Hyponatremia, defined as serum sodium < 135 mEq/L, is a common complication following aneurysmal subarachnoid hemorrhage (aSAH) and has been implicated in the development of cerebral vasospasm, a significant contributor to delayed cerebral ischemia and poor neurological outcomes. However, the strength and consistency of this association remain unclear. This study aimed to evaluate the relationship between hyponatremia and angiographically or radiologically confirmed vasospasm in patients with aSAH. A comprehensive search of PubMed, Scopus, Embase, and Medline was conducted through July 2025, adhering to PRISMA guidelines (CRD42024621575). Eligible studies included adult or pediatric patients with aSAH, reported serum sodium levels, and documented vasospasm confirmed by imaging. Data were extracted independently by three reviewers, and methodological quality was assessed using a modified Newcastle-Ottawa Scale. Pooled odds ratios (ORs) with 95% confidence intervals (CIs) were calculated using a random-effects model. Heterogeneity and publication bias were assessed using I² statistics and funnel plots, respectively. Seven studies comprising a total of 983 patients were included in both the systematic review and meta-analysis. Among these, 403 patients developed vasospasm, with 243 having experienced hyponatremia prior to the event. The pooled analysis demonstrated a significant association between hyponatremia and vasospasm (OR = 2.59; 95% CI: 1.60-4.20; p = 0.0001). Moderate heterogeneity was observed (I² = 53%), and no evidence of publication bias was detected. Hyponatremia is significantly associated with increased risk of cerebral vasospasm in SAH patients. Serum sodium may suggest potential as a component of risk stratification models. Prospective studies are needed to explore causality and the therapeutic impact of sodium correction on clinical outcomes.

Background: Traumatic Brain Injury (TBI) in children is a major cause of morbidity and mortality worldwide. Ocular manifestations are common but often overlooked, despite their potential to cause long-term visual impairment. This study aimed to evaluate the prevalence and characteristics of ocular findings in pediatric TBI patients admitted to the intensive care unit (ICU). Method: We prospectively reviewed records of pediatric patients (≤16 years) with TBI admitted to the Neurosurgery ICU at King Abdullah University Hospital (January 2022–December 2024). TBI was defined using U.S. CDC criteria and confirmed by clinical and radiological findings. Ocular manifestations were identified from ophthalmology consultations, neurosurgical notes, and bedside examinations. Demographics, injury details, and clinical outcomes were recorded. Statistical analyses included Chi-square, Fisher’s exact, and Mann–Whitney U tests, with significance set at p ≤ 0.05. Results: Thirty-eight patients (median age: 8 years; 55.3% male) were included. Ocular findings were present in 20 patients (52.6%). These patients were significantly older (median age 10 vs. 6 years, p = 0.007) and had lower admission GCS scores (11 vs. 14, p = 0.016). Male predominance was higher in the ocular group (75.0% vs. 33.3%, p = 0.030). Ocular findings were significantly associated with surgical intervention (60.0% vs. 22.2%, p = 0.025), orbital fractures (40.0% vs. 5.6%, p = 0.021), basal skull fracture signs (p = 0.036), and extraocular muscle limitation (p = 0.048). On multivariable analysis, orbital fracture remained the only independent predictor of ocular findings (aOR 2.22, 95% CI 1.17–3.57, p = 0.02). Conclusion: Over half of pediatric ICU TBI patients demonstrated ocular manifestations, closely linked to greater injury severity and craniofacial trauma. Routine, comprehensive ophthalmological evaluation should be integrated into the multidisciplinary management of severe pediatric TBI to optimize visual and functional outcomes.

Background: Intra-axial brain schwannomas are exceptionally rare, accounting for less than 1% of all intracranial schwannomas. Their rarity and non-specific radiological features make diagnosis and management challenging. This study provides a systematic review of the existing literature to summarize the clinical, radiological, histopathological, surgical, and outcome characteristics of reported cases. Methods: A systematic review was conducted following PRISMA guidelines. A comprehensive search of PubMed and Scopus was performed using predefined keywords. Studies reporting intra-axial brain schwannomas were included. Data were extracted on patient demographics, clinical presentation, radiological features, tumor location, surgical management, histopathological findings, and outcomes. In total, 80 studies comprising 131 patients were included. Results: The pooled analysis showed that intra-axial schwannomas most commonly occur in young adults, with a median age of 23 years. The most frequent presenting symptoms were seizures, headache, and focal neurological deficits. Radiologically, lesions typically demonstrated heterogeneous contrast enhancement with frequent cystic degeneration. The frontal and temporal lobes were the most commonly affected sites. Surgical resection, most often via craniotomy with gross total resection, was the predominant management strategy. Overall, most reported cases demonstrated favorable postoperative outcomes. Conclusions: Intra-axial brain schwannomas are rare entities that should be considered in the differential diagnosis of intra-axial brain tumors. Surgical resection remains the mainstay of treatment and is generally associated with excellent outcomes.