Doctors in India are heirs to a long tradition of ethics from their own forebears and from those from the West. This paper discusses ethical aspects of topics of relevance to neurological scientists such as brain death, neural transplant and whole brain transplant. Many other topics such as ethics in research, patients with AIDS, patients in a persistent vegetative state and euthanasia deserve similar consideration and debate.

Stem cells are self regenerating multipotential cells, found in the human brain which have the potential to differentiate into neurons, astrocytes and oligodendrocytes, and to self renew sufficiently to provide adequate number of cells in the brain. Neural stem cell grafts have been studied in a variety of animal models for various diseases like metabolic disorders, muscular dystrophies, neurodegenerative disorders, spinal cord repair, brain tumors and demyelinating disease. Stem cells may be derived from autologus, allogeneic or xenogenic sources. Histocompatibility is prerequisite for transplantation of allogeneic stem cells. Fetal tissue is the best current tissue source for human neural stem cells, however ethical issues are a major concern. Thus the prospect that stem cells could potentially be used to promote neurogenesis following injury and disease may seem attractive, yet the inherent problems associated with isolation and rejection in case of stem cells from another source, the potential to form tumors and ethical issues are the major challenges.

The development of image-guided neurosurgery represents a substantial improvement in the microsurgical treatment of tumors, vascular malformations and other intracranial lesions. Despite the wide applicability and many fascinating aspects of image-guided navigation systems, a major drawback of this technology is they use images, mainly MRI pictures, acquired preoperatively, on which the planning of the operative procedure as well as its intraoperative performance is based. As dynamic changes of the intracranial contents regularly occur during the surgical procedure, the surgeon is faced with a continuously changing intraoperative field. Only intraoperatively acquired images will provide the neurosurgeon with the information he needs to perform real intraoperative image-guided surgery. A number of tools have been developed in recent years, like intraoperative ultrasound and dedicated moveable intraoperative CT units. Because of its excellent imaging qualities, combined with the avoidance of ionizing radiation, MRI currently is and definitely will be in the future for the superior imaging method for intraoperative image guidance. In this short overview, the development as well as some of the current and possible future applications of MRI-guided neurosurgery is outlined.

The development of image-guided neurosurgery represents a substantial improvement in the microsurgical treatment of tumors, vascular malformations and other intracranial lesions. Despite the wide applicability and many fascinating aspects of image-guided navigation systems, a major drawback of this technology is they use images, mainly MRI pictures, acquired preoperatively, on which the planning of the operative procedure as well as its intraoperative performance is based. As dynamic changes of the intracranial contents regularly occur during the surgical procedure, the surgeon is faced with a continuously changing intraoperative field. Only intraoperatively acquired images will provide the neurosurgeon with the information he needs to perform real intraoperative image-guided surgery. A number of tools have been developed in recent years, like intraoperative ultrasound and dedicated moveable intraoperative CT units. Because of its excellent imaging qualities, combined with the avoidance of ionizing radiation, MRI currently is and definitely will be in the future for the superior imaging method for intraoperative image guidance. In this short overview, the development as well as some of the current and possible future applications of MRI-guided neurosurgery is outlined.

Most published literature supports the use of ICP monitoring as a standard of care, though the benefit has never been conclusively proved by a prospective, randomized trial. Unfortunately, ICP monitoring is routinely performed in very few centers in India on a systematic basis. This is probably due to the common perception that it requires very sophisticated facilities and is prohibitively expensive for most patients. The author’s institution was also faced with a comparable situation, and we have therefore developed a simple and economical system that is presented in practical detail. No custom-made equipment is necessary, and all disposables should be available in any hospital pharmacy. It is our hope that this will enable any center with an ICU for the management of neurosurgical patients to begin monitoring ICP. The system has been in consistent use for 3 years in our institution, and over 100 patients have been monitored successfully.

Background: About 10% of meningiomas behave aggressively and are graded atypical or malignant with important therapeutic and prognostic implications. Routine histological parameters are inconsistent in the assessment of their aggressive behavior. Aims: The aim of this study was to find a threshold level of the MIB-1 labeling index (MIB-1 LI) with the highest diagnostic validity in predicting histological atypia in a meningioma. Setting and Design: This was a retrospective study of all atypical and malignant meningiomas diagnosed at our center between January 1995 and June 2000 and which were identified from the General Pathology Registry. Material and Methods: These meningiomas were assessed histologically with respect to the individual criteria of atypia. They were categorized according to the WHO 2000 classification as benign, atypical and anaplastic meningiomas, WHO Grades I, II and III respectively and by immunohistochemical analysis using the MIB-1 monoclonal antibody. Statistical Analysis: The diagnostically useful cut-off level for the prediction of atypia was estimated by calculating the sensitivity and specificity of the MIB-1 LI at various levels and a receiver operated characteristic (ROC) analysis was performed. The correlation between the individual histological parameters was studied and the MIB-1 LI was obtained using Fisher’s exact test. Results: Of the 40 meningiomas studied 21 were benign, 16 atypical and 3 anaplastic. Atypical tumors had a higher MIB-1 LI than benign tumors, with diagnostic validity highest at a threshold of 7%, with a sensitivity of 0.86 and a specificity of 0.93, giving a likelihood ratio of 17. The MIB-1 LI correlated well with mitotic activity and the other individual criteria in the WHO 2000 definition of atypia in a meningioma. MIB-1 LI did not, however, correlate well with brain invasion. Conclusion: The MIB-1 LI has the highest validity in the diagnosis of atypia in meningiomas at a threshold level of 7%. The MIB-1 LI used in conjunction with histological features can help in making a recommendation regarding potentially aggressive behavior in meningiomas.

Background: Clinical criteria (symptoms) are not reliable enough to differentiate between different causes of encephalitis. The clinical presentation of herpes simplex virus encephalitis (HSVE) is not classically constant and in such a patient, therefore, it is vital to make early diagnosis. Aims: To investigate satisfactory and crucial clinical signs as guide to perform HSV-PCR in a rapid diagnosis of herpes simplex virus encephalitis. Material and Methods: A total of 156 CSF specimens from 70 patients with clinically suspected HSVE or meningoencephalitis were tested. The criteria for cases suspected of HSVE were fever >380C, altered mental status and other critical manifestations. CSF features, irregularity in brain CT scan and MRI findings were also assessed. All the specimens were collected before and after Acyclovir treatment. Polymerase chain reaction was performed using primers, which amplified DNA sequences for both HSV-1 and HSV-2. Statistical Analysis: To analyze data, two-tailed Fisher’s exact test and the X2-test with Yates’ correction were used as appropriate. The odds ratio was used to express the strength of association between the clinical factors and the PCR results. Results: HSV-DNA was detected in 18% of the specimens, belonging to 25.7% of the patients. Results indicate that the majority of the clinical symptoms are not specific to definitive clinical diagnosis of HSVE, except alteration in the level of consciousness—odds ratio [0.27 (0.07-0.96) (P=0.033)]; and lateralization sign—odds ratio [4.7 (0.98-22.6) (P=0.023)]. However, laboratory data, including total white blood cell count, especially the number of lymphocytes, and MRI findings could be suggested for HSV-PCR examination. Conclusion: At the first admission, a preliminary finding of at least two important clinical features mentioned above along with the pattern of CSF cell and differential counts could be sufficient to perform HSV-PCR which could ultimately result in a rapid and correct diagnosis of herpes simplex encephalitis.

Background: Intensive care resources for the management of severe diffuse brain injury patients (SDBI) are limited. Their optimal use is possible only if we can predict at admission which patients are unlikely to improve. Aims: To develop a simple and effective model to predict poor outcome in patients with SDBI in order to help guide initial therapy. Material and Methods: The prognostic factors and outcomes of 289 patients with severe diffuse brain injury (GCS 3-8) were analyzed retrospectively. The prognostic factors analyzed were age, mode of injury, GCS at admission, pupillary reaction, horizontal oculocephalic reflex, and CT scan findings. Outcome at 1 month was classified as unfavorable—death or persistent vegetative state, or favorable—improvement with or without some disability. A stepwise linear logistic regression analysis was used to identify the most important predictors of poor outcome. A prediction model (NIMHANS model-NM) was developed using these factors. NM and several currently available outcome prediction models were prospectively applied in a separate group of 26 patients with severe diffuse brain injury managed with a different protocol. Results: The most important predictors of poor outcome were found to be the horizontal oculocephalic reflex, motor score of GCS, and midline shift on CT scan. NM was found to be more sensitive (75%) and specific (67%) than most other models in predicting unfavorable outcome. NM had high false pessimistic results (33%). Conclusion: Prediction models cannot be used to guide initial therapy.

Background: Although many experimental and clinical studies were performed on the pathophysiology and treatment of spinal cord injury (SCI), the electrophysiological and ultrastructural changes of the spinal cord were not precisely evaluated. Aims: To investigate the effect of mannitol on Somatosensory Evoked Potentials (SSEP), postoperative neurological recovery and ultrastructural findings after an experimental SCI. Setting: The experimental microsurgery laboratory of a university hospital. Design: A prospective, randomized animal study. Material and Methods: Sprague-Dawley rats were used and divided into three groups (Groups I-III) for this study. Those in Group I were control animals who underwent laminectomy only, and non-traumatized spinal cord samples were obtained 2 weeks later. SCI was produced in Groups II and III using clip compression technique, and cord samples were obtained 2 weeks later. The rats in Group II received 2 g/kg of 20% mannitol intraperitoneally, immediately and three hours after trauma was induced; and those in Group III received the same amount of 0,9% NaCl in the same manner. Preoperative and postoperative SSEP records at the end of 2 weeks were obtained. Electron microscopy examination of the cord samples was done at 2 weeks postoperatively. Statistical Analysis used: Fischer’s Exact Test. Results: SSEP records, ultrastructural findings and clinical recovery showed that minor neural damage and significant recovery occurred in Group II. Conclusion: This study demonstrates that the administration of 2 g/kg of 20% mannitol produces significant improvement in the neural structures and protects the spinal cord following injury.

Background: Angiotensin converting enzyme (ACE) inhibitors are emerging as effective agents for preventing microvascular complications of diabetes. Losartan (angiotensin II antagonist) has an antihypertensive efficacy equivalent to ACE inhibitors, however its role in microvascular complications is not yet known. Material and Methods: We studied the efficacy of losartan (50 mg once daily for 12 weeks) on albuminuria, peripheral and autonomic neuropathy in 25 normotensive microalbuminuric type 2 diabetics who were asymptomatic for neuropathy. Results: Mean age was 46.6 ± 4.34 years with the average duration of diabetes being 8.1 ± 1.54 years. Albuminuria improved significantly from 54 ± 9.35 mg/L to 32.8 ± 25 mg/L (Paired student’s t-test, P=0.0005) after therapy. Autonomic neuropathy was observed in 64% while 76% had peripheral neuropathy; but there was no improvement with losartan. The duration of diabetes had a negative correlation with autonomic neuropathy. It also had a similar negative correlation with median and common peroneal nerve motor conduction velocities (Pearson’s correlation coefficient, r = -0.53, P<0.01 and r = -0.56, P<0.01 respectively) implying that autonomic and peripheral neuropathy worsen as a diabetic ages. However, no correlation existed between albuminuria and autonomic or peripheral nerve function. Conclusion: Autonomic and peripheral neuropathy are highly prevalent in normotensive microalbuminuric diabetic patients. Losartan remarkably improves albuminuria but a similar benefit in autonomic or peripheral neuropathy is not seen over 12 weeks. The future may see a defining role for losartan in microvascular complications in normotensive diabetics.

The association of epilepsy and psychosis is studied. Among the 500 patients of epilepsy evaluated, there were 12 patients, 8 males and 4 females with epilepsy-related psychosis. Their average age was 38 years. The interval between the age of onset of epilepsy and psychotic features was 9 years. Complex partial seizures were present in 7 patients and primary generalized tonic-clonic seizure was present in 1 patient. Four patients had post-ictal psychosis, 7 had acute interictal psychosis and 1 patient had chronic psychosis. The inter-ictal and chronic psychoses were schizophreniform whereas the post-ictal psychoses were not. EEG showed a temporal focus in 7 patients with complex partial seizures and an extra-temporal focus was identified in 4 out of the other 5 patients. Imaging (CT scan/MRI) revealed abnormalities in 10 patients. This study attempts to define the characteristics of psychoses occurring in epileptics.

Aims: The aim of this study was to establish whether nimodipine given orally soon after severe diffuse head injury for a period of three weeks improved outcome. Material and Methods: The present report analyzes the results of a prospective randomized double–blind placebo-controlled trial of nimodipine in 97 severe head injury patients (GCS Score <\=8) treated at the Department of Neurosurgery, NIMHANS, between January 1995 and June 1996. The patients were randomly assigned to two groups which were matched for age, sex, mode of injury, time interval from injury to admission, neurological status and CT scan findings. One group was given nimodipine 30 mg Q6H and the other group was given a placebo. The outcome of these patients at 6 months was evaluated using the Glasgow Outcome Score by and a psychologist. Results: Results showed no significant difference in the functional and psychological outcome between the two groups, even in patients with subarachnoid hemorrhage. No adverse drug events were recorded. Conclusion: Oral nimodipine given for three weeks does not improve outcome in patients with severe diffuse head injury.

A retrospective analysis of 326 clinically diagnosed cases with meningitis over a period of five-and-a-half years was carried out to determine the prevalence of cryptococcal infection, its associated risk factors and therapeutic outcome. Fifty-four (16.6%) patients with cryptococcal meningitis were identified by smear examination, culture and/or cryptococcal antigen latex agglutination test. Records of 45 cryptococcal meningitis patients were available; 18 (40%) of them were apparently healthy immunocompetent individuals, 13 (28.9%) had human immunodeficiency virus (HIV) infection, 9 (20%) were renal transplant recipients, 4 (8.9%) were diabetic and 1 (2.2%) had systemic lupus erythematosus. Ten (22.2%) patients died and 11 (24.4%) patients (all HIV-positive) left against medical advice. The present study indicates that cryptococcal infection is associated with high mortality. Presenting symptoms being indistinguishable from other causes of central nervous system infection, all patients with a clinical diagnosis of meningitis, irrespective of their immune status should be investigated for cryptococcal infection.

The reading frame hypothesis has been proposed to explain the molecular basis of two allelic forms of muscular dystrophies, Duchenne/Becker muscular dystrophy (D/BMD). To evaluate the hypothesis in Indian D/BMD patients, we analyzed deletion of dystrophin exons in 147 DMD and 19 BMD patients. Our studies showed deviation of more than 30% from the reading frame hypothesis in DMD patients (47/147). The present results implicate a need to reevaluate the reading frame hypothesis.

Three hundred and ninety-seven patients undergoing posterior cranial fossa surgery in the sitting position were prospectively studied to evaluate the incidence of venous air embolism (VAE) and its effects on hemodynamics. End-tidal carbon dioxide (ETC02) tension was monitored to diagnose VAE. A sudden and sustained decrease in ETC02 of more than 5 mmHg, in the absence of sudden hypovolemia, was presumed to be the result of VAE. The site of probable air entrainment (whether muscle, bone or tumor) was noted. Hemodynamic consequences were managed symptomatically. ETC02 monitoring detected VAE in 22% of the patients. The highest incidence of embolism resulted from muscles and tumor (40% in each case). Forty-two per cent of patients developed hypotension during the embolic episode (systolic BP less than 100 mmHg). Ten per cent of patients developed ventricular arrhythmias during the embolic episode. Air aspiration was successful in 4.8%. There were no statistically significant differences in the frequency of VAE among the different groups (P>0.05). Also, the frequency of hypotension and ventricular arrhythmias were not significantly different, irrespective of the source of VAE (P>0.05). The general condition of the patients in the preoperative stage had no influence on the incidence of embolism, hypotension or ventricular arrhythmias.

Computerized tomography (CT) scan and operative observations, and histolopathogical findings of 25 cases of intracranial hemangioblastoma were correlated. Solid hemangioblastomas showed a large number of thin-walled capillaries and abundant stromal cells with eosinophilic cytoplasm. Tumors with a cystic component and a mural nodule had a large number of stromal cells with vacuolated cytoplasm and microcysts.

Two cases of neuro-Behçet’s disease with isolated, solitary fronto-temporal and mesencephalic lesions respectively are reported. The cases were misdiagnosed as cerebral tumor. The postoperative outcome of the first patient was not satisfactory as he developed hemispheric edema. The second patient, with mesencephalic lesion, was treated only with corticosteroids, and the patient improved significantly. The lesion in this case resolved completely at six-month follow-up. We conclude that distinguishing the isolated solitary cerebral lesion of the Behçet’s disease from a tumor may prevent surgical intervention.

We report two cases of posterior third ventricular choroid plexus papilloma, one in an 8-month-old infant and another in a two-year-old child. These cases presented with features of obstructive hydrocephalus. Both these patients underwent a ventriculo-peritoneal (VP) shunt surgery prior to the tumor excision. Following the VP shunt surgery both patients developed ascitis requiring exteriorization of the abdominal end of the shunt. There was a clear proof of CSF overproduction: 1400-1500 ml/ day in the eight-month-old infant and 900-1200 ml / day in the two-year-old child. In the former it was transient and could be treated with revision of the VP shunt whereas in the second case a ventriculo-arterial shunt had to be done. In the second case a staged reduction cranioplasty was also performed for an enormously enlarged head (head circumference—74 cm). Interesting clinical and radiological findings and useful management strategies are described.

A rare case of a 40-year-old lady with a sporadic variety of the pallido-pyramidal syndrome (PPS) is reported. She had marked parkinsonian features on the left side. Her single photon emission computed tomography showed left frontoparietal and basal ganglia hypoperfusion. CT scan and central motor conduction time were normal. She responded partially to a combination of trihexyphenydil and L dopa/C dopa therapy. In view of the diversity in the genetic, clinical and laboratory features, it is possible that PPS may be a heterogeneous condition.

The clinical and electrophysiologic profiles of two brothers suffering from Charcot-Marie-Tooth disease are presented. Both had widespread muscle twitching in the legs which showed electrophysiologic features of myokymia. Pedigree analysis suggested an x-linked recessive form of inheritance. This appears to be the first report of an Indian family with x-linked Charcot-Marie-Tooth disease.

This is a case report of a lady who presented with pupil-sparing Weber’s syndrome. She had left oculomotor nerve palsy with normal pupil and right hemiparesis. The patient subsequently made a good recovery. An ischemic lesion of the lower mid-brain was demonstrated on the MRI scan of the brain, which corresponds to the motor nucleus of the oculomotor nerve. The article also describes the neuroanatomy of the oculomotor nerve and how its partial lesions lead to sparing of the pupil. In addition, this case report documents that a pupil-sparing Weber’s syndrome could be reversible.

A 34-year-old female patient presented with an intracranial subarachnoid hemorrhage and was found to have a dural arteriovenous fistula at the site of previous cervical meningocele repair. Subsequent occlusion was achieved with endovascular embolization. To our knowledge, the phenomenon of the development of a spinal dural fistula at the site of a meningocele repair has not been recorded before.

Neuronal migration disorders are an important differential diagnosis to be considered in the evaluation of intractable epilepsy. Though the underlying causative factors which govern their development are many and varied, genetic factors have been found to be contributory in a few forms of these disorders. An X–linked association with lissencephaly has recently been discovered and there are a few families described till now with this entity.

We describe the magnetic resonance imaging (MRI) signal characteristics of isolated (solitary lesion) intra fourth ventricular cysticercus cyst in 4 patients who clinically presented with obstructive hydrocephalus. All patients had routine MRI sequences (T1, T2, & proton density-weighted imaging), Fluid Attenuation Inversion Recovery (FLAIR), and post-gadolinium imaging followed by cerebrospinal fluid (CSF) flow study. It revealed a CSF signal intensity (on all pulse sequences), intra fourth ventricular cyst with a nidus (scolex), and wall enhancement. On T1-weighted and FLAIR images, the cyst wall and nidus (scolex) were seen in 3 cases, which were not seen in other routine sequences. The CSF flow study showed the intraluminal nature of the cyst. The MRI features suspected a cysticercus cyst, and per-operative findings and histopathological examination confirmed the diagnosis. The review of literature of the intra fourth ventricular cyst is briefly discussed.

A 7-year-old boy from an area endemic to Japanese encephalitis (JE) manifested with acute febrile illness, left hemiplegia and preserved consciousness during the prodromal phase of illness. The child developed features of encephalitis 48 hours after the onset of hemiplegia. IgM MAC ELISA for JE virus revealed high titers in the serum and cerebrospinal fluid suggestive of JE. MRI of the brain showed asymmetrical bilateral thalamic hyperintense lesions on T2 weighted image, considered diagnostic of JE. Hemiplegia during the prodromal phase or as an initial symptom of JE is rather unusual.

Herpes Simplex Encephalitis (HSE) is the most common cause of fatal viral encephalitis. A high index of suspicion is mandatory for early diagnosis and successful therapy to restrict morbidity and mortality . We report 4 patients of HSE, with interesting presentations, viz. brainstem involvement in an immunosuppressed patient, Kluver-Bucy Syndrome—a consequence of untreated HSE, HSE in the postpartum period mistaken as cortical venous thrombosis, and response to inadequate treatment. They demonstrate the wide spectrum of clinical features, pitfalls in diagnosis, and a variable response to therapy in HSE.

Cerebrotendinous xanthomatosis (CTX) is exceptionally rare in the Indian population. We present and discuss the clinical, radiological and histopathologic findings in 2 siblings with CTX. Both the patients had juvenile cataract, mental retardation and marked cerebellar ataxia. The Achilles tendon swelling was present in only 1 patient (Case 2). MR imaging showed typical bilateral and symmetrical involvement of the dentate nuclei, inferior olives, brainstem and cerebellar hemispheric white matter. Although the diagnosis of CTX was made in the 3rd decade in both our cases, early diagnosis is possible if neuroimaging is done in the early course of the disease.

A 23-year-old man with cyanotic heart disease, presented with a ring-enhancing mass in the brainstem. Stereotactic intervention for this clinically and radiologically diagnosed pyogenic abscess, revealed a tuberculoma. Antituberculous therapy led to complete recovery. Stereotactic intervention is an ideal management strategy in patients with cyanotic heart disease and an isolated ring-enhancing mass in the brainstem.

We report a series of three patients with suprasellar arachnoid cysts who presented with a rare ‘bobble-head doll’ syndrome. The abnormal head movements improved after surgical evacuation of the cysts in all the three cases. Various pathophysiological mechanisms involved in the bobble-head doll syndrome are discussed. The literature on suprasellar arachnoid cysts is briefly reviewed.

A 47-year-old woman was diagnosed with secondary progressive multiple sclerosis, and was treated with intrathecal morphine for chronic pain via a slow-release subcutaneous pump. She accidentally received a 35-ml (510 mg) bolus injection of morphine by this route, which led to status epilepticus. She was treated with continuous intravenous naloxone infusion, and with medication to control hypertension and stop the seizure activity. The outcome was excellent, and the patient returned to her neurological baseline. This report describes the complications and the successful treatment of intrathecal morphine overdose. In order to prevent these serious errors, it is vital that only care providers who are proficient with these devices perform the refilling procedure.

Penetrating injuries of the brain caused by a nail are rare. An interesting case of a patient with schizophrenia who attempted suicide by a self-inflicted penetrating intracranial injury using a nail is reported here. The literature related to this unusual case is reviewed.

A case of juvenile amyotrophic lateral sclerosis with wasting confined to the distal part of one lower limb and the proximal part of the contralateral upper limb is being presented. A brief review of the literature is carried out.

Functional outcome at three months was studied in 72 patients with ischemic stroke. The Canadian Neurological Scale was used to assess the severity of stroke at admission and functional outcome at 3 months was assessed using modified Rankin scale. The size and site of the infarct was noted from the initial CT. Risk factors like hypertension, diabetes, and serum cholesterol were analyzed. Initial neurological scoring at admission, and size and site of the infarct were significantly associated with functional recovery at 3 months.

A case of temporal bone carcinoma having intradural extension is reported. To the best of our knowledge, no such case has been reported so far.

We report a rare case of an infant with congenital muscular dystrophy who presented at birth with marked generalized hypotonia and normal mental development. Creatinine phosphokinase (CPK) level was markedly raised; however no white matter abnormalities were detected by brain imaging techniques. Immunohistochemical staining for merosin (laminin alpha 2) was negative, thereby confirming merosin-deficient congenital muscular dystrophy.

A case of falcine meningioma associated with acute subdural hemorrhage is reported. The possible mechanisms of hemorrhage in the case are discussed. We believe that an early recognition and surgery can prevent neurological deterioration.

A study was conducted to observe the effect of intravenous sodium valproate in status epilepticus. Eleven patients with status epilepticus, who were resistant to conventional drugs, underwent treatment with intravenous sodium valproate. The seizures were controlled in 10 patients within 24-48 hrs of starting treatment. No complications were observed during therapy. We conclude that intravenous sodium valproate can be recommended for Myoclonic status epilepticus and non-convulsive status epileticus.

Acute subdural hematoma is an uncommon presentation of the rupture of an intracranial aneurysm. We report two cases of intracranial aneurysms causing spontaneous acute subdural hematoma.