We present a rare case of a 16-year-old male who was admitted with bilateral tinnitus and subsequently underwent magnetic resonance imaging (MRI) and digital subtraction angiography (DSA) for further evaluation. The left internal carotid (ICA) artery had a normal caliber but ended as a stump at the C7 segment, with a network of filiform vessels from both the stump and right posterior communicating artery (PComm). The right PComm was hypertrophic and the right posterior cerebral artery (PCA) was mainly supplied by the right ICA. The right ICA’s bifurcation and the initial middle cerebral artery (MCA) segment were absent, while the MCA trunk was hypoplastic. The right PCA and pial branches vascularized the temporal lobe, with collaterals between the PCA and MCA. The left ICA was slightly enlarged with double fenestration at the left A1 segment. The right A1 segment of the anterior cerebral artery had double fenestration and while several diagnoses were considered, no single diagnosis fully explained all clinical findings. A thorough review of the existing literature yielded no comparable cases, highlighting the uniqueness of this presentation. This case emphasizes the complexity of cerebral vascular anomalies and the challenges associated with diagnosing such rare conditions, underscoring the need for careful assessment.

Introduction/Aim: Patients, who stay long in hospitals, nursing homes, and especially in intensive care units, are exposed to the risk of developing chronic wounds. The term "chronic wound" refers to wounds that do not heal despite all treatment measures taken in the period of six to eight weeks. The aim of this retrospective cohort study was to analyze data on chronic pressure ulcers that were collected in intensive care units (ICU) of the Urgent Care Center of the Clinical Center of Serbia during the five-year period, with the aim of determining the factors that influence their occurrence and healing. Methods: The retrospective cohort study was conducted from January 1st, 2018 to April 1st, 2023 at the Urgent Care Center of the University Clinical Center of Serbia in the intensive care units in polytrauma, neurosurgical and surgical patients. The study included 74 patients diagnosed with chronic pressure ulcers. Data for all participants were obtained from medical history and list of discharge. Results: During in-hospital treatment in ICU, pressure ulcers were found in all 74 patients (56.8% of women and 43.2% of men), while combined chronic wounds were found in 57 (77.0%) patients. The largest number of these patients were elderly (70 and older) (31.1%) and with non-traumatic injuries (62%). All patients were tracheotomized with a gastrostomy tube placed. The localization of pressure ulcers was most often in the lumbosacral region (44.6%), followed by the trochanteric region (23.0%). The majority of patients had hypertension (90.5%), diabetes (79.7%) and chronic obstructive pulmonary disease (82.4%), while 28 patients (37.8%) died. 38 patients were underweighted (51.4%), while 11 (14.9%) patients were overweight and obese. Conclusion: Risk factors for the occurrence of pressure ulcers should be evaluated at the moment of the first contact of the doctor with the immobile patient because this is the only prerequisite for timely prevention. Special emphasis should be placed on the elderly, underweight and people with comorbidities.

Introduction: Subdural hematomas (SDHs) are common clinical entities after a traumatic brain injury (TBI). Due to the complicated pathophysiological mechanism of SDHs, the further clinical course of patients with SDHs is affected by pathological entities such as both global and focal ischemia beneath hematoma, reactive hyperemia/hyperperfusion, coagulopathy, delayed hematomas. The hormonal and metabolic imbalance that exists in women with polycystic ovary syndrome (PCOS) can have a positive and negative impact on bone mineral density (BMD). So far, a small number of studies with BMD estimation in women with PCOS have been performed and the results are heterogeneous, while several studies have reported that the prevalence of cerebrovascular risk factors is higher in women with PCOS. Aim To examine BMD in women with PCOS and the impact on the pathophysiological mechanism of SDH, and the tendency to craniofacial injuries with reference to laboratory and biochemical prognostic factors of patient outcomes. Material and methods We evaluated 48 women with PCOS (age: 25.35 ± 5.16 years) and 20 healthy women of the control group (CG), matched by BMI (age: 32.47 ± 5.70 years), cranium BMD, and homocysteine levels. Results There was a significant increase in the mean homocysteine level ​​(39 ± 1.36) in the PCOS group, and the BMD^(Vault) (0.84 ± 0.11) as well. Conclusion Women with PCOS, matched by BMI and equalized by age, together with the homocysteine and BDM results, a correlation between PCOS and the occurrence of subdural hematoma exists. Prevalence of cerebrovascular risk factors is higher in women with PCOS due to higher homocysteine levels.

Introduction: Intracranial aneurysms are the main caus of subarachnoid haemorrhage. Most patients with ruptured aneurysms are between 30 and 60 years of age, and the mortality rate is about 50% in the first month after the rupture. Diagnosis and treatment of multiple brain aneurysms still vary from institutions, physicians and individual patients, lacking a defined course of differential diagnosis, risk of rupture and rebleed evaluation and treatment. For multiple intracranial aneurysms, there are currently no unanimous and infallible guidelines for assessing the risk of rupture, recurrent bleeding, or harmonized treatment methods. Aim: To show the prevalence of multiple aneurysms in the population presenting to the Emergency Center and potentially indicate the right modality of treatment. Material and methods: The study included 304 patients who were treated for neuroradiologically verified cerebrovascular aneurysms in the Emergency Center of the University Clinical Center of Serbia, Belgrade. Results: Out of a total of 304 patients diagnosed with intracranial aneurysms, 85 (27,97%) patients were diagnosed with multiple intracranial aneurysms, 85,9% female, 14,1% male. Two aneurysms were recorded in 52 patients (61,2%), 18 patients (21,2%) had 3 aneurysms, 9 patients (10,9%) had 4 aneurysms, and 6 patients (7,06%) were diagnosed with 5 or more aneurysms. Conslusion: Multiple intracranial aneurysms in our study were present predominantly amongst women. The most frequent localization is ACI followed by ACM, ACoA, AB, while the other arteries were represented in to a very small number of respondents. Endovascular treatment methods are the most prevalent.

The trigeminocardiac reflex (TCR) is defined as sudden onset of parasympathetic dysrhythmias including hemodynamic irregularities, apnea, and gastric hypermotility during stimulation of sensory branches of the trigeminal nerve. Back in 1999 when TCR was first described as such, a clinical discussion on the establishment of terminology is ongoing. We present a case of a 31-year-old male patient who was admitted to the Emergency Department due to traumatic brain injury who died with clinical manifestations of TCR. TCR can be a red flag for neurosurgeons when treating patients with traumatic brain injury.

Introduction/Aims: Adenocarcinomas of gastrointestinal origin rarely metastasize to the craniofacial region. Such manifestations, especially when associated with suspected leptomeningeal involvement, are characterized by high aggressiveness and a very poor prognosis. The aim of this paper is to present a rare case of a massive craniofacial metastasis from an adenocarcinoma with an atypical presentation and a fulminant clinical course. Case Report: A retrospective analysis of the medical records of a 74-year-old female patient was performed. The patient was admitted to the Emergency Center due to a sudden disturbance in the level of consciousness. Radiology revealed a massive frontoparietal lesion with extensive destruction of craniofacial bones and invasion of the orbit, sphenoid and temporal bones, and the infratemporal fossa. No primary intraparenchymal brain lesions were observed, but radiological findings suggested leptomeningeal involvement. Metastases were also detected in the liver and vertebral bodies (Th1, L1, L3). Histopathological and immunohistochemical analysis of the craniofacial mass biopsy confirmed an adenocarcinoma with an immunophenotype indicative of gastrointestinal origin. Despite intensive multidisciplinary treatment, the clinical course was fulminant, resulting in a lethal outcome on the fourth day of hospitalization. Conclusion: Craniofacial metastases of adenocarcinoma can be the first manifestation of an occult gastrointestinal malignancy. Extensive bone destruction and suspected leptomeningeal dissemination lead to an extremely unfavorable outcome. This case highlights the importance of rapid diagnosis and a high degree of clinical suspicion in patients presenting with atypical cranial bone lesions and acute neurological deterioration.