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Background Subdural hematoma (SDH) at a remote operative site is uncommon following neurosurgical procedures. However, supratentorial SDH is one of the rare complications following microvascular decompression (MVD). We report a case of supratentorial SDH following MVD. The welling of cerebrospinal fluid (CSF) in the cerebellomedullary fissure was observed unexpectedly during the dissection. It is a signal case that can improve our understanding of the occurrence of such rare complications and of possible mechanisms. Case presentation A 54-year-old woman was diagnosed with left hemifacial spasm (HFS) and had been receiving botulinum toxin injections since 10 years before surgery. CSF welling-up in the cerebellopontine cistern was noticed by the surgeon during the arachnoid dissection. MVD was performed completely. A thin supratentorial SDH was found on the right side (contralateral) on immediate postoperative computed tomography (CT). The SDH was asymptomatic, and the size of hematoma did not increase in follow-up CT scans after surgery. During the follow-up period, she was relieved of HFS. CSF welling-up can be considered the time of initiation of the hemorrhage. Conclusion Limited case reports of supratentorial SDH following MVD have been published, and none of them have reported time of initiation of the hemorrhage. The phenomenon of abnormal CSF welling-up in the cistern could be a sign of remote supratentorial hemorrhage.

BackgroundDeep brain stimulation of the bilateral subthalamic nucleus (STN-DBS) improves motor fluctuation and severe dyskinesia in advanced Parkinson’s disease (PD). Effects on non-motor symptoms, such as neurocognitive side effects, can also influence the quality of life of both patients with PD and caregivers. Predictive quantitative factors associated with postoperative neurocognitive deterioration therefore warrant further attention. Here, we evaluated preoperative electroencephalogram (EEG) as a predictive marker for changes in neurocognitive functions after surgery.MethodsScalp EEG was recorded preoperatively from 17 patients with PD who underwent bilateral STN-DBS. Global relative power in the theta, alpha, and beta bands was calculated. Cognitive function was assessed with neuropsychological batteries preoperatively and 1 year after STN-DBS.ResultsPerformance on the Symbol Search subtest of the WAIS III declined 1 year after DBS. The theta band was chosen for analysis with a 40% cutoff point for increased (≥ 40%) and decreased (< 40%) power. No significant differences between the two groups in baseline performance on most neuropsychological batteries were found, except for the Digit Symbol Coding subtest of the WAIS III. Changes in visual spatial functions were significantly different between groups. The increased theta band power group demonstrated a significant deterioration in performance on the WAIS III Matrix Reasoning subtest and the copy and immediate recall tasks of the Rey-Osterrieth complex figure test.ConclusionsThese findings suggest that preoperative increases in theta power are related to postoperative deterioration of visuospatial function, which indicates the predictive potential of preoperative quantitative EEG for neurocognitive changes after STN-DBS.

Confirmation of the exact voluntary movements of patients with disorder of consciousness following severe traumatic brain injury (TBI) is difficult because of the associated communication disturbances. In this pilot study, we investigated whether regional brain glucose metabolism assessed by 18F‐fluorodeoxyglucose positron emission tomography (FDG‐PET) at rest could predict voluntary movement in severe TBI patients, particularly those with sufficient upper limb capacity to use communication devices. We visually and verbally instructed patients to clasp or open their hands. After video capture, three independent rehabilitation therapists determined whether the patients' movements were voluntary or involuntary. The results were compared with the standardized uptake value in the primary motor cortex, referring to the Penfield's homunculus, by resting state by FDG‐PET imaged 1 year prior. Results showed that glucose uptake in the left (p = 0.0015) and right (p = 0.0121) proximal limb of the primary motor cortex, based on Penfield's homunculus on cerebral cartography, may reflect contralateral voluntary movement. Receiver operating characteristic curve analysis showed that a mean cutoff standardized uptake value of 5.47 ± 0.08 provided the best sensitivity and specificity for differentiating between voluntary and involuntary movements in each area. FDG‐PET may be a useful and robust biomarker for predicting long‐term recovery of motor function in severe TBI patients with disorders of consciousness. Resting FDG‐PET of the primary motor cortex may predict upper limb movements. Glucose uptake differs between voluntary and involuntary movement at resting FDG. Glucose uptake cutoff in the primary motor cortex may help detect voluntary movements.

Diagnostic, prognostic, and therapeutic procedures for patients with prolonged disorders of consciousness (pDoCs) vary significantly across countries and clinical settings, likely due to organizational factors (e.g., research vs. non-academic hospitals), expertise and availability of resources (e.g., financial and human). Two international guidelines, one from the European Academy of Neurology (EAN) and one from the American Academy of Neurology (AAN) in collaboration with the American Congress of Rehabilitation Medicine (ACRM) and the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR), were developed to facilitate consistent practice among professionals working with this challenging patient population. While the recommendations of both guidelines agree in principle, it remains an open issue how to implement them into clinical practice in the care pathway for patients with pDoCs. We conducted an online survey to explore health professional clinical practices related to the management of patients with pDoCs, and compare said practices with selected recommendations from both the guidelines. The survey revealed that while some recommendations are being followed, others are not and/or may require more honing/specificity to enhance their clinical utility. Particular attention should be given to the implementation of a multimodal assessment of residual consciousness, to the detection and treatment of pain, and to the impact of restrictions imposed by COVID-19 pandemics on the involvement of patients’ families/representatives.

In the original version of this article, the affiliation detail for author Anna Estraneo was incorrectly given as IRCCS Fondazione Don Carlo Gnocchi ONLUS, Florence and Sant’Angelo dei Lombardi, AV, Italy but should have been: IRCCS Fondazione Don Carlo Gnocchi ONLUS, Florence, Italy.

A 41-year-old man was diagnosed with chronic pulmonary thromboembolism and underwent pulmonary thromboendarterectomy (PTE) with deep hypothermia and circulatory arrest. Five days after the operation, chorea emerged in the lower extremities. The patient was referred to our hospital for disabling chorea 16 years after PTE. Neurological examination revealed choreatic movements in the four extremities. Brain magnetic resonance images indicated atrophy in the bilateral head of the caudate nuclei. The patient underwent deep brain stimulation (DBS) of the bilateral globus pallidus interna (GPi). Continuous GPi-DBS diminished the choreatic movements. GPi-DBS may be a treatment option for sustained choreatic movements after PTE.