Iranian Journal of Neurosurgery

Background and Aim: Hydrocephalus can cause ventricular expansion, which if not treated promptly, can result in brain damage. The hydrocephalus-induced damage is not fully improved, even by means of surgical procedures, leading to permanent damages to the brain. Methods and Materials/Patients: The aim of this study was to evaluate the demographic characteristics as well as hydrocephalus in patients with head trauma in Poursina Hospital, Rasht. The information including age, sex, Glasgow Coma Scale (GCS), trauma mechanism and accompanying brain injuries on admission were recorded. Patients with hydrocephalus diagnosed by CT scan underwent further investigation and therapeutic approaches. The treatment-related results were collected based on the GOS scale. Finally, the data were entered into SPSS version 18, and the results were analyzed by Fisher’s exact test, and Independent t-test. Results: Of the 548 patients, hydrocephalus was observed in 14 patients (2.6%). The mean age of the patients was 44.07±24.48 years old. 31.1% of men (14 cases) had hydrocephalus, while none of women suffered from this complication. Car accidents (12 people) and fall (2 people) were identified as causes of incident in hydrocephalus patients. Head injury severity in most patients with hydrocephalus was mild (n=7, GCS=13-15) and moderate (n=6, GCS=9-12), and severe (n=1, GCS=3-8). Subarachnoid hemorrhage (n=5) and then epidural hematoma (n=4) and intracerebral hemorrhage (n=4) had the most severe damage to the skull. Most patients (n=11) were treated by surgery. Three patients recovered completely. Moderate disability, severe disability, vegetative state, and death occurred in 3, 2, 1, and 5 Patients, respectively. According to independent t-test, there is a statistically significant relationship between Glasgow Coma Scale and hydrocephalus (P=0.03). Fisher’s exact test also showed a statistically significant relationship between intracerebral hemorrhage (P=0.045) and intraventricular hemorrhage (P=0.013) on admission with hydrocephalic incidence. Conclusion: This complication was mostly observed in young traumatic patients (younger than 40 years of age) and in patients with mild head injury. Therefore, it is necessary to pay attention to these people in order to detect hydrocephalus, if any, as soon as possible, and these patients be treated appropriately.

Background and Importance: The novel SARS-CoV-2 virus has had an undeniable effect worldwide in different aspects. Although cerebrovascular diseases, especially subarachnoid hemorrhage (SAH), have already been reported in COVID-19 patients, little is known about various types and patterns of SAH in these patients. Case Presentation: A 63-year-old woman was admitted to the emergency department with a headache. Her headache was severe (Hunt and Hess score, grade 2). She was diagnosed with COVID-19 by a positive nasopharyngeal swab PCR test. Her CT scan revealed a perimesencephalic hemorrhage, thick SAH without any signs of hydrocephalus or intraventricular hemorrhage. Conclusion: Regarding the different associations of SAH with COVID-19, the perimesencephalic hemorrhage in our case is a novel type. Although not uncommon among non-infected populations, SAH occurrence in COVID-19 patients has not been reported before and needs further investigation.

Background and Importance: SARS-CoV-2 virus causes COVID-19. The virus’s primary target is the respiratory system, but it can also affect other systems, such as the cardiovascular and the central nervous system. Case Presentation: In this study, we introduce an 83-year-old man who was referred due to a reduced level of consciousness and hemiparesis in the left part of his body without symptoms such as fever, cough, muscle aches, and fatigue. In High-Resolution Computed Tomography (HRCT) of the lung, the Ground-Glass Opacification/Opacity (GGO) view indicated COVID-19 disease, and in Computerized Tomography (CT) scans of the brain, hemorrhage was evident in the right thalamus, lateral and right ventricle. The Polymerase Chain Reaction (PCR) test performed on the upper part of the nose was also positive. This research is a case report of intracranial and intraventricular hemorrhage in an aged man with asymptomatic COVID-19. Conclusion: Low level of consciousness in the elderly can be a sign of infection with the SARS-CoV-2 virus.

Background and Importance: Secondary complications after SARS-CoV-2 virus infection including cardiovascular and neurological pose additional morbidity and mortality. The data on spondylodiscitis with spinal abscess after COVID-19 infection is very limited. Case Presentation: A 71-year-old man presented with tachypnea and cough since 24 hours before admission. He was febrile and his chest CT showed typical picture of bilateral covid-19 pneumonia. Nasopharyngeal swabs showed a positive PCR for COVID-19. The patient was admitted to the intensive care unit (ICU) due to low oxygen saturation. Forty-eight hours after admission, the patient started to develop paraparesis which rapidly progressed to paraplegia within a few hours. In MRI scan, multilevel spondylodiscitis and epidural abscess in the thoracic spine were observed. Urgent surgery was performed and the patient was treated medically with hydroxychloroquine and Favipiravir for COVID-19. Calculated antibiotic treatment with meropenem and vancomycin. No COVID-19 was detected in the abscess samples. The patient passed away later due to multiorgan failure. Conclusion: Spondylodiscitis with spinal abscess secondary to COVID-19 infection is a severe condition and might be a consequence of dysbalanced immune response with immunodepression after COVID-19 infection.

Background and Aim: SARS-COV-2 can present with pulmonary, renal, gastrointestinal, hematological, and neurological manifestations. Neurological manifestations may occur after or before COVID-19 symptoms and signs. Spine and spinal cord complications are documented as neurological complications of COVID-19. Spinal cord pathology following COVID-19 showed inflammatory myelopathy and suspected cord ischemia. The most frequent presentation of COVID-19 myelitis is non-enhancing central expansile cord T2 signal changes, but it can present with lateral and dorsal column-specific disease and in some cases with negative magnetic resonance imaging (MRI). There is no known documented mechanism for spinal cord involvement in COVID-19 infection, but it seems as a post-infectious immunological and post-inflammatory disorder and reaction. Viral infection of SARS-CoV-2 can cause demyelination of the brain and spinal cord and also can exacerbate the known primary demyelinating disorders. Methods and Materials/Patients: This is a narrative study about the spinal cord complications of COVID-19. To provide up-to-date information, we precisely reviewed COVID-19 articles on spine and spinal cord complications. Based on the keywords COVID-19, SARS-CoV-2, spine, and spinal cord, all the related articles were taken from Google Scholar, PubMed, and Medline and were precisely studied. Results: There are reported cases of COVID-19 spine and spinal cord involvement. There is no documented mechanism for these involvements but the possible mechanisms are direct invasion, cytokine storm, coagulopathy, and an autoimmune response. The routine therapy of such complications is the treatment of these complications with other primary causes with a poor and unsatisfactory response of myelopathy to treatment; however, early diagnosis and vigilance of such involvement improve outcome. Conclusion: COVID-19 can cause spine and spinal cord complications in some patients without a known incidence rate of such complications. The pathogenesis is not completely known; therefore, more conclusive studies are obligatory to improve our information on COVID-19 spinal cord and spine complications.

Background and Aim: The viral agent in severe acute respiratory distress syndrome coronavirus 2 (SARS-CoV-2) is the cause of the novel coronavirus disease 2019 (COVID-19). It was first identified in December 2019 in the city of Wuhan, Hubei, China, and the World Health Organization declared it as an outbreak and a Public Health Emergency of International Concern on 30 January 2020, and a pandemic on 11 March 2020. Neurosurgeons are not prime in COVID-19 management but they continue for caring, visiting, and operating neurosurgical patients. In neurosurgical cases that need non-urgent operation, systematic SARS-CoV-2 testing of low-risk patients should be considered. In cases with positive SRAS-COV-2 testing, the procedures should be delayed until they are cured. The high-risk settings in the neurosurgical operation room are endotracheal intubation and extubation, operations in the vicinity of sinuses and/or mastoids, operations with accidental injury to respiratory or digestive tracts, and usage of aerosol-generating instruments on virioncontaminated tissues. The risk of SARS-COV-2 infection is decreased by delaying all nonemergent cases, replacing general anesthesia with other anesthesia methods, replacing neurosurgical approaches with alternative approaches that bypass the respiratory tract, and decreasing the usage of aerosol-generating instruments. Methods and Materials/Patients: This is a narrative study about COVID-19 infection in neurosurgery. Using the keywords SARS-COV2, neurosurgery, and COVID-19, all the relevant articles (about 52) were retrieved from Google Scholar, Medline, and PubMed and reviewed and critically analyzed. Results: Neurosurgeons can change neurosurgical routines in COVID-19 patients such as delaying all nonemergent cases, replacing general anesthesia with other anesthesia methods, replacing neurosurgical approaches with alternative approaches that bypass the respiratory tract, decreasing the usage of aerosol-generating instruments, and doing preoperative SRAS-COV-2 testing. Conclusion: For decreasing the risk of COVID-19 transmission in neurosurgery, we can change routine neurosurgical protocols. Without the prevention of COVID-19 transmission, all neurosurgeons, personnel, and patients will contract COVID-19.

Background and Aim: Telemedicine can be considered a primary modality of patient care for non-emergent conditions in the COVID-19 era. The usage and expansion of telemedicine are important and inevitable issues. We decided to investigate the neurosurgeons’ perspective on telemedicine in the treatment and follow-up of neurosurgical patients during the COVID-19 period. Methods and Materials/Patients: This cross-sectional study was carried out in the Department of Neurosurgery, Tehran, from June 2021 to July 2021. An internet-based questionnaire was distributed among all postgraduate and assistant neurosurgeons at the Tehran University of Medical Sciences. Statistical analysis was performed using SPPS (IBM SPSS Statistics for Windows, Version 24.0. Armonk, NY: IBM Corp; 2016). Results: This study was performed among 74 neurosurgeons who were mainly male (89.2%). Their mean age was 33.16±5.69 years (ranging from 27 to 62 years), and telemedicine has not been used previously in 37 precipitants (50%). Most precipitants preferred telemedicine for follow-up (93.24%). The common reasons for unimplemented telemedicine were determined by insurance and repayment obstacles (58.11%). Most of the participants believed that telemedicine should first be adapted to working condition and local setting, then it can be applied more in the future. Eventually, the effectiveness of telemedicine was controversial, according to most neurosurgeons’ replies. Conclusion: This study indicated neurosurgeons’ preference for telemedicine. They considered it a comfortable alternative. However, the effectiveness of telemedicine is controversial as it should be adapted first and then used extensively for future purposes. It is also suggested that future studies compare the results of this research with those of studies performed after the COVID-19 outbreak.

Introduction: Survival rate in brain tumors have not been reported in Iran. The purpose of this study, given the lack of such information, has set to evaluate 3 years survival rate in patients with all kinds of glioma tumors who had been admitted and already diagnosed with one type of glioma tumor, in department of neurosurgery, Al-Zahra hospital, Isfahan, Iran over period of 2001-2010. Methods: This study was descriptive and retrospective, including 222 patients who had been admitted to the department of neurosurgery, already diagnosed with one type of glioma tumor. All patients (for minors, their parents) were contacted and explained whole structure of the study and its objectives and consented (according to regulations of the Ethics committee and declaration of Helsinki) if they desired to participate in the study; also, they were asked about 3 years survival rate following their tumor resection surgery. Data such as patient age at time of admission, gender, histological diagnosis of tumor and treatment regimen (surgical/non-surgical, radiation, chemotherapy) were collected from patients’ medical record. 3 years survival rate and frequency of each tumor based upon age and gender, were measured. Patients with Diffuse Astrocytoma, Oligodendroglioma, Ependymoma and Pilocytic Astrocytoma had been treated with surgery and radiation. Patients with Glioblastoma Multiform (GBM) and Anaplastic Astrocytoma had been treated with surgery plus chemo-radiation. Results: 3 years survival rate in this study for GBM and Anaplastic Astrocytoma were 8.7% and 0% respectively. These tumors are categorized as high-grade glioma with poor prognosis. On the other hand, 3 years survival rate for Diffuse Astrocytoma, Oligodendroglioma, Ependymoma and Pilocytic Astrocytoma were 100%, 95.2%, 100% and 100% respectively. These tumors are considered as low-grade glioma which have good prognosis. Conclusion: In this study, 3 years survival rate in patients with low-grade glioma following surgery and radiation was almost 100%. In contrast, 3 years survival rate in patients with high-grade glioma following surgery plus chem-radiation was almost 0%.

Background & Aim: Spondylolisthesis is a visible deformity in lumbosacral region with vertebral slip and fracture or other deformities of pars interarticularis. This study aims at investigating the characteristics of spondylolisthesis surgery in operated patients. Methods & Materials/Patients: This is a retrospective study which included all the patients who had undergone spondylolisthesis surgery by one same surgeon from 2006 to 2011. Demographic characteristics such as age, gender, and surgery information including type of spondylolisthesis, incision site, laminectomy site, foraminotomy site, fixation site of vertebra and site of vertebral disc evacuation were collected. The data were analyzed using SPSS (Version16). Results: 52 of 63 enrolled patients were women (82.5%) and 11 men (17.5%) with mean age of 49.6 years. Based on frequency, spondylolisthesis types were 60 degenerative (95.2%), 2 post-surgical (3.2%) and 1 post-traumatic (1.6%), respectively. 58 patients had spondylolisthesis only in one vertebra and 5 patients in two vertebrae. The total number of slipped vertebrae was 68, in which slip was seen in L3, L4 or L5 vertebrae. In 42 patients, laminectomy was performed only in one vertebra, in 19 patients in two vertebrae, in 1 patient in three vertebrae and in 1 patient in five vertebrae. The total number of vertebrae with foraminotomy was 106. The highest frequency of foraminotomy was seen in L5, L4, and S1 vertebrae, respectively. Except in one case, the rest 62 patients underwent fixation surgery in two or three vertebrae. Conclusion: Based on the results, the frequency of spondylolisthesis was approximately five times in women compared to men. The most common type was degenerative spondylolisthesis. Type of surgery was fixation with pedicle screw and fusion.

Background and Aim: Cerebrovascular brain incidents especially brain aneurysm ruptures are a major cause of death and disability. Monitoring Somatosensory Evoked Potential (SSEP) and corresponding changes are used for identifying cerebral ischemia and predicting neuronal injuries during using temporary clips in brain aneurysm surgeries. This approach limits integrated performance evaluation for somatosensory and cortex paths. Methods and Materials/Patients: This clinical trial study was conducted on the patients who were candidate for anterior cerebral circulation aneurysm surgery during 2017-2018 in Rasul Akram Hospital. SSEP monitoring was performed related to the median nerve in the contralateral wrist to examine the Middle Cerebral Artery (MCA) and posterior tibialis nerve in the contralateral ankle to examine Anterior Cerebral Artery (ACA) during the surgery procedure. Incentive parameters with a power of 5 to 25 milliampere and corresponding duration of 0.2 milliseconds and waves with a frequency of 3.3 Hertz were registered. Before locating temporary clips, SSEP was extracted as a baseline from every patient and then recorded. Results: Totally 9 patients (9 aneurysms) were studied. Three of them were men and 6 patients women. The age of patients ranged 39-78 years. The clinical status of patients was assessed using the Hunt-Hess scale. Five cases were classified as grade 1, 2 cases as grade 2, and 2 cases as grade 3. Among 9 aneurysms, 7 cases were about A.com artery and 2 cases were in connection with MCA artery, having the size of 5 to 11 millimeters. Friedman test was applied to explore average latency change percentage and amplitude change percentage in 1st, 2nd, and 3rd minutes for the 1st, 2nd, and 3rd clips where the results were significantly different (P=0.050). Conclusion: Neuromonitoring can be used as an index for examining tissue perfusion level of the brain and help to prevent accidental ischemic injuries of the brain followed by temporary clipping.

Background and Aim: The assessment of Quality of Life (QoL) as a measurement of Traumatic Brain Injury (TBI) outcome can play a key role in identifying the adverse effects of TBI. There is no study on the evaluation of psychometric properties of the Persian version of Short Form Health Survey Questionnaire (SF-36) in the TBI patient population. Therefore, the present study aimed to validate and test the reliability of the Persian version of the SF-36 in patients with TBI. Methods and Materials/Patients: In the present cross-sectional study, 185 patients with TBI were selected by non-probability and consecutive sampling. First, the construct validity of the Persian version of the SF-36 questionnaire was evaluated using the Confirmatory Factor Analysis (CFA) in AMOS-22, and then the internal consistency reliability and item-total score correlation of each subscale were assessed by SPSS V. 22. Results: Results of CFA indicated that the dimensionality of SF-29 questionnaire with eight-factor structure among the Iranian TBI patients had construct validity (GFI=0.825, CFI=0.963, NFI=0.919, TLI=0.957, RMSEA=0.06) by eliminating 6 items and freeing some of the covariance errors between items, but the two-factor dimensionality (physical and psychological components of QoL) of this questionnaire was not approved. Internal consistency of the eight-factor form of SF-29 subscales was acceptable to excellent (=α0.70 to 0.99). Correlation analysis of item-total score for determining the construct validity of SF-29 indicated that except for 2 items, all items of the questionnaire had a positive and strong correlation with their subscales (r=0.40 to 0.99, P<0.0001). Conclusion: Persian version of SF-29 with an eight-factor construct had good validity and reliability and could be used to measure health-related QoL in Iranian patients with TBI. Keywords: Brain injuries, Traumatic, Quality of Life, Surveys and questionnaires, Measurement, Reliability, Validity.

Background and Aim: Neurovascular lesions can cause death or disability. Some of them are operable, but surgical approaches are complicated, and proper access to these lesions is crucial. A few of these surgeries occur during the residency educational program, and residents' experience in operating these lesions may be quite inadequate. Using new technologies like 3D-reconstruction of vascular lesion images may result in better training and improve residents' knowledge and understanding of these operations. Methods and Materials/Patients: Four senior neurosurgery residents were enrolled in this study. They were taught to use a 3D image rebuilding program (3D Slicer). They were then asked to rebuild a 3D image of every patient lesion, practice different surgical views, and review anatomical structures around the lesion before surgery. Results: All residents mentioned that their knowledge of surgical approaches improved, and they learned more from each operation. Two of them commented that more self-trust during surgeries led to more effective education. Their ability in surgical planning was enhanced too. Attending physicians of these residents believed that this practice improved the residents' skills and educational quality. Conclusion: New technologies can promote residency educational programs. It seems that working on 3D images of lesions before surgery can boost residents' educational attributes.

Background and Aim: Degenerative lumbar spine disease can lead to lumbar spine instability. The patients can present with Low Back Pain (LBP), radicular pain, and motor and sensory dysfunction. Age >50, female sex and pregnancies are among prevalent risk factors. The degeneration process usually starts from the intervertebral discs progressing to involve facet joints, ligaments, and vertebral bodies leading to spinal instability and deformity. This study aims to evaluate the effect of lumbar decompression and Posterolateral Fusion (PLF) on the short- and long-term outcomes of these patients. Methods and Materials/Patients: This prospective study assessed the effect of lumbar decompression and PLF in patients with lumbar instability referred to the Neurosurgery Clinic of Chamran hospital between March 2011 and March 2013. Forty-four patients with degenerative lumbar spine instability and stenosis were eligible for participation to undergo lumbar decompression and PLF. Its clinical effect was evaluated using Visual Analogue Scale (VAS) score and Oswestry Disability Index (ODI). The change in sagittal and coronal planes was also assessed according to pre- and post-operative findings at 2-year follow-up. The statistical method of assessment was repeated using paired t-test. P

Background and Aim: This study aimed to present the results of early and delayed operation on patients with ruptured brain aneurysms. In addition to comparing the results and rates of morbidity and mortality in the surgical procedure and identifying the effective factors, this study aimed to provide methods to improve the treatment of brain aneurysm. Methods and Materials/Patients: This was a retrospective study on 60 patients with a definitive diagnosis of brain aneurysm admitted to Neurosurgery Ward of Poursina Hospital, Rasht, Iran from 2009 to 2013. Results: 7(11.7%) patients on the first 3 days and 37(61.7%) patients on the days 4-14 and 16(26.7%) after 2 weeks and selectively underwent surgery. In total, 11.7% of patients died and 15% developed severe complications. In the group underwent surgery on the first 3 days, 2(28.5%) patients died and 2 experienced severe complications. In the second group (in 4-14 days), 4(10.8%) patients died and 5(13.5%) suffered from severe complications, and in the group (16 patients) with delayed surgeries, 1(6.2%) patient died and 2(12.5%) suffered from severe complications. Neurological grading and operation time were important factors in complications and mortality of patients. Conclusion: This study showed that Hunt and Hess neurological grading score has a direct relationship with increased morbidity and mortality rates, while delayed operation is associated with a reduction in morbidity and mortality. Given the complications of early aneurysm surgery (during the first 3 days) compared with delayed surgery, and also most of these patients die due to vasospasm or recurrent hemorrhage before the onset of a delayed phase, performing early surgery in these patients requires further evaluation. According to this study, the reduction of each episode of occlusion with temporary clipping will result in fewer complications.

Background and Aim: Ventriculoperitoneal shunt (VPS) is the most commonly used procedure for treatment of hydrocephalus in children. Abdominal cerebrospinal fluid pseudocyst is a rare complication but potentially fatal. The pathogenesis of this complication remains unclear. This complication should be considered during differential diagnosis of an abdominal mass. Our aim is to report how large and giant an abdominal cerebrospinal fluid pseudocyst can develop, and how severe the neurological damage can be. Case Presentation: A 6 year-old girl known to have a ventriculoperitoneal shunt presented with abdominal distension and signs of increased Intracranial Pressure (ICP). Ultrasonography revealed a hypoechoic intraperitoneal fluid containing cyst with a well-defined margin and septations. Abdominal computerized tomography revealed a huge cyst in the abdomen and the distal part of the peritoneal shunt tube located within the cyst. Laparotomy revealed a huge cyst extending from the upper right side of the abdomen to the pelvis. The whole cyst was excised and the catheter repositioned. Conclusion: Early diagnosis of abdominal Cerebrospinal Fluid (CSF) pseudocyst is only possible through close and periodic examination of patients after the procedure.

Background and Aim: Lumbar Disc Degeneration (LDD) is one of the most important causes of pain in the lower back, and lack of physical activity, overweight and obesity have been regarded as the most significant factors in its occurrence. The present study was conducted with the aim of evaluation of body mass index, abdominal obesity and physical activity level in patients undergoing for lumbar disc degeneration surgery. Methods and Materials/Patients: This descriptive-analytical study was conducted on 130 adult patients (20 to 77 years old) candidates for surgery admitted to the Poursina Hospital in Rasht City, Iran in 2016 due to degenerative lumbar vertebrae diseases. After obtaining the patients' consent, their abdominal circumference, weight, and height were measured by the researcher. The Rapid Assessment of Physical Activity (RAPA) questionnaire was used to assess the level of physical activity of the subjects and questions about professional sports were asked by the researchers. SPSS 16 was used to analyze the study findings. The Chi-square test and Fisher exact test were applied to examine the relationship between qualitative data. Results: The mean±SD BMI values in males and females were 26.63±4.47 and 28.96±4.45 kg/ m2, respectively. Also, the mean±SD values of abdominal circumference in men and women were 99.8±13.35 cm and 107.44±17.58 cm, respectively. The majority of the people (88.5%), including 71.7% of men and 97.6% of women had suboptimal physical activity, and a small percentage of samples (10.8%) reported previous professional exercises Conclusion: The present study results indicate the lack of activity level, high BMI and abdominal obesity in our patients. Further study is required to investigate the significant relationship between BMI and degenerative disease types.

Introduction: Thermal ablation by microwave (MWA) has proven efficacy in treatment of primary and metastatic cancers. Soft tissue tumors could be ablated completely using MWA. However, bony tissue metastasis particularly spinal vertebral metastasis ablation has not reported yet. Case presentation: A 50 year old male patient with primary diagnosed colon cancer undergone surgical resection of tumor. Recently, he was diagnosed with metastasis to liver and spinal vertebral bone. He was referred to pain clinic with severe non-radiating back pain. In MRI Imaging, hyperdensity lesions were identified on body of L5 and T12 and in spinal canal of L1 indicating metastatic involvement. Under fluoroscopy guidance, the metastatic tumor was ablated by MWA and the generator was powered to 20 Watt/3 minutes in the temperature control mode. Patient had no low back pain afterward. Conclusion: MWA could be used to ablate vertebral bone metastasis without any complications and with good prognosis

Background and Aim: Spine trauma is an important health problem. Traumatic Spinal Cord Injury (SCI) due to Motor Vehicle Accident (MVA) might have a different epidemiologic pattern in Guilan province of Iran owing to its geographical characteristics. Therefore, the present study was conducted to the study epidemiology of SCI injuries due to road accidents in a trauma referral center in Guilan. Methods and Materials/Patients: In this cross-sectional study, we used data SCI registry of Poursina Hospital. All the patients with spine trauma, due to MVA, hospitalized in the trauma center of Poursina Hospital, Rasht, Guilan, Iran between March 2015 and March 2018 were studied. Results: A total of 127 patients with spine trauma due to MVA were reviewed. The Mean±SD age of patients was 38.27±16.22 years. We observed that 93.7%, 1.6%, and 4.7% of the patients had initial Glasgow Comma Scale (GCS≥13, 9≤GCS≤12, and GCS

Background & Aim: Using pharmaceutical agents in treatment of aphasia has caught the attention of many neurologists and neuroscientists. This short review study has sought the role of pharmacotherapy in treatment of aphasia, a linguistic impairment after acquired brain lesions. The pharmacological principles and mechanisms related to the effects of drugs used in aphasia rehabilitation are pointed. Then, some evidence of clinical trials on different drugs in this field is presented. Methods & Materials/Patients: A comprehensive search in databases including MEDLINE, Cochrane, PubMed, Scopus, EMBASE, Science Direct on experimental studies and clinical trials associated with pharmacotherapy of aphasia after neurological damages was performed. Results: Pharmacological interventions through manipulating neurochemical levels in synapses, the pre- and post-synaptic spaces and even inside neurons start to modulate the disturbed balance of neurotransmitters due to brain lesions. Pharmacotherapy is based on the principle that drugs via balancing the molecular signaling cascades triggered due to neuronal damage can restore the function of neurons, facilitate the brain plasticity process and improve the linguistic deficits in aphasic patients. Among the drugs that have been studied in treatment of aphasia, those acting on central cholinergic and glutamergic systems were more effective and led to better clinical outcomes. Conclusion: Although existing evidence has proved the pivotal role of pharmacotherapy in treatment of aphasia after acquired brain lesions in adults, further research is required to assure the clinicians in using pharmacotherapy as a standard approach in treatment of aphasia.

Background and Aim: Paroxysmal sympathetic hyperactivity (PSH) is a clinical syndrome characterized by paroxysmal and transient episodes of fever, tachypnea, tachycardia, hypertension, diaphoresis, and dystonia following non-noxious stimuli. It is a rare clinical condition and is seen in patients with acquired brain injury (trauma, meningitis, encephalitis, and stroke). Paroxysmal sympathetic hyperactivity-assessment measure (PSH-AM) is a clinical tool for diagnosing PSH. This study aims to describe the clinical characteristics and the outcomes of PSH. Case Presentation: Of the 412 patients admitted to the neurosurgery intensive care unit at PSGIMSR, Coimbatore, India, 11 (2.6%) patients were diagnosed to have PSH according to the PSH-AM scale. Trauma (72%) was the leading cause of the development of PSH. All patients (100%) had developed at least two PSH episodes per day that persisted for at least 3 consecutive days. Tachycardia and tachypnea were the most common symptoms noted in all PSH patients. The Glasgow Outcome Score (GOS) was less than 3 in 72% of PSH cases at the time of discharge, indicating a poor outcome. Conclusion: Traumatic brain injury remained the leading cause of PSH. The duration of hospitalization was increased in patients with PSH. Along with the prompt treatment of the primary disease, appropriate medications to overcome sympathetic hyperactivity ensure better recovery for these patients. Patients with PSH had relatively poor GOS at the time of discharge.

Background and Importance: Symptomatic Rathke’s cleft cyst is a rare lesion that often presents without any symptoms. Case Presentation: We report a 40-year-old female with symptomatic Rathke’s cleft cyst located in the sellar and suprasellar region. She presented with visual disturbance, headache, weight gain, hypothyroidism and amenorrhea. The patient underwent surgery and the pathological examination confirmed Rathke’s cleft cyst. Conclusion: Although the symptomatic Rathke’s cleft cyst is rare, the differential diagnosis must be done with intrasellar and suprasellar lesions.