Purpose Transcranial magnetic stimulation (TMS) has emerged as a promising treatment for various neuropsychiatric conditions, including depression, obsessive–compulsive disorder, and Parkinson's disease. Recent research has focused on evaluating its effectiveness in treating patients with anorexia nervosa (AN). This systematic review and meta-analysis examined the impact of TMS on patients with AN and evaluated any potential adverse effects. Methods We conducted search according to PRISMA guidelines and comprehensively analyzed data from multiple databases, including Pubmed, Scopus, Embase, Web of Science, and the Cochrane Library, up to September 13th. Statistical analysis utilized the Comprehensive Meta-analysis software version 3.0. Results The systematic review encompassed 17 studies, with nine undergoing meta-analyses. The primary target for TMS was the dorsolateral prefrontal cortex, with two studies targeting the dorsomedial prefrontal cortex, one targeting the insula and one targeting the inferior parietal lobe. The findings revealed a significant increase in body mass index (BMI) following TMS (SMD: −0.025, 95% CI: −0.0505 to −0.005, P-value = 0.045). Additionally, the Eating Disorder Examination Questionnaire (EDE-Q) score was quantitatively reported in six studies, which permitted its inclusion in the meta-analysis. The analysis exhibited a significant decrease in EDE-Q score after TMS (SMD: 0.634, 95% CI: 0.349–0.919, P-value < 0.001). Subgroup analysis based on TMS session duration indicated that the effect size of TMS on EDE-Q score is more pronounced when the session duration exceeds 20 min. Conclusion TMS represents an effective therapy for patients with AN, leading to improvements in both BMI and core symptoms of AN, with minor and transient side effects. Level of evidence Level I, systematic reviews and meta-analyses.

Introduction: Paradoxical brain herniation (PBH) represents a rare and potentially life-threatening complication observed in individuals following decompressive craniectomy. Its diagnosis necessitates a high level of suspicion, combined with clinical and imaging evidence, such as midline shift, herniation, and a decreased Glasgow Coma Scale (GCS). Given the rarity and severity of this condition, we conduct a comprehensive literature review to identify all documented predisposing factors, clinical presentations, and appropriate clinical management. This review will serve as a guide for effective treatment strategies. Case presentation: In this report, we document three cases of post-traumatic PBH following decompressive craniectomy. The patient's predisposing factor was a lumbar puncture, with two cases resolving after Terendlenburg repositioning, hydration, and elective cranioplasty. The third case developed PBH after external ventricular drainage (EVD) insertion. Although the patient's GCS improved after clamping the EVD and hydration, the patient ultimately succumbed to meningitis. Clinical discussion: The primary clinical manifestations of PBH often encompass a diminished GCS alongside radiographic evidence of midline shift and brain herniation. Various precipitating factors have been associated with PBH after decompressive craniectomy, including CSF drainage, dehydration, and upright positioning, although instances of spontaneous PBH have been documented. Reported therapeutic strategies encompass rehydration, Trendelenburg positioning, temporary cessation of CSF drainage, and cranioplasty. Conclusion: Given the infrequency of PBH and the potential for misdiagnosis with brain edema, it is imperative to consider this condition in every patient who experiences a decreased level of consciousness following decompressive craniectomy. Highlights:

Primary dural lymphoma (PDL) is a subtype of primary central nervous system (CNS) lymphoma (PCNSL) with only an extra-axial dural location. It accounts for less than 1% of all CNS lymphomas. PDL is a sporadic CNS tumor, and in the preoperative period, because of imaging characteristics, it is usually mimicking a meningioma. Usually, PDL is a low-grade B-cell lymphoma with a relatively good response to surgical resection with or without radiotherapy. Here we reviewed 102 case reports of PDL in the literature. Then, we present the case of our patient with PDL and explain the complexity of our treatment approach. Primary dural lymphoma (PDL) is a subtype of primary central nervous system (CNS) lymphoma (PCNSL) with only an extra-axial dural location. It accounts for less than 1% of all CNS lymphomas. PDL is a sporadic CNS tumor, and in the preoperative period, because of imaging characteristics, it is usually mimicking a meningioma. Usually, PDL is a low-grade B-cell lymphoma with a relatively good response to surgical resection with or without radiotherapy. Here we reviewed 102 case reports of PDL in the literature. Then, we present the case of our patient with PDL and explain the complexity of our treatment approach.

Aim: Brain arteriovenous malformations (AVMs) represent a complex vascular anomaly that carries a significant risk of complications. The Spetzler–Martin (SM) grading system and its supplementary variant (supp-SM) have been developed to estimate surgical risk; however, there remains a lack of consensus regarding grading systems that can accurately predict patient outcomes. Method: This study evaluated a cohort of 26 patients with brain AVM who underwent surgical resection at a single institution over seven years. The primary clinical and imaging characteristics of the patients were assessed. Utilizing Python for data analysis, this study aimed to identify correlations among the SM and supp-SM grading, Glasgow Coma Scale (GCS) scores, postoperative Karnofsky Performance Scale (KPS), duration of intensive care unit admission, and intraoperative blood loss. In addition, we did a literature review on AVM surgical outcomes. Results: Incorporating GCS into the supp-SM grading framework significantly enhanced the predictive ability regarding intraoperative blood loss and KPS at discharge compared to using the SM or supp-SM grading in isolation. Conclusion: The combination of supp-SM grading and GCS is a more reliable indicator of postoperative outcomes for patients with brain AVMs. Nevertheless, additional longitudinal studies are required to substantiate this conclusion further.

Multiple arteriovenous malformations (AVMs) are uncommon, accounting for only 0.3–3.2% of all AVM cases. These AVMs are often found in syndromic pediatrics of HHT and WMS. Consideration of the patient’s condition, the angioarchitecture of each AVM, and the hemodynamic connection of AVMs is crucial in determining the optimal therapeutic approach. However, the optimal therapeutic decision-making for these complex vascular lesions can be challenging due to the scarcity of their reports and their long-term follow-up. In this report, we present the case of a young man who presented with a headache, and DSA shows three left parietal AVMs, each with a separate nidus, feeder artery, and draining vein.

This study investigates the impact of the anterior nucleus of the thalamus deep brain stimulation (ANT-DBS) on patients with drug-resistant epilepsy (DRE) in Iran, specifically focusing on its effects on seizure metrics, severity and its influence on quality of life over time. A cohort of eight patients with DRE in Iran who underwent ANT-DBS was evaluated. Pre-operative assessments included comprehensive documentation of seizure frequency, duration, severity scores, and the Quality of Life in Epilepsy Inventory (QOLIE-13). Each patient also underwent high-resolution imaging using a 1.5 Tesla MRI, with targeted electrode placement in the anterior thalamic area. Post-operative evaluations measured changes in seizure frequency, severity scores, duration, and quality of life indicators. All subjects presented with DRE, and the mean age of participants was 24.62 years. Post-operative data revealed significantly reduced seizure frequency, duration, and severity scores. Notably, this reduction was more pronounced at the 6-month follow-up than the 3-month assessment, indicating a progressive therapeutic effect. All patients demonstrated a response to ANT-DBS, with two individuals achieving seizure freedom. Additionally, there was a marked improvement in quality of life, particularly in the domains of energy/fatigue and social functioning. ANT-DBS has been established as a promising and safe therapeutic intervention for patients with DRE. In a cohort of DRE patients in Iran, the treatment demonstrated comparable efficacy in decreasing seizure frequency and severity and enhancing self-reported quality of life, consistent with findings reported in the existing literature. The therapeutic benefits of ANT-DBS appear to augment over time.