Post-traumatic stress disorder (PTSD) is a prevalent psychiatric disorder that often occurs following war trauma. Despite its high prevalence, there is still a lack of comprehensive understanding regarding the mechanisms underlying its progression and treatment resistance. Recent research has shed light on the biological basis of PTSD, with neuroimaging studies revealing altered brain connectivity patterns in affected individuals. In war contexts, traumatic brain injury (TBI) is a common occurrence and is associated with a high prevalence of PTSD. This study aimed to compare the severity of PTSD and depression in patients with and without a history of TBI to shed light on the impact of comorbid TBI on the presentation of PTSD symptoms. To achieve this goal, a cross-sectional study was conducted involving a sample of 60 outpatients who were diagnosed with both PTSD and Depressive Disorder. The inclusion criteria required participants to meet the diagnostic criteria for both disorders using validated tools. The severities of PTSD and depressive symptoms were assessed using scales that have been widely used and validated in previous research. By utilizing these standardized assessment tools, this study aimed to ensure the reliability and validity of the obtained data. The results of this study revealed that patients with comorbid PTSD and TBI exhibited a significantly higher severity of PTSD symptoms compared to those with PTSD only. Specifically, the comorbid group demonstrated higher ratings of symptom intensity across all symptom clusters. These findings are consistent with previous research that has highlighted the impact of comorbid TBI on the intensity and persistence of PTSD symptoms. When controlling for PTSD severity, no significant differences were observed in the severity of depressive symptoms between the two groups. This suggests that the increased depressive symptoms observed in the comorbid group may be primarily driven by the presence of more intense PTSD symptoms rather than TBI per se. The findings highlight the need for an accurate diagnosis of TBI in individuals with PTSD to guide appropriate treatment interventions. Further research is warranted to delve into the underlying mechanisms that contribute to the interaction between TBI and PTSD and to develop targeted interventions for individuals with comorbid PTSD and TBI.

Central nervous system (CNS) tumors involve a large and diverse group of malignancies that arise from various cell types within the brain tissue. Although there are advances in treatments, CNS tumors still remain challenging, due to their complex biology and the delicate nature of the surrounding tissue. NAD(P)H O=oxidoreductase 1 (NQO1) is an enzyme that plays a critical role in the detoxification of quinones, protecting cells from oxidative stress. In CNS tumors this enzyme is often overexpressed, which contributes to the resistance of tumor cells to chemotherapy by enhancing their antioxidant defenses. NQO1 influences the progression of CNS tumors by affecting downstream signaling pathways, such as those involving the transcription factor SNAIL, as well as others that are associated with tumor behavior. Plants represent a valuable source of numerous constituents with different chemical structures known to affect different molecular signaling pathways associated with different pathologies.

Background/Aim. About 10% of patients diagnosed with systemic cancer leads to the appearance of brain metastases in the central nervous system. Diseased lungs, breasts, urinary and digestive tract as well as melanoma of the skin, are increasingly treated by neurosurgeons due to their dissemination and creation of secondary deposits in the brain. Methods. The retrospective study was performed at the Clinic for Neurosurgery and the Clinic for Oncology in the period from 2018 to 2020. 111 patients with solitary changes in the brain and 122 patients with multiple changes were examined. Results. It was found that multiple metastases are more common in primary lung cancer, while single metastases are more common in adenocarcinoma, but patients with primary adenocarcinoma died in a significantly higher number. Conclusion. Surgery and radiation remain the cornerstone of therapy for symptomatic lesions; We should strive to improve surgical techniques in the direction of less damage to the surrounding healthy tissue. Radiosurgery, as well as VBRT radiation, remain the basic form in the treatment of multiple metastases.

Background: Formation and rupture of cerebral aneurysms may be related to certain types of configuration of the circle of Willis. Analysis of their interdependence can be of great importance. Methods: A group of 114 patients treated operatively for the cerebral aneurysm rupture and a group of 56 autopsied subjects were involved in the study. Four basic types of the circle of Willis configurations were formed–two symmetric types A and C, and two asymmetric types B and D. Results: A statistically significantly higher presence of asymmetry of the circle of Willis in the group of surgically treated subjects (p=0.006) with a significant presence of asymmetric Type B in this group (p=0.017) were determined. The presence of changes in the A1 segment in the group of subjects with solitary aneurysms on the anterior communicating artery showed a statistically significant presence in the group of autopsied subjects (p=0.0004). Analyzing the presence of symmetry of the circle of Willis between the two groups, that is, the total presence of symmetric types A and C indicated their statistically significant presence in the group of autopsied patients (p=0.043). Conclusion: Changes such as hypoplasia or aplasia of A1 and the resulting asymmetry of the circle of Willis directly affect the possibility of the rupture of cerebral aneurysms. Detection of the corresponding types of the circle of Willis after diagnostic examination can be the basis for the development of a protocol for monitoring such patients.

Introduction. Parkes-Weber syndrome (PWS) is a complex and rare genetic disease of combined vascular malformations that primarily occur in the extremities and can involve the pelvic blood vessels. In extremely rare cases, the disease is manifested by endocranial and spinal involvement, while the treatment of such patients represents a challenge for neurosurgical centers and requires multidisciplinary approach. Case report. We present the case of a 46-year-old male patient who was admitted to the emergency department due to spontaneous subarachnoid hemorrhage (SAH), moderate flaccid paraparesis and urinary incontinence. Furthermore, the patient was previously diagnosed with PWS, while the genetic evaluation proved the RASA1 gene mutation. He experienced a spontaneous SAH and was hospitalized 26 years ago, while 6 years ago he underwent a right nephrectomy due to multiple hilar aneurysms of the right renal artery and its branches. Digital subtraction angiography of the endocranium was performed, which detected no aneurysmal dilatations or arteriovenous malformations (AVM). The magnetic resonance imaging recorded spinal intradural AVM in the vertebral levels between T12 and L3, which completely filled the dural sac. After the conservative treatment, there was a significant improvement in the patient's neurological and clinical condition. Conclusion. To the best of our knowledge, this is the only case report of a patient with PWS who had a spinal intradural AVM and spontaneous SAH without high-output heart failure, with a history of a previous nephrectomy.

Background/Aim. There are several serious complications that can accompany both spontaneous and posttraumatic subarachnoid hemorrhage (SAH) such as the development of intracranial hypertension, hydrocephalus, rebleeding, cerebral hypoxia, cerebral vasospasm, impaired pituitary function, electrolyte imbalance and electrocardiographic (ECG) abnormalities. Although there is a declining trend in mortality, the treatment of SAH and its complications represents a challenge even in imposing neurosurgical centers. Therefore, the aim of the study was to compare some clinical characteristics and complications between spontaneous and posttraumatic SAH. Methods. This retrospective study included 138 patients treated at the Clinic for Neurosurgery in the period from January of 2018 to the January of 2023. There were 71 patients with spontaneous and 67 patients with posttraumatic SAH. Results. A predominance of spontaneous SAH in female and posttraumatic SAH in male patients (p < 0.00001) was found. There was a statistically significant difference in the frequency of hydrocephalus between groups of spontaneous and posttraumatic SAH patients (p = 0.012663). Cerebral vasospasm was significantly more prevalent in patients with spontaneous SAH (p = 0.000091). A statistically significant association was also obtained between the thickness of the coagulum in these two groups (p = 0.000187). Patients with spontaneous SAH were significantly more likely to have a negative T wave (p = 0.000315). Furthermore, there was no statistically significant difference regarding electrolyte imbalance in these two groups of patients with SAH. Conclusion. There were statistically significant differences between gender distribution, the frequency of abnormal ECG findings in the form of a negative T wave, greater coagulum thickness, vasospasm occurrence and a higher rate of hydrocephalus in patients with spontaneous SAH compared to patients with posttraumatic SAH.