorphisms (SNPs) which were predicted to affect certain pathways and to increase the risk of breast cancer. METHODS: The study included 81 Saudi breast cancer patients and 100 matching healthy controls from the Eastern Province in Saudi Arabia. The following SNPs (rs3168891, rs2899849, rs2230394, rs2229714) were then genotyped by TaqMan genotyping assay and the allele and genotype distribution was compared. RESULTS: The minor allele frequency of the following SNPs (rs3168891, rs2899849, rs2230394, rs2229714) was T=0.17, A=0.28, A=0.22, and G=0.16 respectively. The G allele of the SNP rs3168891 was significantly associated with increased breast cancer risk (P = 0.00001) while the T allele of the same locus was associated with reduced risk of breast cancer in both heterozygous and homozygous states. The T allele of SNP rs2229714 which is located in the RPS6KA1 gene was also significantly associated with the increased risk of breast cancer. However, the rs2899849 SNP located in the Integrin beta-1 (ITGB1) gene was not associated with the increased risk of breast cancer in our study population. Haplotype analysis revealed the presence of three risk haplotypes that increases the risk of breast cancer (TGGT, TGTA, GATA). CONCLUSION: We showed that three, previously untested, SNPs are associated with increased risk of breast cancer in our population.  This may be added to the list of factors involved in breast cancer risk assessment studies. The benefit and the utility of the in-silico prediction of disease risk factors and their genetic association had been demonstrated in this study, yet the predicted risk alleles have to be tested in clinical studies.
.

Spontaneous Regression of Pineal Region Arachnoid Cyst: A Case Report and Review of Literature.

Arachnoid cyst is a rare benign cerebrospinal fluid-filled cyst that can develop anywhere in the brain along the arachnoid membrane and usually unaccompanied by the anomalous development of the brain structure. These cysts are usually located in the middle cranial fossa. However, they are also denoted in other regions. Arachnoid cysts are mostly asymptomatic and diagnosed incidentally. Spontaneous regression of arachnoid cysts in different anatomical regions of the brain has been reported in the literature. However, to the best of our knowledge, this is the first case reporting an unusual spontaneous regression of arachnoid cyst in the pineal region in a 3-year-old child presented to our hospital with hydrocephalus without alarming signs and was treated conservatively as the patient was stable, and the cyst showed spontaneous regression. A comprehensive review of the literature regarding spontaneous regression of arachnoid cysts has been collected and discussed in this article.

A Case Report of Intraparenchymal Neurocysticercosis in a Postpartum Female in Saudi Arabia.

Neurocysticercosis is a neurologic disease caused by infection with larvae of Taenia solium. It is most commonly transmitted by consumption of pork, water contaminated with T. solium or poor hygiene habits. As only few cases of neurocysticercosis have been documented in Saudi Arabia, the authors report a case of neurocysticercosis in a young Indian female residing in Saudi Arabia who presented with generalized tonic-clonic seizures 6 days after a normal vaginal delivery. Her physical and laboratory investigations as well as chest X-ray and electroencephalogram were all normal. Computed tomography of the head revealed multiple calcified nodular lesions, and magnetic resonance imaging showed ring-enhancing lesion in the left frontoparietal area. Serum enzyme-linked immunosorbent assay (qualitative) was positive for immunoglobulin G antibodies for cysticercosis. A diagnosis of neurocysticercosis was made, and the patient was treated with dexamethasone and levetiracetam for 4 days before discharge. At the 3-month follow-up, the patient's condition had significantly improved, and her seizures had not recurred. This report recommends considering neurocysticercosis as a differential diagnosis in patients presenting with new-onset seizures, even if the symptoms do not initially indicate neurocysticercosis or if the patient resides in an area where the disease is rare.

Tumefactive multiple sclerosis masquerade as a central nervous system tumor: a case report.

INTRODUCTION: Tumefactive multiple sclerosis is a demyelinating disorder that appears tumor-like on MRI. To most physicians, diagnosing tumefactive MS by applying clinical, radiological, or laboratory examination like Cerebrospinal fluid (CSF) analysis, can be challenging and ultimately biopsy is necessary to confirm the diagnosis. CASE PRESENTATION: This paper reports a case of a 37-year-old woman who presented with progressive headache and a strong family history of cancer and was misdiagnosed as having a CNS glioma. After considering the MRI features, CSF analysis results and observing improvement with IV steroids, the diagnosis of tumefactive MS was made. The patient refused biopsy to rule out the possibility of tumor or abscess. Nine months later, she presented with another relapse and an injectable disease modifying treatment (DMT) was initiated, and her course has been stable in follow up. TAKE-AWAY LESSON: The overall clinical importance of this case report is to highlight the real possibility of being forced to decide between Tumefactive demyelinating lesions (TDLs) and brain tumors in clinical practice, in order to avoid unnecessary biopsy.