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Context: Dural arteriovenous fistulas (DAVFs) of the cavernous sinus are arteriovenous connections located in the dura mater leaflets of this region. DAVFs usually present with ocular symptoms such as diplopia, conjunctival hyperemia, involvement of cranial nerves III/IV/VI, etc. Trigeminal neuralgia caused by a cavernous DAVF is rare, being reported only three times in the literature. Case report: A 46-year-old female smoker sought care with a complaint of multiple daily episodes of shock-like right temporal headache and facial pain in the V1/V2 dermatomes, of 2 years’ duration. A clinical diagnosis of trigeminal neuralgia was established. Magnetic resonance (MR) imaging of the brain and MR angiography of the cerebral and cervical vessels were both normal. Conservative treatment and balloon compression of the trigeminal ganglion were ineffective. Therefore, we chose to perform an angiography for diagnostic clarification, which demonstrated a DAVF of the right cavernous sinus, fed by branches of the external carotid artery. We decided to catheterize the fistula and complete obliteration was achieved. Soon after the procedure the patient reported pain relief. At 3-month follow-up the patient remained pain free and required no analgesia. Conclusion: Trigeminal neuralgia caused by a cavernous DAVF is rare. The fistula in this case was only diagnosed after an angiography was performed, so clinicians must be aware that not all vascular conditions can be identified non invasively, and that cavernous DAVFs may be an underdiagnosed cause of trigeminal neuralgia.

Background:Moyamoya disease (MMD) is a steno-occlusive cerebral angiopathy. The incidence of intracranial aneurysms (IA) associated with MMD is high (3.4-14.8%) when compared to the general population (1-3%). IA in the middle cerebral artery (MCA) associated with MMD are rare, with only 25 cases described in the literature. Methods:Search on the PubMed platform, in English, with the MeSH terms “Moyamoya Disease”, “Intracranial Aneurysm” and “Middle Cerebral Artery”. There were 151 results, of which 7 were included in the review. Results:Sumi et al. and Larson et al. reported non-ruptured IA of the M1 segment, treated by surgical clipping and wrapping, respectively. Endo et al. chose to clip a ruptured IA in the M1 segment, followed by anastomosis between the superficial temporal artery and the MCA, excluding the IA . Liu et al. reported a non-ruptured MCA IA in a pediatric patient, treated through an encephalo-duro-arterio-synangiosis; the IA was excluded. Peltier et al. performed an indirect revascularization using the multiple bur-hole technique in a pediatric patient with non-ruptured IA in the M1 segment, excluding the IA. Rivera et al. opted for the conservative approach of a ruptured IA in the M1 segment, which was successful. Yan et al. described 19 IA in the MCA associated with the MMD, without specifying the adopted therapeutic. Conclusion:Due to the low number of cases, no recommendation can be made, and treatment should be individualized.

Background: Meningitis is the inflammation of the meninges. The outcome varies between etiologies. It is endemic in Brazil with mandatory notification. Objectives: To analyze the number of diagnoses and outcomes of meningitis in Brazil in the 2019-2020 biennium. Design and setting: Cross-sectional epidemiological study using DATASUS database. Methods: Data from patients diagnosed with meningitis in the period from 2019 to 2020 were included, correlating them to the etiologies and their outcomes. Results: There was a 70.8% reduction in the absolute number of diagnosed meningitis in 2020 (4,713) compared to 2019 (16,155). The most prevalent specified cause was “viral meningitis”, corresponding to 49,1% in 2019 and 42% in 2020. There was no great variation in the percentage of etiologies. “Hospital discharge”, corresponding to 76.8% in 2019 and 68% in 2020. “Death” was the outcome of 14.8% of patients in 2020 and 12.9% in 2019. The most related option to “Death from meningitis” was “Bacterial meningitis”, responsible for 24% in 2020 and 21.3% in 2019. Conclusions: The number of diagnoses of meningitis fell in the 2019-2020 comparison. The context of under-diagnosis worries because it means late diagnoses and worse outcomes.