A recent surge of nitrous oxide misuse around London which merits a public health warning.

Background: Use of nitrous oxide (N2O) gas for recreational purposes by young people is increasingly recognized as a public health hazard in the UK.

Methods: We looked at the hospital records of patients admitted over the last 4 years to a single neurological centre in Essex to determine the demographics, presentation, and management of patients presenting with symptoms of N2O toxicity from its recreational use.

Results: Of the 17 patients (mean age = 22.

Potential Surgical Implications of Internal Jugular Stenosis in a Craniocervical Junction Meningioma.

We report a case of a 61-year-old lady presenting with several weeks of progressive left-sided weakness, and found to have a foramen magnum meningioma. She was counselled on surgical resection of the tumour, and a preoperative computed tomography angiogram (CTA) was obtained for operative planning purposes. CTA demonstrated incidental bilateral internal jugular vein (IJV) stenosis, with enlarged extracranial collateral vessels and elongated styloid processes.

Validation of an artificial intelligence solution for acute triage and rule-out normal of non-contrast CT head scans.

Purpose: Non-contrast CT head scans provide rapid and accurate diagnosis of acute head injury; however, increased utilisation of CT head scans makes it difficult to prioritise acutely unwell patients and places pressure on busy emergency departments (EDs). This study validates an AI algorithm to triage patients presenting with Intracranial Haemorrhage (ICH) or Acute Infarct whilst also identifying a subset of patients as Normal, with the potential to function as a rule-out test.

Methods: In total, 390 CT head scans were collected from 3 institutions in the UK, US and India.

Respiratory difficulty with palatal, laryngeal and respiratory muscle tremor in adult-onset Alexander's disease.

Sleep apnoea and respiratory difficulties are reported in adult-onset Alexander's disease (AOAD), an autosomal-dominant leukodystrophy that presents mainly with progressive ataxia. We demonstrate for the first time that the respiratory symptoms can result from association of palatal tremor with a similar tremor of laryngeal and respiratory muscles that interrupts normal inspiration and expiration.A 60-year-old woman presented with progressive ataxia, palatal tremor and breathlessness.

Anti-collapsin response mediator protein 5 encephalitis masquerading as a low-grade brain tumour.

A 71-year-old woman presented acutely with seizures; her MRI suggested a low-grade glioma of the right temporal lobe. Over the preceding 18 months, she had developed progressive limb chorea and orofacial dyskinesia. Examination showed a predominantly amnestic cognitive profile.

A rare stapes abnormality.

The aim of this study is to increase awareness of rare presentations, diagnostic difficulties alongside management of conductive hearing loss and ossicular abnormalities. We report the case of a 13-year-old female reporting progressive left-sided hearing loss and high resolution computed tomography was initially reported as normal. Exploratory tympanotomy revealed an absent stapedius tendon and lack of connection between the stapes superstructure and footplate.

Reversible cerebral vasoconstriction syndrome as a cause of thunderclap headache: a retrospective case series study.

Thunderclap headache is a common emergency department presentation. Although subarachnoid hemorrhage (SAH) should be the first diagnosis to exclude, reversible cerebral vasoconstriction syndrome (RCVS) is an important alternative cause, which may be commoner than appreciated. Reversible cerebral vasoconstriction syndrome is characterized by multifocal narrowing of cerebral arteries, typically manifested by acute, severe headache with or without neurologic deficits.

Wholly endoscopic permeatal removal of a petrous apex cholesteatoma.

We report a case of a petrous apex cholesteatoma which was managed with a wholly endoscopic permeatal approach. A 63-year-old Caucasian male presented with a 10-year history of right-sided facial palsy and profound deafness. On examination in our clinic, the patient had a grade VI House-Brackmann paresis, otoscopic evidence of attic cholesteatoma behind an intact drum, and extensive scarring of the face from previous facial reanimation surgery.

Do immediate cytology and specialist radiologists improve the adequacy of ultrasound-guided fine-needle aspiration cytology?

Objective: To assess whether a dedicated "1-stop" neck lump clinic has improved the percentage of adequate fine-needle aspiration cytology (FNAC) samples and reduced the need for repeat FNAC.

Study Design: Retrospective review.

Setting: District General Hospital in the United Kingdom.

Peripartum isolated cortical vein thrombosis in a mother with postdural puncture headache treated with an epidural blood patch.

A 32-year-old woman presented with low pressure headache 3 days after delivery of her baby. An assessment of postdural puncture headache was made. This was initially treated with analgesia, caffeine, and fluids for the presumed cerebrospinal fluid (CSF) leak.

Detached Coil Migration that Assisted Stent Migration, during Stent Assisted Coiling of a Recurrent Aneurysm. A Case Report.

This is a pictorial case report of previously unreported intra-procedural complication of an intra-procedural migrated stent-coil complex. It shows fluoroscopic detail of the migration of a stent with the help of a migrated coil with subsequent retrieval of coil and deployment of a second stent proximally. It also briefly covers postulated mechanisms for this in the discussion.

Embolization of a wide neck giant basilar tip aneurysm using two coils. A case report.

Pictorial demonstration of aneurysm lumen thrombosis and diversion of flow hemodynamics with the use of a minimum number of coils in the treatment of hemorrhagic basilar tip aneurysm. We present a 62-year-old lady who underwent endovascular treatment for acute subarachnoid hemorrhage due to a giant basilar tip aneurysm and a left carotico-ophthalmic aneurysm. Following deployment of two of the longest available coils, the procedure was terminated due to a sudden change of jet flow within the aneurysm and unsustainable coil and microcatheter positions in spite of further attempts.

MRI and visual-evoked potentials in partners of multiple sclerosis patients.

Objective: Some epidemiological evidence, particularly concerning the role of Epstein Barr Virus implies that multiple sclerosis (MS) may be transmissible and if correct, this might be revealed by increased prevalence of MS in cohabiting partners.

Methods: We addressed this problem by neurological assessment, visual-evoked potentials (VEP) and magnetic resonance imaging (MRI) in 112 partners of patients with MS in comparison to a control group of 93 individuals with clinically non-significant head or neck pain and in comparison to UK prevalence.

Results: We found one instance of conjugal definite MS.

Radiological appearances of oropharyngeal soft tissue reduction with bipolar radio-frequency ablation in sleep disordered breathing. A pilot study.

To demonstrate and track the changes of bipolar radiofrequency volumetric tissue reduction (BRFVTR) induced lesions of the tongue base and soft palate in the treatment of sleep disordered breathing (SDB) in a pilot study.

Fibromuscular dysplasia of the middle cerebral artery in an adolescent male. A case report.

To illustrate the imaging features of fibromuscular dysplasia (FMD) in this rare presumptive case of FMD in a sixteen year old male with intracranial features only and highlight it as an important cause of stroke in the young. FMD is a non-atheroscelerotic, non-inflammatory vasculopathic arterial disease affecting large and medium size vessels of unknown aetiology. It is a rare cause of paediatric stroke and strokes in young adults.

Paravertebral cervical chordoma--a case report.

Chordomas constitute <5% of vertebral column tumours and a third of these arise in the upper cervical spine and tend to be clival - usually midline, with occasional eccentric extension. We report a case of cervical chordoma presenting as a lateral neck mass and discuss its origin, diagnosis and management.

Radiological airway changes following bipolar radiofrequency volumetric tissue reduction.

Objective: To characterise the appearance of lesions of the tongue base and soft palate induced by bipolar radiofrequency volumetric tissue reduction, using magnetic resonance imaging up to six weeks post-procedure.

Methods: Five men with sleep-disordered breathing were treated with one session of bipolar radiofrequency volumetric tissue reduction to a number of sites, including the tongue base and soft palate. Magnetic resonance imaging was performed pre-operatively and one week and six weeks after surgery.

Pressure-induced polymerization of diiodobutadiyne in assembled cocrystals.

Diiodobutadiyne forms cocrystals with bis(pyridyl)oxalamides in which the diyne alignment is near the ideal parameters for topochemical polymerization to the ordered conjugated polymer, poly(diiododiacetylene) (PIDA). Nonetheless, previous efforts to induce polymerization in these samples via heat or irradiation were unsuccessful. We report here the successful ordered polymerization of diiodobutadiyne in these cocrystals, by subjecting them to high external pressure (0.

Delayed fibrotic obliteration of the spinal subarachnoid space after cerebral aneurysmal subarachnoid hemorrhage: case report.

Objective: Widespread fibrotic obliteration of the spinal subarachnoid space after cerebral aneurysmal subarachnoid hemorrhage (SAH) is rare.

Clinical Presentation: A 57-year-old woman presented with the gradual development of a spastic paraparesis. Two years earlier, she experienced a cerebral aneurysmal SAH that was successfully managed with endovascular coiling.

The implications of ISAT and ISUIA for the management of cerebral aneurysms during pregnancy.

Both the International Subarachnoid Aneurysm Trial (ISAT) and the International Study on Unruptured Intracranial Aneurysms (ISUIA) have been widely extrapolated to influence the management of actual or anticipated aneurysmal subarachnoid hemorrhage (SAH). However, it remains possible that sub-groups exist for which such extrapolation might subsequently prove premature. In this review, we discuss the implications that such extrapolation may potentially have for one such SAH sub-group: the clinically rare scenario of SAH in pregnancy.