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A late adolescent patient was admitted after a collapse and was found to have an intracranial haemorrhage due to an underlying midline arteriovenous malformation (AVM). The patient underwent trans-arterial squid embolisation of the AVM with good radiological resolution. 18 months later, the patient presented with new onset headaches. Cranial imaging demonstrated an enhancing lesion at the site of the previously thrombosed AVM in the corpus callosum. This was deemed to be a foreign body granuloma, a rare complication of intravascular embolisation of AVMs. The patient continued to have periodic imaging with subsequent scans demonstrating progressive changes in the granuloma and this was then resected surgically. We describe the natural history of the granuloma formation, outline the cranial imaging features associated with this rare condition and review the literature of similar cases., Competing Interests: Competing interests: None declared., (© BMJ Publishing Group Limited 2024. No commercial re-use. See rights and permissions. Published by BMJ.)

There is limited literature on the use of mechanical thrombectomy with stent-retrievers in paediatric stroke, especially in the posterior circulation. We report a paediatric case of acute basilar artery occlusion successfully treated by mechanical thrombectomy using stent-retriever but complicated by delayed basilar artery stenosis. This case emphasises prudent selection of thrombectomy device and meticulous long-term follow-up when employed in paediatric stroke., Competing Interests: Competing interests: None declared., (© BMJ Publishing Group Limited 2019. No commercial re-use. See rights and permissions. Published by BMJ.)

We report the first case of genital tuberculosis (TB) occurring in tunica albuginea (TA) and tunica vaginalis (TV) presenting as acute hydrocoele. A 35-year-old man presented with acute onset left scrotal swelling. Physical examination revealed left hemiscrotal swelling with overlying skin erythema and tenderness. Surgical exploration was carried out due to increasing pain and per operatively found thickened TA and TV with a single small nodule on TA. Histopathology revealed typical granuloma formation, however, no Mycobacterium was seen. Subsequent Ziehl-Neelsen stain on separate tissue specimen confirmed the presence of acid-fast bacilli. Based on these findings, antituberculous treatment was started involving daily isoniazid (INH), rifampicin, ethambutol and pyrazinamide for 2 months and further INH and rifampicin for further 4 months., (2015 BMJ Publishing Group Ltd.)

We present our initial patient experience with an innovative temporary bridging device, the Comaneci (Rapid Medical, Israel), to assist in the coiling of cerebral aneurysms. The Comaneci device confers the same benefits as balloon remodeling but without the risks of parent artery occlusion. This alleviates time pressure on the clinician, and could reduce the risk of parent artery thrombosis. Three patients were treated with the Comaneci device. Two patients had acute ruptured posterior communicating aneurysms and one patient was treated electively for a carotico-ophthalmic aneurysm. Excellent occlusion of all three aneurysms was obtained. One patient developed a distal middle cerebral artery clot, that was treated with intravenous aspirin, with minor neurological consequences. These early results show that the Comaneci device can be used to achieve good cerebral aneurysm occlusion. Vessel patency is maintained throughout the procedure with potential advantages over conventional balloon assisted coiling., (2015 BMJ Publishing Group Ltd.)

We present the case of a 24-year-old man who presented with vertigo and right-sided weakness. Subsequent imaging demonstrated a lateral ventricle haemangioblastoma. This is the first case ever to be treated with surgical excision augmented by preoperative endovascular embolisation, as illustrated with perfusion CT scanning performed pre-embolisation and postembolisation. We present the case followed by a summary of the previously published cases and a discussion of the advantages of perfusion scanning and endovascular embolisation in these highly vascular (and therefore potentially dangerous) lesions., (2014 BMJ Publishing Group Ltd.)

Surgical exploration has been the standard of care for abdominal gunshot injuries. The authors report a case of a 28-year-old man who sustained a transabdominal gunshot injury, which entered the anterior abdominal wall and exited adjacent to the T12 vertebra posteriorly with a tangential trajectory. On presentation, the patient was haemodynamically stable with no peritoneal signs. Based on trajectory of the bullet, intra-abdominal injury was suspected. Therefore a CT scan abdomen with intravenous and rectal contrast was performed. The CT scan revealed no extravasation of the rectal contrast but showed free air specks behind the descending colon. Delayed renal images of the left ureter were also normal. Based on the clinical findings, the patient was managed non-operatively with nothing per oral, intravenous antibiotics and frequent abdominal assessments. He made an uneventful recovery without necessitating laparotomy.