Occipital dural fistula presenting with hydrocephalus: A case reportIntroduction: Dural arteriovenous fistula (DAVF) is an abnormal vascular communication between branches of dural arteries and dural veins or venous sinuses. These fistulas are associated with hydrocephalus in 35% of cases in the pediatric population. However, the presence of hydrocephalus in adults is rare in DAVF. We presented a case report of DAFV accompany by hydrocephalus and was managed with endovascular therapy.Case presentation: A 15-year-old school girl presented with nausea and vomiting for two weeks. She had spastic paraparesis and cognitive impairment. Her mother had a history of cerebral arteriovenous malformation that was associated with hydrocephalus. Magnetic resonance imaging was further examined and revealed dilation of both lateral ventricular and hyperintensity on the periventricular area. Diagnostic angiography was performed which showed the presence of a dural fistula between occipital sinus and multi-side of Galen vein. Embolization with onyx was performed successfully. Conclusion: DAVF in our case was a rare condition with an atypical localization. Further study will be needed to describe this rare entity and to establish its true prevalence.
Traumatic brain injury (TBI) is often associated with an increase in the intracranial pressure (ICP). This increase in ICP can cross the physiological range and lead to a reduction in cerebral perfusion pressure (CPP) and the resultant cerebral blood flow (CBF). It is this reduction in the CBF that leads to the secondary damage to the neural parenchyma along with the physical axonal and neuronal damage caused by the mass effect. In certain cases, a surgical intervention may be required to either remove the mass lesion (hematoma of contusion evacuation) or provide more space to the insulted brain to expand (decompressive craniectomy). Whether or not a surgical intervention is performed, all these patients require some form of pharmaceutical antiedema agents to bring down the raised ICP. These agents have been broadly classified as colloids (e.g., mannitol, glycerol, urea) and crystalloids (e.g., hypertonic saline), and have been used since decades. Even though mannitol has been the workhorse for ICP reduction owing to its unique properties, crystalloids have been found to be the preferred agents, especially when long-term use is warranted. The safest and most widely used agent is hypertonic saline in various concentrations. Whatever be the concentration, hypertonic saline has created special interest among physicians owing to its additional property of immunomodulation and neuroprotection. In this review, we summarize and understand the various mechanism by which hypertonic saline exerts its immunomodulatory effects that helps in neuroprotection after TBI.
Harvey Cushing (1869-1939) considerado el fundador de la neurocirugía como especialidad en los Estados Unidos, fue uno de los grandes médicos del siglo XX. Además de su exitosa práctica clínica fue un pionero en la investigación y avances en diversos campos de la medicina (anestesiología, endocrinología, medicina basada en la evidencia, historia de la medicina y por supuesto neurocirugía). Era además un hombre de familia, padre de cinco hijos, deportista, dibujante y amante de la literatura y escritura.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.