Myxopapillary Ependymoma–a Case Report of Rare Multicentric Subtype and Literature Review Faisal AlMatrafi, Abdullah Aseeri, Mohammad AlQahtani, Liqa AlMulla, Saeed Jubran, Majed AlOmair, Sultan AlSalmi, Rawan AlAnazi Medical Archives, 2023 Background: Myxopapillary ependymoma is a rare type of primary spinal tumor, it is distinctly a slow-growing tumor that originates in the conus medullaris, cauda equina, or film terminals and is rarely identified as a multicentric type. Myxopapillary ependymoma has a unique histological characteristic and is associated with a generally better prognosis. Objective: We present a case of a rare multicentric myxopapillary ependymoma. Case presentation: A 28-year-old male with 1-year history of low back pain and 3 months of radiating pain to left lower limb with perianal anesthesia. Magnetic resonance imaging (MRI) exhibited a large intradural intramedullary lesion from the level of the conus medullaris extending to the filum terminals at the level of T12 to L3 with smaller multiple enhancing lesions seen opposite to L4 and L5 level as well as within the exiting nerve roots, at the left side of L1/L2 and L2/L3 and right side of L3/L4 and L5/S1 level. The patient underwent surgical resection with significant improvement in symptoms and no tumor progression on follow up MRI scan. Conclusion: We hereby present a case of multicentric myxopapillary ependymoma with a literature review of the previous reported cases. We believe that our study will make a significant contribution to the literature and will be of interest to the readership regarding of the rarity of multicentric Myxopapillary ependymoma and it will help in decision making for the proper surgical Intervention on these kinds of cases.
Pediatric Stroke from Bench to Bedside: A Single-Center Experience in Saudi Arabia Abdulaziz Mohammad Al-Sharydah, Hussain Khalid Al-Arfaj, Sari Saleh Al-Suhibani, Fahad Safran Al-Safran, Abdulrahman Hamad Al-Abdulwahhab, Saeed Ahmad Al-Jubran, Abdulhadi Ahmad AlSaflan Vascular Health and Risk Management, 2022 Purpose Stroke is a leading cause of severe long-term disability and death worldwide. This study aimed to determine the genetic background, causative factors, and diagnostic and outcome measures of pediatric stroke in an area endemic to sickle cell disease (SCD). Patients and Methods This retrospective review analyzed pediatric patients with acute stroke who were admitted to King Fahd Hospital of the University, Eastern Province, Saudi Arabia, between January and June 2019. We assessed 49 cases based on computed tomography (CT) and magnetic resonance imaging (MRI) findings. Patients with incomplete records or unavailable radiological images were excluded. Results A high likelihood of familial coexistence of stroke was detected in patients with affected siblings (33%). Among various central nervous system manifestations, motor weakness (28.6%) and headache (20.4%) were the most common symptoms/signs. Hypoxic-ischemic encephalopathy (HIE) (28.6%), SCD (22.5%), and moyamoya disease (14.3%) were the most prevalent underlying etiologies. CT without intravenous contrast was the most used initial imaging technique (92.5%). An arterial blockage was more prevalent (53.4%) than a venous infarct (46.6%) (p = 0.041), while arterial ischemic stroke was more prevalent (56.5%) than hemorrhagic stroke (43.5%). The middle cerebral artery (MCA) was most affected (63.5%), followed by the anterior cerebral artery (22.7%) and posterior cerebral artery (13.6%). Most patients were managed with medical treatment (86.1%). No mortalities occurred during the initial hospital stay. The mean length of hospital stay was 12 days. Conclusion HIE was the most prevalent etiology of pediatric stroke. Motor weakness and headache were the most common initial manifestations. Arterial ischemic stroke was more prevalent than venous or hemorrhagic stroke. Considering the rarity of pediatric stroke, future studies should be performed with a aborative effort nationally and internationally.
Therapeutic dilemma of wake-up stroke: clinical and brain imaging characteristics and reperfusion as a treatment option. Erum Mubashir Shariff, Fahd Ali Al Khmais, Saima Nazish, Noman Ishaque, Aishah Ibrahim Al Bakr, Reem S. AlOmar, Danah Aljaafari, Mohammad AlShurem, Azra Zafar, Rizwana Shahid, Sari AlSuhaibani, Saeed Al-Jubran, Nehad M. Soltan, Abdulaziz Mohammad Al-Sharydah, Majed Alabdali Primary Care Companion for CNS Disorders, 2022 Objective: Wake-up stroke (WUS) comprises a significant proportion of ischemic strokes. However, due to unclear onset, these patients are often not considered for reperfusion therapy. The objective of this study was to investigate the clinical and imaging differences between WUS patients and those with clear-onset stroke, documenting any sex, age, or risk factor predilection for WUS. Methods: This prospective observational cohort study used an ongoing stroke registry to identify patients with acute ischemic stroke admitted to a hospital in Saudi Arabia within 5 days of symptom onset from April 2018 to March 2020. Patients were classified into 2 groups: WUS and clear-onset stroke. Results: Among 645 patients, 448 met the criteria for acute ischemic stroke and were included in the study. WUS was identified in 112 (25%) patients. There were no differences in sex or median age between the 2 groups. Diabetes mellitus, hypertension, and dyslipidemia were higher in the WUS group, while atrial fibrillation, history of stroke and epilepsy were higher in the clear-onset stroke group. Bihemispheric stroke was higher in the clear-onset stroke group than in the WUS group (6.0% vs 2.7%). Conclusions: Only minor dissimilarities between clinical and radiologic features of WUS and clear-onset stroke were found. Circadian patterns of stroke onset were observed in both groups. Stroke was more likely to occur during waking than during sleep, and a diurnal pattern of common occurrence during the morning was documented. Recognition of the acceptable timeframe for acute reperfusion therapy in unwitnessed strokes is crucial so that thrombolytic treatment can be started for these patients.
Rates of cerebrospinal fluid infection and the causative organisms following shunt procedures in Saudi Arabia AbdulAziz M. Al-Sharydah, Yaser A. Abu Melha, Sari S. Al-Suhibani, Abdulrazaq A. Alojan, Tareq H. Al-Taei, Iba I. Alfawaz, Lateefah T. AlShammari, Saeed A. Al-Jubran, Ahmed S. Ammar Saudi Medical Journal, 2020 Objectives: To assess the incidence of infection following various cerebrospinal fluid (CSF) shunt procedures among patients with hydrocephalus and related conditions, based on the age of the patient, and to determine the types of pathogens responsible for shunt infections. Methods: This retrospective single center study reviewed the records of patients with culture-confirmed CSF shunt infection diagnosed between January 2012 and December 2017. Cases without central nervous system imaging investigations were excluded. Results: The incidence rate of shunt-related infections was 32.2%. Among the 189 patients whose records were included, Staphylococcus epidermidis (47.5%) and Acinetobacter baumannii (18%) were the most common causative organisms. The incidence of postoperative infection was higher among those who underwent external ventricular drain procedures (65%) than among those who underwent ventriculoperitoneal shunt procedures (24%). There were no intraoperative deaths. However, the postoperative death rate was 12.2% during hospital stay (mean duration = 9 days); 2% of these deaths occurred after shunt removal. Conclusion: The incidence of infections after CSF shunt procedures was high in our tertiary academic hospital during the study period, compared to those reported in similar clinical settings and before developing a detailed standardized protocol for infection control. Although gram-negative organisms were the most prevalent cause of CSF infections, S. epidermidis (a gram-positive organism) was the most commonly encountered causative agent. Shunt protocols should be implemented to address perioperative shortcomings and to reduce overall mortality and morbidity.
A ruptured posterior communicating artery aneurysm presenting as tentorial and spinal isolated subdural hemorrhage: A case report and literature review Abdulrahman Hamad Al-Abdulwahhab, Abdulaziz Mohammad Al-Sharydah, Sari Saleh Al-Suhibani, Abdullah Salman Almulhim, Obaied M. Al-Dhafeeri, Saeed A. Al-Jubran BMC Neurology, 2020 Background Ruptured intracranial aneurysms are often associated with subarachnoid or intraparenchymal hemorrhage. However, the prevalence of subdural hemorrhage post aneurysmal rupture is low and rarely reported in scientific studies. Here, we report an unusual case of a ruptured posterior communicating artery aneurysm resulting in an isolated subdural hematoma located in the tentorial and spinal canal without subarachnoid or intraparenchymal hemorrhage. Case presentation In this case, a 34-year-old woman with no history of trauma or coagulopathy was diagnosed with a subdural hematoma in the tentorium cerebellum tracing to the subdural space of the spinal column. Computed tomography angiography was used to identify the source of the bleeding, which revealed a ruptured left-sided posterior communicating artery saccular aneurysm. The aneurysm was clipped, and the hematoma was evacuated. The patient recovered without any neurological complications. Conclusions Our results suggest that a diagnosis of ruptured intracranial aneurysm should be considered in patients with nontraumatic subdural hematoma. Prompt diagnostic imaging and interventional diagnostic procedures are required to ensure proper management of these patients and to avoid unnecessary complications.
Multiple dural arteriovenous fistulas manifesting as progressive otalgia and tinnitus and treated using a single session of endovascular embolization Abdulrahman Hamad Al-Abdulwahhab, Sari Al-Suhibani, Abdulaziz Mohammad Al-Sharydah, Saeed Ahmad Al-Jubran, Moath Abdullah Al-Thuneyyan Clinical Interventions in Aging, 2020 Background Multiple cranial dural arteriovenous fistulas (dAVFs) are considered to be an uncommon vascular condition. dAVFs usually manifest with vague symptoms, which are related to the site of occurrence of the lesion and present with complex angio-architectural features, which in turn can render treatment procedures difficult. Appropriate treatment that aims to reduce the risk of intracranial bleeding and manage the patient’s symptoms requires a multidisciplinary approach. Case Presentation The patient was a 62-year-old man who developed symptoms of progressive right-sided otalgia and tinnitus. Cross-sectional imaging revealed long-standing venous congestion with intracranial hemorrhage in the right parieto-occipital region. Moreover, cerebral angiography demonstrated multiple complex dAVFs at the right transverse sinus-sigmoid sinus (TS-SS) junction, right posterior condylar confluence (PCC), and torcula. Treatment consisted of one session of endovascular treatment, in which transarterial Onyx embolization was used to treat the dVAF at the right TS-SS junction, transvenous coil embolization for the dVAF at the right PCC, and particle embolization for both occipital arteries feeding the torcular dAVF. Postoperative improvement with favorable clinical outcomes was observed at the patient’s last follow-up visit. Conclusion Multiple cranial dAVFs are an uncommon vascular lesion, which can present with unusual symptoms such as otalgia. Moreover, a single session of endovascular therapy can treat this lesion, ie, it can improve the patient’s symptoms and provide a beneficial long-term outcome.
Can apparent diffusion coefficient values help distinguish between different types of pediatric brain tumors? Abdulaziz Mohammad Al-Sharydah, Hussain Khalid Al-Arfaj, Husam Saleh Al-Muhaish, Sari Saleh Al-Suhaibani, Mohammad Saad Al-Aftan, Dana Khaled Almedallah, Abdulrhman Hamad Al-Abdulwahhab, Abdullah Abdulaziz Al-Hedaithy, Saeed Ahmad Al-Jubran European Journal of Radiology Open, 2019 Rationale and objectives Classifying brain tumors is challenging, but recently developed imaging techniques offer the opportunity for neuroradiologists and neurosurgeons to diagnose, differentiate, and manage different types of brain tumors. Such advances will be reflected in improvements in patients’ life expectancy and quality of life. Among the newest techniques, the apparent diffusion coefficient (ADC), which tracks the rate of microscopic water diffusion within tissues, has become a focus of investigation. Recently, ADC has been used as a preoperative diffusion-weighted magnetic resonance imaging (MRI) parameter that facilitates tumor diagnosis and grading. Here, we aimed to determine the ADC cutoff values for pediatric brain tumors (PBTs) categorized according to the World Health Organization (WHO) classification of brain tumors. Materials and methods We retrospectively reviewed 80 cases, and assessed them based on their MRI-derived ADC. These results were compared with those of WHO classification-based histopathology. Results Whole-lesion ADC values ranged 0.225–1.240 × 10−3 mm2/s for ependymal tumors, 0.107–1.571 × 10−3 mm2/s for embryonal tumors, 0.1065–2.37801 × 10−3 mm2/s for diffuse astrocytic and oligodendroglial tumors, 0.5220–0.7840 × 10−3 mm2/s for other astrocytic tumors, and 0.1530–0.8160 × 10−3 mm2/s for meningiomas. These findings revealed the usefulness of ADC in the differential diagnosis of PBT, as it was able to discriminate between five types of PBTs. Conclusion The application of an ADC diagnostic criterion would reduce the need for spectroscopic analysis. However, further research is needed to implement ADC in the differential diagnosis of PBT.
Neuroschistosomiasis mimicking lower back pain: Case report of a rare differential diagnosis in a pediatric patient Abdulrahman Hamad Al-Abdulwahhab, Abdulaziz Mohammad Al-Sharydah, Sari Saleh Al-Suhibani, Saeed Ahmad Al-Jubran, Ali Khalaf Al-Haidey, Abdulkhaliq Ibrahim Al-Hifzi, Wissam Al-Issawi Patient Safety in Surgery, 2018 BackgroundSpinal myelitis is an infrequent manifestation of spinal cord infection. It is caused by the Schistosoma species, which are endemic in South America, part of the Middle East, and Africa.Case presentationWe report the case of a 13-year-old male adolescent complaining of progressive lower back pain and weakness of the lower extremities for 3 days. Initial magnetic resonance imaging revealed typical transverse myelitis. Subsequently, parasite serology showed a markedly elevated level of Schistosoma antibody titers, and cerebrospinal fluid analysis yielded normal results. Because of our presumptive diagnosis of neuroschistosomiasis, the patient was prescribed an empirical regimen of an anti-parasitic agent, after which his neurological deficit promptly subsided. The patient was followed for 1 year and showed a complete long-term resolution of symptoms.ConclusionsThis case highlights the increasing prevalence of neuroschistosomiasis in recent years, particularly in patients with a history of travel to endemic regions. Moreover, the study reports the clinicoradiological features of this enigmatic disorder. This rare occurrence potentiates further studies to address unanswered questions about neuroschistosomiasis.
Endoscopic management of Atypical sellar cavernous hemangioma: A case report and review of the literature A.M. Al-Sharydah, S.S. Al-Suhibani, S.A. Al-Jubran, A.H. Al-Abdulwahhab, M. Al-Bar, H.M. Al-Jehani, W.M. Al-Issawi International Journal of Surgery Case Reports, 2018 Highlights • Seller cavernous hemangioma is an extremely rare vascular lesion with special radiological characteristics.• When performing MRI, physicians should be aware of the possibility of encountering this rare mass, whose characteristics are consistent with those of pituitary lesions, such as a pituitary macroadenoma.• Our experience in treating this rare lesion with a standardized endoscopic endonasal surgical approach allowed us sufficient access to the tumor for debulking with less surgical complications.• Post-surgical planning for stereotactic radiosurgery is preferable to manage residual lesions. However, the long-term effects of stereotactic radiosurgery are unknown and need to be further studied.
Radiological sinonasal anatomy: Exploring the Saudi population Redha A. Alrumaih, Mona M. Ashoor, Ahmed A. Obidan, Khulood M. Al-Khater, Saeed A. Al-Jubran Saudi Medical Journal, 2016 Objectives: To assess the prevalence of common radiological variants of sinonasal anatomy among Saudi population and compare it with the reported prevalence of these variants in other ethnic and population groups. Methods: This is a retrospective cross-sectional study of 121 computerized tomography scans of the nose and paranasal sinuses of patients presented with sinonasal symptoms to the Department of Otorhinolarngology, King Fahad Hospital of the University, Khobar, Saudi Arabia, between January 2014 and May 2014. Results: Scans of 121 patients fulfilled inclusion criteria were reviewed. Concha bullosa was found in 55.4%, Haller cell in 39.7%, and Onodi cell in 28.9%. Dehiscence of the internal carotid artery was found in 1.65%. Type-1 and type-2 optic nerve were the prevalent types. Type-II Keros classification of the depth of olfactory fossa was the most common among the sample (52.9%). Frontal cells were found in 79.3%; type I was the most common. Conclusions: There is a difference in the prevalence of some radiological variants of the sinonasal anatomy between Saudi population and other study groups. Surgeon must pay special attention in the preoperative assessment of patients with sinonasal pathology to avoid undesirable complications.
RECENT SCHOLAR PUBLICATIONS
Correction: Evaluation of the Level of Dural Sac Tip in Saudi Population: A Magnetic Resonance Imaging Study MA Alhomoud, FM Alfaraj, FN Almuhaimeed, FA AlDawsari, ... Cureus 15 (1) , 2023 2023.0
Evaluation of the Level of Dural Sac Tip in Saudi Population: A Magnetic Resonance Imaging Study MSAL Jawad, MA Alhomoud, FM Alfaraj, FN Almuhaimeed, FA AlDawsari, ... Cureus 14 (12) , 2022 2022.0 Citations: 1
Therapeutic Dilemma of Wake-up Stroke: Clinical and Brain Imaging Characteristics and Reperfusion as a Treatment Option EM Shariff, FA Al Khmais, S Nazish, N Ishaque, AI Al Bakr, RS AlOmar, ... The Primary Care Companion for CNS Disorders 24 (6), 21m03216-21m03216 , 2022 2022.0 Citations: 1
Pediatric stroke from bench to bedside: a single-center experience in Saudi Arabia AM Al-Sharydah, HK Al-Arfaj, SS Al-Suhibani, FS Al-Safran, ... Vascular Health and Risk Management, 529-540 , 2022 2022.0 Citations: 7
Corrected: Evaluation of the Level of Dural Sac Tip in Saudi Population: A Magnetic Resonance Imaging Study MSAL Jawad, MA Alhomoud, FM Alfaraj, FN Almuhaimeed, FA AlDawsari, ... 2022.0
Multiple dural arteriovenous fistulas manifesting as progressive otalgia and tinnitus and treated using a single session of endovascular embolization AH Al-Abdulwahhab, S Al-Suhibani, AM Al-Sharydah, SA Al-Jubran, ... Clinical Interventions in Aging, 2313-2320 , 2020 2020.0 Citations: 7
Rates of cerebrospinal fluid infection and the causative organisms following shunt procedures in Saudi Arabia: a retrospective study based on radiological findings AAM Al-Sharydah, YAA Melha, SS Al-Suhibani, AA Alojan, TH Al-Taei, ... Saudi medical journal 41 (6), 607 , 2020 2020.0 Citations: 10
A ruptured posterior communicating artery aneurysm presenting as tentorial and spinal isolated subdural hemorrhage: a case report and literature review AH Al-Abdulwahhab, AM Al-Sharydah, SS Al-Suhibani, AS Almulhim, ... BMC neurology 20 (1), 102 , 2020 2020.0 Citations: 20
Can apparent diffusion coefficient values help distinguish between different types of pediatric brain tumors? AM Al-Sharydah, HK Al-Arfaj, HS Al-Muhaish, SS Al-Suhaibani, ... European journal of radiology open 6, 49-55 , 2019 2019.0 Citations: 30
Neuroschistosomiasis mimicking lower back pain: case report of a rare differential diagnosis in a pediatric patient AH Al-Abdulwahhab, AM Al-Sharydah, SS Al-Suhibani, SA Al-Jubran, ... Patient safety in surgery 12 (1), 28 , 2018 2018.0 Citations: 12
Endoscopic management of Atypical sellar cavernous hemangioma: A case report and review of the literature AM Al-Sharydah, SS Al-Suhibani, SA Al-Jubran, AH Al-Abdulwahhab, ... International journal of surgery case reports 42, 161-164 , 2018 2018.0 Citations: 12
Radiological sinonasal anatomy: exploring the saudi population RA Alrumaih, MM Ashoor, AA Obidan, KM Al-Khater, SA Al-Jubran Saudi Medical Journal 37 (5), 521 , 2016 2016.0 Citations: 41
Correction Notice MSAL Jawad, MA Alhomoud, FM Alfaraj, FN Almuhaimeed, FA AlDawsari, ...
MOST CITED SCHOLAR PUBLICATIONS
Radiological sinonasal anatomy: exploring the saudi population RA Alrumaih, MM Ashoor, AA Obidan, KM Al-Khater, SA Al-Jubran Saudi Medical Journal 37 (5), 521 , 2016 2016.0 Citations: 41
Can apparent diffusion coefficient values help distinguish between different types of pediatric brain tumors? AM Al-Sharydah, HK Al-Arfaj, HS Al-Muhaish, SS Al-Suhaibani, ... European journal of radiology open 6, 49-55 , 2019 2019.0 Citations: 30
A ruptured posterior communicating artery aneurysm presenting as tentorial and spinal isolated subdural hemorrhage: a case report and literature review AH Al-Abdulwahhab, AM Al-Sharydah, SS Al-Suhibani, AS Almulhim, ... BMC neurology 20 (1), 102 , 2020 2020.0 Citations: 20
Neuroschistosomiasis mimicking lower back pain: case report of a rare differential diagnosis in a pediatric patient AH Al-Abdulwahhab, AM Al-Sharydah, SS Al-Suhibani, SA Al-Jubran, ... Patient safety in surgery 12 (1), 28 , 2018 2018.0 Citations: 12
Endoscopic management of Atypical sellar cavernous hemangioma: A case report and review of the literature AM Al-Sharydah, SS Al-Suhibani, SA Al-Jubran, AH Al-Abdulwahhab, ... International journal of surgery case reports 42, 161-164 , 2018 2018.0 Citations: 12
Rates of cerebrospinal fluid infection and the causative organisms following shunt procedures in Saudi Arabia: a retrospective study based on radiological findings AAM Al-Sharydah, YAA Melha, SS Al-Suhibani, AA Alojan, TH Al-Taei, ... Saudi medical journal 41 (6), 607 , 2020 2020.0 Citations: 10
Pediatric stroke from bench to bedside: a single-center experience in Saudi Arabia AM Al-Sharydah, HK Al-Arfaj, SS Al-Suhibani, FS Al-Safran, ... Vascular Health and Risk Management, 529-540 , 2022 2022.0 Citations: 7
Multiple dural arteriovenous fistulas manifesting as progressive otalgia and tinnitus and treated using a single session of endovascular embolization AH Al-Abdulwahhab, S Al-Suhibani, AM Al-Sharydah, SA Al-Jubran, ... Clinical Interventions in Aging, 2313-2320 , 2020 2020.0 Citations: 7
Evaluation of the Level of Dural Sac Tip in Saudi Population: A Magnetic Resonance Imaging Study MSAL Jawad, MA Alhomoud, FM Alfaraj, FN Almuhaimeed, FA AlDawsari, ... Cureus 14 (12) , 2022 2022.0 Citations: 1
Therapeutic Dilemma of Wake-up Stroke: Clinical and Brain Imaging Characteristics and Reperfusion as a Treatment Option EM Shariff, FA Al Khmais, S Nazish, N Ishaque, AI Al Bakr, RS AlOmar, ... The Primary Care Companion for CNS Disorders 24 (6), 21m03216-21m03216 , 2022 2022.0 Citations: 1
Correction: Evaluation of the Level of Dural Sac Tip in Saudi Population: A Magnetic Resonance Imaging Study MA Alhomoud, FM Alfaraj, FN Almuhaimeed, FA AlDawsari, ... Cureus 15 (1) , 2023 2023.0
Corrected: Evaluation of the Level of Dural Sac Tip in Saudi Population: A Magnetic Resonance Imaging Study MSAL Jawad, MA Alhomoud, FM Alfaraj, FN Almuhaimeed, FA AlDawsari, ... 2022.0
Correction Notice MSAL Jawad, MA Alhomoud, FM Alfaraj, FN Almuhaimeed, FA AlDawsari, ...
