Idiopathic spontaneous bilateral subdural hematoma in a 28-year-old male: A comprehensive literature review and case report.

Background: Subdural hematoma (SDH) is considered spontaneous in the absence of trauma history. It is a common presentation in the geriatric age group due to the many influential factors. Most cases have a known underlying etiology that explains the incidence, otherwise, they are considered idiopathic. We present a rare case report of idiopathic nontraumatic bilateral SDH with a literature review of similar cases. Case Description: A 28-year-old fit individual presented to the Emergency Department with a chronic history of severe headache and neck pain, associated with behavioral changes in the last 2 days. He reported that his symptoms started after lifting a heavy object 2 months ago; however, they became worse after a neck chiropractor therapy session. He is not on any chronic medications, and there was a negative history of trauma, seizure, hematological diseases, family history of neurological conditions, smoking, alcohol, or drug abuse with an unremarkable systemic review. A brain computerized tomography (CT) showed bilateral SDHs, for which he underwent bilateral mini craniotomies and drainage. The symptoms improved after surgery and the follow-up brain CT showed no recurrence. Conclusion: Idiopathic spontaneous bilateral SDH in the adult age group is an extremely rare pathology and the literature review only revealed three similar cases. With the absence of any pathology that would explain the presentation after extensive investigations, we hypothesized that a sudden rise in vascular pressure was the underlying etiology, especially with the fact that the symptoms became unbearable after the neck chiropractor therapy session.

Incidental and Clinical Significance of Slit Ventricles in Fixed Pressure Valves.

INTRODUCTION: Slit ventricle syndrome (SVS) is a recognized delayed complication of cerebrospinal fluid (CSF) shunting in children. It had been linked to the use of low-pressure shunts and considered an argument for the use of programmable valves. In this study, we aim to assess the rate of SVS in children that were shunted using fixed-pressure valves. METHODOLOGY: This study is a retrospective cohort study that occurred in King Abdulaziz Medical City, Jeddah, which reviews 100 patients with a median age of 15.5 months that were shunted by using fixed pressure valves during the period from 2010 to 2018. Fixed low-pressure valves were used in 69% of patients, while fixed medium-pressure valves were used in 31% of patients. SVS was defined by the presence of slit-like ventricles (fronto-occipital [F-O] horns ratio was ≤ 0.2 on any post-shunt CT scan) and the occurrence of slit-like ventricle-related symptoms (chronic headache, nausea, vomiting, and altered conscious level_ in the absence of other causes of shunt malfunction. RESULTS: The overall SVS rate in the cohort was 6%. Nine children had slit-like ventricles, but only six of them were symptomatic. Relatively higher SVS rates were observed in younger male children, obstructive hydrocephalus, and medium-pressure valves. Slit-like ventricle-related symptoms in the absence of a slit-like ventricle were reported in 24 out of 91 (26%) patients. A total of 42 patients underwent shunt revisions for other complications. All SVS patients were treated conservatively. There was a temporal fluctuation in the F-O horns ratio and in some patients with SVS their F-O horns ratio returned to normal at further follow-up without intervention. CONCLUSIONS: The overall SVS rate following the use of fixed-pressure CSF valves in children is low and managed conservatively. Not all patients with slit-like ventricles are symptomatic and the radiological appearance of SVS may improve on further follow-up without intervention. Fixed pressure valves remain an acceptable device in the treatment of hydrocephalus in children.

Factors affecting the choice of becoming a neurosurgeon in the western region of Saudi Arabia.

Background: The preference of medical specialty for students can start even before enrollment into medical school, or as late as following their graduation. During their senior years, students often get a prospective on the working environment and the difficulties faced in the field. This, along with other factors, can strongly alter their career choice. This study aims to explore the degree of interest in neurosurgical specialty among medical students and the factors influencing their choice of becoming a neurosurgeon in the western region of Saudi Arabia. Methods: This is a cross-sectional study which was done across three universities of the western region of Saudi Arabia including King Saud bin Abdulaziz University for Health Sciences, Umm Al Qura University, and King Abdulaziz University. Results: A sample of 1023 students from the second medical year up to the internship was conducted, and out of them, 585 (57.2%) were males and 438 (42.8%) were females. Three hundred and fifty-nine (35.1%) of the students were interested in neurosurgery, while 664 (64.9%) were not. The data show that females have more interest (40.8% of females) compared to males (35.1% of males). Furthermore, there was a general trend toward a decrease in the interest in neurosurgery with time. The impact on patients "rewarding feeling" was the most reported attraction to the specialty, followed by income. Stress was the most reported deterring factor among students. Neurosurgery is one of the most challenging specialties, yet it is still considered one of the most competitive ones. Conclusion: Many factors have been found to influence medical students' choices to apply for neurosurgical training as we described. Interestingly, we noted higher interest among female students, and among college freshmen compared to their counterparts. Further studies should be conducted on a larger scale to analyze these findings.

Cervical Spinal Cord Ischemic Reperfusion Injury: A Comprehensive Narrative Review of the Literature and Case Presentation.

Cervical spinal ischemic reperfusion injury (CSIRI) refers to a state of sudden neurological deterioration after surgical spinal decompression. The CSCIRI refers to a state of sudden neurological deterioration after surgical spinal decompression. The pathophysiology is hypothesized to be due to instant relief of a chronically compressed spinal cord, leading to an inflammatory cascade named ischemic reperfusion injury. Deterioration of neurological function after cervical spine decompression surgery often occurs secondary to direct cord injury, compressing hematoma, or hardware failure. Complete loss of neurological function with no organic explanation is an extremely rare complication, with only a few cases reported in the literature. We are reporting a 67-year-old male patient diagnosed with severe cervical spinal canal stenosis at level C5/6 who underwent anterior cervical discectomy and fusion (ACDF). The patient developed complete transient loss of neurological functions after the surgery and was labeled as a case of CSCIRI after excluding compressing pathology. A literature review of the CSCIRI was carried out, and ten articles were included. Due to the rarity of these cases, there is no class 1 or 2 evidence to establish management protocol nor identifiable risk factors to predict their occurrence. However, we recommend using an intra-operative neurophysiology monitor in cases with long-standing severe cervical canal stenosis with myelomalacia and managing these cases according to the acute spinal cord injury management protocol after excluding compressing pathologies.

Attrition and Success Rates in the Saudi Board of Neurosurgery: Analysis of 115 Consecutive Residents Who Started Training From 2001 to 2014.

Objectives At present, the literature lacks data on the outcome of neurosurgery training programs in the Middle East. In this study we aim to assess the attrition, completion of training and success rates in the Saudi Board of Neurosurgery (SBNS). Methods A cohort of 115 trainees who started SBNS training during 2001-2014 was reviewed. The outcome was the rate of attrition, completion of training, and success in the final examination of the SBNS. Results Attrition rate was 29% (14% to neurosurgery training elsewhere and 15% to non-neurosurgery). Completion of training rate was 71%. Success in the final examination rate was 74% (60% on the first attempt). Attrition rate was significantly influenced by being sponsored by University Hospitals. Success rate was impacted positively by being sponsored by King Fahad Medical City and negatively by Ministry of Health Hospitals. Trainees who started during 2011-2014 had a significantly better success rate in the final examination. Conclusions SBNS attrition rate was high due to access to training opportunities abroad, particularly for university-sponsored trainees. Success rate in the final examination was considered comparable to some other neurosurgical qualifications. The first attempt pass rate was significantly impacted by being sponsored by certain hospitals. Factors contributing to attrition and failure should be identified and addressed during the selection process and during training.

The Impact of Country Self-Citation Rate Among Medical Specialties in Saudi Arabia.

Objectives The purpose of the study was to evaluate the impact of country self-citation rate (SCR) among medical specialties in Saudi Arabia, and to assess the impact of self-citations on the country's total cites world ranking in different specialties. Methods SCImago Journal & Country Rank (SJR) was used to collect data related to all medical specialties in Saudi Arabia for the period 1996-2019. The country SCR for the specialties was correlated with several bibliometric parameters and examined statistically. The specialties that showed a drop in Saudi Arabia's total cites world ranking following the exclusion of self-citations were identified. Results The median country SCR for 46 specialties in Saudi Arabia was 9.5% (range: 4.6-23.1%). The two specialties with the highest country SCR were Public Health (23.1%) and Family Practice (22.9%). Country SCR was significantly higher in the non-clinical specialties compared to clinical specialties (15.3% vs. 9.6%). It did not correlate significantly with any of the examined productivity indices. The exclusion of self-citations resulted in a drop in Saudi Arabia's total cites world ranking in six (13%) specialties only. There was no significant difference between the country's total cites and net total cites world rankings in the specialties. Conclusions Self-citation may be appropriate and signify an expansion of the authors' previous work. Country SCR in medical specialties in Saudi Arabia is relatively low and not affected by total documents and total cites. Non-clinical specialties tend to self-cite more. The exclusion of self-citations had minimal effect on Saudi Arabia's total cites world ranking, indicating that country SCR in the specialties is unlikely to impact its international scientific standing. Our findings do not support the argument for eliminating self-citation from citation-based metrics. We believe that more collaborative and global research practices should be encouraged.

De novo Craniopharyngioma of the Fourth Ventricle: Case Report and Review of Literature.

Craniopharyngiomas usually involve the sella and suprasellar space. Their occurrence in the posterior fossa without extension to the suprasellar region is uncommon with only 16 cases reported in the literature. We report a case of a primary posterior fossa craniopharyngioma that was managed by complete excision with a good recovery. Our case was unique in that the craniopharyngioma occurred in the fourth ventricle and extended downward to the level of C1, a manifestation that was reported only twice in the past. The literature on the topic is reviewed.

Posterior Reversible Encephalopathy Syndrome: Local Experience From Saudi Arabia.

OBJECTIVES: Posterior reversible encephalopathy syndrome (PRES) is a clinicoradiological syndrome characterized by headache, altered mental status, seizures, or loss of vision. In this study, we report the largest series of PRES coming from Saudi Arabia and explore the etiology, clinical presentation, and outcome. We also report new imaging findings associated with this condition. METHODS: We performed a retrospective study of all cases of PRES admitted to King Abdulaziz Medical City, Jeddah, Saudi Arabia, between the years 2005 and 2015. A neurologist reviewed all charts and analyzed the clinical presentations, etiological factors, and outcomes, and a neuroradiologist reviewed the imaging studies. Only patients with clinical and imaging features consistent with PRES were included in the study. RESULTS: We collected 31 patients who had clinical and radiological features consistent with PRES. Females were more affected than males (18 females and 13 males), and patients' age ranged from 6 to 95 years, with a mean of 38.3 years. Patients were treated by removing the precipitating causes and treating the underlying conditions. Resolution of neurologic signs occurred within 2 to 3 weeks in all patients. CONCLUSION: In our opinion, PRES itself is usually a benign condition with complete recovery if the condition is recognized early and managed appropriately. Although clinical signs are nonspecific, the constellation of symptoms including headache, visual problems, seizures, and altered level of consciousness should suggest the possibility of PRES, especially in high-risk group. Abnormalities on magnetic resonance imaging are often characteristic and may be the first clue to the diagnosis.