Day: June 3, 2025

Subarachnoid Hemorrhage From Ruptured Pseudoaneurysm Secondary to Dissection of the Anterior Cerebral Artery

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In a single-patient case report Fuentes et al. from The Medical City, Pasig City published in Cureus to report a rare case of subarachnoid hemorrhage (SAH) from a ruptured pseudoaneurysm secondary to anterior cerebral artery (ACA-A1 segment) dissection, and its successful treatment with stent-assisted coiling. The authors document a favorable outcome following endovascular treatment of a rare ACA-A1 dissection-induced pseudoaneurysm, arguing for its consideration in similar cases despite the absence of clear guidelines 1)

Critical Review

This case report contributes to the sparse literature on anterior cerebral artery dissections—particularly in the A1 segment—and their endovascular management. However, while the case is clinically relevant, the article offers limited scientific depth.

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Efficacy of Adding Clonidine to Bupivacaine 0.25% Versus Plain Bupivacaine 0.25% Infiltration in Scalp Blocks for Supratentorial Craniotomy

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In a prospective randomized controlled trial Lemos et al. from the Netaji Subhash Chandra Bose Medical College, Jabalpur published in Cureus, to assess whether the addition of clonidine (2 mcg/kg) to 0.25% bupivacaine in scalp blocks improves perioperative analgesia and hemodynamic control during supratentorial craniotomy. Clonidine significantly prolonged analgesia duration and improved perioperative hemodynamic stability, with lower postoperative pain scores, reduced need for rescue analgesia, and decreased intraoperative and postoperative analgesic consumption 3)

Critical Review

While the study is prospective and randomized, the sample size of 60 patients (30 per group) is underpowered for robust generalization. The statistical significance of the analgesic duration and pain scores (p<0.001) is compelling, but it is unclear whether the effect size translates into meaningful clinical benefit beyond delayed rescue analgesia. Hemodynamic data is selectively highlighted, and potential bradycardia and hypotension risks with clonidine are underexplored. Additionally, the lack of blinding of the assessors and a placebo control weakens internal validity. The study does not account for potential long-term side effects or the impact on overall surgical outcomes.

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