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.

Introduction. Periventricular nodular heterotopia (PNH) is a developmental malformation of the cerebral cortex characterized by abnormal migration of neurons into the cortical plate and is often associated with drug-resistant focal epilepsy. Case report. A 33-year-old female patient suffered from drug-resistant epilepsy, which was predominantly characterized by focal seizures, with occasional seizures that had a focal onset and progressed into bilateral tonic-clonic seizures. Magnetic resonance imaging showed bilateral heterotopic nodules in the occipital horns of the lateral brain ventricles. 18-Fluoro-deoxyglucose positron emission tomography ? FDG-PET scan demonstrated a zone of reduced glucose metabolism on the right temporal region. Electroencephalogram suggested focal electrocortical activity on the temporo-parieto-occipital regions, predominantly on the right temporal side. The woman was treated with polytherapy (valproic acid, lamotrigine, levetiracetam, oxcarbazepine, pregabalin, clobazam, and lacosamide), but it did not affect the seizure frequency. Due to the bilateral localization of the heterotopic nodules, surgical treatment was not recommended. After a multidisciplinary assessment, we decided on vagus nerve stimulation (VNS) and achieved satisfying seizure control. Conclusion. Patients with PNH require multidisciplinary assessment and treatment, while in this report we have a case of a patient in whom satisfying control of drug-resistant epilepsy was achieved after the implantation of the VNS device.

Background: Penetrating head injuries (PHI) caused by sharp objects are associated with a high risk of potentially life-threatening complications and are estimated to account for approximately 0.4% of all head injuries. Since not many cases of PHI with a screwdriver have been described in the literature, the treatment of these patients is quite controversial and non-standardized. Therefore, the aim of this paper was to present our experience with treating a patient with a PHI caused by a screwdriver. Case description: The authors present a three-year-old female patient who accidentally sustained a PHI with a screwdriver through the right orbit. A computed tomography scan of the head was performed, which demonstrated the presence of the metal end of a screwdriver in the anterior cranial fossa. The patient underwent emergency surgery and the foreign body was evacuated with the repair of dura and brain injury. The intervention was followed by a complete postoperative recovery without any gross neurological deficits. Follow-up examinations were performed up to three years after the injury, while the patient's condition remained unchanged. Our patient's case supports immediate neurosurgical intervention and removal of a foreign object from the endocranium.

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.

To the best of our knowledge, no previous study has reported characteristics of C-reactive protein (CRP) levels in COVID-19 patients with comorbidities such as sciatica and lumbar syndrome. Th e objective of this study was to examine whether CRP le...

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.