The risk of ventriculostomy-related hemorrhage among patients requiring antiplatelet therapy (AT) for the endovascular treatment of acutely ruptured intracranial aneurysms needed further investigation. The authors performed a systematic review and meta-analysis of the literature examining the EVD-related hemorrhage rate among patients with and without AT (controls). According to PRISMA guidelines, a comprehensive review of studies published between January 1990 and April 2018 was carried out. The authors identified series with > 5 patients reporting the EVD-associated hemorrhage rate among the AT group and the control group. Variables influencing outcomes were analyzed using a random-effects meta-analysis model. We included 13 studies evaluating 516 (with AT) and 647 (without AT) patients requiring ventriculostomy. EVD-related hemorrhage rates were higher among the AT group (125/516 = 20.9%, 95% CI = 11.9-30%, I = 90% vs 57/647 = 9%, 95% CI = 5.5-12.5%, I = 45.8%) (p < 0.0001). Major EVD-associated hemorrhage rates were low in both the AT and control group (25/480 = 4.4%, 95% CI = 1.7-7.7%, I = 53.9% vs 6/647 = 0.7%, 95% CI = 0.03-1.7%, I = 0%) (p < 0.0001). Ventriculostomy before embolization and intraprocedural AT were associated with lower rates of EVD-related bleeding (32/230 = 9.6%, 95% CI = 2.1-17.1%, I = 75.4% vs 6/24 = 25.1%, 95% CI = 8.8-41%, I = 0%) (p < 0.02). The rate of major hemorrhage was higher after dual AT (CP + ASA) compared to single AT (ASA or CP) used as an intraprocedural loading dose (13/173 = 7%, 95% CI = 3.3-10.7%, I = 0% vs 6/210 = 1.7%, 95% CI = 0.1-3.4%, I = 0%) (p < 0.009). AT during endovascular treatment of acutely ruptured intracranial aneurysms increases the risk of EVD-related hemorrhages, although most of them are small and asymptomatic. When ventriculostomy is performed before endovascular procedures requiring antiplatelet administration, the hemorrhagic risk is minimized. A single antiplatelet therapy is associated with a lower rate of major bleeding than a dual therapy.

Object The novel severe acute respiratory syndrome (SARS)-CoV-2 outbreak has been declared a pandemic in March, 2020. An increasing body of evidence suggests that patients with the coronavirus disease (COVID-19) might have a heterogeneous spectrum of neurological symptoms Methods A systematic search of two databases was performed for studies published up to May 29th, 2020. PRISMA guidelines were followed. Results We included 19 studies evaluating 12,157 patients with laboratory-confirmed COVID-19 infections. The median age of patients was 50.3 (IQR 11.9), and the rate of male patients was 50.6% (95% CI 49.2-51.6%). The most common reported comorbidities were hypertension and diabetes (31.1%, 95% CI 30-32.3% and 13.5%, 95% CI 12.3-14.8%, respectively). Headache was reported in 7.5% of patients (95% CI 6.6-8.4%), and dizziness in 6.1% (95% CI 5.1-7.1%). Hypo/anosmia, and gustatory dysfunction were reported in 46.8 and 52.3%, of patients, respectively. Symptoms related to muscular injury ranged between 15 and 30%. Three studies reported radiological confirmed acute cerebrovascular disease in 2% of patients (95% CI 1.6-2.4%). Conclusions These data support accumulating evidence that a significant proportion of patients with COVID-19 infection develop neurological manifestations, especially olfactory, and gustatory dysfunction. The pathophysiology of this association is under investigation and warrants additional studies, Physicians should be aware of this possible association because during the epidemic period of COVID-19, early recognition of neurologic manifestations otherwise not explained would raise the suspect of acute respiratory syndrome coronavirus 2 infection.

Background: Double epidural hematomas (EDHs) have a higher mortality rate compared to single EDHs and same Glasgow Coma Scale (GCS), although double EDHs incidence is less common. Case Description: We present the case of a 34-year-old female who underwent single skin incision and frontotemporal and suboccipital craniotomies for fatal traumatic double acute EDHs, then, a literature review was performed. Conclusion: Double EDHs in association with low GCS at presentation and traumatic diastasis of cranial sutures or other maxillofacial injuries are associated to an unfavorable outcome.

Object: The novel severe acute respiratory syndrome (SARS)-CoV-2 outbreak has been declared a pandemic in March, 2020. An increasing body of evidence suggests that patients with the coronavirus disease (COVID-19) might have a heterogeneous spectrum of neurological symptomsMethods. A systematic search of two databases was performed for studies published up to April 17th, 2020. PRISMA guidelines were followed.Results: We included 13 studies evaluating 2499 patients with laboratory-confirmed COVID-19 infections. The median age of patients was 50.3 (IQR 9.6), and the rate of male patients was 50% (95% CI 47.9-52%). The most common reported comorbidities were hypertension and diabetes (18.7%, 95% CI 16.9-20.7% and 9%, 95% CI 7.4-11.3%, respectively). Headache was reported in 17.9% of patients (95% CI 16.1-19.8%), and dizziness in 13.9% (95% CI 10.7-18%). Fatigue or myalgia, hypo/anosmia, and gustatory dysfunction were reported in 24%, 55.2%, and 55.4%, of patients, respectively.Conclusions: These data support accumulating evidence that a significant proportion of patients with COVID-19 infection develop neurological manifestations, especially olfactory and gustatory dysfunction. The pathophysiology of this association is under investigation and warrants additional studies, Physicians should be aware of this possible association because during the epidemic period of COVID-19, early recognition of neurologic manifestations otherwise not explained would raise the suspect of acute respiratory syndrome coronavirus 2 infection.