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Key Clinical Message: Cerebral venous sinus thrombosis in itself is rarely encountered clinical entity and its association with immune thrombocytopenic purpura (ITP) makes it more unusual presentation. No any as such standard guidelines exist that guides the prompt evidence based management in such concurrent cases but neuroendovascular modality can play a pivotal role. [ABSTRACT FROM AUTHOR]

Key Clinical Message: Diastematomyelia, tethered cord, intradural extramedullary dermoid tumor and lipomyelomeningocele such disease entities themselves are rare in their own form and concurrent presentation of all those pathological states in a single individual can be considered one of the rarest forms of spinal dysraphism globally. Moreover for prompt management with optimal prognosis needs refined neurosurgical intervention guided by intraoperative neuromonitoring so as to bring about the best quality of life in the patient. [ABSTRACT FROM AUTHOR]

Introduction and Importance: When compared to other cranial nerve palsies idiopathic unilateral oculomotor nerve palsy with pupillary sparing is one of the least noted neurological conditions. Moreover, there lies a series of diagnostic dilemmas to come into a final diagnosis resulting in several array of clinical investigations. Hence, there is a delay in prompt management., Case Summary: An elderly female without any known comorbidities presented with the complaint of headache, dizziness and dropping of left eyelid. Several arrays of diagnostic workups was done to come to a diagnosis, but even with rigorous laboratory investigations and radiological examinations, a common working diagnosis could not be made. Hence with a diagnosis of exclusion after proper neurological and neuro-ophthalmological examination, idiopathic unilateral common oculomotor nerve palsy was identified for which improvement with steroids was noted in the patient., Discussion: Idiopathic unilateral complete oculomotor nerve palsy is considered as a diagnosis of exclusion when all the diagnostic parameters fail to signify and positive results. The vague symptomatic presentation of the disease condition further compels the treating physician to carry out several panels of laboratory to radiological investigations. But if identified in time the treatment modality is straightforward., Conclusion: The diagnostic quandary in timely identification of such disease conditions needs a pertinent diagnostic guideline so as to avoid the unwanted panel of investigations., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc.)

Introduction and Importance: Intracerebral haemorrhage (ICH) secondary to use of anti-coagulants is one of the fearsome complications. Haemorrhage within the intracranial space due to such anti-coagulants results in expansion of the intracranial bleeding despite the reversal of anti-coagulants. Hence, timely surgical intervention can be lifesaving., Case Summary: An elderly female who was undergoing management for her deranged coagulation parameters was found to be in a state of features suggestive of stroke. The patient was on regular anti-coagulants medication for her cardiology issues. Computed tomography (CT) scan showed intracranial haemorrhage, which underwent expansion on same day; hence decompressive craniectomy was done. During further stay in the ICU patient's Glasgow coma scale fluctuated but symptomatic improvement was noted. Anti-coagulants adjustment was made by a cardiologist and further, there was no expansion of intracranial bleeding within normal coagulation parameters., Discussion: Anti-coagulants are rampantly used in several cases. Despite the several complications, there is a desperate need for such medications for the betterment of the patient's condition. Pharmacological management is a major modality in the reversal of oral anti-coagulants (OAC)-induced ICH, but in rare cases in the background of OACs-induced ICH, there occurs expansion of haemorrhage. Hence there is a need for neurosurgical intervention, whether it be minimally invasive surgery or decompressive craniectomy., Conclusion: In the background of the low prevalence of OACs-induced ICH, there is an absence of a robust guiding treatment protocol. Furthermore, there exist minimal reported cases which underwent surgical intervention and resulted in a good prognosis., Competing Interests: The authors declare no conflicts of interest.Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article., (Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc.)

Introduction: Preoperative diagnosis of intracranial space occupying lesion based solely on clinical and neuroimaging evaluation may not be sufficient to institute treatment plan without histopathological certainty. Frame based stereotactic biopsy is a technique of retrieving biopsy specimen to determine the histopathology. The aim of this study is to assess the efficacy and accuracy of frame based technique., Methods: This is a cross-sectional study conducted among 80 patients who underwent computed tomography guided frame based stereotactic biopsy during a period of 6 years. All operations were performed under local anesthesia. Histopathology reports were retrieved and accuracy of biopsy technique analyzed., Results: Out of 80 patients, 58 were male with male to female ratio of 2.6:1. Median age of patients were 50 years with range from 16 to 75 years. Most lesions were in deeper location 49 (61.3%). Most common location was Parietal, 15 (18.8%) followed by Thalamic, 12 (15%). Mean size of lesion was 2.88±0.71cms ranged from 2 to 5cms. Biopsy was accurate to retrieve target in 74 (92.5%) patients. Histopathology revealed glial tumor in 41 (51.2% ) of cases. Overall morbidity was observed in 3 (5.5%) patients. There is no procedure related mortality in this study during study period., Conclusions: Frame based biopsy of intracranial space occupying lesion is safe and efficacious procedure with high diagnostic yield.