Context: Neuromyelitis optica spectrum disorders (NMOSDs) are an autoimmune disorders resulting from astrocytic aquaporin-4 (AQP-4) channelopathy in young adults. The AQP-4 IgG antibodies may be present in the context of some paraneoplastic disorders which should be suspected when NMOSD occur in elderly patients. Findings: This study reported a case of 65-year-old male patient with paraneoplastic NMOSD. The patient presented with quadriparesis due to acute cervical long segment myelitis not responsive to pulse steroid therapy; 18 months later he developed acute bilateral diminution of visual acuity due to bilateral optic neuritis with no response to either pulse steroid therapy or IVIG. Serological serum tests revealed that the patient was AQP-4-IgG positive, but after 22 months of the initial presentation, the patient showed widespread metastasis in bone and liver secondary to bronchogenic carcinoma. Conclusion: Late onset of NMOSD should raise the suspicion of paraneoplastic neurological disorder, and extensive work up is advised to identify the underlying neoplasm.

Background Spontaneous intraventricular haemorrhage (IVH) is a life-threatening condition associated with high morbidity and mortality and is conventionally managed using external ventricular drain (EVD). However, EVD is commonly associated with a high rate of complications, which necessitates another alternative management with a comparable or better outcome. This study aims to compare the efficacy and safety of ventriculosubgaleal shunt (VSGS) compared to EVD for the management of adult patients with spontaneous IVH. Results A total of 48 patients were enrolled in this study. Twenty patients underwent EVD and 28 had VSGS. Postoperative complications were non-significantly more prevalent in the EVD than in the VSGS group (75 vs. 64.3%, p = 0.430), including non-CR (20 vs. 32.1%), infection (20 vs. 7.1%), blocked ventricular catheter (15 vs. 3.6%), and dislodged catheter (10 vs. 7.1%). Convulsions and CSF leaks occurred more frequently in the VSGS group (7.1 vs 5%, p = 1.000). Postoperative GCS and Graeb’s score were comparable between the groups (p > 0.05). The EVD group had a non-significantly higher rate of hydrocephalus after ventricular catheter removal (80 vs. 53.6%, p = 0.059) and a higher mean GOS 3 months postoperatively (mean score: 4 vs. 3). Conclusions VSGS is as effective and safe compared to EVD, with a lower rate of infection, blocked/dislodged catheters, as well as a reduced incidence of hydrocephalus. On the other hand, EVD showed better GOS at 3 months. However, these differences did not reach statistical significance.

Background: Drug-resistant epilepsy (DRE) is a commonly faced problem in epilepsy practice associated with great psychosocial consequences. This work aimed to study the role of seizure semiology analysis (SSA), long-term EEG monitoring, high field strength MRI, and positron emission tomography (PET) scan of the brain to confirm the diagnosis of true-RDE cases as well as seizure onset zone (SOZ) localization. Methods: This study was conducted on 67 DRE patients subjected to SSA, long-term video EEG, 3-Tesla MRI brain, and 18-FDG PET scan of brain. Results: Forty-three patients had true-DRE and 24 had non-epileptic episodic events (NEEE). The former group consisted of 23 patients with temporal lobe, 17 with frontal lobe, and 3 with occipital lobe epilepsies. Forty-eight patients had abnormal EEG included all patients with true-DRE and 5 patients with NEEE. Thirty patients had abnormal MRI brain findings in the form of mesial temporal sclerosis and/or focal cortical dysplasia. Sixteen true-DRE patients with normal 3-T MRI underwent PET scan of the brain where regional hypometabolism was detected in 14 (87.5%) of them. Conclusion: Practicing with DRE patients' needs meticulous assessment through detailed SSA, adequate neurophysiological long-term video EEG monitoring, and thorough neuroradiological investigation (structural and/or functional) to confirm the diagnosis of true-DRE and localize the SOZ as well as identification of patients with NEEE.