Some evidences suggest the involvement of the central nervous system in patients infected with SARS-CoV-2. We aim to analyze possible associations between coronavirus disease 2019 (COVID-19) pandemic and spontaneous subarachnoid hemorrhage (SAH), in a comprehensive neurological center. We conducted a retrospective case series of 4 patients infected by COVID-19, who developed spontaneous SAH. Clinical data were extracted from electronic medical records. Between March 24, 2020, and May 22, 2020, 4 cases (3 females; 1 male) of SAH were identified in patients infected with SARS-CoV-2, in a comprehensive neurological center in Brazil. The median age was 55.25 years (range 36 -71). COVID-19-related pneumonia was severe in 3 out of 4 cases, and all patients required critical care support during hospitalization. The patients developed Fisher grade III and IV SAH. Digital subtraction angiography (DSA) was performed in 3 of the 4 patients. However, in only 1 case, an aneurysm was identified. Inflammatory blood tests were elevated in all cases, with an average D-dimer of 2336 μg/L and mean C-reactive protein (CRP) of 3835 mg/dl The outcome was poor in the majority of the patients, with 1 death (25%); 2 (50%) remained severely neurologically affected (mRS:4); and 1 (25%) had slight disability (mRS:2). This study shows a series of 4 rare cases of SHA associated with COVID-19. The possible mechanisms underlying the involvement of SARSCoV-2 and SHA is yet to be fully understood. Therefore, SHA should be included in severe neurological manifestations in patients infected by this virus.

Epidermoid cyst is a congenital benign lesion, rarely seen in the topography of the fourth ventricle. The authors report a case of a 48-year-old patient with headache and cerebellar ataxia due to an epidermoid cyst in the fourth ventricle. We performed a surgical resection with histopathological confirmation of the lesion.

Objective To identify the factors associated with the intra-hospital mortality in patients with traumatic brain injury (TBI) admitted to intensive care unit (ICU). Methods The sample included patients with TBI admitted to the ICU consecutively in a period of one year. It was defined as variables the epidemiological characteristics, factors associated with trauma and variables arising from clinical management in the ICU. Results The sample included 87 TBI patients with a mean age of 28.93 ± 12.72 years, predominantly male (88.5%). The intra-hospital mortality rate was of 33.33%. The initial univariate analysis showed a significant correlation of intra-hospital death and the following variables: the reported use of alcohol (p = 0.016), hemotransfusion during hospitalization (p = 0.036), and mechanical ventilation time (p = 0.002). Conclusion After multivariate analysis, the factors associated with intra-hospital mortality in TBI patients admitted to the intensive care unit were the administration of hemocomponents and mechanical ventilation time.

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Meningiomas arising from the falcotentorial junction are rare, and the selection of the optimal surgical approach is essential. We report a 41-year-old man presented with progressive left paresis in the lower limbs. An MRI showed a solid mass inside the third ventricle in contact with the falcotentorial dural junction. The tumor was removed by the transtentorial/transfalcine occipital approach, performed with the patient in the three-quarter prone position. The tumor was devascularized from the tentorium, then debulked and finally dissected. The affected falx and tentorium were resected, but all of patent dural venous sinuses were preserved. The tumor was a subtotal resect. Choosing the surgical approach is essential for the safe and effective removal of an FTM and preoperative imaging analysis should identify the tumor’s anatomical relations and guide toward the least disruptive route that preserves the neurovascular structures. This article aims to report a successfully treated FTM.