aneurysm. The patient did not suffer any cardiological and neurological insufficiency; haemodynamics remained stable and was tracheally extubated after planned elective overnight post-operative mechanical ventilation. We repeated electrocardiograms (ECGs), echocardiograms and Troponin I assay post-operatively at 6 and 24 h, respectively, which were within normal limits.A 44-year-old female with interstitial lung disease and Systemic Lupus Erythematosus presented with subarachnoid haemorrhage (Hunt and Hess Grade I, WFNS Grade-I) and investigations revealed a large fusi-saccular left vertebral artery aneurysm. We planned treatment by clip reconstruction and anticipated the use of adenosine to facilitate dissection and deal with a possible intra-operative rupture. We followed all necessary precautions like putting the external defibrillator paddles and keeping defibrillator ready with closed monitoring of vitals. During dissection, the aneurysm ruptured. At the time of rupture, the arterial blood pressure was 100/60 mmHg with heart rate of 60 beats/min. Adenosine 18 mg IV was administered as a quick bolus through the central line with 20 ml of normal saline flush. Asystole was achieved for 25 s, during which, the surgeon could clip the ruptured part of the aneurysm. Following asystole, the patient's heart rate recovered spontaneously without any haemodynamic sequelae. The surgeons again requested for a second dose for further clip reconstruction of the fusiform aneurysm. By this time, the patient had suffered a blood loss of about 1.5 l and patient's arterial blood pressure was 96/60 mmHg and heart rate of 70 beats/min with normal sinus rhythm. The second dose of adenosine (18 mg) was administered after about 22 min from the first dose, following which asystole was achieved in 15 s, which lasted for further of 20 s. The patient developed supraventricular tachycardia (SVT) on recovery from asystole with mean arterial pressure of 50 mmHg, which soon progressed to atrial fibrillation (AF) with persistent hypotension; this helped the surgeons to apply permanent clip. Following surgery, AFs continued and so, we decided to deliver synchronised DC shock with 100 J. This led to immediate return of sinus rhythm with arterial blood pressure of 90/60 mmHg and heart rate of 88 beats/min with minor T-wave changes, which recovered fully after about 5 min. Rest of the surgery was uneventful. Volume resuscitation was done with colloids, crystalloids as well as packed red blood cells during the procedure and the patient was kept ventilated electively. Intra-operative and post-operative arterial blood gases

Glioblastoma multiforme (GBM) is the most prevalent central nervous system malignancy portending dismal prognosis. The median overall survival (OS) is 14.6 months with currently available standard care of surgery, radiotherapy and Temozolomide (TMZ) chemotherapy. TMZ, which is the best chemotherapeutic drug till date for this malignancy, gives a median OS advantage of only 2.5 months over surgery and radiotherapy alone. It is not clear how the benefit of TMZ is severely limited in a large majority of patients. To understand this we investigated genome wide sequence alterations of GBM neoplastic cells in response to TMZ. We present here two cases of GBM, A49910 and M45481, where the first one (A49910) showed response and the second one (M45481) showed no response to standard treatment in clinic. We isolated their primary tumor cells at the time of surgery and cultured them in vitro as neurospheres. When we exposed these two patient-derived neurospheres to clinically relevant dose of TMZ in vitro differential responses were observed among the two neurospheres which mirrored the clinical outcomes of the two patients respectively. Initially, at the end of 5 days of TMZ treatment, both A49910 and M45481 neurospheres showed 50% and 65% reduction in viable cell numbers respectively but after a 23 days of gap (“post TMZ-treatment recovery” from the 5 days long drug treatment), at 28th day of the treatment cycle, the total number of viable cells was 5% in TMZ-treated A49910 with a stark contrast of 60% in the TMZ-treated M45481 as compared to their respective DMSO-treated controls. Their growth curves, as measured by MTT assays, showed the exact reflection of this pattern, i.e., after 5 days of treatment both TMZ-treated A49910 and TMZ-treated M45481 showed equally retarded growth compared to their DMSO-treated controls, and at 28th day, only the TMZ-treated A49910 but not the TMZ-treated M45481 cells showed growth retardation. Moreover, almost every single cell of TMZ-treated A49910 appeared bigger and stained intensely with SA-βgal confirming drug induced senescence at 28th day whereas this phenotype was completely absent in TMZ-treated M45481, where no apparent sign of senescence was observed. However, apoptosis was two-fold higher in M45481 than in A49910 after 5 days of TMZ treatment. Whether this “drug induced cellular senescence (DICS)” phenotype is more beneficial to the patients claims further investigation with a larger cohort of GBM patients. For the proof of principle we sequenced the whole exome and also analyzed the genome wide single nucleotide polymorphisms (SNPs, intronic and exonic) in these two patient-derived neurospheres before and after TMZ treatment in vitro and detected a list of unique sequence alterations in both the cases, in response to TMZ. Citation Format: Neeta Sarkar Roy, Nidhan Biswas, Vikas Chandra, Tapojyoti Das, Ankita Chatterjee, Rabindra Narayan Bhattacharya, Laxminarayan Tripathy, Sunandan Basu, Arindam Maitra, Pryiadarshi Basu, Analabha Basu, Surajit Dhara. How important is the “post TMZ-treatment recovery” of GBM neoplastic cells. [abstract]. In: Proceedings of the 104th Annual Meeting of the American Association for Cancer Research; 2013 Apr 6-10; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2013;73(8 Suppl):Abstract nr 3430. doi:10.1158/1538-7445.AM2013-3430

No abstract

Spinal epidural hematoma (SEH) is a rare condition and it accounts for less than 1% of all spinal canal space occupying conditions. Spontaneous SEH most commonly occurs in the cervical and thoracic regions. They present with neck or back pain with radiculopathy and/ or myelopathy. Early surgical decompression is the recommended treatment in the presence of progressive neurological deficits. Spontaneous SEH (SSEH) presenting as Cauda Equina syndrome (CES) are rarely reported in the literature. We present a case of SSEH presenting late with CES. Due to delay in presentation and multiple co-morbidities, patient was treated conservatively.

Hydatid cyst is a common zoonosis, affecting the liver and lungs in the endemic areas. Occasionally it involves the brain. We present a rare case of multicystic cerebral Hydatid cyst present over a long time in an adult patient with some odd radiological features like calcification and discuss the relevant literature. In endemic areas, neurosurgeons must be aware of this entity.Nepal Journal of Neuroscience 12:49-51, 2015