Medical management for cerebellar mutism syndrome following posterior fossa surgery: A systematic review.

INTRODUCTION: Cerebellar mutism syndrome (CMS) is a serious complication of posterior fossa surgeries affecting mainly pediatric age group. The pathophysiology is still not fully understood. It adversely affects the recovery of patients. There is no definitive and standardized management for CMS. However pharmacological therapy has been used in reported cases with variable effectiveness. We aim through this review to summarize the available evidence on pharmacological agents used to treat CMS. METHOD: A thorough systematic review until December 2022, was conducted using PubMed Central, Embase, and Web of Science, databases to identify case reports and case series of CMS patients who underwent posterior fossa surgery and received pharmacological treatment. Patients with pathologies other than posterior fossa lesions were excluded from the study. RESULTS: Of 592 initial studies, 8 studies met our eligibility criteria for inclusion, with 3 more studies were added through manual search; reporting on 13 patients. The median age of 13 years (Standard deviation SD=10.60). The most frequent agent used was Bromocriptine. Other agents were fluoxetine, midazolam, zolpidem, and arpiprazole. Most patients recovered within 48 hours of initiating medical therapy. The median follow-up period was 4 months (SD=13.8). All patients showed complete recovery at the end of follow-up period. CONCLUSION: Cerebellar mutism syndrome is reported after posterior fossa surgeries, despite attempts to identify risk factors, pathophysiology, and management of CMS, it remains a challenging condition with significant morbidity. Different Pharmacological treatments have been proposed with promising results. Further studies and formalized clinical trials are needed to evaluate available options and their effectiveness.

Combined Preoperative Endovascular Embolization and Surgical Excision for Scalp Arteriovenous Malformations: A Systematic Review and Case Illustration.

OBJECTIVE: To evaluate the efficacy of the combined approach of preoperative endovascular embolization (EE) and surgical excision (SE) for scalp arteriovenous malformation (AVM) and present an illustrative case report. METHODS: A systematic review was conducted using online databases (PubMed/Medline, Cochrane, and Embase) on February 15, 2023. The inclusion criteria were any type of study of patients with scalp AVMs who were diagnosed and confirmed through angiography and treated with combined preoperative EE and SE. All the articles that met the inclusion criteria were included in this study. RESULTS: A total of 49 articles (91 patients) were included. The patients' age ranged from 10 days to 70 years at the time of presentation. The most common symptoms were a pulsatile mass in 51 patients (56.04%), progressively growing mass in 31 patients (34.06%), and bruits and/or thrills in 22 patients (24.17%). Complications of preoperative EE and SE were observed in only 5 patients; 3 patients (3.29%) had harvested skin graft marginal necrosis, 1 patient (1.09%) had skin necrosis, and 1 patient (1.09%) had a wound infection. Only 2 patients (2.19%) reported a recurrent or residual mass during a median follow-up period of 12 months. CONCLUSIONS: The management of scalp AVMs can be challenging; therefore, focused, and accurate identification of the complexity of the vascular anatomy is required. The combined method of preoperative EE and SE showed satisfactory outcomes with low rates of complications and recurrence; thus, we recommend this approach for the management of scalp AVMs.

Unexpected Recovery: A Report on the Spontaneous Regression of a Herniated Cervical Disc.

We describe a case in which a herniated cervical disc was compressing the spinal cord. Surgical treatment was offered based on the patient's symptoms and magnetic resonance imaging (MRI), but the patient declined. The patient's symptoms were relieved after 10 months of nonsurgical intervention, and a subsequent MRI revealed that the cervical disc herniation (CDH) had regressed. This phenomenon is well established in the lumbar region but remains rare in the cervical spine. We recommend opting for conservative management and frequent follow-ups for patients with CDH unless they present with a surgical urgency.

Intraparenchymal meningioma in the parieto-occipital region: A case report of a diagnostically challenging tumor.

Background: Intraparenchymal meningioma is a rare entity of one of the most common brain tumors. It is challenging to diagnose preoperatively due to the vague clinical presentation and absence of stereotypical radiological features. These atypical features might mislead the differential to favor high-grade gliomas or brain metastasis. Case Description: We describe a case of a 46-year-old male who presented with vertigo, right-sided sensorineural hearing loss, and bilateral blurred vision. Contrast-enhanced magnetic resonance imaging of the brain revealed a large parieto-occipital contrast-enhanced mass with a multi-loculated cystic component and diffusion restriction but without dural attachment. A gross total reaction was achieved, and the histopathological results yielded a World Health Organization Grade I meningioma diagnosis. The patient exhibited no signs of recurrence after 2 years of follow-up. Conclusion: Intraparenchymal meningiomas are difficult to identify without histopathological assessment. We emphasize the importance of considering this diagnosis when outlining an initial differential as it may direct management planning. Total surgical resection is the best treatment modality for such cases; however, radiotherapy is a valuable option. The prognosis of intraparenchymal meningiomas is generally favorable.

Melioidosis Pneumonia in Saudi Arabia: A Rare Case Report and Review of the Literature.

Melioidosis is a serious infection caused by the bacterium Burkholderia pseudomallei (B. pseudomallei) mostly found in endemic areas like Southeast Asia and Northern Australia. However, in non-endemic regions, such as Saudi Arabia, it remains somewhat rare and unknown to healthcare workers and the public. Herein, we present a case of melioidosis in a 59-year-old Bangladeshi man who presented with pneumonia. He recently returned from Bangladesh, was a known case of type 2 diabetes on metformin, and presented to the emergency department (ED) with a history of cough, shortness of breath, and fever for three weeks. He was initially misdiagnosed and treated as pulmonary tuberculosis in another hospital prior to his latest presentation. Melioidosis is a severe infection that can be misdiagnosed due to variable presentation and low awareness among healthcare workers of the disease. Diagnosis requires high clinical suspicion, especially in patients who are coming from endemic areas with appropriate risk factors such as diabetes mellitus. Treatment with appropriate antibiotics for a long duration, and outpatient follow-up is vital to reduce the risk of recurrence.

Childhood vaccination hesitancy in Saudi Arabia: A time for action.

OBJECTIVES: This study aims to assess the health care provider (HCP) perception and knowledge about vaccination and to determine the presence of hesitancy toward it. METHODS: An observational study on HCPs was conducted in King Abdullah Specialized Children's Hospital (KASCH), Saudi Arabia using a questionnaire. The HCPs were categorized as physicians, nurses, and allied health care specialists with total participants of 344. RESULTS: 24% expressed disagreement with the vaccination schedule required by the Saudi Ministry of Health and 17% expressed reluctance in recommending or receiving vaccines in general. There was an apparent reluctance toward the influenza vaccination among allied health care specialists compared to nurses and physicians (42.5% vs 6% vs 11.8% respectively, p = <0.0001). Furthermore, 6% of the HCPs stated they believe of a strong correlation between GBS and the seasonal influenza vaccine, and 8% expressed an association between measles vaccine and autism. Years of experience significantly implicated HCP perceived confidence in explaining vaccine safety and efficacy. HCPs with less experience expressed a lack of confidence in the matter compared to their colleagues with more experience (20.9% vs. 10.7%, respectively, p = 0.0262). CONCLUSIONS: HCPs' confidence in vaccination are essential in influencing their patients. Therefore, it is essential to improve the knowledge and awareness of vaccination among HCPs.

Ulnar Nerve Injury Following Open Carpal Tunnel Release: A Case Report.

Carpal tunnel syndrome (CTS) is one of the most common peripheral nerve diseases. It is managed medically and if not, resolved by surgical procedure. Decompression of the carpal tunnel is considered the definitive treatment. There are multiple complications after this procedure, which can be classified into three categories: (I) persistent, (II) recurrent, or (III) new symptoms, and ulnar nerve palsy after decompression of the carpal tunnel is a rare complication. In this study, we present a case of carpal tunnel decompression, which was complicated by ulnar nerve palsy, which exacerbated a pre-existing chronic ulnar nerve injury. We also explore the possible causes that may have led to this outcome.

Horace Wells and His House on 120 Chambers St in New York City.

On January 24, 1848, delirious from chloroform, Horace Wells rushed from his house and office on 120 Chambers St into the street and threw acid on 2 alleged prostitutes. He was arrested and committed to New York's infamous Tombs Prison (currently Manhattan Detention Complex), where he committed suicide. Remodeled and reconstructed, this house, 120 Chambers St, is still standing in Tribeca District.