Decision making in managing intracranial artereovenous malformation emphasizing the application of specific grading system for each therapeutic modality

Intracranial AVM comprise a heterogeneous group of lesions, the management of which depends on a clear understanding of the anatomy, patho-physiology, natural history, and expected results of various treatment modalities. The close cooperation between members of a multidisciplinary team, consisting of vascular / endo vascular neurosurgeon, interventional neuroradiologist, neuroanaesthesiologist, and radiation therapist, gives the best results. The goal of treatment of AVM is to remove the risk of future hemorrhage. The different treatment modalities include microsurgical excision, endovascular obliteration, and stereotactic radiosurgery, are applied separately or in various combinations. The best option for any individual patient depends on the angioarchitecture, the clinical status, and the technical expertise of the multidisciplinary team. In cases in which cure is impossible, palliation is sometimes a reasonable objective for symptomatic AVM. As the risk of early rebleeding is much lower than in cases harboring arterial aneurysm, converting an acute emergency case into a routine case, when possible, gives the neurosurgeon time to study fully the characteristics of the A VM in each specific patient. The author has reported previously on new grading system specifically applied to endovascular options to predict safety and feasibility of the procedure. This article reviews and discusses the different therapeutic modalities available for the management of arteriovenous malformation, their cones and pros

Prognosis of severe head injury in shaken-impact baby syndrome

shaken-impact baby syndrome is known in the literature to be related to child abuse. In some cultures relative "vigorous" playing with the child, such as throwing high in the air and catching back repeatedly, may result in a condition similar to that of a maltreated child. Recognition and management of maltreated children by the physician demands a full measure of clinical acumen, skill and diplomacy. this is a retrospective study of patients in a childhood age group who sustained severe head injury secondary to malhandling seen between 1992 and 2002. The age, sex, neurological status, nervous and general systems involvement, treatment and outcome are analysed. 236 children below the age of 16 years with severe head injury were identified. Among these, four children were diagnosed as having shaken-impact baby syndrome. The patients' age ranged between two and eight months. Two patients were males and two females. All patients had subdural haematoma, ranging from acute to subacute stage. Two patients had retinal haemorrhages. All patients discharged with Glasgow coma score of 15. children with head injury due to a vague history have to be considered as a malhandled patient and the family status should be considered. Understanding the problem of child maltreatment is different from one community to another. The prognosis is good if the condition is discovered early and managed promptly

Tuberculoma of the optic nerve

This is a case of 50 year-old Saudi lady complaining of progressive loss of vision in both eyes, associated with a constant, steady headache. She was referred to King Fahd Hospital of the University for evaluation. A computed tomography scan and magnetic resonance imaging were done and a craniotomy was planned. A biopsy from the left optic nerve showed evidence of a granulomatous lesion, which proved to be tuberculosis. In this report, we discuss the clinical and pathological findings in a case of tuberculosis of the optic nerve. A review of the literature indicates that this is the first report of its kind from this area. With the resurgence of tuberculosis throughout the world, this rare aetiology as a cause of visual loss should be kept in mind

Forestier's disease causing dysphagia

Forestier's disease, diffuse idiopathic skeletal hyperostosis [DISH] is an ossifying diathesis of unknown aetiology. Dish is characterised by flowing ossification along the anterior and anterolateral aspects of at least four contiguous vertebrae, radiolucent line between the deposited bone and the anterior vertebral surface, preserved intervertebral disc height, absence of bony ankylosis of the posterior spinal facet joints, and without erosion, sclerosis or bony ankylosis of the sacroiliac joints. Although Forestier's disease has been reported in 6-12% of autopsy cases, clinical presentation is rare and consists mostly of swallowing disorders. Most of these patients are treated conservatively in the initial stages and later by excision of the osteophytes. Most of the cases have been reported by otolaryngologists and orthopaedists. As the subject is not common in the neurosurgical literature, we report a case of Forestier's disease with progressive dysphagia and review of the literature