Acute hemorrhagic leukoencephalitis following the first dose of BNT162b2 vaccine against SARS-CoV-2: A case report.

Acute hemorrhagic leukoencephalitis (AHLE), is a rare inflammatory demyelinating disorder, variant of acute disseminated encephalomyelitis. The diagnosis of AHLE remains challenging due to the rarity of the disease and the lack of a reliable biomarker. We report here a case of a 73-year-old male patient with a progressive, low-grade febrile confusional syndrome 20 days after receiving the first dose of BNT162b2 vaccine against SARS-CoV-2. Evidence indicative of the underlying condition by an extensive panel of imaging (brain magnetic resonance imaging, computed tomography and digital subtraction angiography), laboratory (complete blood count, biochemistry, coagulation, tests for autoimmune or infectious disorders, tumor markers, hormonal levels, cerebrospinal fluid analysis) and electrodiagnostic tests were scarce, and mainly non-specific. Sequential neuroimaging revealed the appearance of extensive T2 lesions (signs of gliosis) along with multiple hemorrhagic lesions at various cortical sites. The patient was treated with corticosteroids, discontinued due to severe adverse effects, and subsequently with sessions of plasmapheresis and monthly intravenous administration of cyclophosphamide. Considering the rapid aggravation of the patient's neurological status, the MRI findings of cortical lesions and the lack of response to any treatment, a biopsy of a frontal lobe lesion was conducted, confirming the presence of confluent, inflammatory-edematous lesions with scattered areas of necrosis and hemorrhage, and ultimately areas of demyelination, thus confirming the diagnosis of AHLE. After more than 5 months of hospitalization the patient was transferred in a primary care facility and remained in a permanent vegetative state until his death, more than 2 years later.

Sphenoid wing meningioma and glioblastoma multiforme in collision - case report and review of the literature.

The coexistence of two histologically different primary tumours in the same brain region is relatively rare. The situation where these tumours in collision appear in an area of a previously excised meningioma is even more rare and only two cases have been reported so far. We present the third case of a 73-year-old woman who underwent an uneventful excision of a right sphenoid wing meningioma. She was re-admitted 3 years later due to reappearance of a tumour in the area adjacent to the previously excised meningioma. Histological diagnosis revealed a collision tumour of a glioblastoma multiforme and a fibrillary meningioma. The coincidence of these two different neoplasms in the same location at the same time 3 years after surgical removal of a meningioma leads us to speculate on the pathogenesis, and to review the literature regarding this particular issue.

The "hanging technique" of vascular transposition in microvascular decompression for trigeminal neuralgia: technical report of four cases.

The successful long-term outcome of microvascular decompression for trigeminal neuralgia is largely dependent on the maintenance of the isolation between the trigeminal nerve and the offending vessel, avoiding also the development of scar tissue around the nerve. We propose an alternative technique to achieve this target by "hanging" the offending vessel from the overlying tentorium using a strip of autologous tissue without interposing any foreign material.