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Background: Propeller-related injuries from motorboats are a major cause of injury in recreational water activities including severe and multiple lacerations that can promote scarring, blood loss, traumatic, or surgical amputations. The real incidence of these accidents is still unclear. The authors here present a systematic review of the literature, focusing on head injury, and related recommendations for its evaluation and management, also reporting a case of a female patient injured by a motorboat propeller. Methods: A systematic literature review was conducted according to the preferred reporting items for systematic reviews and meta-analyses statement, with no limits in terms of publication date. The following Mesh and free text terms were identified: “motorboat and propeller and injuries” (107 results). Results: A total of 12 papers were included in this systematic review. Only few case reports describing traumatic brain injury (TBI) have been documented. Out of a total of 90 cases analyzed, only five cases with TBI were reported. The authors also reported a case of a 12-year-old female, that during a boat trip, reported a severe polytrauma with concussive head trauma from a penetrating left fronto-temporo-parietal lesion, left mammary gland trauma and fracture of the left hand from falling into the water and impact with a motorboat propeller. She underwent an urgent left fronto-temporo-parietal decompressive craniectomy and then surgery with a multidisciplinary team. At the end of the surgical procedure, the patient was transferred to the pediatric intensive care unit. She was discharged on postoperative day 15. The patient was able to walk without assistance, with mild right hemiparesis and persistence of aphasia nominum. Conclusion: Motorboat propeller injuries can result in extensive damage to soft tissue and bones with severe functional disability, amputations, and high mortality. There are still no recommendations and protocols for the management of motorboat propeller related injuries. Although there are several potential solutions that aim to prevent or ease motorboat-propeller injuries, there are still lack of consistent regulations.

Background: Spinal epidural abscesses are rare and are misdiagnosed in up to 75% of cases. Fever, back pain, and neurological deficits are part of the classical triad. Here, the authors report a patient with a L2–L5 spinal epidural abscess with the left paravertebral extension attributed to acute pyelonephritis. Case Description: A 54-year-old female presented with persistent low back pain and lower extremity weakness accompanied by paresthesias. Previously, she had been hospitalized with the left acute pyelonephritis. The lumbosacral MRI documented a T12/L5 anterior epidural abscess with ring enhancement on the contrast study; the maximum diameter of the abscess at the L2–L3 level contributed to severe cauda equina compression. She underwent a L2/L4 decompressive laminectomy with drainage of the intraspinal/extradural and paravertebral components. Intraoperative microbiological sampling grew Staphylococcus aureus for which she then received targeted antibiotic therapy. Fifteen days later, she was walking adequately when discharged. Conclusion: Thoracolumbar epidural abscesses are rare. They must be considered among the differential diagnoses when patients present with acute back pain, fever, and new neurological deficits following prior treatment for acute pyelonephritis.

Background: Frontotemporal dementia (FTD) is a highly disabling neurologic disorder characterized by behavioral alterations and movement disorders, involving patients with a mean age of 58 years. We present a unique case of a patient suffering from FTD who developed post traumatic bilateral hygromas. Case Description: A 52-year-old male patient, with an history of head trauma 3 months before, was admitted to our department for recurrent motor seizures. Anamnesis was positive for FTD with severe frontal syndrome. Brain computed tomography and magnetic resonance imaging (MRI) showed the typical “knife-blade” appearance of the cortical atrophy associated to bilateral hemispheric hygromas exerting mild mass effect. Brain MRI showed the signs of the cortical and “anti-cortical” vein. The two subdural collections were evacuated through two bilateral burr holes and controlled drainage. Despite anti-epileptic drugs therapy, in the early postoperative period, the patient presented further tonic-clonic seizures. The patient showed progressive recovery and was transferred to the neurorehabilitation center. After 6-month follow-up, he completely recovered. Conclusion: In FTD, severe cortical atrophy leads to space increase between arachnoid and pia mater that could affect the anatomical integrity especially after trauma, with possible development of hygromas. The coexistence of radiological findings of the cortical vein and sign of the “anti-cortical” vein can make difficult an exact differential diagnosis between a primitive hygroma and a Virchow hygroma from resorption of previous blood collection. Surgical treatment may be indicated in selected patients, but it is burdened by higher postoperative risks compared to the general population.

Background:Burkitt’s lymphoma is a non-Hodgkin B-cell lymphoma, occurring mostly in Equatorial Africa. According to the WHO, classification is three different variants: sporadic, endemic, and immunodeficient-associated. Here, we present a patient with “sporadic” primary epidural Burkitt’s lymphoma resulting in chronic low back pain (LBP).Case Description:A 63-year-old female presented with a 2-month history of LBP and the left lower extremity sciatica. The thoracolumbar MRI showed a L5 irregular, osteolytic epidural lesion that was hypointense on T1-weighted images, hyperintense on STIR studies, and inhomogeneously enhanced with contrast. Additional hypointense lesions were also seen at the L2, L3, and L4 levels. The patient underwent a L4-L5 laminectomy for piecemeal epidural resection of tumor, and a L4-S1 transpedicular screws/rod fusion. In addition, a L2-L3 radiofrequency ablation was performed. The histological examination documented a primary “sporadic” spinal Burkitt’s lymphoma. The patient subsequently was treated with both radiotherapy/chemoradiotherapyConclusion:Primary “sporadic” spinal Burkitt’s lymphoma is rare. Following tumor resection, adjunctive radiation and chemotherapy are typically warranted.

Background: Citrobacter species are an unusual cause of cerebral abscess in infant. In particular, Citrobacter freundii can invade and replicate in human brain microvascular endothelial cells with a selective neurovirulence, producing ventriculitis and brain abscess mainly in the infant. A delayed brain abscess caused by C. freundii species in adult patients and after surgery is an occurrence that has not yet been reported in the literature. Case Description: The authors reported a case of a 60-year-old patient that presented a delayed postoperative brain abscess following resection of a left parietal convexity meningioma. A resurgery was performed, with bone flap removal, debridement, and culture of the purulent content of the previous surgical cavity. The microbiological examination showed the isolation of C. freundii. Postoperatively, the patient improved, with progressive headache reduction and right upper limb weakness improvement. She was continued on medical therapy for 4 weeks, until inflammatory index and white blood cells count gained normal range, then, she was admitted to a neurorehabilitation center. Conclusion: A delayed brain abscess caused by C. freundii in adult patients and after surgery is an occurrence that has not yet been reported in the literature, with a consequent complex management, due to the lack of clear guidelines.

Background: Nontuberculous mycobacteria (NTM) represents an important cause of infection, particularly in immunocompromised patients. Spondylodiscitis is unusual and may be associated with underlying causes such as drug abuse. Timely diagnosis and treatment are critical, as without this, patients will demonstrate progressive neurological deterioration. Here, we present a rare case of Mycobacterium mucogenicum spondylodiscitis in a 36-year-old male, along with a focused literature review. Case Description: A 36-year-old female with previous drug abuse presented with 3-years of progressive thoracolumbar pain. The MRI of the spine revealed paravertebral abscesses from Th10–L1 with vertebral lesions involving Th11–Th12 levels (e.g., vertebral body collapse/deformity and destruction of the posterior vertebral walls). After a needle CT-guided biopsy of the paravertebral tissues, real time-polymerase chain reaction (RT-PCR) amplification documented NTM; the final identification was M. mucogenicum. The patient then underwent a Th11–Th12 decompressive laminectomy, facetectomy, granulomatous tissue debridement, and posterior pedicle screw fusion from Th8–Th10, and L1–L3. Postoperatively, the patient’s pain resolved, and she was left with residual lower extremities dysesthesias; 6-months later, she could walk without assistance. Conclusion: Spondylodiscitis caused by M. mucogenicum is rare, and the medical and surgical treatment is comparable to that for other NTM groups.

Background: Epidural dumbbell-shaped chordomas are localized slow growing, and malignant/aggressive neoplasms. Here, we present a 62-year-old male with a T3-T4 dumbbell-shaped chordoma and reviewed the appropriate literature. Case Description: A 62-year-old male presented with a three-month history of thoracic pain. When the thoracolumbar magnetic resonance (MR) showed a T3-T4 dumbbell-shaped intracanalicular/extradural tumor, he underwent tumor removal. After the histological examination proved the lesion was a spinal chordoma, he underwent a secondary radical transthoracic tumor resection. Postoperatively, the patient was able to walk without assistance, and at 6-month follow-up, was neurologically intact with only residual paresthesias. Conclusion: Malignant spinal chordomas may mimic benign neurinomas on MR scans. Here, biopsy of the lesion to confirm the diagnosis of chordoma was critical and directed subsequent definitive transthoracic tumor resection.

Background: Chronic subdural hematoma (cSDH) represents a complex and unpredictable disease, characterized by high morbidity and mortality, especially in elderly patients. Factors affecting the postoperative brain reexpansion along to cSDH recurrence have not been yet adequately investigated. The authors presented the case of a schizophrenic patient affected by trabecular type cSDH that presented a delayed brain reexpansion despite a craniotomy and membranotomy. Case Description: A 51-year-old female patient with diagnosis of schizophrenia was admitted to the emergency department with GCS score of 5/15 and right anisocoria. An urgent brain CT revealed a trabecular right cSDH (35 mm in maximum diameter) with recent bleeding. After surgery, a brain CT scan showed a markedly reduced brain reexpansion and pneumocephalus. Nevertheless, postoperative 7-day brain CT documented a progressive brain reexpansion with reduced midline shift. Conclusion: According to our opinion, anatomopathological alterations in schizophrenia reduce normal brain compliance and increasing elastance, thus modifying the normal timing of reexpansion after cSDH drainage, also after craniotomy and membranotomy. Although postoperative pneumocephalus is a well-known cause of hindered reexpansion, this could be due to anatomical alterations in schizophrenia. Such factors must be considered in the preoperative planning but mostly in the postoperative management.

Background: Tethered spinal cord syndrome (TCS) can occur after the surgical repair of lipomeningoceles (LMCs). In these cases, the tethering results from postoperative adhesions between the spinal cord and the overlying repaired dura. A watertight dural closure using the residual dura and/or the surrounding tissues does not always provide enough space for the spinal cord and risks retethering. Here, we report a 16-year-old patient with secondary TCS following lipomeningocele repair who successfully underwent release of the tethered filum terminale utilizing a novel dural splitting reconstructive technique to attain a water-tight closure without the need for a duroplasty. Methods: A 16-year-old patient had a LMC repaired at birth. She now presented with progressive low back pain, and gait disturbances. The MRI documented secondary spinal cord tethering at the prior spinal dysraphism repair site. Results: A secondary release of the filum terminale utilizing a novel dural splitting technique to avoid the need for a duroplasty was performed. Conclusion: Here, in a 16-year-old patient with a recurrent tethered cord syndrome following repair of a LMC at birth, we utilized a novel dural splitting reconstruction technique and averted the need for a duroplasty.

Background: The treatment of spontaneous spinal epidural hematomas (SSEHs), depending on the lesion size and myeloradicular involvement, can be surgical or conservative. Here, we present a 55-year-old patient who sustained a SSEH several months following a systemic SARS-CoV-2 infection. Case Description: A 55-year-old immunocompromised female (i.e., history 17 years ago of Hodgkin’s lymphoma, nodular sclerosis variant) recently developed a SARS-CoV-2 infection treated with nonsteroidal anti-inflammatory agents. She then reported the sudden onset of cervicodorsalgia after a slight cervical flexion/extension maneuver. The brain and cervicothoracic spine MRI studies documented a clival anterior spinal epidural hematoma with maximum spinal compression at the T1-T2 level; it also extended inferiorly to the T6 level. Two weeks later, the follow-up MRI showed a remarkable reduction in the anteroposterior diameter of the hematoma that correlated with significant neurological improvement and almost complete pain regression. She was discharged after a total 15-day hospital stay, with complete symptoms relief. Conclusion: We present a 55-year-old chronically immunocompromised (i.e., due to the history of Hodgkin’s lymphoma) female who, following a SARS-CoV-2 infection, developed an anterior SSEH extending from the clivus to the T6 spinal level that spontaneously regressed without surgical intervention.

Background: Intradural disc herniations (IDHs) are rare occurrences (0.26–0.30%), and most frequently involve the lumbar spine at the L4–L5 level. Here, we present a patient with an L1–L2 IDH and reviewed the current literature. Case Description: A 65-year-old female presented with the acute onset of bilateral paraparesis accompanied by urinary dysfunction. The lumbar MRI showed a mass at the L1–L2 level with caudal migration, accompanied by a positive “hawk-beak” sign. At surgery, consisting of a L1–L2 laminectomy, a large IDH was encountered responsible for marked cauda equina/root compression. Postoperatively, the patient immediately fully recovered. The literature we identified cited just seven similar studies of L1–L2 IDH. Conclusion: In a 65-year-old female, an IDH was anticipated at the L1–L2 level due to the combined MR findings of a large L1–L2 mass with caudal migration and the positive “hawk-beak” sign.