Background Traditionally, cerebral arteriovenous malformations (cAVMs) are surgically treated with microscopy, and no cases receive full neuroendoscopy. We operated on two small cAVMs with hematoma under a neuroendoscope, and the two patients obtained excellent results.
 Objective
 To explore the feasibility of treating cAVMs with a full transcranial neuroendoscopic approach.
 Methods
 The clinical data and operative techniques were collected and described for two patients who were diagnosed with cAVMs with hematoma and treated via a full transcranial neuroendoscopic approach.
 Results
 In the two patients, the hematomas were successfully evacuated, and the AVMs were removed simultaneously; both patients had achieved excellent recoveries at discharge.
 Conclusion
 To our knowledge, this is the first report in the literature to successfully treat cAVMs with hematoma with a full transcranial neuroendoscopic approach, showing that this approach is feasible and may be an alternative for small ruptured cAVMs. However, while the feasibility of attempting this approach was demonstrated, it was difficult to certify its obvious advantage. Nevertheless, we believe that this approach might be difficult for middle and large AVMs due to the shortcomings of neuroendoscopy. More cases and practice are needed to confirm the merits and limitations of this new approach for AVMs.

Cerebral Arteriovenous Malformation Treatment by Full Transcranial Neuroendoscopic Approaches.

[1]. In the InCiTe study on intracranial hemorrhage (ICH) in patients with thrombocytopenic hematology, a platelet count< 50× 10/L is considered low enough to cause ICH [2]. We agree that the functional activity of platelets is a better marker for bleeding risk than the platelet count. However, a patient with ICH and confirmed uncal herniation onnon-contrast computed tomography (NCCT) with pancytopenia, including thrombocytopenia, is an ideal candidate for platelet transfusion. The current practice of transfusing blood products based on viscoelastic hemostatic assays such as thromboelastography or rotational thromboelastometry is predominantly used in non-cardiac surgery with ongoing bleeding, usually intraoperatively, where there is an acute need for multiple blood transfusions [3]. In the recent literature, few case reports have reported the correlation of active cannabis smoking with ischemic and hemorrhagic cerebral stroke. Of the 107 neurovascular cases reported on active cannabis smokers, almost 84% were related to ischemic stroke [4]. Our patient was a reformed, not an active, cannabis smoker. Furthermore, hemorrhagic stroke in our patient, in contrast to ischemic stroke caused by cannabis, makes cannabis use a less likely cause of ICH in this case. The most common location of aneurysm rupture is the anterior communicating artery, and 90% of all ruptures present with subarachnoid hemorrhage. Basal ganglia hematomas resulting from the rupture of aneurysms of the distal middle cerebral artery are extremely rare [5]. Most aneurysms develop after the age of 40 years, and the occurrence of basal ganglia bleeding caused by an aneurysmal rupture in a 35-year-old man is highly unlikely. As our patient was diagnosed with uncal herniation in an urgent NCCT of the head, we immediately intubated him and transferred him to the operating theater rather than performing a cerebral angiography to rule out an aneurysm, which was a very unlikely possibility.

/pdf/a-rare-case-of-wilson-disease-associated-with-intracerebral-vbygl9cla0.pdf

A rare case of Wilson disease associated with intracerebral hemorrhage

tracranial hemorrhage (ICH), which concluded that penicillamine administration in this particular patient may have caused bone marrow suppression and low platelet count was very interesting. Bone marrow suppression and thrombocytopenia are known complications of penicillamine use reported in up to 10% of cases [2] that can cause bleeding, including ICH. However, the level of coagulopathy based on laboratory parameters (platelet count: 43 × 10/L, international normalized ratio [INR]: 1.65) was not severe enough to have caused massive bleeding leading to intraventricular extension in a patient with cirrhosis [3]. The authors have also commented that marijuana users are more likely to have ICH. The patient being an alcohol user as well could have had inadvertent head injuries [4]. Although not independent predictors of ICH, marijuana and alcohol use are more likely to cause ICH. Additionally, we would like to point out that in a young patient presenting with ICH, a search for an intracranial aneurysm should have been considered and cerebral angiography could have been performed. It is also our observation that the trigger for transfusion was the absolute levels of platelets and INR in the presence of an intracranial bleed in a patient with cirrhosis. However, the current practice is to transfuse products based on viscoelastic hemostatic assays such as TEG or ROTEM, as such patients could be in a procoagulant state despite the deranged coagulation parameters [5].

/pdf/response-to-comment-on-a-rare-case-of-wilson-disease-1tzzxq05su.pdf

Response to comment on "A rare case of Wilson disease associated with intracerebral hemorrhage".

Background: Basal ganglia bleed is a major cause of disability with 40% subjects suffering frommoderate to severe disability. Among different treatments, mobilization on a tilt-table and functionaltraining, which consisted of strengthening and stretching exercises of the limbs, postural control trainingin sitting and standing positions, therapist-guided techniques for facilitating normal movement, andsimple forward stepping might have effect on balance in subjects with Basal ganglia bleed.Objective: To see the effect of tilt table mobilization and functional training on balance in subjects withbasal ganglia bleed.Methodology: 10 subjects within age group of 18-65 years diagnosed with Basal ganglia bleed wereincluded in the study based on inclusion and exclusion criteria. After measuring the baseline data,subjects were given mobilization on tilt table and functional training 30 minutes per session 5 days aweek for 6 weeks. Pre and post measures of balance were assessed using dynamic gait index (DGI).Results: Mobilization on tilt table and functional training on balance in subjects with basal gangliableed showed statistically significant improvement in balance (p<0.05) on paired t test.Conclusion: Tilt table training can be beneficial for improving balance in subjects with basal gangliableed.

/pdf/effect-of-tilt-table-training-on-balance-among-subjects-with-1oi3e7jnv1.pdf

Effect of Tilt Table Training on Balance among Subjects with Basal Ganglia Bleed: A Pilot Study

Background Basal ganglia hemorrhage (BGH) is a devastating neurologic disease with high morbidity and mortality, and its management is still controversial. We evaluated the effectiveness of surgical treatments for BGH and investigated computed tomography (CT) imaging features affecting the hematoma evacuation rate (ER) in patients treated with neuroendoscopic surgery. Materials and Methods A total of 104 BGH patients who underwent craniotomy, burr-hole drainage, or neuroendoscopic surgery were analyzed retrospectively. Clinical characteristics, imaging features, and postoperative complications were compared. Univariate and multivariate regression analyses were applied to identify imaging factors associated with ER. Results A significant difference in ER was observed: 78.4% in patients treated with neuroendoscopic surgery, 33.6% in patients treated with burr-hole drainage, and 82.5% in patients treated with craniotomy (p  Conclusions The benefits and drawbacks of surgical treatments confirmed they have their own indications, and neuroendoscopic surgery may be relatively beneficial for BGH treatment. The island sign was an independent factor affecting ER for neuroendoscopic surgery. Therefore, comprehensive assessment of clinical data, especially the island sign, should be performed preoperatively in BGH patients.

Effectiveness of Surgical Treatments for Basal Ganglia Hemorrhage and Imaging Factors Affecting Hematoma Evacuation Rate by Neuroendoscopic Surgery.

Basal ganglion hematoma evacuation and clipping of middle cerebral artery aneurysm by neuroendoscopy: A case report.

PP056 [Resuscitation, Stabilisation & Transport » Resuscitation]: EPIDEMIOLOGY OF CARDIOPULMONARY ARREST AND OUTCOME OF RESUSCITATION IN PICU ACROSS CHINA: A PROSPECTIVE MULTICENTER COHORT STUDY

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Basal ganglion hematoma evacuation and clipping of middle cerebral artery aneurysm by neuroendoscopy: A case report.

PP056 [Resuscitation, Stabilisation & Transport » Resuscitation]: EPIDEMIOLOGY OF CARDIOPULMONARY ARREST AND OUTCOME OF RESUSCITATION IN PICU ACROSS CHINA: A PROSPECTIVE MULTICENTER COHORT STUDY