An Approach for Cognitive Evaluation and Management of Grade 5 Arteriovenous Malformation-Associated Thalamic Dementia: A Case Report and Literature Review.

The clinical approach to managing high-grade arteriovenous malformations (AVMs) has been challenging due to its various presentations, surgical risk of complications, and impact on patients' quality of life. We report a case of a 57-year-old female who experienced recurrent seizures and progressive cognitive decline secondary to a grade 5 cerebellar AVM. We reviewed the patient's presentation and clinical course. We also searched the literature for studies, reviews, and case reports involving the management of high-grade AVMs. We outline our recommendations on how to approach these cases after a review of the currently available treatment options.

Topiramate-Induced Coma in a 39-Year-Old Female Patient: Burst Suppression on EEG.

Reported cases of topiramate ingestion resulting in coma and generalized convulsive status epilepticus are very rare. Such a phenomenon of a relatively safe antiepileptic drug (AED) causing serious neurological compromise should be carefully reviewed. A 39-year-old female with a history of uncontrolled epilepsy, migraine headaches, hypothyroidism, obsessive-convulsive disorder, and depression presented with generalized tonic-clonic seizures that progressed to status epilepticus and coma thereafter. She was intubated due to a depressed level of consciousness and transferred afterward to our hospital. Electroencephalography (EEG) demonstrated a burst suppression pattern without receiving any sedating agents. The level of consciousness improved on the fourth day, and she achieved complete neurological recovery by the sixth day of hospitalization. She was offered AEDs and supportive therapy during her admission. Upon further investigation into the cause of her seizures, it was discovered that she had ingested a large dose of topiramate in a suicide attempt.

Understanding the Radial Force of Stroke Thrombectomy Devices to Minimize Vessel Wall Injury: Mechanical Bench Testing of the Radial Force Generated by a Novel Braided Thrombectomy Assist Device Compared to Laser-Cut Stent Retrievers in Simulated MCA Vessel Diameters.

BACKGROUND: Recent reports have raised various concerns about the risk of vessel wall injury while withdrawing current laser-cut stent retrievers during active strut apposition to the vessel walls. The development of braided thrombectomy assist devices in conjunction with aspiration systems may be gentler on the fragile brain vessels and more optimized with regard to the radial force (RF) for vessel diameters of proximal (M1) and distal (M2) large vessel occlusions (LVOs). METHODS: Mechanical bench testing of the RF was performed using a radial compression station mounted on a tensile testing machine. The total RF in newtons (N) generated in vessels with diameters ranging from 2.25 to 3 mm as seen in proximal LVOs (∼M1), and in vessel diameters ranging from 1.5 to 2.24 mm as seen in distal LVOs (∼M2), was measured. The outer diameter of each stent was recorded, and an RF ≤1 N was grouped as "low," while an RF >1 N was grouped as "high" for this analysis. RESULTS: The total RFs of all laser-cut stent retrievers were all higher in the simulated M2 vessels (>1 N) than in the M1 vessels (<1 N), whereas the total RFs of the braided thrombectomy assist devices were uniformly low in both the simulated M1 and the simulated M2 vessels. CONCLUSIONS: Novel braided thrombectomy assist devices in conjunction with aspiration systems have lower RFs than existing laser-cut stent retrievers in M1 and M2 vessel diameters. Further in vivo studies are needed to delineate the impact of lowering the RF on vessel wall integrity.

Adnexal masses in pregnancy: An updated review.

Adnexal masses in pregnancy are not commonly encountered. The majority of these masses are discovered incidentally during routine follow-up. However, some of these masses become symptomatic due to their size, location, and impingement of adjacent structures. Several diagnostic modalities can be utilized for the detection of adnexal masses with different sensitivity and specificity rates. The differential diagnosis of adnexal masses discovered during pregnancy is broad and includes both benign and malignant lesions. The management of such lesions has been a subject of debate for years with no consensus regarding the best management plan. Tumor size, site, and the trimester of mass detection are all crucial in management. In this account, we review adnexal masses discovered in pregnancy, the diagnostic modalities utilized for detecting these lesions, their differential diagnosis, and management strategies.