EXTENSIVE PERITUMORAL BRAIN EDEMA IN A SMALL CLINOIDAL MENINGIOMA: CLINICAL CASE.

Peritumoral brain edema (PTBE) is seen in 40-78% of all cases of intracranial meningiomas. It may vary in shape and size, occasionally being two to three times larger than the tumor. We present a case of a 62-year-old female patient, suffering from seizure and progressive headache. She was diagnosed with left medial sphenoid wing meningioma and referred for treatment to Uzhhorod Regional Center of Neurosurgery and Neurology. The patient had no major focal neurological deficit and Karnofsky Performance Scale (KPS) of 70 on admission. The preoperative magnetic resonance imaging (MRI) with and without contrast showed a 2.1×2.2×2.5 cm solid mass at the inner third of the left sphenoid wing, with homogenous enhancement and encasement of middle cerebral artery (MCA). In addition, there was a disproportionately extensive PTBE in the left cerebral hemisphere that caused midline shift and mass effect. The patient underwent left pterional craniotomy and gross total resection of the mass. The postoperative course was without complications or new neurological deficit, MRI within 48 hours revealed gross total tumour resection with residual brain edema and the patient was discharged with a KPS of 80 on day 7. Based on several studies, significant correlation between PTBE and tumor volume was observed: larger tumors cause larger PTBE. This particular case had a very large hemispheric PTBE, which was disproportionate to the small size of the meningioma. Most likely, the PTBE in this patient was caused by venous congestion, but this had no influence on surgical outcome. Therefore, the presence of a large PTBE does not necessarily indicate a poor prognosis and isn't always the reason of surgical complications.

Epilepsy after ishemic stroke: is it worth administering anticonvulsants after the first attack?

OBJECTIVE: Introduction: Epileptic attacks frequency in patients after stroke ranges widely from 3 % up to 60 %. Today many aspects of this problem in post-stroke epilepsy haven't been completely studied, regarding the problem of the time for administering antiepileptic drugs (AEDs). The aim of this study was to define the prognosis of symptomatic epilepsy development after stroke depending on the patients taking AEDs after the first epileptic attack. PATIENTS AND METHODS: Materials and methods: We perform a complex examination of 1012 patients (562 males and 450 females) aged from 49 up to 90 who had suffered from ischemic stroke during 2011-2014. Neurologic examinations were carried out according to the conventional methods scaling score NIHSS (National Institute of Health Scale of Stroke Severity, USA). RESULTS: Results: It was revealed that within 6 months after the ischemic stroke at least one epileptic attack was observed in 151 patients. According to the type of attacks focal attacks (80.9%, p<0.001) prevailed, and only in 11.1% initially generalized epileptic attacks were diagnosed. In the first patients group who took anticonvulsants during one year repeated epileptic attacks were revealed in 27.1% of patients while in the other group where there was no treatment with anticonvulsants during a year repeated attacks were observed in 53.75% patients. CONCLUSION: Conclusions: Obtained results are the basis for further investigations and possible recommended administration of AEDs just after the first epileptic attack in the patients after stroke.