Takotsubo cardiomyopathy is an uncommon clinical entity in children, resulting in severe but sometimes reversible systolic dysfunction of the left ventricle. This condition is triggered by multiple emotional or physical stressors, while neurogenic stress cardiomyopathy after brain injuries has become increasingly recognized in children over the past few years. We report the case of an 11-year-old child with an atypical clinical presentation after a serious car crash accident. An initial computed tomography scan revealed an acute epidural hematoma, which was immediately treated by an emergency craniotomy. During the patient’s following pediatric intensive care unit hospitalization, severe hemodynamic instability was observed, leading to gradually higher doses of vasopressors for circulatory support. On echocardiography, the patient had signs of severe cardiac contractility compromise, with characteristic pattern of regional wall motion abnormalities of the left ventricle, which, in combination with seriously elevated cardiac enzymes, electrocardiographic (ECG) abnormalities and continuous thermodilution hemodynamic monitoring (PICCO) findings, led to intensification of inotropic support and to the diagnosis of takotsubo cardiomyopathy. Despite supportive measures, the patient developed multiorgan failure and succumbed to their serious illness. For this atypical case, extracorporeal membrane oxygenation (ECMO) was addressed as an option for the seriously failing heart, but due to the extremely high risk of intracranial bleeding, it could not be used for this patient’s treatment. In conclusion, Takotsubo cardiomyopathy should be suspected in pediatric cases of cardiac dysfunction after serious injuries or stress conditions.

Background/Objectives: Intracranial arachnoid cysts (ACs) may be congenital, primary, or secondary due to trauma. These cysts are benign, contain cerebrospinal fluid (CSF), and are classified based on location, size, and their clinical symptomatology. They are uncommon lesions in children, rarely leading to severe mass-effect neurological symptomatology. Methods: The present report describes a 30-month-old female presenting with quadriparesis. An emergency magnetic resonance imaging (MRI) study revealed the presence of a primary intracranial arachnoid cyst of the posterior cranial fossa, exerting significant pressure on the medulla oblongata and the cervical portion of the spinal cord, displacing them dorsally, with a remnant diameter of 2.5 mm. Results: This benign malformation located in a crucial area might have been complicated by severe neurological deterioration and required prompt intervention, so the patient underwent a suboccipital craniectomy in a sitting position, along with a neurosurgical procedure, which established a lasting communication channel between the cyst and the basal cisterns. This led to a favorable outcome. Conclusions: Up to the present report, postoperative complete resolution of quadriparesis secondary to a posterior cranial fossa arachnoid cyst has not been reported. At present, no therapeutic modality has been established as the definitive standard of care for pediatric ACs, and their management raises a great deal of controversy among neurosurgeons. The narrative literature review of the present study integrates the various perspectives regarding ACs and their possible treatment approaches that are currently available.

Background/Objectives: Diffusion tensor tractography is used to visualize white matter pathways relevant to neurosurgical planning, but manual ROI-based reconstruction may be operator-dependent. This study assessed the inter-rater and intra-rater reproducibility of a standardized deterministic protocol for reconstruction of the frontal aslant tract (FAT). Methods: Diffusion-weighted MRI datasets from 30 neurologically healthy adults were retrospectively reanalyzed. Three independent raters reconstructed the left and right FAT using the same standardized protocol, with identical predefined ROI locations and fixed tracking parameters; however, each rater independently delineated the ROIs. Reconstructions were repeated after 3 weeks. Spatial agreement was assessed using the Dice similarity coefficient and HD95, while reliability of fractional anisotropy (FA), mean diffusivity (MD), and tract volume were evaluated using intraclass correlation coefficients (ICC). Results: FAT reconstruction was successful in 339 of 360 attempts (94.2%), with a higher success rate for the left than for the right FAT (96.7% vs. 91.7%). Mean inter-rater Dice similarity was 0.74 for the left FAT and 0.69 for the right FAT. Inter-rater reliability was highest for FA (ICC 0.88–0.90), followed by MD (ICC 0.85–0.88) and tract volume (ICC 0.79–0.84). Intra-rater agreement was consistently higher than inter-rater agreement. Conclusions: Standardized deterministic FAT reconstruction demonstrated moderate-to-good reproducibility, although operator-dependent variability remained. These findings provide baseline estimates of procedural reliability and support further evaluation of standardized ROI-based tractography approaches.