Background: Brucellosis is an endemic zoonotic infection in Saudi Arabia, with thousands of cases reported annually. Although musculoskeletal involvement is common, spinal complications – particularly cervical spondylodiscitis with epidural abscess – are rare and often difficult to diagnose due to nonspecific symptoms. Delayed recognition may lead to neurological compromise requiring urgent intervention. Case Description: A 55-year-old farmer with regular exposure to cattle and a history of brucellosis presented with progressive right-sided weakness and neck pain. Magnetic resonance imaging revealed cervical stenosis with cord compression. Serology on admission showed Brucella immunoglobulin G positive, immunoglobulin M negative. The patient underwent anterior cervical decompression, biopsy, and fixation. Intraoperative cultures confirmed Brucella infection; however, species-level identification was not performed. Targeted antibiotic therapy with ceftriaxone 2g intravenous daily, doxycycline 100 mg orally twice daily, and rifampicin 600 mg orally daily was initiated. The patient showed gradual neurological recovery with complete resolution at follow-up. Conclusion: Spinal brucellosis, though rare, should be considered in endemic regions. Early diagnosis and combined surgical and medical management can prevent permanent neurological sequelae. The absence of Brucella species identification represents a limitation of this report.

Background/Objective: Intracranial arteriovenous malformations (AVMs) are high-flow cerebrovascular lesions associated with a significant risk of intracranial hemorrhage, neurological morbidity, and mortality. Current management strategies, including microsurgical resection, endovascular embolization, stereotactic radiosurgery, and conservative observation, remain limited by procedural risk and uncertain long-term outcomes. Beta-blockers, particularly propranolol, have recently attracted interest as potential adjunctive therapies because of their vasoconstrictive, antiangiogenic, and vascular remodeling properties. This review evaluates the mechanistic rationale and current evidence regarding beta-blocker use in intracranial AVMs. Methods: A comprehensive literature review was conducted using PubMed, Scopus, and Google Scholar databases through January 2026 using combinations of the terms “arteriovenous malformation,” “AVM,” “beta-blocker,” “propranolol,” “angiogenesis,” “hemorrhage,” and “cerebral cavernous malformation.” Eligible studies included experimental investigations, translational studies, observational cohorts, case reports, clinical trials, systematic reviews, and meta-analyses evaluating beta-blocker use in intracranial AVMs or related vascular malformations. Studies unrelated to cerebrovascular lesions, duplicate reports, and non-English publications were excluded. Given the heterogeneity and limited volume of available AVM-specific literature, findings were synthesized narratively rather than through formal systematic review methodology. Discussion: Preclinical studies suggest that beta-blockers modulate molecular pathways implicated in AVM pathophysiology, including VEGF, HIF-1α, SDF1α/CXCR4, MMP-9, and Notch-associated signaling. These mechanisms may reduce abnormal angiogenesis, endothelial instability, and pathological vascular remodeling. Clinical evidence, however, remains limited to retrospective studies, perioperative reports, and indirect evidence from cerebral cavernous malformations. Observational studies have reported associations between beta-blocker exposure and certain favorable AVM characteristics, including lower rates of hemorrhagic presentation and less complex angioarchitecture. However, these findings are highly susceptible to confounding, reverse causation, and selection bias and should not be interpreted as evidence of disease modification. Conclusions: Beta-blockers cannot currently be recommended as definitive therapy for intracranial AVMs. Their established role remains perioperative hemodynamic control, while potential disease-modifying effects require validation through prospective studies and randomized clinical trials.

Background: Pilocytic astrocytoma is a benign, slow-growing pediatric brain tumor, while Grisel’s syndrome refers to nontraumatic atlantoaxial subluxation classically associated with infection or head-and-neck surgery. Postoperative atlantoaxial rotatory subluxation following intracranial surgery is rare and poses significant diagnostic and management challenges. Case Description: We report a 7-year-old girl who presented with progressive headaches, imbalance, and signs of obstructive hydrocephalus. Imaging revealed a large cystic pilocytic astrocytoma involving the left frontotemporo-parietal region. The patient underwent left fronto-temporo-parietal craniotomy with excisional biopsy and placement of an Ommaya reservoir. Two weeks postoperatively, she developed painful neck spasm and mild torticollis. Cervical imaging confirmed C1–C2 rotatory subluxation (Fielding Type II), likely related to surgical positioning, with Grisel’s syndrome considered a possible inflammatory mechanism. Management included halo traction, closed reduction under general anesthesia, followed by halo vest immobilization and later application of a Miami-J cervical collar. The patient demonstrated good clinical and radiological recovery. Conclusion: This case highlights a rare postoperative complication of craniotomy with the development of atlantoaxial rotatory subluxation. Early recognition and multidisciplinary management are essential to prevent neurological sequelae. Surgical positioning may represent a contributing risk factor, and further research is required to establish preventive strategies.

Background/Objectives: External ventricular drains (EVDs) are widely used in the management of intracranial hemorrhage and hydrocephalus; however, they carry a significant risk of device-related central nervous system infections, including ventriculitis and meningitis, which are associated with increased morbidity, mortality, and prolonged intensive care stays. We conducted a systematic review and meta-analysis to evaluate whether prolonged EVD duration (>10 days) is associated with an increased risk of ventriculostomy-related infection compared with shorter duration (≤10 days), and to explore the association with cerebrospinal fluid (CSF) leak where data were available. Methods: A comprehensive literature search of PubMed, Google Scholar, Web of Science, and Cochrane CENTRAL was performed from database inception through September 2025, including English-language clinical trials, cohort studies, and case–control studies reporting infection outcomes related to EVD management factors. Two reviewers independently screened studies and extracted data. A random-effects meta-analysis was conducted to calculate pooled odds ratios (ORs) with 95% confidence intervals (CIs). Results: Sixteen studies comprising approximately 5500 patients met the inclusion criteria. Shorter EVD duration (≤10 days) was associated with a significantly lower risk of infection (pooled OR 0.45, 95% CI 0.30–0.68; p = 0.0002), corresponding to a 55% reduction in the odds of ventriculostomy-related infection. Prolonged EVD duration was consistently associated with increased infection risk across studies. Conclusions:These findings suggest that minimizing EVD duration may reduce infection risk and support early removal when clinically feasible. However, given the observational nature of the included studies, the results should be interpreted with caution. Further research is warranted to evaluate additional modifiable risk factors, including CSF leakage and sampling practices.