Background and Purpose: Blood Blister-like aneurysms (BBAs) of the internal carotid artery (ICA) are rare entities of cerebral aneurysms. FD use in acutely ruptured aneurysms, timing of treatment and antiplatelet regimen are main debate topics in clinical practice when the treatment decision is flow diversion. The aim of this study is to report the safety and efficacy of a single-center FD treatment for ruptured BBAs in the early phase of SAH using the SAPT regimen.Material and Method: This study involved a retrospective analysis of a prospectively collected database. Records of patients admitted to our clinic and treated by endovascular route on ruptured BBA between January 2013 and December 2020 were reviewed. Ruptured supraclinoid ICA BBAs treated with FD devices with SAPT within 48 h from ictus of SAH are included. BBA of atypical anatomic locations, other endovascular techniques performed, and delayed admissions (>48 h) were excluded from the study. Demographic, clinical and angiographic features of patients and aneurysms, FD types and numbers, periprocedural complications, immediate and follow-up angiographic and clinical outcomes were recorded.Results: A total of six patients with ruptured BBAs treated via FDs within 48 h and used SAPT were included in the study. The mean age was 41.6 years (range from 34 to 45 years), and four of six patients were female. All patients were treated within 48 h after ictus, and the mean treatment day was 1.33 days. One patient received ticagrelor, and five patients received prasugrel as SAPT for one year after treatment. No procedure-related death and rebleeding were recorded. One (16.7 %) treatment responsive procedure-related complication occurred (transient ischemia). Overall good outcome rate was 83.3%. One patient died due to pneumonia. The immediate control angiograms showed complete occlusions of BBAs in one patient (16.6%). The complete occlusion rate was 100 % for five survivors at the control angiogram. The median follow-up was 49.5 months.Conclusion: This single-center experience suggests that early treatment (<2 days) within SAH of ruptured BBAs with FDs using SAPT is safe and effective in terms of clinical and radiological long-term outcomes.

Following a generalized tonic–clonic seizure, a previously healthy 27‐year‐old pregnant woman (18‐week pregnancy) was admitted to our emergency department. She experienced lethargy, forgetfulness and persecutory hallucinations the day before hospitalization. Cerebrospinal fluid examination revealed moderate pleocytosis, and abdominal ultrasonography did not detect neoplasia. Orofacial dyskinesia, catatonia and central hypoventilation gradually developed despite medical intervention to ameliorate the symptoms. At 32 weeks of pregnancy, vaginal bleeding and hypotension occurred. Further, owing to septic shock due to fetal demise, the patient died. N‐methyl‐d‐aspartate antibody test results obtained after the patient's death were positive (2++). Currently, no consensus exists on the appropriate treatment and follow‐up for pregnant women with anti‐N‐methyl‐d‐aspartate receptor encephalitis; however, immunomodulators and teratoma resection may be helpful. Second line immunotherapy (rituximab, cyclophosphamide) and teratoma resection may be necessary in pregnant patients with high N‐methyl‐d‐aspartate receptor antibody titers and inadequate response to first‐line treatment.

This study has been presented in the 31 th Scientific Congress of Turkish Neurosurgical Society.

Postdural ponskiyon başağrısı (PDPB) kazara yapılan dural yırtığın en sık rastlanan komplikasyonudur. Tanısal semptomu ayağa kalkınca veya oturunca başlayan, yatınca düzelen postural baş ağrısıdır. Bu semptom, BOS göllenmesi sonucu BOS basınç veya volüm düşüklüğü ile ortaya çıkar. Ayağa kalkınca ağrıya duyarlı yapıların traksiyonu, intrakraniyal içeriğin şifti postural baş ağrısına yol açar. PDPB genellikle kendini sınırlayan, 2 hafta içinde kendiliğinden düzelen bir tablodur. Daha az sıklıkla epidural kan yamasına ihtiyaç duyulur. Spontan intrakraniyal hipotansiyonun tekrarlaması nadir değildir, ancak PDPH spontan ve geç dönemde rekürensi oldukça nadir rapor edilmiştir. Bu yazının amacı epidural kan yamasından sonra düzelip, 10 ay sonra postural baş ağrısı tekrarlayan olguyu tartışmaktır Anahtar sözcükler: Epidural kan yaması; post-dural ponksiyon baş ağrısı; rekürens.

Background/aim We aimed to determine in which cases this procedure may be more effective based on the data of patients who underwent decompressive hemicraniectomy (DHC). Material and methods Overall, 47 patients who underwent DHC due to acute middle cerebral artery (MCA) infarction between January 2014 and january 2019 were retrospectively investigated. These patients were divided into two groups: those who died after DHC (Group A) and those who survived DHC (Group B). The groups were compared in terms of various parameters. We investigated whether the patient’s modified Rankin scale (mRS) status changed depending on age (> 60 and < 60 years). Results The median age of all patients was 65 (37–80) years; groups A and B had median ages of 66.5 (37–80) and 61 (44–79) years (p = 0.111), respectively; 55.3% patients were male. The elapsed times until hospitalization after the onset of symptoms were 4.5 and 3 h in groups A and B, respectively (p = 0.014). The median GCS score at the time of admission was 7 (5–12) and 10 (8–14) in groups A and B, respectively (p = 0.0001). At the time of admission, 63.3% patients in group A had anisocoria, whereas no patient in group B had anisocoria (p = 0.0001). In postoperative period, 40% patients in group A and all patients in group B received AC/AA treatment. The survival of patients aged < 60 and > 60 years who underwent DHC for MCA infraction was 61.5% and 26.5%, respectively (p = 0,041). The median mRS of patients < 60 and > 60 years were 4 (1–6) and 6 (1–6), respectively (p = 0.018). Conclusion Age, DHC timing, and elapsed time until hospitalization or access to treatment directly affect the functional outcome and survival in MCA-infarcted patients who underwent DHC. In patients in whom the medical treatment fails, early DHC administration will increase survival without waiting for neurological worsening once herniation is detected radiologically.

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Background: Little is known about the profile of dermatological problems in patients hospitalized in neurology wards or neurological intensive care units (NICUs). In this study, we aimed to provide the demographic and clinical characteristics of inpatients admitted to the neurology ward or the NICU.Methods: This study was designed as a retrospective observational study. Medical records of patients who consulted with dermatology while they were hospitalized in the neurology ward or the NICU of our hospital, from January 2016 to June 2022, were reviewed retrospectively. Demographic and clinical characteristics of the patients were recorded.Results: A total of 106 patients, including 86 patients in the ward and 20 patients in the NICU, were included in the study. Forty-nine patients (46.2%) were female and 57 (53.8%) were male. The mean age was 58.47±18.84 years. The frequency of dermatology consultations was 1% overall. The most common causes of hospitalization were ischemic stroke (n=47), demyelinating diseases of the central nervous system (n=10), and encephalitis (n=7). The most common dermatological problems in patients were infectious dermatoses (n=25), drug eruptions (n=18), and physical dermatoses (n=18). While drug eruptions were encountered as a common problem in the neurology ward, physical dermatoses were a common problem in the NICU. Conclusion:The frequency of dermatology consultations requested from neurology for inpatients was low, especially in the NICU. Drug eruptions in the neurology ward and physical dermatoses in the NICU are encountered as common problems. Neurologists should pay attention to accompanying dermatological problems as well as neurological diseases. Large-scale prospective studies are needed for dermatological problems in patients hospitalized in the neurology clinic.