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The article discusses spontaneous intracranial hypotension (SIH), a clinical condition characterized by postural headaches caused by the spontaneous leakage of cerebrospinal fluid (CSF) into the extradural space. The most common cause of CSF leakage is a longitudinal dural tear, meningeal diverticulum, or direct cerebrospinal venous fistula (LVF). SIH is an underdiagnosed condition with an incidence of 5 per 100,000 people per year, typically affecting individuals between the ages of 40-50, with a higher prevalence in women. The article presents a case study of a 61-year-old woman with SIH who underwent surgical treatment, resulting in the resolution of her symptoms. The article also discusses the diagnosis and treatment of LVF, a potential cause of SIH. [Extracted from the article]

Brain metastases are serious complication of cancer. Progress in brain imaging, intraoperative electrophysiological monitoring and neurosurgical equipment have increased the extent of the resection and safety of neurosurgical operations while reducing mortality and morbidity. Surgical resection is still the first considered therapeutic option. It is especially recommended for patients with solitary cerebral metastasis in accessible localization, in good clinical conditions and with favourable prognosis. It is relatively contraindicated in the case of uncontrolled cancer disease, poor clinical conditions, in the case of radiosensitive tumours, poor disease prognosis and presence of more than three cerebral metastases. Surgical therapy for two or three metastases is also possible, but its role may be questionable in some aspects. General recommendations are not clearly defined in the case of recurrent metastases as well, and individual assessment is preferred based on the evaluation of the number of prognostic factors. The Editorial Board declares that the manuscript met the ICMJE "uniform requirements" for biomedical papers. [ABSTRACT FROM AUTHOR]

Introduction: The aim of our study is to present the treatment outcomes of patients with aneurysmal subarachnoid hemorrhage (SAH) 3 months after the attack who were treated with clipping (MS) or coiling (EV). Materials and methods: The study was based on a retrospective analysis of a database of patients with cerebral aneurysms who were treated at the University Hospital Brno between 2009 and 2019. A total of 499 patients were included in the study. Of these patients, 345 (69%) were treated with surgical MS and 154 (31%) were treated with EV. Patients were divided into 4 groups: according to the age into 0–64 years and 65+ years group, and according to the modality of treatment of aneurysm by MS or EV. We evaluated the effect of the initial Hunt-Hess (HH) score on the treatment outcome according to age and modality and also the relationship between the current age of the patient and the treatment outcome at 3 months after the SAH attack, as assessed by a modified Rankin scale (mRS), where the successful treatment outcome was mRS 0–2 (self-sufficient patient), and the effect of the initial Hunt-Hess score (HH) on the treatment outcome was based on age and modality. Results: Of the 499 patients, 345 (69%) were treated with MS and 154 (31%) with EV, and the average age of MS and EV treated patients was not statistically significantly different (P = 0.2216). In both surgically and endovascularly treated patients in all age categories; we did not observe a statistically significant difference in HH score (P = 0.1664) or in graphical severity of SAH according to the Fischer score (P = 0.5041). Satisfactory treatment outcome (mRS 0–2) at 3 months after the attack was found in 49 (52.88%) in the 65+ years group after MS and 23 (60.61%) in the 65+ years group after EV. Poor treatment outcome (mRS 3–6) at 3 months was found in 43 (47.12%) in MS treated and 15 (39.39%) in EV treated patients, which was statistically significant (P = 0.0002). Satisfactory treatment outcome (mRS 0–2) at 3 months with good clinical status on admission (HH 1–2) was seen in 136 (55%) patients in the 0–64 years group after MS and 28 (33%) in the 65+ years group after MS. Poor treatment outcome (mRS 3–6) after 3 months with poor initial clinical condition (HH 3–5) had 50 (20%) patients treated with MS in the 0 -64 years group and 39 (44%) treated with MS in the 65+ years group, which is statistically significant (P = 0.0001). Conclusion: Elderly (65+ years) after SAH are at a higher risk of poor neurological status 3 months after the attack compared to younger patients, especially if they are in a severe clinical condition on admission. However, a significant proportion of these patients remain in a good clinical condition after treatment of an aneurysm, so the method of treatment and extent of treatment needs to be assessed individually. In elderly patients treated endovascularly, we observed a better treatment outcome at 3 months compared with patients treated by open surgery. [ABSTRACT FROM AUTHOR]

Aim: The aim of this study was to evaluate whether levels of IL-6 in the cerebrospinal fluid are associated with parameters of transcranial dopplermetry or brain oxygen partial pressure (PbtO2) in patients with subarachnoid haemorrhage. Patients and methods: Patients with aneurysmal subarachnoid haemorrhage, who were unconscious during the fourth day after the onset of bleeding, were enrolled in the study. We explored associations betweer levels of IL-6 in the cerebrospinal fluid as measured on the fourth day after subarachnoid hemorrhage and transcranial dopplermetry parameters or brain oxygen partial pressure meassured one day later. Results: A total of 20 patients were enrolled into this study. There was a trend to higher levels of IL-6 in patients with cerebral vasospasm (med: 3,544; 25%/75% = perc: 2,106/6,907 vs. med: 10,080; 25%/75% perc: 2,540/13,958; p = 0.0946), however, no correlation between the levels of IL-6 and mean velocities in magistral vessels was observed. There was a tendency to higher levels of IL-6 related to PbtO2 lower than 20 mm Hg (med: 2,860; 25%/75% perc.: 940/8,580 vs. med: 6,937; 25%/75% perc: 3,811/14,524, p = 0.0587) and there was a significant correlation between the levels of IL-6 and PbtO2 in our study group (rs = -0,626; p = 0.002). Conclusion: In this study group, there was a correlation between levels of IL-6 in the cerebrospinal fluid and subsequent PbtO2 values at the beginning of the period representing the highest risk of delayed cerebral ischemia development. Based on these results we assume that IL-6 might be considered as a promising marker to predict risk of developing delayed cerebral ischemia. [ABSTRACT FROM AUTHOR]