Introduction: Intracranial aneurysms affect 3-8 percent of the world’s population, with rupturedaneurysms being the most common cause of subarachnoid hemorrhage. The sensitivity of ComputedTomography Angiogram in diagnosing intracranial aneurysm is 97%. The aim of our study is to findout the prevalence of ruptured intracranial aneurysms among all the admitted cases encountered inour hospital. Methods: A descriptive cross-sectional study was done at Upendra Devkota Memorial NationalInstitute of Neurological and Allied Sciences from 2016 to 2018. Convenience sampling method wasdone. In order to detect the site and size of aneurysms16 slice Siemens Computed Tomography withComputed Tomography angiogram was used. Ethical approval was obtained from the InstitutionalReview Board at Upendra Devkota Memorial National Institute of Neurological and Allied Sciences.Based on demographic data and computed tomography angiography findings, various morphometricparameters along with demographic parameters were considered for the study. Results: Among 10,856 cases, prevalence of ruptured intracranial aneurysms were found in 42(0.386%) [Confidence Interval= 0.395 to 0.377]. Among 42 cases, Middle Cerebral Artery aneurysmwas present on 16 (39.02%) followed by Anterior Communicating Artery on 14 (34.14%), thenPosterior Communicating Artery on 5 (12.19%). The largest neck and dome size were seen in basilartip aneurysm with size of 11mm and 8mm respectively. The most common type was Fischer grade 4. Conclusions: The prevalence of ruptured intracranial aneursyms were found to be higher ascompared to the other international studies.

Giant cell arteritis (GCA) is a large cell vasculitis that can present with a plethora of symptoms affecting several different systems. Before the COVID-19 pandemic, diagnosis of GCA was straightforward since the list of differential diagnoses for this disease was relatively short. However, the development of a SARS-CoV-2 viral infection challenges this standard. COVID-19 is a viral illness that also can present with similar vascular symptoms as GCS and creates a substantial inflammatory reaction, similar to most vasculitis. We present a case of a patient who had developed GCA after recovering from a COVID-19 viral illness. This is a rare presentation of GCA in the setting of COVID-19, and recognition of the nuanced differences between the two diseases may significantly change a patient’s prognosis if not detected early.

Myocardial bridging is a rare anatomical variant that can lead to detrimental cardiac consequences when undiagnosed and untreated. This rare variant can induce anginal-type symptoms due to disrupted blood flow to the myocardium during systole. The patients presented in this report of two cases had previously undiagnosed myocardial bridging of the left anterior descending artery, however clinically, they presented quite differently. Here we present two cases discussing the course of diagnosis and treatment of myocardial bridging of these two patients. The goal of this case report is to highlight the significant cardiovascular injuries that can be a result of undiagnosed myocardial bridging.

Heparin-induced thrombocytopenia (HIT) is categorized into type 1 and type 2. It causes a decrease in platelet count during or shortly after exposure to heparin. Type 1 is mild and has a non-immune mechanism. Type 2 is a hypercoagulable state resulting from anti-heparin platelet factor 4 (PF4) IgG antibodies. These antibodies cause the activation of endothelium and thrombin generation. Type 2 HIT is complicated by life-threatening thromboembolic events such as deep venous thrombosis, pulmonary embolism, and myocardial infarction. HIT remains an under-recognized cause of dialysis catheter dysfunction and thrombosis. We present a case of a 66-year-old male with recurrent dialysis catheter thrombosis secondary to Type 2 HIT. Avoiding heparin-based dialysis or switching to non-heparin-based anticoagulation or peritoneal dialysis are the possible management strategies for such patients.

Biopsy is mandatory for histological diagnosis of non-resectable brain tumors. Of various techniques, neuronavigation guided biopsy provides intraoperative real-time reference and allows biopsy from multiple trajectories. The aim of this study is to assess the efficacy and accuracy of frameless neuronavigation biopsy. We retrospectively reviewed the medical archives of patients with intracranial space occupying lesion who underwent frameless neuronavigation biopsy at our institute between 2016 to 2018. All operations were performed under general anesthesia. Data were analyzed by SPSS version 20. P value of <0.05 was considered significant. There were 46 patients who underwent neuronavigation guided biopsy over the period of two years. Median age of patients was 46.5 years. Supratentorial tumors accounted for 95.8% of cases. Mean tumor diameter was 3.35 cm. Accuracy was 89.1%. More than half were glial tumors. Histopathology was inconclusive in 10.9% cases. Complication rate was 4.3%: one tract hematoma and one new neurological deficit. Frameless neuronavigation guided biopsy of intracranial space occupying lesion is safe and efficacious procedure with high diagnostic yield.