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Introduction Ependymomas represent approximately 2%–8% of all primary intracranial brain tumors. The occurrence of extra-axial posterior fossa ependymomas in adults is rare. Case and outcomes We report a case of extra-axial cerebellopontine (CP) angle ependymoma in an adult patient, managed through gross total resection (GTR) and adjuvant radiotherapy. At her one-year postoperative visit, the patient remained clinically stable without any symptoms or focal neurological deficit and a follow up MRI showed no evidence of tumor recurrence. Discussion Only six cases of adult cerebellopontine angle ependymomas have been reported in the English literature, with the left side affected more commonly. Including this case, the mean age of the reported cases of adult extra-axial CP angle ependymoma is 44.14 years (range 22–66 years). Men accounted for five out of seven cases (71.4%). Maximal surgical resection is the mainstay of treatment in extra-axial CP angle ependymomas. Among seven reported cases, five received GTR and two had subtotal resection (STR). Patients were followed an average of 13.6 months (range 2–30 months) and only two patients with STR died during the follow-up period (6 weeks and 2 months after surgery). Six of the seven reported cases (including this one) received adjuvant radiotherapy. Conclusion Although rare, extra-axial CP angle ependymomas should be considered as a differential diagnosis to other lesions of the CPA. Radical resection, whenever possible, is usually associated with a good outcome. Adjuvant radiotherapy remains an optional treatment with an unknown impact on overall and progression-free survival.

Sheno-occipital diastasis happens more frequently in children and is accompanied with neural and vascular injuries leading to a high rate of mortality. We present a rare type of clival fracture in a 21 years old man who could survive without any deficit even though the fracture extended widely from left Asterion to the right orbit accompanied by widespread damage of the skull base air sinuses in 3D CT scan. To the best knowledge of the authors, neither this type of fracture, nor the clinical presentation, has been reported in relevant literature.

Background and Objectives: Stabbing the head is a rare event. It may occur following an assault or self-inflicted injury. We intend to report our experience with four such cases and review narratively the relevant literature. A treatment algorithm will be delivered. Materials and Methods: We have reviewed four of our cases; three were stabbed to the orbit and one to the head. Results: Enucleation was performed in one case. Vision could be preserved in the other two and brain abscess developed in the other cases due to a retained piece of knife. We made a comparison between our cases and those limited reports in the literature to reach an algorithm. Conclusion: The temporal region and the orbit are the targets mostly attacked in the craniofacial stabs. Since knives have a sharp and thin edge, they may break when penetrating the skull. The damage to the brain tissue and the retained piece of knife may be missed easily by overlooking the small injury to the scalp. The suggested algorithm would be a contrast-enhanced computed tomography scan of the skull and brain and a kind of brain vascular study are necessary, considering the location of the knife in the skull and brain passing the area with crowded vasculature. The best treatment protocol is surgery accompanied by antibiotic therapy.

Fusiform aneurysms of cerebral arteries are less prevalent than saccular aneurysms and are rarely associated with subarachnoid hemorrhage (SAH). In this article, we report SAH due to a rare case of bilateral fusiform aneurysm of the supraclinoid segment of the internal carotid arteries (ICAs) (C4 segment of the ICA).

Background: Electrocardiography (ECG) changes after subarachnoid hemorrhage (SAH) are well described. However, concurrent myocardial infarction (MI) and SAH are rarely reported, and its management remains a dilemma. We report a patient with traumatic SAH concurrent with acute MI that managed successfully by endovascular intervention and dual antiplatelet therapy. Case Description: A 47-year-old man was admitted to the emergency department with a complaint of severe headache. Diffuse SAH, with a Hunt and Hess score of 5, was noticed. ECG showed ST elevation in anterior leads, and cardiac troponin became positive. On brain computed tomography angiogram, a 6 mm anterior communicating artery aneurysm was seen. Considering the possibility of MI and SAH simultaneously, endovascular obliteration of the aneurysm was done, and then, the patient received dual antiplatelet medications until coronary angiography was done. Coronary angiography revealed normal epicardial coronary arteries. The patient was discharged with a Glasgow Coma Scale score of 15 and was visited 2 months after discharge without any new episodes of intracranial hemorrhage with a modified Rankin scale score of 2. Conclusion: Cerebral aneurysm coiling could be considered as the first choice of treatment in the case of acute MI with hemodynamic stability, before carrying out cardiac endovascular intervention or antiplatelet medication to reduce the risk of rebleeding from a brain aneurysm.

Depression is a one of the most prevalent psychiatric disorder. Despite several pharmacological treatments, still treating depression is a challenge. Herbal medicine that is better culturally accepted may play an important role in treatment of depression. In this double blind placebo controlled clinical trial, 40 patients that were suffering from major depression according to DSM-IV criteria were randomly allocated to take either fluoxetine and saffron (20 patients) or fluoxetine and placebo (20 patients). The patients of the two groups were evaluated with Beck depression scale at the beginning of the study and after four weeks. Lipid profile (total Triglyceride (TG) level, total cholesterol level, low density lipoprotein (LDL) level and high density lipoprotein (HDL) level) of the patients also was measured at the beginning and end of the trial. 30 patients (19 in saffron group and 11 in placebo group) completed the study. The two groups improved significantly in depression severity at the end of the study without significant difference (P: 0.560). The lipid profile of the two groups did not change significantly. Our study did not demonstrate antidepressive effects for saffron. We did not observe any lipid lowering effect in saffron group too. Of note is that our study is preliminary and larger studies with more patients and longer duration are needed to prove our results. Clinical trial registration number: IRCT 2013110915334

Abnormal elongation of styloid process (Eagle syndrome) may cause compression of the adjacent structures in the neck, the most important of which is the carotid artery. This condition may cause damage to the wall of carotid artery and result in cerebrovascular ischemic event. Bilateral carotid artery damage and cerebral stroke because of overgrown styloid processes at both sides is a rare condition. In this article, we report a case of bilateral ischemic stroke because of carotid compression by elongated styloid process at both sides treated by surgical resection of both processes.

Breast cancer is the leading type of cancer in Iranian women and affects them at least one decade younger than their counterparts in developed countries. Breast tumor progression and metastasis is accompanied by a decrease in the membranous expression of Syndecan-1 and an increase in its shedding. We measured the level of soluble Syndecan-1 in the sera of Iranian patients with breast cancer. The study population included 61 chemotherapy-naive breast cancer patients and 30 age/sex-matched healthy individuals. Blood was collected by venipuncture method and serum was separated, aliquoted and kept at −40 °C until used. A commercial ELISA was used to detect Syndecan-1 levels in the sera. Soluble Syndecan-1 levels were increased in the sera of patients with breast cancer compared to healthy controls (87.89 ± 89.29 vs. 47.57 ± 46.46 ng/ml, p = 0.005). There was a positive correlation between soluble Syndecan-1 levels and tumor size (p = 0.017). The serum level of Syndecan-1 in patients without calcification showed a trend of increase compared to that of patients with calcification (108.80 ± 101.76 vs. 59.82 ± 57.13 ng/ml). The positive correlation between soluble Syndecan-1 levels and tumor size in the present study highlights the importance of different varieties (cell-bound and soluble) of this molecule in the breast tumor progression and their significance as tumor biomarkers.

Introduction: Trauma has been recognized as one of the leading causes of death in many countries for decades. Reduction in mortality and morbidity rate of trauma cases is one of the most important attitudes in this field. Evaluation of different risk factors have been considered as the main goal of some studies. The purpose of this study was determining potential risk factors of death in trauma patients. Method: In a retrograde study, data of 740 patients admitted during three years (2009-2011) were studied. Demographic data (sex and age), clinical factors (blood pressure, pulse rate, respiratory rate, Glasgow coma scale (GCS)), trauma characteristics (location, type of injury, etc.), as well as outcome of patients were evaluated. Data analyses was done using SPSS 18.0. Stepwise multivariate regression analysis was used for recognition of independent predictive factors of death in multiple trauma patients. Results: Of those admitted, majority of patients were male (81.4%), 68% between 18 to 60 years, and 11.2% of them died during the course of treatment. Age; type of trauma; abnormal respiration rate, pulse rate, blood pressure; total GCS ≤8; abnormal pupil size; and head and neck; vertebral, and extremities fractures were obtained as significant predictive factor of death. GCS≤8, head and neck fracture, and abnormal pulse rate were independent death predictors. Conclusion: We identified GCS≤8, head and neck fracture, and abnormal pulse rate as predictive factors of mortality after trauma, which remained independent in the presence of all other factors and potentially treatable.