Nonaneurysmal subarachnoid hemorrhage associated with COVID-19 infection: A case report.

Background: Most coronavirus disease 2019 (COVID-19)-related cerebrovascular disorders are ischemic while hemorrhagic disorders are rarely reported. Among these, subarachnoid hemorrhage (SAH) is very rarely reported and nonaneurysmal SAH has been reported in only about a dozen cases. Here, we report a case of nonaneurysmal SAH as the only clinical manifestation of COVID-19 infection. In addition, we reviewed and analyzed the literature data on cases of nonaneurysmal SAH caused by COVID-19 infection. Case Description: A 50-year-old woman presented to an emergency department with a sudden headache, right hemiparesis, and consciousness disturbance. At that time, no fever or respiratory failure was observed. Laboratory data were within normal values but the rapid antigen test for COVID-19 on admission was positive, resulting in a diagnosis of COVID-19 infection. Computed tomograms (CTs) showed bilateral convexal SAH with a hematoma but three-dimensional CT angiograms showed no obvious sources, such as a cerebral aneurysm. Therefore, the patient was diagnosed with nonaneurysmal SAH associated with COVID-19 infection. With conservative treatment, consciousness level and hemiparesis both improved gradually until transfer for continued rehabilitation. Approximately 12 weeks after onset, the patient was discharged with only mild cognitive impairment. During the entire course of the disease, the headache, hemiparesis, and mild cognitive impairment due to nonaneurysmal SAH with small hematoma were the only abnormalities experienced. Conclusion: Since COVID-19 infection can cause nonaneurysmal hemorrhaging, it should be considered (even in the absence of characteristic infectious or respiratory symptoms of COVID-19) when atypical hemorrhage distribution is seen as in our case.

Simultaneous intracerebral and subarachnoid hemorrhages caused by multiple infectious intracranial aneurysms treated endovascularly and by microsurgical clipping: illustrative case.

BACKGROUND: Infected intracranial aneurysms are relatively rare but tend to occur in multiple locations. Establishing an optimal treatment strategy for multiple ruptured aneurysms is often challenging, especially when simultaneous ruptures occur in different locations. We report a case of simultaneous intracerebral and subarachnoid hemorrhages caused by the rupture of multiple infected intracranial aneurysms. OBSERVATIONS: A 23-year-old male with a 2-week history of chronic fever presented with sudden onset of severe headache and visual disturbance. Computed tomography showed intracerebral hemorrhage in the right occipital lobe and subarachnoid hemorrhage in the area of the left Sylvian fissure. Further investigation documented Staphylococcus bacteremia, verrucae on the mitral valve, and aneurysms arising from the right posterior cerebral artery (PCA) and the left middle cerebral artery (MCA). A larger aneurysm arising from the PCA was successfully occluded endovascularly, but subsequent endovascular occlusion of the MCA aneurysm was unsuccessful because some important branches were observed extending from the aneurysm. The left MCA aneurysm was then obliterated by angioplastic clipping via left pterional craniotomy. The patient showed a favorable neurological recovery after treatment. LESSONS: In such complex cases of infectious aneurysms, the method and timing of treatment need to be carefully determined based on the medical condition.

Spontaneous regression of a posterior fossa meningioma: A case report.

Background: Since most incidentally discovered meningiomas grow or remain unchanged, spontaneous regression is extremely rare. Here, we report a case of posterior fossa meningioma showing spontaneous regression. Case Description: A 55-year-old female was referred to our hospital because she was diagnosed with a left posterior fossa meningioma (diameter: 1.6 cm) during a brain check-up. The patient was followed up on periodic magnetic resonance imaging studies. Tumor size remained almost unchanged for 2 years but then began to regress. Twelve years after the initial examination, the tumor diameter idiopathically decreased from 1.6 cm to 1.1 cm while the tumor volume decreased from 2.3 cm3 to 0.5 cm3 (about 1/4th the original size). Postmenopausal hormonal imbalances may have been associated with the observed spontaneous regression. Conclusion: Understanding the natural history of meningiomas is essential for a better selection of treatment approaches or appropriate follow-up. This case may provide new insights into the progression of meningiomas.

Brainstem anesthesia during removal operation of ventriculoperitoneal shunt - A case report.

Background: Brainstem anesthesia is a transient loss of brainstem function usually associated with retrobulbar block and rarely seen by neurosurgeons. Case Description: Here, we report a case of brainstem anesthesia during shunt revision operation in a 79-year-old woman. Local anesthesia administered at the end of surgery was thought to have infiltrated the subarachnoid space through a burr hole, causing prolonged unconsciousness and cranial nerves' impairment. Spontaneous resolution occurred during systemic support. Conclusion: As brainstem anesthesia may occur by leakage of local anesthetic through small burr holes, timing injections carefully can avoid this rare complication.

Emergent carotid artery stenting for cervical internal carotid artery injury during carotid endarterectomy: A case report.

BACKGROUND: Carotid endarterectomy (CEA) has been the standard preventive procedure for cerebral infarction due to cervical internal carotid artery stenosis, and internal shunt insertion during CEA is widely accepted. However, troubleshooting knowledge is essential because potentially life-threatening complications can occur. Herein, we report a case of cervical internal carotid artery injury caused by the insertion of a shunt device during CEA. CASE DESCRIPTION: A 78-year-old man with a history of hypertension, diabetes, and hyperuricemia developed temporary left hemiplegia. A former physician had diagnosed the patient with a transient cerebral ischemic attack. The patient's medical history was significant for the right internal carotid artery stenosis, which was severe due to a vulnerable plaque. We performed CEA to remove the plaque; however, there was active bleeding in the distal carotid artery of the cervical region after we removed the shunt tube. Hemostasis was achieved through compression using a cotton piece. Intraoperative digital subtraction angiography (DSA) revealed severe stenosis at the internal carotid artery distal to the injury site due to hematoma compression. The patient underwent urgent carotid artery stenting and had two carotid artery stents superimposed on the injury site. On DSA, extravascular pooling of contrast media decreased on postoperative day (POD) 1 and then disappeared on POD 14. The patient was discharged home without sequela on POD 21. CONCLUSION: In the case of cervical internal carotid artery injury during CEA, hemostasis can be achieved by superimposing a carotid artery stent on the injury site, which is considered an acceptable troubleshooting technique.

Solving the Challenge of the Severely Compromised Implant in the Esthetic Zone: An Interdisciplinary Care Case.

Considered to be an excellent treatment option for the replacement of lost or missing teeth, dental implants can dramatically improve a patient's quality of life. Patient selection, clinical skill, and maintenance are all factors that can significantly affect outcome. This case report highlights problems encountered in what many would consider to be a straightforward case: extraction of a fractured root, implant placement, and restoration in an otherwise dentally and medically fit and healthy patient. The report exposes some of the issues that could potentially result in what could be deemed an implant catastrophe and then explores possible treatment options to help rectify the failures. Finally, the authors describe the treatment provided--a periodontal-prosthodontic solution--and report on the 4-year post-treatment follow-up.

An introduction to the implant crown with an esthetic adhesive margin (ICEAM).

UNLABELLED: This article describes a novel technique with the addition of a pressed porcelain abutment margin capable of bonding to the porcelain margin of an implant crown restoration. This allows for supragingival margin placement, reduces the potential effect of excess cement-induced peri-implant disease, and provides a controlled environment for the bonding process. Another advantage is the matching esthetics of the crown and supporting abutment, which in the event gingival recession occurs, the restoration appears as a longer tooth without the risk of exposing an underlying abutment margin with different esthetic properties. CLINICAL SIGNIFICANCE: The transition margin from an implant abutment to a crown is challenging to manage especially esthetically. Placing the abutment margin in a subgingival position helps hide the unesthetic transition, however, this reduces the ability to clean excess cement, increases the risk of peri-implant disease and the inability to control gingival sulcular fluids may affect the cement bond. The implant crown with an esthetic adhesive margin provides for supragingival bonded margins that can aid in complete removal of excess cement at the same time providing an esthetically pleasing result.

Ridge Width Alteration After Implant Placement Into the Fresh Extraction Socket With Deproteinized Bovine Bone Mineral and Acellular Dermal Matrix.

INTRODUCTION: Immediate implant placement into a fresh extraction socket in an esthetic zone can be challenging because a reduction in ridge width after healing will result in gingival asymmetry. CASE SERIES: In this case series, 17 consecutively treated patients with 19 immediately placed implants between maxillary second bicuspids were included. Only sites with an intact facial plate were included. If dehiscence or fenestration was found on the facial plate during extraction, the site was excluded. The implant was placed toward the palatal side, allowing a ≥2 mm gap between the implant body and the facial plate. This gap was grafted with deproteinized bovine bone mineral (DBBM). Sharp dissection and grafting using acellular dermal matrix (ADM) were performed on the facial side. A custom-made healing abutment was connected to the implant and allowed to heal for 3 months. Preoperative and 3-month postoperative models were used to measure the alteration in the ridge width at 2 and 5 mm from the preoperative gingival margin at the midfacial point. All implants healed without complications and integrated appropriately. Measurement comparison showed a 0.1 mm reduction and a 0.5 mm increase in the ridge width at the 2- and 5-mm positions, respectively. Biotype did not make difference in the outcome. CONCLUSION: This case series demonstrates that, when DBBM and ADM were used during immediate implant placement into an intact extraction socket, minimal to no alteration in the ridge width was observed after 3 months of healing.