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Mycotic aneurysm presenting as subdural empyema: illustrative case

Joshua T. M. Lucas, Shahed Elhamdani, Seung W. Jeong, and Alexander Yu

other common sources of infection including intravenous drug use (6.3%), bacterial meningitis (5.2%), poor dental hygiene (4.2%), and cavernous sinus thrombosis (2.8%). 3 In these settings, characteristic radiological findings in the cerebrovascular system may lead to the diagnosis of an MA. More typically, however, MAs remain clinically silent until spontaneous rupture. Once ruptured, they primarily present as either intracerebral hemorrhage (ICH) or subarachnoid hemorrhage (SAH). 4 , 5 Rarely do MAs present as subdural hematoma, with only 13 cases reported in the

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Spontaneous bilateral epidural hematomas caused by chronic sinusitis: illustrative case

Lin Yao, Zhenhua Luo, Yin Zhou, Chen Huang, Xinggen Fang, Xiaochun Jiang, and Tao Yu

developed spontaneous EDHs and subdural hematomas. Cranial lesions and meningeal metastases of tumor can also cause spontaneous EDH. Melike et al. 8 reported a 7-year-old boy with eosinophilic granuloma of skull, who developed spontaneous bilateral EDHs. The rupture of the tumor cyst was the possible cause for EDHs in this case. There are also reports of EDH caused by rupture of meningeal metastatic tumor, but those EDHs are unilateral and occur generally in middle-aged or elderly patients. 9 , 10 Long-term sinusitis can erode intracranial blood vessels, which may

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

Ken Akimoto, Kiyoyuki Yanaka, Kazuhiro Nakamura, Hayato Takeda, Minami Saura, Maya Takada, Hisayuki Hosoo, Yuji Matsumaru, and Eiichi Ishikawa

mycotic aneurysms . Radiology . 2002 ; 222 ( 2 ): 389 – 396 . 10.1148/radiol.2222010432 23 Matsuda T , Kiyosue H , Yamashita M , A case of multiple mycotic intracranial aneurysms presenting with subdural hematoma. Article in Japanese . No Shinkei Geka . 2002 ; 30 ( 1 ): 73 – 78 .

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Adolescent subdural empyema in setting of COVID-19 infection: illustrative case

Vladimir A. Ljubimov, Robin Babadjouni, Joseph Ha, Viktoria O. Krutikova, Jeffrey A. Koempel, Jason Chu, and Peter A. Chiarelli

approximately 80% over normal, likely facilitating the development of sinusitis. Our novel finding was a negative SARS-CoV-2 RT-PCR result from the intracranial purulent material. This suggests that SARS-CoV-2 viral particles were not transmitted into the subdural space despite documented COVID-19 infection within the nares. Al-Olama et al. recently published a report on a patient with COVID-19 meningoencephalitis with resultant intraparenchymal hemorrhage and subdural hematoma. 7 The subdural hematoma required burr hole evacuation in a delayed fashion, and the authors

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Non-contrast–enhancing subdural empyema: illustrative case

Alexander D. Rebchuk, Stephano J. Chang, Donald E. G. Griesdale, and Christopher R. Honey

adjacent effacement of the sulci but without any brain edema, herniation, or midline shift ( Fig. 1 ). This was interpreted as most likely a chronic subdural hematoma given his recent falls. Dedicated vascular imaging (CT angiography) did not demonstrate any vessel occlusions or stenosis. A lumbar puncture was deferred since international normalized ratio and partial thromboplastin time were elevated. FIG. 1. Axial ( left ) and coronal ( right ) contrast-enhanced CT of the head demonstrating a nonenhancing left parietal subdural collection. The patient was

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Coccidioidal meningitis with multiple aneurysms presenting with pseudo–subarachnoid hemorrhage: illustrative case

Rohin Singh, Visish M. Srinivasan, Joshua S. Catapano, Joseph D. DiDomenico, Jacob F. Baranoski, and Michael T. Lawton

from the EVD, prompting concern for aneurysmal rupture. CT of the head demonstrated diffuse hyperdensities in the basal cisterns, obscuring visualization of possible aneurysmal SAH ( Fig. 1E ). However, CT scans also showed a clear right acute subdural hematoma with a midline shift ( Fig. 2A ). The patient was taken for emergent craniotomy. A right pterional craniotomy was performed, and the subdural hematoma was evacuated. Upon inspection, all aneurysms were intact, and the blood was determined to be of subdural origin, likely caused by the patient’s CM ( Fig. 2B

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Wound vacuum-assisted closure as a bridge therapy in the treatment of infected cranial gunshot wound in a pediatric patient: illustrative case

Harjus Birk, Audrey Demand, Sandeep Kandregula, Christina Notarianni, Andrew Meram, and Jennifer Kosty

/F Traumatic SDH complicated by empyema Infection 15 Thigh free flap Good wound healing Makler et al., 2018 11 56/F Invasive scalp squamous cell carcinoma Infection 30 None; death due to carcinoma Death due to carcinoma SDH = subdural hematoma; STSG = split-thickness skin graft. There is only one other case in which a wound VAC was used in the setting of a CGI. This case was presented by Powers et al. and involved a 24-year-old man who sustained a gunshot wound to the face that extended into the anterior fossa. 5 He received

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Spontaneous intracranial hemorrhage presenting in a patient with vitamin K deficiency and COVID-19: illustrative case

Nathaniel R. Ellens and Howard J. Silberstein

lethargic with a bulging but compressible fontanelle and a fixed right gaze deviation with reports of seizure activity en route to the hospital. Intravenous Keppra was administered at a dose of 60 mg/kg. Noncontrast computed tomography (CT) scans of the head demonstrated extensive subdural hematomas, most prominently over the tentorium bilaterally, along the falx, and extending inferiorly toward the foramen magnum. There was also moderate intraventricular hemorrhage within the bilateral lateral ventricles and the 3rd and 4th ventricles, with prominent hydrocephalus ( Fig

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Strongyloides hyperinfection syndrome due to corticosteroid therapy after resection of meningioma: illustrative case

Víctor Rodríguez Domínguez, Carlos Pérez-López, Catalina Vivancos Sánchez, Cristina Utrilla Contreras, Alberto Isla Guerrero, and María José Abenza Abildúa

corticosteroids in neurosurgery (e.g., chronic subdural hematoma, brain tumor, inflammatory pain, hypopituitarism) for long periods (before surgery, during the perioperative period, and after the surgery), it is important in neurosurgical practice to know the risk factors, epidemiology, and management to avoid delays in diagnosis and prevent the high mortality that this disease entails. 4 , 5 We report a case of Strongyloides hyperinfection syndrome in a patient diagnosed with a large sphenoid planum meningioma and treated with corticosteroids. Illustrative Case A