Search Results (29)

Background/Objectives: Spontaneous intracranial hypotension (SIH) is a rare pathology that arises in the context of a known or suspected cerebral spinal fluid (CSF) leak. A key symptom of SIH is an orthostatic headache; however, additional neurological complications are common. This case study not only highlights the co-existence of Menière’s disease and SIH but describes a subsequent complication of benign paroxysmal positional vertigo (BPPV) and management thereof. Case Description: The patient is a 61-year-old female who presented to the emergency department due to an intractable headache, right sided weakness and aphasia. CT/MRI revealed a subdural hematoma overlying the left cerebral hemisphere measuring up to 8 mm with 4 mm left to right midline shift. Fluoro-guided total spine myelogram, cisternogram, and lumbar epidural blood patch were performed for suspected SIH. As headache, right sided weakness and aphasia resolved, the patient began reporting onset of constant “spinning” dizziness, tinnitus and aural fullness mimicking symptoms of a Menière’s attack. The vestibular examination was consistent with compensated bilateral Menière’s disease (left > right) and right horizontal canalithiasis BPPV. The patient was treated with Gufoni and Lempert maneuvers with complete resolution of positional dizziness and associated nystagmus along with improved balance and gait. Discussion/Conclusions: This case study highlights the importance of multidisciplinary assessment in complex neurological cases and specifically recommends that patients with Menière’s disease accompanied by intractable headaches undergo extended neuroradiological examination of the brain to exclude underlying spontaneous intracranial hypotension syndrome. Full article

Background/Objectives: Intracranial hypotension is a rare and underdiagnosed serious condition characterized by low cerebrospinal fluid (CSF) pressure, often resulting from trauma to the dura mater. While manual therapy is increasingly used for musculoskeletal complaints, it is not without risk and may, in rare cases, result in complications such as dural tears. Although these complications are rare, they require early recognition and appropriate treatment to prevent further morbidity. This case report aims to highlight a rare presentation of multilevel dural defects in temporal association with manual therapy and to demonstrate the efficacy of epidural blood patch (EBP) treatment. Case Presentation: We report a case of a 46-year-old woman without chronic illness who developed worsening orthostatic headaches, weakness, and vomiting after multiple manual therapy sessions. Only after 6 months did the patient undergo magnetic resonance imaging (MRI), which revealed intracranial hypotension due to dural damage in the spinal dura mater at C6–T1 and T8–T10, brain sagging, and an increased risk of subdural hematoma. After excluding other causes of dural defects, EBP was performed under CT guidance at C6–C7 and T8–T9, which resulted in symptom regression. Follow-up MRI was recommended for the patient. Conclusions: This case highlights a rare but clinically significant occurrence of multilevel dural defects and intracranial hypotension in temporal association with manual therapy. This emphasizes the critical role of timely diagnosis using MRI and the clinical effectiveness of EBP as a minimally invasive procedure. Full article

Background: Sarcopenia is increasingly recognized as a prognostic factor in surgical populations. This study evaluated the association between cranial CT-based markers of sarcopenia and neurological outcomes in patients undergoing surgery for chronic subdural hematoma (CSDH). Methods: This retrospective case–control study included 82 patients who underwent surgery for unilateral CSDH. Demographic data, comorbidities, use of anticoagulant and antiplatelet therapy, postoperative complications and length of hospital stay were collected from patients’ medical records. Radiological parameters of sarcopenia, including temporal muscle thickness, temporal muscle area, and occipital fat pad thickness, as well as standard radiological features of CSDH, were measured preoperatively on the initial CT scan. Neurological outcome 3 months after surgery was assessed using the Glasgow Outcome Scale, with scores ≥ 4 defined as favourable and scores 1–3 as poor. Results: Demographic and clinical characteristics, including age, sex, comorbidities, hematoma thickness and intracranial midline shift, did not differ significantly between outcome groups. Temporal muscle thickness (4.7 vs. 2.8 mm, p < 0.001), temporal muscle area (160 vs. 106 mm², p = 0.04), and occipital fat pad thickness (4.7 vs. 3.4 mm, p = 0.04) were significantly greater in patients with favourable neurological outcomes. After corrections for age and comorbidities, multivariate logistic regression with temporal muscle thickness, area and density, temporal bone thickness and density, and occipital fat pad thickness demonstrated that temporal muscle thickness was the only independent predictor of good neurological recovery (OR 3.20, 95% CI 1.37–7.46, p = 0.007). ROC analysis showed good discriminatory power of temporal muscle thickness (AUC 0.812, 95% CI 0.695–0.930, p < 0.001), with a cut-off value of ≥3.37 mm for its ability to predict favourable neurological outcome. Conclusions: Temporal muscle thickness is a reliable, non-invasive imaging biomarker for predicting good neurological recovery after CSDH surgery and may aid in risk stratification, particularly in elderly or frail patients. Full article

Background: Traumatic head injury (THI) includes a diverse range of hemorrhagic brain lesions (HBL), which are distinct phenotypes with characteristic pathophysiological mechanisms. Computed tomography (CT) is the cornerstone of the initial assessment and diagnosis; however, its sensitivity is limited, especially in mild head injury. Blood-derived biomarkers, including Neuron-Specific Enolase (NSE) and S-100B, have been extensively studied; however, their efficacy in distinguishing HBL subtypes remains unclear. We evaluated whether circulating serum levels of S-100B and NSE can discriminate between distinct intracranial HBLs and extracranial hemorrhagic lesions (ECH). Methods: This is an interim analysis of a prospective, randomized, double-blind clinical trial including 434 adult patients with blunt THI. HBL phenotypes identified by CT scan included subarachnoid hemorrhage (SAH), subdural hematoma (SDH), epidural hematoma (EDH), and brain contusion (BC). Unique lesions were considered while overlapping lesions were excluded. Subgaleal hematoma (SGH) was included as an example of ECH. Serum S-100B was assessed within 6 h post-injury, while serum NSE was evaluated at admission, 24 h, and 48 h thereafter. Serum NSE and inflammatory cytokines were quantified in duplicates using a Human Magnetic Luminex 5-plex assay, while serum S-100B concentrations were measured separately. Serum epinephrine concentrations were quantified using an ELISA. Biomarker profiles were analyzed based on lesion phenotype, lesion multiplicity, injury pattern, and clinical outcomes, including hospital length of stay (HLOS) and the Glasgow Outcome Scale—Extended (GOSE). Results: Admission median S-100B levels were higher in patients with SAH (495 pg/mL) and lower in those with SGH (191 pg/mL); however, they did not show statistically significant difference among HBL phenotypes. They were significantly higher in patients with polytrauma TBI (420 pg/mL) compared to isolated TBI (258 pg/mL). Baseline and 48 h NSE concentrations were significantly higher in SDH (25,089 and 28,438 pg/mL) than in other THI lesions (p = 0.04). There were no statistically significant changes in NSE values over time across all THI lesions except for SDH in which they raised more after 48 h (p = 0.02). They had a significant drop in polytrauma over the time (p = 0.001). Compared to intracranial lesions, S-100 B levels were significantly lower in SGH and in skull fractures without intracranial hematomas. Both S-100B and NSE levels were elevated in individuals with unfavorable GOSE scores. Conclusions: In this secondary exploratory analysis, elevated serum NSE and S-100B levels discriminate between extra- and intracranial lesions and appear to represent distinct but complementary aspects of THI, indicating neuronal damage and its temporal evolution, and predicting clinical and functional outcomes. The present findings reflect association and not causation. Future studies incorporating larger or multicenter cohorts, volumetric imaging, and long-term outcomes are required to validate and refine biomarker-guided algorithms for personalized THI care. Full article

Background: Routine admission inflammatory and metabolic biomarkers have been proposed as adjunctive tools in mild traumatic brain injury (mTBI). However, their association with specific traumatic intracranial lesion types remains unclear. Methods: We conducted a prospective observational study including adult patients with isolated mTBI who underwent head computed tomography (CT) on admission. Admission laboratory parameters included the platelet-to-lymphocyte ratio (PLR), systemic immune-inflammation index (SII), and glucose-to-potassium ratio (GPR). Two predefined endpoints were assessed. The first compared biomarker values between CT-positive and CT-negative patients. The second evaluated associations between biomarkers and individual intracranial lesion subtypes, including analyses restricted to isolated lesions. Results: A total of 125 patients were included, of whom 95 (76%) were CT-positive. No significant differences were observed between CT-positive and CT-negative patients for PLR (p = 0.793), GPR (p = 0.531), or SII (p = 0.291). In lesion-specific analyses including all intracranial injuries, subdural hematoma (SDH) was associated with higher GPR compared with patients without SDH (p = 0.016). In analyses restricted to patients with isolated lesions, SDH was associated with higher PLR (p = 0.018) and higher GPR (p = 0.015). No significant associations were observed between any biomarker and intraparenchymal hemorrhage, subarachnoid hemorrhage, or epidural hematoma (all p > 0.05). Patients with multiple intracranial injuries exhibited higher PLR (p = 0.012) and higher SII (p = 0.021) compared with those with isolated lesions. After correction for multiple comparisons, none of the observed associations remained statistically significant. Conclusions: These findings suggest that routine systemic biomarkers have limited global discriminatory value in mTBI. Exploratory lesion-specific associations with SDH did not remain significant after correction for multiple comparisons, underscoring the preliminary nature of these findings. Full article

Background: Post-traumatic epilepsy (PTE) is a recognized complication of traumatic brain injury (TBI), yet its risk following mild and moderate TBI remains underappreciated. Although mild TBI represents the majority of cases in clinical practice, a subset of patients develop unprovoked seizures months or even years post-injury. This review aims to synthesize current evidence on the incidence and predictors of PTE in mild and moderate TBI and to propose a clinically actionable decision-support tool for early risk stratification. Methods: We performed a narrative review of peer-reviewed studies published between 1985 and 2024 that reported on the incidence, risk factors and predictive models of PTE in patients with mild (Glasgow Coma Scale [GCS] 13–15) and moderate (GCS 9–12 or imaging-positive) TBI. Data from 24 studies were extracted, focusing on neuroimaging findings, early post-traumatic seizures, EEG abnormalities and clinical risk factors. These variables were integrated into a rule-based algorithm, which was implemented using Streamlit to enable real-time clinical decision-making. The decision-support tool incorporated five domains: injury severity, early post-traumatic seizures, neuroimaging findings (including contusion location and hematoma type), clinical and demographic variables (age, sex, psychiatric comorbidities, prior TBI, neurosurgical intervention) and EEG abnormalities. Results: PTE incidence following mild TBI ranged from <1% to 10%, with increased risk observed in patients presenting with intracranial hemorrhage or early seizures. From moderate TBI, incidence rates were consistently higher (6–12%). Key predictors included early seizures, frontal or temporal contusions, subdural hematoma, multiple contusions and midline shift. Additional risk-enhancing factors included prolonged loss of consciousness, male sex, psychiatric comorbidities and abnormal EEG patterns. Based on these features, we developed a decision-support tool that stratifies patients into low-, moderate- and high-risk categories for developing PTE. Conclusions: Even in non-severe cases, patients with mild and moderate TBI who exhibit high-risk features remain vulnerable to long-term epileptogenesis. Our proposed tool provides a pragmatic, evidence-based framework for early identification and follow-up planning. Prospective validation studies are needed to confirm its predictive accuracy and optimize its clinical utility. Full article

The elderly population in Japan was 29.3% in 2024, the highest in the world, making medical care for elderly patients an urgent social issue. There are challenges in providing care for elderly patients with head injury, since the buffering effect of the expansion of the subdural space due to brain atrophy masks the neurological symptoms caused by a hematoma, making detection difficult. However, brain damage can be detected with high sensitivity and specificity using blood D-dimer as a biomarker without the need for head computed tomography (CT). Also, about 30% of elderly patients with traumatic brain injury (TBI) are taking antithrombotic drugs, and the effects of these drugs on TBI may include an increase in intracranial hematomas and an increased risk of deterioration. Reversal therapy is used as a countermeasure to prevent hematoma expansion, but this requires the administration of a reversal agent early after injury and before hematoma expansion. In decompression surgery, the use of a mini-craniotomy with neuroendoscopic assistance under local anesthesia can reduce invasiveness, and this method significantly reduces intraoperative bleeding and operation times compared to a major craniotomy. These innovations have improved mortality for TBI in elderly patients, but there is still a need for improvements in functional outcomes. Full article

Background and Clinical Significance: Fulminant pulmonary embolism (PE) leading to an out-of-hospital cardiac arrest (OHCA) is associated with a high mortality rate and cardiopulmonary resuscitation (CPR) frequently failing to achieve return of spontaneous circulation (ROSC). Extracorporeal CPR (eCPR) has emerged as a potential life-saving intervention. Case Presentation: A 66-year-old woman suffered an OHCA due to massive PE, presenting with pulseless electrical activity (PEA). After 90 min of pre- and in-hospital CPR without sustained ROSC, venoarterial extracorporeal membrane oxygenation (va-ECMO) was initiated as eCPR upon arrival at the hospital. Even after implantation of the va-ECMO, there was initially a pronounced acidosis (pH 6.9) with a high elevated lactate level (>30 mmol/L); these factors, together with the prolonged low-flow period, indicated a poor prognosis. Further diagnostic tests revealed intracranial hemorrhage (subdural hematoma), and systemic lysis was not possible. With persistent right heart failure, surgical thrombectomy was performed during hospitalization. Intensive multidisciplinary management finally led to successful therapy and weaning from mechanical ventilation, as well as to complete neurological recovery (CPC-Score 1-2). Conclusions: This case illustrates that eCPR can facilitate survival with good favorable neurological outcomes despite initially poor prognostic predictors. It underscores the importance of refining patient selection criteria and optimizing management strategies for eCPR in refractory cardiac arrest secondary to PE. Full article

Background/Objectives: Venous thromboembolism (VTE) is a preventable cause of morbidity in the neurocritical ill patient population. There is ongoing debate regarding the optimal timing and choice of pharmacologic thromboprophylaxis (PTP) and how these decisions relate to balancing the risk of bleeding complications with the development of VTE. Our review assesses the available data to provide un updated perspective to clinicians. Methods: A literature search was performed in December 2024 in PubMed and EMBASE. We focused on the timing of PTP initiation and the comparison of enoxaparin (ENX) with unfractionated heparin (UFH) in patients with traumatic brain injury (TBI), intracerebral hemorrhage (ICH), subarachnoid hemorrhage (SAH), spinal or spinal cord injury (SCI), or requirement for neurosurgical intervention. Results: We included 90 articles spanning a total of 669,725 patients with injuries of interest within neurocritical care. The existing data largely signaled a benefit of early administration (<24–72 h) of PTP in VTE prevention, though some studies suggested increased risks of complications. Data to inform a preference for PTP agent was less robust, though a signal of benefit for enoxaparin is suggested for subsets of patients with acute brain injury such as TBI. The data quality is limited by the large body of retrospective studies, the heterogeneity of study populations, outcome definitions, study methodologies, and the lack of detailed reporting of relevant factors. Conclusions: Our review provides an updated assessment of the available data on PTP timing and choice in neurocritically ill patients with hemorrhages or surgical need, with a practice-focused overview for clinicians balancing VTE risk with bleeding risk. The data suggest that in most circumstances, early PTP appears safe and indicated, and that low-molecular weight heparin (LMWH) can be considered over UFH in certain subsets of patients. Still, data gaps and conflicting results highlight the need for patient-specific decision making and indicate that more robust research is warranted to inform optimal clinical practice. Full article

Background/Objectives: Nonacute subdural hematomas (naSDHs) are a prevalent intracranial pathology, particularly in older people, due to increased brain atrophy, fall risk, and anticoagulant use. This study examines the impact of frailty on the surgical outcomes of craniotomy for naSDH over 20 years. Methods: Data from the Nationwide Inpatient Sample (NIS) from 2000 to 2021 were analyzed, including 251,597 patients who underwent cranial decompression for naSDH. Patients were selected using specific ICD codes. Frailty was calculated using the modified frailty index (mFI-5 and mFI-11) and the Charlson Comorbidity Index (CCI). Outcomes were compared using descriptive statistics and multivariable regression models. Results: 251,597 patients underwent craniotomy, with a mean age of 69.2 years. The cohort exhibited significant comorbid conditions, reflected in a mean Charlson Comorbidity Index (CCI) of 3.8, and a high frailty prevalence, with 23.49% of patients classified as frail and 20.14% as severely frail. The CCI demonstrated the highest predictive value for adverse outcomes, with an area under the curve (AUC) of 0.6346 for mortality and 0.6804 for complications. Frailty indices (mFI-5 and mFI-11) were also strongly associated with increased mortality (p < 0.001), complications (p < 0.001), and extended length of stay (p < 0.001). Age was not a significant predictor of outcomes. Conclusions: This study highlights the moderate impact of frailty on surgical outcomes for naSDH. Full article

Background/Objectives: Childhood hemophilia, a hereditary bleeding disorder predominantly affecting males, arises due to gene mutations encoding clotting factors VIII or IX. Intracranial hemorrhage represents a significant and life-threatening complication in pediatric patients with hemophilia. The incidence of intracranial hemorrhage in children with hemophilia, although relatively low, is notably higher compared to the general pediatric population. Methods: In this study, the objective is to examine patients with hemophilia who have experienced intracranial hemorrhage retrospectively. This study is a multicenter, retrospective analysis using data from three tertiary care centers in a provincial city in Turkey. Data were obtained from the participants’ hospital records. The presence of inhibitors against FVIII in the participants and the prophylaxis used against them were included in the analysis. Trauma history was queried, with types of traumas examined, including traffic accidents, falls, and a traumatic vaginal delivery. The duration and causes of complaints among the participants were investigated. The causes of complaints were categorized as fever, hematoma, convulsions, loss of consciousness, and hemiparesis. The participants’ Physical Examination Findings were classified as fever, hematoma, and loss of consciousness. The duration of hospital stays was evaluated. The hemorrhage location was classified into five groups: parenchymal, subdural, scalp, subarachnoid, and multiple hemorrhagic foci. The recurrence of bleeding, the need for transfusion, surgical intervention, and mortality were also examined. Results: A significant difference was identified between the participants’ survival rates and age variables, as well as transfusion in <36 months. A total of 9 participants had spontaneous intracranial bleeding, 2 experienced cranial trauma as a result of traffic accidents, and 25 participants were exposed to head trauma due to falls. Of the remaining individuals, one suffered head trauma from a severe impact, and one had cranial trauma following a traumatic vaginal delivery. Fourteen participants required transfusion, and three underwent surgical intervention. Conclusions: According to the results of the statistical analyses, the variables Factor Level, Physical Examination Findings, Transfusion, Recurrent Bleeding, Inhibitor, and Prophylaxis were found to affect survival significantly. No significant relationship was determined between the other analyzed variables and survival. During our study, five of the participants examined died. Accordingly, the mortality rate identified in our study is 13.1%. Full article

Traumatic brain injury (TBI) remains one of the leading causes of death. Because of the individual nature of the trauma (brain, circumstances and forces), humans experience individual TBIs. This makes it difficult to generalise therapies. Clinical management issues such as whether intracranial pressure (ICP), cerebral perfusion pressure (CPP) or decompressive craniectomy improve patient outcome remain partly unanswered. Experimental drug approaches for the treatment of secondary brain injury (SBI) have not found clinical application. The complex, cellular and molecular pathways of SBI remain incompletely understood, and there are insufficient experimental (animal) models that reflect the pathophysiology of human TBI to develop translational therapeutic approaches. Therefore, we investigated different injury patterns after acute subdural hematoma (ASDH) as TBI in a post-hoc approach to assess the impact on SBI in a long-term, human-sized porcine TBI animal model. Post-mortem brain tissue analysis, after ASDH, bilateral ICP, CPP, cerebral oxygenation and temperature monitoring, and biomarker analysis were performed. Extracerebral, intraparenchymal–extraventricular and intraventricular blood, combined with brainstem and basal ganglia injury, influenced the experiment and its outcome. Basal ganglia injury affects the duration of the experiment. Recognition of these different injury patterns is important for translational interpretation of results in this animal model of SBI after TBI. Full article

Background: Post-hemicraniectomy patients often need extended intensive care treatment. While computed tomography (CT) is considered the gold standard for regular imaging, its frequent use could be linked to adverse clinical outcomes. This study aimed to assess bedside transcranial ultrasound (TUS) to capture intracranial anatomical structures and pathologies. Methods: We analyzed 19 patients treated in our neurosurgical ICU from 1 January 2023 to 1 February 2024. Six physicians from our unit (three residents and three attending physicians) conducted a retrospective evaluation. A total of 158 sessions, including multiple freeze frames and video footage, were analyzed, including 7 imaging categories, using a Likert scale. Subsequently, correlation between CT and TUS was evaluated for midline (ML) shift, subdural space, lateral ventricular width (LVW), and extent of intracerebral hematoma using the Pearson’s correlation coefficient (r). Results: TUS was performed on average on 8.32/19.53 days (mean inpatient stay). It provided the lowest Likert scores for the imaging categories ventricular system, midline, subdural space, intraventricular catheter placement, and cortical gyration. Residents reported slightly inferior assessability, resulting in higher scores on the Likert scale (0.02–0.93 mean difference compared with attending physicians). A high correlation was shown in terms of ML shift, LVW, and intracerebral hematomas. No relevant correlation was shown in subdural space. Conclusions: TUS is a safe, cost-, and time-efficient method, potentially gaining relevance for imaging post-hemicraniectomy patients. In our setting, the method seemed effective in depicting intraventricular catheter placement, hydrocephalus, ML shift, and space-occupying lesions. Further improvement in image quality could potentially reduce the overall number of indicated CT scans. Full article

Background: Spontaneous intracranial hypotension (SIH) is a rare and frequently misdiagnosed disorder characterized by a low volume of cerebrospinal fluid (CSF) caused by the leakage of CSF through the spinal dural membrane. Patients with Marfan Syndrome (MS) and other connective tissue disorders are at an increased risk for dural ectasia, which may predispose them to spontaneous CSF leaks due to the structural weakness of their dural membranes. The management of SIH in MS patients is debated. Conservative measures, an epidural blood patch (EBP), and surgical treatments are the options generally provided. Methods: Herein, we report on the case of a 52-year-old female affected by MS, genetically confirmed, with a two-month history of sudden-onset, “thunderclap” headache, worsened in an upright position and horizontal diplopia. A Computed Tomography (CT) scan of the brain showed a bilateral chronic subdural hematoma, slit ventricles, and a caudal descent of the brainstem without overt tonsillar herniation. The Magnetic Resonance Imaging (MRI) scan of the whole spine revealed dural ectasia in the lumbosacral area and presacral perineural cyst without extradural CSF collection. The case was successfully managed with bed rest and high-dose corticosteroid therapy. Then, we discuss the pertinent literature, consisting of 25 papers dealing with the treatment of SIH in patients affected by MS. Results: The literature review yielded 25 papers dealing with SIH management in patients with MS, including 28 patients overall; 21 patients underwent EBP, of whom 7 patients had multiple procedures. Overall, in 23 cases (82%), the symptoms improved. In three cases, the patients were managed conservatively with bed rest. In three of these cases, there was an improvement. In one case, the surgical fenestration of two lumbar intradural spinal meningeal cysts was performed and the patient improved after the procedure. Our patient underwent 15 days of steroid therapy (dexamethasone iv 12 mg/day for 7 days, then reduced to 4 mg/day) and intravenous hydration (Ringer lactate 1500 mL/day). In ten days, the symptoms disappeared. At the 6-month follow-up, the patient was in good clinical condition, and a CT scan showed an almost complete regression of the bilateral subdural hematoma. Conclusions: The management of SIH in MS patients is still challenging. Patients with connective tissue disorders such as MS are at an increased risk for SIH. Few studies have assessed the management of these patients and different strategies. Our case and the available literature provide further data for this type of case. Full article

Background and Objectives: In recent years, electronic scooters (e-scooters) have gained popularity, whether for private use or as a publicly available transportation method. With the introduction of these vehicles, reports of e-scooter-related accidents have surged, sparking public debate and concern. The aim of this study was to analyze the epidemiological data, characteristics, and severity of traumatic brain injury (TBI) related to e-scooter accidents. Materials and Methods: This retrospective case series evaluated patients who were admitted to the three largest neurosurgery clinics in Riga, Latvia, from the time period of April to October in two separate years—2022 and 2023—after e-scooter-related accidents. The data were collected on patient demographics, the time of the accident, alcohol consumption, helmet use, the type of TBI, other related injuries, and the treatment and assessment at discharge. Results: A total of 28 patients were admitted with TBI related to e-scooter use, with a median age of 30 years (Q1–Q3, 20.25–37.25), four individuals under the age of 18, and the majority (64%) being male. In 23 cases, the injury mechanism was falling, in 5 cases, collision. None were wearing a helmet at the time of the injury. Alcohol intoxication was evident in over half of the patients (51.5%), with severe intoxication (>1.2 g/L) in 75% of cases among them. Neurological symptoms upon admission were noted in 50% of cases. All patients had intracranial trauma: 50% had brain contusions, 43% traumatic subdural hematoma, and almost 30% epidural hematoma. Craniofacial fractures were evident in 71% of cases, and there were fractures in other parts of body in three patients. Six patients required emergency neurosurgical intervention. Neurological complications were noted in two patients; one patient died. Conclusions: e-scooter-related accidents result in a significant number of brain and other associated injuries, with notable frequency linked to alcohol influence and a lack of helmet use. Prevention campaigns to raise the awareness of potential risks and the implementation of more strict regulations should be conducted. Full article