The results illustrated that enhanced discharge planning and nurse follow-up sessions are considered essential in maintaining the well-being of the stroke caregivers and bridging the gap between the hospital and the community.

Patients with cerebellar arteriovenous malformations (AVM) commonly present to the neurosurgical department after having suffered hemorrhages. The subarachnoid space is the usual location for these often repeating episodes of bleedings. In addition, these patients can present with parenchymal hemorrhage. Acute subdural hematoma caused by a ruptured cerebellar AVM is a rare entity and is not generally recognized. The authors present a case of acute posterior fossa subdural hematoma resulting from a ruptured cerebellar AVM.

Objective:To review the result of microsurgical treatment for cerebral aneurysms at Princess Margaret Hospital, Hong Kong, SAR, with the focus on the use of elective temporary clipping (ETC) in reducing intraoperative aneurysm rupture (IOR). Methods: All clinical notes and operation records of patients who had undergone aneurysm-clipping microsurgery from July 1996 to November 2002 were reviewed. Results: In the past 6 years, 148 patients with 150 aneurysms had undergone microsurgical clipping operations. The overall usage rate of ETC was only 25% (38 out of 150) in the present surgical series. Elective temporary clipping was most frequently applied (40%) in treating anterior communicating artery aneurysm. The overall IOR rate was 26% without ETC, versus 8% with ETC, with 18% absolute risk reduction (95% confident interval: 3.2% -28.2%) and 70% relative risk reduction, respectively. The numbers needed for treatment was 5.55. The benefit of ETC was most prominently observed in treating anterior communicating artery aneurysm in which the IOR rate was reduced from 42 to 12%, with 30% absolute risk reduction. Among cases of IOR that occurred without prior elective temporary clip application, the mortality rate was 20.7%. For IOR patients with prior elective temporary clip application, there was no mortality. Conclusion: The present study demonstrates that ETC had led to a significant overall reduction in IOR rate and ETC was associated with better clinical outcome. We encourage and recommend the use of ETC in preventing IOR during aneurysm microsurgery. A prospective study will be conducted on the same topic in our hospitals.

Dural AVMs can produce a wide variety of symptoms related to raised intracranial pressure, venous congestion, and cerebral ischaemia. We present a unique case of reversible dementia, due to venous hypertension. The cerebral ischaemia was caused by extensive bilateral arteriovenous malformations of the external carotid system, which drained into the superior sagittal and transverse sinuses and resulted in venous hypertension. Although partial occlusion by endovascular embolization and ligation procedures had some effect, only 'scalping and silastic implantation' gave satisfactory amelioration of symptoms.

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