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Purpose: IDH1 and IDH2 are hotspot mutations commonly identified in WHO-grade 4 astrocytomas. Their association with TAMs has never been investigated. We aim to explore the crosstalk between the IDH1/2 mutation metabolic effect and TAMs in tumour microenvironment and how this relationship affects the tumour recurrence., Patients and Methods: The study included 20 samples of patients with WHO-grade 4 astrocytoma. The alteration hotspot in codon IDH1 R132 and IDH2 R172 was examined using direct sequencing. The protein expression of CD204 on TAM was detected through immunohistochemistry., Results: IDH1 R132 and IDH2 R172 were symmetrically identified as wildtype in 18/20 tumours (90%) and the remaining 2 tumours (10%) showed synonymous mutations on both codons. Tumours with IDH1/2-wildtype showed high expression of CD204 + TAMs in 10 cases and low expression in 8 cases. Typical expression was seen equally in IDH1/2 mutant tumours. There was no significant association between IDH1/2 and CD204 + TAM expression (p= 0.999). The association between the two groups was significantly observed among IDH-wildtype tumours (p=0.027). Highly expressed CD204 in IDH-wildtype tumours showed a median recurrence at 10 months compared to low CD204 expression, showed a median recurrence interval at 24 months., Conclusion: IDH1 R132 or IDH R172 has the same impact on the classification and prognosis of WHO-grade 4 astrocytoma. There was no crosstalk between IDH1/2 metabolic effect and CD204 + TAM. However, IDH-wildtype glioblastomas with dense CD204 + TAM are associated with early recurrence. Because the sample size is small, a larger study is recommended to determine the impact of IDH1/2 on TAMs., Competing Interests: The authors report no conflicts of interest in this work., (© 2023 Kurdi et al.)

The coexistence of myelomeningocele (MMC) and split cord malformation (SCM) is a well-known phenomenon. The SCM is usually above or at the level of the MMC. Split cord malformation distal to the MMC is considered to be the rarest form of such a combination. We report a case of SCM (type I) distal to the MMC diagnosed pre-operatively. Repair of the MMC and the SCM were carried out in the same setting.

This report concerns a case of a 32-year-old male with right ulnar neuropathy caused by arterio-venous fistula due to gunshot wound injury presenting with severe neuropathic pain along the ulnar nerve distribution. Intra-operative exploration and ligation of the fistula relieved the patient`s neuropathic pain. A review of the recent English literature did not reveal any reports of arterio-venous fistula of the ulnar nerve.

We report a case of left upper trunk neuropraxia following an uneventful case of lumbar spine fixation and fusion performed in the prone position. The cause of the injury was believed to be a very tight endotracheal tube tie in addition to the patient`s head turned to one side; both caused a compression in the left supraclavicular region compressing the upper trunk of the brachial plexus. On literature review, there are limited reports of endotracheal tube tie causing upper trunk brachial plexus reported in the English literature. Attention and care needs to be exercised to avoid this largely preventable complication.

The pathoanatomical explanation of lumbar disc herniation causing the rare cauda equina syndrome with sacral 2- sacral 4 roots sparing is not well described. A case report of bladder sparing cauda equina syndrome due to a large posteriorly sequestered lumbar disc fragment is presented. Magnetic resonance imaging of the lumbosacral spine showed herniation of a large disc fragment at lumbar 3-lumbar 4 deforming the thecal sac posteriorly, with the left side more affected than the right. Bladder sparing cauda equina syndrome can be explained by the anatomical organization of the nerve roots within the thecal sac. The medial sacral roots are not as stretched and strained by the herniating disc as the laterally placed lumbar roots. Early laminectomy and decompression of the thecal sac may relieve this stretch and strain on the nerve roots and therefore preserve bladder function.

Brain abscess due to listeria monocytogenes mainly involves the cerebral hemispheres. Cerebellar abscess is an infrequent event, which could lead to rapid neurological deterioration if unrecognized. We present a case of multiple brain stem and cerebellar abscesses in a previously healthy individual exposed to unpasteurized milk. This is the 2nd case of cerebellar abscess due to listeria monocytogenes reported in the English literature. The diagnosis of listeria monocytogenes was made in the surgical specimen. Our case illustrates the difficulty of early diagnosis of cerebellar listeria monocytogenes abscesses and the importance of prompt neurosurgical intervention.