Hussam Alhathlol

Background: Traumatic skull base fractures carry a risk of cerebrospinal fluid (CSF) leak, predisposing patients to meningitis, neurological complications, and prolonged hospitalization. Predictive factors for posttraumatic CSF leak remain incompletely defined. The primary objective of this study is to identify clinical and radiological predictors of CSF leak among patients with traumatic skull base fractures and evaluate associated outcomes at a Level-1 trauma center. Methods: A retrospective cohort study was conducted at King Abdulaziz Medical City, Riyadh, including all patients with computed tomography-confirmed skull base fractures from 2016 to 2024. Demographics, injury characteristics, management variables, and complications were extracted from the trauma registry and electronic medical records. Bivariate comparisons and logistic regression were performed to determine independent predictors of CSF leak. Results: Among 499 patients, 36 (7.2%) developed a CSF leak. Mixed temporal fractures and pneumocephalus were independent predictors of CSF leak. CSF leak was associated with significantly higher rates of meningitis (11.1% vs. 0.9%), cranial nerve deficits (19.4% vs. 4.8%), and internal carotid artery injury (13.9% vs. 3.7%) (all P < 0.05). Median hospital stay was longer in patients with CSF leak (23.5 vs. 14 days, P = 0.038). Conclusion: Mixed temporal bone fracture patterns and pneumocephalus are strong predictors of posttraumatic CSF leak, while the presence of meningitis and cranial nerve deficits reflects more severe injury and increased morbidity. Structural fracture complexity and radiologic markers appear more informative than fracture location alone. Early recognition, risk-based monitoring, and timely multidisciplinary management are essential to mitigate infectious and neurological sequelae.

Candidozyma auris (formerly known as Candida auris) is an emerging multidrug-resistant fungal pathogen that has become increasingly implicated in healthcare-associated infections; however, its involvement in spondylodiscitis is exceedingly rare. We report the case of a 65-year-old Saudi male with multiple comorbidities who presented with altered mental status and was subsequently diagnosed with Candidozyma auris spondylodiscitis and bilateral psoas abscesses. Despite broad-spectrum antifungal therapy and multidisciplinary management, the patient’s condition rapidly deteriorated. This case highlights the significant challenges in diagnosing and managing multidrug-resistant C. auris infections and underscores the need for early suspicion, effective source control, and novel antifungal strategies in high-risk populations.

Background: Intracranial atherosclerotic stenosis (ICAS) is a significant cause of ischemic stroke worldwide, with high recurrence rates despite optimal medical therapy. While endovascular stenting has been proposed as an adjunctive treatment, its clinical benefit remains controversial as a first line therapy. Objective: To evaluate the efficacy and safety of stenting plus medical therapy (STN+MT) compared to medical therapy alone (MT) in patients with symptomatic ICAS through a systematic review and meta-analysis of randomized controlled trials (RCTs). Methods: We systematically searched PubMed, Web of Science, the Cochrane Library, Embase, Scopus, and EBSCO for RCTs comparing STN+MT with MT in adult patients with symptomatic ICAS. Primary outcomes included transient ischemic attack (TIA), stroke, intracerebral hemorrhage (ICH), and death at 30 days and 1 year. Pooled risk ratios with 95% confidence intervals were calculated using random-effects or fixed-effects models as appropriate. Meta-regression was conducted to assess effect modification by study-level characteristics. Results: Four trials comprising 990 patients were included. STN+MT was associated with significantly higher 30-day risk of stroke and ICH compared to MT alone. No significant differences in TIA, stroke, ICH, or death were found at 1 year. Meta-regression revealed no significant effect modifiers, suggesting consistent findings across subgroups. Conclusions: Our meta-analysis consolidates the evidence that intracranial stenting as a first line therapy offers no significant advantage over medical therapy in preventing stroke in symptomatic ICAS, while it does pose added early risks. This holds true across different trials, patient demographics, and clinical scenarios examined. The consistency of this message across multiple RCTs provides a high level of evidence to guide practice. At present, aggressive medical therapy alone should be the default management for most patients. Endovascular intervention should be reserved for clinical trial settings or carefully selected salvage cases, until and unless new evidence emerges to change the risk–benefit calculus such as the promising use of balloon angioplasty in the BASIS trial.

Summary: This case involves a 58-year-old man who sustained a severe left forearm injury from a motor vehicle accident. Imaging revealed comminuted fractures and arterial occlusions in the left forearm. As the injury was crush type and exploration revealed vessels with avulsion, the decision was made to perform amputation due to nonsalvageability. The patient underwent irrigation, debridement, and amputation, followed by coverage via a full-thickness skin graft from the amputated hand. Postoperatively, the patient received antibiotics and wound care, resulting in successful graft integration and healing. This case highlights the use of a full-thickness skin graft from the amputated limb for stump coverage, demonstrating that if the patient refuses to take a graft from other common sites, the amputated dorsum of the hand can be an excellent alternative site.