Extensive Type A Aortic Arterial Dissection Presenting With Stroke Symptoms: A Case Report.

Aortic dissection (AD) is a rare but often lethal condition if not properly and urgently treated. Most often, patients arrive with acute hemodynamic instability and ripping chest agony. The patient's life depends critically on a correct diagnosis made as soon as possible. We describe a 60-year-old man who arrived at the emergency room with symptoms of a brain stroke, including poor consciousness, left-sided weakness, and speech disturbance associated with hemodynamic instability, and chest pain. Thoracic aortic arch dissection was observed on CT angiography (CTA). In addition, CTA revealed that the dissection extends proximally into the left common carotid artery, left subclavian artery, brachiocephalic trunk, and right common carotid artery and distally to the left common iliac artery, coupled with significant stenosis of the left common iliac artery. Proper management of blood pressure (BP) parameters is life-saving for the patient. Since our hospital did not offer cardiothoracic surgery services, the patient was transferred to a different institution, where he received medical care immediately from an expert team and had surgery.

Scrotal migration of a ventriculoperitoneal shunt in an adult. A case report and literature review.

Introduction: Scrotal migration of a ventriculoperitoneal shunt (VPS) catheter is a rare complication of VPS. Scrotal migrations usually manifest in the first year post-operatively, usually in the pediatric population, due to processus vaginalis patency and increased abdominal pressure. Research question: To review cases of scrotal migration of a VPS catheter that occur in the adult population, and its recommended management. Material and methods: A case report and review of the literature. Results: A 75-year-old male with a ventriculoperitoneal shunt for normal pressure hydrocephalus, presented with testicular swelling. Imaging revealed that the distal shunt catheter had migrated into his scrotum. He required an emergency shunt revision, with a truncation of the catheter, and involvement of the general surgical team for hernia management. He remained well at one year follow-up. Discussion and conclusion: To the best of our knowledge, this is the fifth case in an adult. This case serves as a reminder to take a thorough clinical history, imaging of the entire VPS pathway, and to consider unusual reasons for VPS failures. Emergency intervention for distal shunt revision is required to prevent further neurological or urological morbidity. Treatment includes not only catheter revision and reinsertion, but the catheter should be truncated, to avoid testicular migration recurrence. Hernia repair can be done either as an emergency or elective case, depending on the patient's clinical status and presentation.

Human Immunodeficiency Virus in Adults Undergoing Surgery for Brain Tumors.

Introduction Early diagnosis and treatment of human immunodeficiency virus (HIV) can improve outcomes. HIV prevalence in brain tumor patients and the impact of an HIV diagnosis on patient outcomes are poorly understood. Materials and methods This was a prospective study of 100 consecutive brain tumor patients admitted to a Greater London Tertiary Neurosurgical center for surgery between January 2021 and October 2021. All brain tumors were included. All patients have appropriately consented. Blood was tested to detect HIV antibodies and p24 antigen. Outcomes were noted at 30-day postoperative follow-up. Results In 100 patients, there was one case of a known HIV-positive, seronegative patient, and no new diagnosis was made, giving a prevalence of 1%. The mean age of patients included was 61.7 ± 13.3, with 57% female. The patient with HIV suffered a postoperative pseudomonas infection, requiring intensive care, additional surgery, and antibiotics. This resulted in an inpatient stay of 55 days - an increase of 274% compared to patients without HIV. Conclusion Literature regarding the prevalence of HIV in glioma patients is inconclusive, of low quality, and primarily out-of-date. Our literature search found no similar study of rates of HIV in brain tumor patients in the United Kingdom. The incidence of both HIV and brain tumors, particularly glioblastomas, is low.

Conservative management of post-traumatic cerebral myiasis: Report of a unique case and literature review.

Cerebral myiasis is extremely rare, and surgical intervention is the primary treatment used. Successful conservative management alone, without surgical removal of the brain infestation has not yet been published. We report a case of a 24-year-old African homeless man who was found on the street in a state of decreased level of consciousness, with larvae exiting from the left supra and postauricular dirty wounds and from his left ear. The patient was diagnosed with post-traumatic cerebral myiasis of the left temporal lobe and cerebellum. It was treated successfully by debridement of the external wounds and administration of antibiotics, without surgical removal of the brain infestations. For the first time, this case illustrates the novelty and appropriateness of the conservative management of cerebral myiasis. This is also the first report of cerebral myiasis with cerebellar involvement and the second report of post-traumatic cerebral myiasis in literature.

Atypical haemorrhagic colloid cyst: 2 case reports surgical management and review of literature.

INTRODUCTION: Colloid cysts are benign cystic lesions located at the anterior part of the third ventricle mostly at the foramen of Monro and contain colloid material. Hemorrhage in a colloid cyst is exceedingly rare. Only 15 clinically diagnosed cases of haemorrhagic cysts were reported in the literature and 5 more cases on autopsy. Here we report two rare cases of a haemorrhagic colloid cyst describing the atypical radiological findings, the undertaken surgical procedures and histopathological results. PRESENTATION OF CASES: We presented 2 cases of haemorrhagic third ventricle colloid cysts. First case is a 27-year-old male patient, presented with dizziness, nausea, vomiting and blurring of vision. He was operated by transcortical endoscopic transventricular excision of a third ventricular cyst and the insertion of external ventricular drain. The second patient is a 21-year-old male, presented with history of worsening headache for 1 month associated with blurring of vision. The patient had a transcortical microscopic, transventricular cyst excision. DISCUSSION: Many questions regarding the best way to diagnose and manage such lesions remain unanswered. Hence, we summarize the relevant diagnostic images and best surgical techniques. CONCLUSION: We concluded that, though exceedingly rare, colloid cyst can bleed and cause rapid deterioration in neurological status, thus, presence of atypical features should alert the physicians to consider atypical colloid cyst that would be valuable in surgical decision making whether endoscopic or microscopic.