COVID-19 infection causes coagulopathy, which may lead to cerebral venous thrombotic (CVT) event. It usually occurs in patients with higher severity level of infection and manifests mostly within a month after the infection. However, in rare cases, the CVT may happen long after the infection and unrelated to the degree of the infection severity. We present the case of a previously healthy 62-year-old male patient with very mild COVID-19 symptoms that resolved in 3 weeks of home isolation treatment. Immediately after the infection, he developed hypercoagulability and was treated routinely with a novel oral anti-coagulant drug. Four months after the infection, he developed a worsening headache which, in several days, deteriorated to cause reduction in his consciousness level. Imaging showed a right temporoparietooccipital massive brain hemorrhage with right transverse and sigmoid sinus thrombosis. Emergency decompressive craniectomy was performed and the patient recovery was excellent. In patients with a hypercoagulable state after COVID-19 infection, the possibility of CVT event should be observed. It may not be related to the severity of the infection, and it may happen long after the infection.

High body mass index and high body fat percentage increase risk of meningioma among menopausal womenBackground: Meningiomas are the most common primary brain tumors. One known risk factor for meningioma is exposure to estrogen hormone. Body mass index (BMI) and high body fat percentage have been found to be associated with increased production of estrogen hormone particularly among menopausal women. This study was conducted to determine the effect of BMI and body fat percentage with increased risk of meningioma in menopausal women. Methods: This was a cross-sectional study which selected its subject using consecutive non-probability sampling method at Neurosurgery Department of Dr. Hasan Sadikin Hospital Bandung from December 2018 to November 2019. A total of 50 subjects were categorized into two groups, the menopausal and premenopausal groups consisting of 25 subjects each.Results: Menopausal women whose BMI was above the normal reference range had a 2.95 times greater risk of suffering from meningioma compared to those with normal BMI, and 1.312 times greater risk (95% CI 0.934-1.84) when compared to premenopausal women having higher-than-normal BMI. High body fat percentage in menopausal women was found to increase the risk of developing meningioma for up to 2.49 times compared with those with normal body fat percentage and had 1.36-time greater risk (95% CI 0.901 -2.051) compared to premenopausal women with normal body percentage. Conclusion: Menopausal women with higher BMI and body fat percentage were at increased risk of developing meningioma for up to 1.3 times compared to premenopausal women with higher BMI and body fat percentage and nearly 2.5 -3 times higher risk compared to menopausal women with normal BMI and body fat percentage.

Reperfusion injury of the spinal cord or “white cord syndrome” (WCS) refers to the sudden onset of neurological deterioration after spinal decompressive surgery. It is thought to be caused by reperfusion injury of the spinal cord. The risk of WCS might be increased in elderly and patients with chronic hypertension as commorbidities.  A 50-year-old male suggestive a continuous ossified posterior longitudinal ligament (OPLL) with cervical spinal stenosis from C2-C4 underwent posterior decompression and posterior fixation from C2 to C4. After the patient recover from anesthesia, he developed hemiparesis on right side with motor strength 1/5. Immediate postoperative CT scan imaging revealed no malpositioned screw, on cervical MRI disclosed a hyperintense signal in T2-weighted sequences at C3-C4 levels and the diagnosis of WCS was suspected. A high dose methylprednisolone according to NASCIS II, mannitol, and methylcobalamin were given. On post-operative day (POD)-1 the patient's muscle strength improved to grade 3/5 in the upper extremity and to grade 4/5 in the lower extremity but the elbow flexion muscle strength still 1/5. Two weeks after surgery the patient able to walk normally but the upper extremity still no improvement. There are still no class I, II, and III evidence backing specific treatment of WCS. However, there are several prevention strategies to decrease the risk of WCS such as CSF pressure management, remote ischemic preconditioning (RIPC), intraoperative monitoring, and technique switch to laminoplasty. We recommend that the importance of early recognition and prompt treatment of white cord syndrome to minimize the complication.