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Background. Mucormycosis is a deadly invasive fungal infection whose characteristics are only partially understood. Methods. Data on mucormycosis obtained in France between 2005 and 2007 from 2 notification systems were merged. The 2008 European Organisation for Research and Treatment of Cancer/Mycoses Study Group definition criteria were applied and risk factors for death were analyzed by hazard ratios (HRs) calculated from the Cox proportional hazards regression model. Results. A total of 101 cases (60 proven, 41 probable), mostly in men (58%) > 50 years (mean age, 50.7 ± 19.9) were recorded. Hematological malignancies represented 50% (median time for occurrence, 8.8 months after disease onset), diabetes 23%, and trauma 18% of cases. Sites of infection were lungs (28%; 79% in hematology patients), rhinocerebral (25%; 64% in diabetic patients), skin (20%), and disseminated (18%). Median time between first symptoms and diagnosis was 2 weeks. The main fungal species were Rhizopus oryzae (32%) and Lichtheimia species (29%). In cases where the causative species was identified, R. oryzae was present in 85% of rhinocerebral forms compared with only 17% of nonrhinocerebral forms (P < .001). Treatment consisted of surgery in 59% and antifungals in 87% of cases (liposomal amphotericin B in 61%). Ninety-day survival was 56%; it was reduced in cases of dissemination compared with rhinocerebral (HR, 5.38 [2.0-14.1]; P < .001), pulmonary (HR, 2.2 [1.0-4.7]; P = .04), or skin localization (HR, 5.73 [1.9-17.5]; P = .002); survival was reduced in cases of hematological malignancies compared with diabetes mellitus (HR, 2.3 [1.0-5.2]; P < .05) or trauma (HR, 6.9 [1.6-28.6], P = .008) and if ≥2 underlying conditions (HR, 5.9 [1.8-19.0]; P = .004). Mucormycosis localization remained the only independent factor associated with survival. Conclusions. This 3-year study performed in one country shows the diverse clinical presentation of mucormycosis with a high prevalence of primary skin infection following trauma and a prognosis significantly influenced by localization.

Purpose Spontaneous cerebellar hemorrhage (sCH) is associated with high mortality, but favorable outcomes can be achieved with appropriate surgical management. We evaluated treatment strategies, complications, outcomes, and prognostic factors in sCH patients at a tertiary center. Methods Adults with primary sCH treated at the neurointensive care unit in Uppsala, Sweden, between 2008 and 2024 were retrospectively included. Clinical and radiological data were collected. Patients were managed conservatively or surgically according to institutional protocols. Outcomes were mortality at discharge and 6 months, and functional outcome at NIC discharge assessed with the Glasgow Outcome Scale-Discharge (GODS). Predictors of 6-month mortality and favorable outcome (GODS > 3) were analyzed. Results A total of 194 patients were included; 50% underwent surgery. Surgically treated patients had lower admission Glasgow Coma Scale motor scores, larger hematoma volumes, and more infratentorial mass effect. Among awake patients with hematomas > 15 mL initially managed conservatively, 78% did not require delayed surgery and most achieved favorable outcomes. Combined hematoma evacuation, suboccipital decompression, and external ventricular drainage (EVD) was associated with low complication rates and low early mortality. Selected patients with hydrocephalus and smaller hemorrhages were successfully treated with EVD alone. Overall mortality was 11% at discharge and 28% at 6 months. Age, neurological status, and hematoma volume independently predicted mortality. Conclusions Favorable outcomes after sCH are achievable, including in elderly patients. Conservative management is appropriate in neurologically stable patients with moderate hematoma volumes, while EVD alone may suffice in selected cases with isolated hydrocephalus.

Objective To ascertain the presence of catatonia in cases of pediatric postoperative cerebellar mutism syndrome (PPCMS). Method A systematic review of PPCMS case reports of patients aged 0–17 years with sufficient clinical information to extract catatonic phenomena was undertaken following PRISMA guidelines. Standardized catatonia rating scales were applied to selected cases retrospectively to ascertain whether diagnostic criteria for catatonia were met. A case known to the authors is also presented. Results Two hundred twenty-one suitable full-text articles were identified. Following screening and application of inclusion criteria, 51 articles were selected plus seven more from their references, reporting on 119 subjects. All cases met Bush and Francis (BF) diagnostic criteria for catatonia, 92.5% Pediatric Catatonia Rating Scale (PCRS), 52.9% ICD-11, and 44.5% DSM-5. All patients presented with mutism. The next most frequent signs were immobility/stupor (77.3%), withdrawal (35.3%), mannerisms (23.5%), and excitement/agitation (18.5%). Most cases presented with stuporous catatonia (75.6%). Catatonia most frequently occurred following resection of medulloblastoma (64.7%). Preoperative hydrocephalus occurred in 89 patients (74.8%). Conclusion Catatonia was frequent in this PPCMS sample, with a predominant stuporous variant; it should be considered in patients with PPCMS and assessed with reliable and validated instruments for prompt diagnosis and management.

Brain amyloidoma is an exceedingly rare localized deposition of amyloid that often radiologically mimics neoplastic or inflammatory disease. We report the case of a previously healthy 53-year-old woman who developed subacute right-hand tremor, pain, and weakness, followed by gait instability. Magnetic resonance imaging (MRI) showed a 35–45 mm hypervascular, infiltrative lesion in the right cerebellar hemisphere, extending into the vermis and middle cerebellar peduncle, with ill-defined margins suggesting of posterior fossa tumor. Subtotal resection was performed. Histopathology confirmed amorphous Congo-red positive amyloid material with perivascular and parenchymal distribution, accompanied by lymphoplasmacytic infiltrates lacking light-chain restriction and therefore without evidence of monoclonality, consistent with amyloidoma. According to the literature, fewer than 100 cases of intra-axial brain amyloidoma have been reported, with infratentorial presentations being extremely uncommon and none previously have been described as an isolated intra-axial cerebellar lesion. This case expands the recognized anatomical spectrum of cerebral amyloidoma, highlights its diagnostic pitfalls, and underscores the essential role of histopathology in establishing the diagnosis.

Background/objectives Despite space-occupying cerebellar infarctions (SOCIs) carrying a high morbidity and mortality due to mass effect in the posterior fossa, optimal management remains uncertain: particularly regarding patient selection, timing, and surgical technique. We conducted a systematic review and network meta-analysis to compare outcomes between medical versus surgical management, and to identify prognostic thresholds that may guide treatment. Methods A search of PubMed, Embase, and CENTRAL was performed from database inception through October 30, 2024. Studies were included if they reported outcomes in ≥ 10 patients with SOCI treated with medical management and/or surgical interventions, including suboccipital decompressive craniectomy (SDC), external ventricular drainage (EVD), and necrosectomy. Data extraction and risk-of-bias assessment were performed independently by multiple reviewers. Random-effects meta-analyses and frequentist network meta-analyses were conducted. Primary outcomes were favorable functional status and mortality; secondary outcomes included length of hospital stay. Results Eighteen studies comprising 754 patients met inclusion criteria. Surgical intervention was associated with superior outcomes in patients with infarct volumes > 51 mL (61.5% favorable outcome vs. 35.0% with medical therapy; p  = 0.018) or GCS ≤ 13 ( p  < 0.05). Among surgical strategies, SDC combined with necrosectomy and an EVD (SDC–N–EVD) conferred the greatest probability of favorable outcome (OR 3.1, 95% CI: 1.18–8.14; p  < 0.05), reduced mortality risk, and shortened length of hospitalization. Neither patient age nor surgical timing within 72 h significantly altered outcomes. Conclusions Surgical management, particularly SDC–N–EVD, was associated with improved outcomes compared to medical therapy alone for SOCI, especially in patients with large infarcts or impaired consciousness. Infarct volume and pre-interventional GCS can provide prognostic thresholds. While the inherent heterogeneity of the data indicates these results should be interpreted with caution, they provide impetus for conducting standardized multicenter prospective studies to validate these observations and establish evidence-based treatment algorithms.

Background The association between preoperative language impairment and development of cerebellar mutism after surgical treatment of posterior fossa tumors has gained increasing interest in recent years based on the concept that both local compression/infiltration of the infratentorial periventricular anatomical structures involved in speech and language, as well as an increased distraction of supratentorial periventricular anatomical structures, due to an associated hydrocephalus, involved in the coordination of speech circuits, might lead to the subclinical presence of language disturbances already at diagnosis, predicting the development of a cerebellar mutism syndrome after tumor removal. Methods A thorough review of the literature on the subject has been performed, together with a review of our institutional experience reporting the related long-term (10 years) results. Results and conclusions According to our institutional experience, 20/70 (28.5%) children presented preoperative language impairment and developed cerebellar mutism after surgery. A residual impairment persists in 75% of the cases at a follow-up of 2 years, and in 50% of the cases at 10 years, a finding which actually depicts cerebellar mutism no more as a transient deficit but among long-term sequelae . The appearance of complex dysarthria in the postoperative period is a negative prognostic factor for the long-term persistence of speech disturbances.

Background Elevated blood glucose (BG) variability has been reported as an independent risk factor for poor prognosis in a variety of diseases. This study aimed to investigate the association between BG variability and clinical outcomes in patients with spontaneous cerebellar hemorrhage (SCH) undergoing surgical operation. Methods This retrospective cohort study of the consecutive patients admitted to the department of Neurosurgery, the Affiliated Hospital of Qingdao University between January 2014 and June 2022 with the diagnosis of SCH underwent surgical intervention. BG analysis was continuously and routinely performed. BG variability was represented by the standard deviation (SD) of the serial measurements within the first 7 days. The general characteristics, imageological information, blood glucose level, and surgical information were reviewed and compared through medical records. Results A total of 115 patients (65 male and 50 female) were enrolled. Out of all 115 patients, the overall clinical outcomes according to the modified Rankin Scale (mRS) were poor (mRS 3–6) in 31 patients (26.96%) and good (mRS 0–2) in 84 patients (73.04%). Twelve of the 115 patients died during hospitalization, and the mortality rate was 10.43%. Multivariate logistic regression analysis showed that SD of BG (odds ratio (OR), 4.717; 95% confidence interval (CI), 1.054–21.115; P  = 0.043), GCS (OR, 0.563; 95% CI, 0.330–0.958; P  = 0.034), and hematoma volume (OR, 1.395; 95% CI, 1.118–1.748; P  = 0.003) were significant predictors. The area under the ROC curve of SD of BG was 0.911 (95% CI, 0.850–0.973; P  < 0.001) with a sensitivity and specificity of 90.3% and 83.3%, respectively, and the cut-off value was 1.736. Conclusions High BG Variability is independently correlated with the 6-month poor outcomes in patients with SCH undergoing surgical operation.

Children undergoing surgical removal of tumors in the posterior cranial fossa can encounter a varied and complex constellation of neurological symptoms, called cerebellar mutism, defined as a disturbance in the planning and programming of motor language with preserved understanding, behavioral disorders such as inattention, visual-spatial disorganization, personality change, as well as ataxia and dysmetria. In the last years, several groups have been trying to establish risk factors or even predictive scores in order to be able at least in part to predict the appearance of speech disorders before surgery. We report on a child with pilocytic astrocytoma of the cerebellar vermis who had already been diagnosed with developmental linguistic delay two years earlier. This disorder initially worsened after surgery and later improved in the following 12 months. The aim of this paper is to emphasize the importance of preoperative neuropsychological evaluation. The present case, along with those reported in the literature, suggests that the risk of long-term cerebellar mutism is higher in children with preoperative speech disorders. In these patients a thorough assessment of cognitive and linguistic functions is therefore necessary to better evaluate the risk of cerebellar mutism after surgery.

This study compared the efficacies of robotic-assisted stereotactic hematoma drainage and suboccipital craniotomy (SC) in patients with spontaneous cerebellar hemorrhage (SCH). This retrospective study included 138 non-comatose patients with SCH (Glasgow Coma Scale score [GCS] >8), divided into the SC and Robotic Stereotactic Assistance (ROSA) groups. The study recorded and analyzed complications and prognoses 90 days after ictus. The inclusion criteria were met by 138 patients: 61 in the SC and 77 in the ROSA group, with no significant differences in sex, age, GCS score, hematoma volume, and the time from ictus to operation. The time of operation was greater in the SC group (287.53±87.57) than in the ROSA group (60.54±20.03). The evacuation rate (ER) was greater in the SC group (93.20±1.58) than in the ROSA group (89.13±2.75). The incidence of pneumonia and stress ulcers, as well as the length or costs of medical services, were lower in the ROSA group than in the SC group. Ninety days after ictus, the modified Rankin Scale (mRS), Glasgow Prognostic Scale (GOS), and Karnofsky Performance Scale (KPS) scores significantly differed between the groups. The rate of good prognosis in the ROSA group was significantly higher compared with that in the SC group. The incidence of balance disorders was lower in the ROSA group than in the SC group; no statistically significant difference was found in the incidence of dysarthria and swallowing disorders. Robotic-assisted stereotactic hematoma drainage may be suitable for non-comatose and stable condition patients with SCH. This procedure improves prognosis 90 days after ictus, lowers the incidence of pneumonia and stress ulcers, and reduces the length and costs of medical services. •ROSA surgery may improve outcomes in non-comatose SCH patients.•This surgery reduces the length and costs of medical services.•Further, it is associated with a better prognosis compared to SC.