Primary brain tumors (PBTs) refer to the growth of abnormal cells originating in the brain. These tumors account for approximately two percent of all cancers in the adult population of the United States. Patients diagnosed with glioblastoma, one of the most common malignant PBTs, often require treatments in intensive care unit (ICU). Surgical removal of PBTs through craniotomy is often the firstline treatment for many types of brain tumors. ICU admission following major surgery like craniotomy is considered a standard of care in many healthcare systems. ICU provides access to specialized equipment, such as mechanical ventilators, continuous renal replacement therapy machines, continuous electroencephalogram monitoring, and invasive hemodynamic monitoring devices, which might be essential for the care of these patients. Understanding potential complications is essential for healthcare professionals to monitor patients more effectively and guide decision-making for optimal management. Over the years, perceptions of ICU utilization have shifted, raising questions about whether ICU admission is always the right choice for patients who have undergone brain surgery. Traditional scoring systems may not always demonstrate the necessity of ICU care for patients undergoing elective craniotomy for PBTs. Further research is needed to identify the most effective strategies for optimizing patient care, determining the need for ICU care in specific cases, and minimizing costs in neurosurgery.

Transcatheter aortic valve replacement (TAVR) has been approved for patients with severe symptomatic aortic stenosis (AS) across the spectrum of surgical risk. Although there is substantial evidence regarding the utility of TAVR in patients with classic high-gradient symptomatic AS, the management of patients with discordant AS and gradients that are lower than expected remains uncertain. As low-gradient AS is quite prevalent, it warrants our attention. The TAVR approach in these patients requires risk stratification and additional imaging modalities, such as stress echocardiography, to more accurately evaluate the severity of AS. TAVR complications include stroke, kidney injury, conduction abnormalities, devicerelated thrombosis, endocarditis, and mechanical or vascular complications, which affect both patients with low- and high-gradient AS (HGAS). Contemporary research has demonstrated that TAVR is more effective in the low-gradient AS population than in the HGAS population and shows better outcomes than conservative management. The management of patients with AS, particularly low-gradient AS, remains poorly understood.

Post-operative large vessel occlusion (LVO) stroke is one of the most severe complications associated with cardiac surgery. Mechanical thrombectomy (MT) is the first-line treatment for LVO stroke. In this paper, we present cases of patients who underwent MT guided by multimodal computed tomography (CT) to treat LVO stroke after cardiac surgery at our institution to clarify the impact of MT on patient outcomes. We analyzed the in-hospital stroke database from July 1, 2023, to June 30, 2024, to identify patients who had undergone MT to treat LVO stroke after cardiac surgery in our institution. Demographic data, stroke severity, type of operation, imaging features, and 90-day modified Rankin scale (mRS) scores were assessed. Of the 21 patients receiving endovascular therapy, we included nine (42.9%) who had undergone multimodal CT-guided MT after cardiac surgery. The operations varied and comprised four coronary artery bypass grafts, four surgical valve replacements, and one extended Morrow myectomy. The median time from post-surgery to the onset of stroke symptoms was 4 days (interquartile range [IQR]: 2.5 - 5 days), the median National Institutes of Health Stroke Scale score was 16 (IQR: 15 - 18), and the median time between the onset of symptoms and recanalization was 320 min (IQR: 270 - 465 min). One patient died of severe cerebral hemorrhage, while eight patients survived and were discharged to another hospital (n = 1), a rehabilitation facility (n = 3), or home (n = 4). The median 3‐month mRS was 2 (IQR: 0.5 - 3). In summary, multimodal CT-guided MT can improve the prognosis of patients with LVO stroke, although severe neurological deficits and mortality were observed in some patients. A larger sample size is required to clarify the effects of MT.

Overexpression of prokineticins and their receptors is increasingly recognized as a contributing factor in heart failure and often fatal myocyte necrosis. Activation of prokineticin pathways is typically triggered by cerebral hypoxia and ischemia, viral and bacterial infections, inflammatory and immune responses, or energy deprivation leading to cell apoptosis. However, experimental models have demonstrated that prokineticin pathway activation can also occur independently due to aberrant expressions of specific microduplicated/microdeleted genes. Although prokineticins may play a causal role in cardiac death in adults and children with abnormalities of accessory pathways between the atria and ventricles, they have never been reported to cause brain injuries, especially in neonates. This report describes an infant born with facial dysmorphisms and moderate hypoxic distress at birth but without evidence of atrioventricular conduction defects, viral or bacterial infections, or severe metabolic dysfunction. Despite these findings, neuropathologic examination following the infant’s death at 5 months revealed recent necrotic foci in the cerebral cortex and, in particular, older brain lesions with features indicative of metabolic energy failure in subcortical structures. Genetic analysis identified a rare prokineticin receptor 2 (PROKR2) gene microduplication, which, in the absence of other identifiable causes, is strongly implicated as a contributing factor in the observed chronic brain lesions. These findings suggest that PROKR2 gene microduplication may contribute to unexplained neonatal brain injury, warranting further investigation.

Carotid endarterectomy (CEA) is the first-line treatment for internal carotid artery stenosis that can lead to stroke. This study aimed to compare the incidence of early adverse clinical events and restenosis between patient groups receiving the newly developed bovine pericardial (BP) and polyurethane patches during CEA. We conducted a multicenter, randomized, non-inferiority trial at five tertiary centers in China. Participants were assigned to either the BP patch or polyurethane patch group. The primary outcome was freedom from restenosis at 1 year after surgery. Restenosis was defined as a narrowing of >50% in the target artery on duplex ultrasound or computed tomography angiography examination. The total number of participants was 120, including 60 each randomized to the BP patch and polyurethane patch groups. Demographics were similar in both groups. Death or significant disability was comparable between the two groups (3:1, p = 0.619) during the perioperative period. At the 12-month assessment (n = 112), three patients had severe restenosis: two in the BP patch group (n = 57) and one in the polyurethane patch group (n = 55). There was no significant statistical difference in restenosis, morbidity, or mortality between the two groups (p > 0.4), indicating that the BP patch was noninferior to the polyurethane patch (p = 0.013 for the full analysis set; p = 0.016 for the per-protocol set). The two groups of patches had similar safety and effectiveness, and the BP patch was non-inferior to the mature polyurethane patch available on the market.

Pregnancy-associated spontaneous coronary artery dissection (P-SCAD) is a rare but severe cause of acute coronary syndrome. The clinical presentation of P-SCAD can vary widely, ranging from asymptomatic cases to cardiac arrest and sudden cardiac death. Chest pain is the most common presenting symptom, though other symptoms, such as dyspnea, nausea, vomiting, and palpitations, may also occur. P-SCAD is often underdiagnosed because patients typically do not fit the profile of those with atherosclerosis and myocardial infarction. It predominantly occurs in younger individuals without traditional cardiovascular risk factors. The diagnosis of P-SCAD is commonly made during coronary angiography. Therefore, in pregnant and postpartum females presenting with chest pain or pressure, P-SCAD should be considered in the differential diagnosis, regardless of the presence of other risk factors such as age, hypertension, or diabetes.

This study evaluates the efficacy of cardioneuroablation (CNA) for vagally mediated bradyarrhythmia (VMB) through two case reports, a systematic review and a metaanalysis. Two patients with VMB were treated with CNA targeting ganglionated plexi using a radiofrequency ablation catheter. Both patients showed sustained clinical improvement post-CNA, with no recurrence of syncope or pre-syncope during follow-up periods of 26 and 16 months. We performed a meta-analysis, according to the preferred reporting items for systematic reviews and meta-analyses guidelines to review 19 studies involving 618 patients, excluding animal studies, case reports, and studies limited to immediate responses. The analysis revealed that 94.3% (95% confidence interval [CI]: 90.9 - 97.7%) of patients were symptom-free during follow-up, while only 4.5% (95% CI: 2.6 - 6.4%) required pacemaker implantation. Procedure-related complications were reported in 4.7% (95% CI: 2.3 - 7.1%) of overall cases. These findings suggest that CNA is an effective and safe treatment option for VMB, reducing symptom recurrence and the need for pacemaker implantation. Further randomized controlled trials are warranted to validate its long-term efficacy.

Arterial hypertension, anxiety, and depression are common in Western and Eastern medicines, with each offering therapeutic instructions and proposals. Arterial hypertension has been identified as a harmful factor that causing cardiovascular diseases and increasing global mortality. Depression affects over 322 million people worldwide, with an overall incidence of 4.4%. In cases of hypertension, depression is observed in approximately 30% of patients when assessed using questionnaires and in approximately 21% when assessed psychiatrically. Anxiety and depression are risk factors for arterial hypertension. On the contrary, hypertension has been considered to cause anxiety and depressive symptoms. This could be attributed to the direct effects of high blood pressure (BP), side effects of antihypertensive drugs, or psychological reactions to the diagnosis of hypertension. An unhealthy lifestyle increases stress and BP levels. Therefore, controlling stress is a complementary therapy for hypertension. In this context, this study presents a protocol aimed at evaluating stress/depression levels as well as the quality of life in patients with hypertension and examining their correlation with BP control and target organ damage. In addition, we will assess the effect of subsequent psychiatric interventions in hypertensive patients with increased levels of depression/stress on BP control, treatment compliance, and quality of life after a follow-up period of 1 year.

A 45-year-old male presented to the Emergency Department with a 2-h history of sudden onset right-sided headache and difficulty walking. Initial non-contrast computed tomography (CT) of the brain was unremarkable. Twelve-lead electrocardiogram showed left ventricular (LV) hypertrophy with strain pattern. On echocardiography, the aortic valve was noted to be bicuspid, associated with at least moderate eccentric aortic regurgitation and moderate aortic stenosis. In view of the initial presentation of ataxia and headaches, and the finding of bicuspid aortic valve (BAV) on echocardiography, an urgent CT of aorta and carotid arteries was performed, revealing dissection of the right vertebral artery and a right lateral medullary infarct. Aortic root dilatation and aortic dissection are well known complications of BAV. However, vertebral artery dissection in the context of BAV with a normal aortic root is unusual, and to our knowledge has only been reported once in the literature so far.

Stroke is a leading cause of illness and death worldwide, often leaving survivors with severe disabilities. In sub-Saharan Africa, strokes remain prevalent among individuals with diabetes, hypertension (HTN), or both, significantly impacting the health, social stability, and economic well-being of families and communities. This study aimed to assess the risk of stroke development in Nigerian individuals diagnosed with both diabetes and HTN. The research included diabetic and hypertensive patients who attended the outpatient clinics at Imam Halliru and Imam Wali General Hospitals in Kano between January 2015 and August 2020. Patient data were manually extracted from hospital records. Regression and correlation analyses were conducted to compare the stroke risk between patients with either diabetes or HTN and those with both conditions. Among the 933 participants, 200 exhibited clinical features consistent with the World Health Organization definition of stroke. Of these, 85 (37.5%) had HTN, 67 (33.5%) had diabetes, and 58 (29%) had both conditions. Unemployment, female gender, advanced age, diabetes, and HTN were identified as factors associated with an increased stroke risk in the unadjusted analysis. The findings highlight a significantly higher stroke risk for Nigerians with both diabetes and HTN. Therefore, strict blood pressure control for hypertensive patients and rigorous blood sugar management for diabetic patients is critical.