Multimodality treatment of cerebral arteriovenous malformations.

Background: Many arteriovenous malformations (AVMs) can be treated with one modality, but with increasing complexity a combination of techniques, including surgical excision, embolization, and radiosurgery, may be beneficial. The 2 senior authors' experience in the multimodal management of AVMs from 1980-2008 is reported, including the results in all patients with rehemorrhage while awaiting treatment or after partial initial treatment has begun. The series contains a disproportionately high number of Spetzler-Martin grade IV and V lesions, owing to the nature of the referral practice.

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.

Lumbar extradural arteriovenous malformation: case report and literature review.

Background Context: Most spinal arteriovenous malformations (AVMs) are dural arteriovenous fistulas in which a singularly intradural venous drainage emanates from an extradural nidus. A pure extradural spinal arteriovenous malformation (E-AVM), in the absence of a vertebral body (cavernous) hemangioma, is extremely rare, and full clinical, radiological, and operative descriptions are scant.

Purpose: To fully document the rare occurrence of a symptomatic E-AVM producing spinal claudication.

Trauma as an etiologic factor of primary bone lymphoma: a report of 4 cases.

Primary bone lymphoma (PBL) is a rare entity. Nevertheless, very high long-term complete remission and survival rates following adriamycin-based chemotherapy alone or combined with involved-field radiation therapy have been reported. While the etiology is unknown, factors comprising local or general immunocompromised states have been suggested.

Multiple sclerosis in Latter Day Saints (Mormons).

Background: Compliant members of the Church of Jesus Christ of Latter Day Saints (LDS, Mormons) have a low incidence of heart and lung disease that may relate to their healthy life style. We wished to determine whether multiple sclerosis (MS) was less frequent in this religious body.

Methods: To ascertain this, diagnostic and treatment coding records were accessed from the Deseret Mutual Benefit Administrators (DMBA) for the 6 year period 1997-2002.

"Disc cysts" and "posterior longitudinal ligament ganglion cysts": synonymous entities? Report of three cases and literature review.

Objective And Importance: Extradural cysts intimately associated with relatively normal lumbar discs have rarely been reported. Histologically nonspecific, most have been designated posterior longitudinal ligament (PLL) or annulus fibrosus (AF) "ganglion cysts." Recently, "disc cysts" have been distinguished as a separate entity, mostly on the grounds of cyst-disc communication.

Seroprevalence of herpes simplex virus type 2 in multiple sclerosis.

Background: It has been proposed that multiple sclerosis (MS) might be a sexually transmitted disorder. There is evidence that seropositivity to herpes simplex virus type 2 (HSV-2) correlates well with the number of sexual partners. Accordingly, a raised overall HSV-2 seroprevalence in MS would lend support to this theory.

Influence of bone quality on the strength of internal and external fixation of tibial plateau fractures.

We studied the influence of different parameters of bone quality on the fixation strength of bicondylar tibial plateau fractures and examined the relationship between these parameters. Bone quality was measured in the plateau of 16 cadaveric tibias using three modalities: dual-energy X-ray absorptiometry (DXA), peripheral quantitative computer tomography (pQCT), and spectral analysis of digitized radiographs (SADR). The tibias were divided into two groups by the median bone mineral density (BMD) and randomized to receive either dual plating or external fixator for the stabilization of a standardized bicondylar tibial fracture.

Olfaction in neurodegenerative disorder.

There has been gradual increase of interest in olfactory dysfunction since it was realised that anosmia was a common feature of idiopathic Parkinson's disease (IPD) and Alzheimer-type dementia. It is an intriguing observation that a premonitory sign of a disorder hitherto regarded as one of movement or cognition may be that of disturbed sense of smell. In this review of aging, IPD, parkinsonian syndromes, tremor, Alzheimer's disease (AD), motor neuron disease (MND), Huntington's chorea (HC) and inherited ataxia, the following observations are made: (1) olfactory senescence starts at about the age of 36 years in both sexes and accelerates with advancing years, involving pleasant odours preferentially; (2) olfactory dysfunction is near-universal, early and often severe in IPD and AD developing before any movement or cognitive disorder; (3) normal smell identification in IPD is rare and should prompt review of diagnosis unless the patient is female with tremor-dominant disease; (4) anosmia in suspected progressive supranuclear palsy and corticobasal degeneration is atypical and should likewise provoke diagnostic review; (5) subjects with hyposmia and one ApoE4 allele have an approximate 5-fold increased risk of later AD; (6) impaired sense of smell may be seen in some patients at 50% risk of parkinsonism, and possibly in patients with unexplained hyposmia; (7) smell testing in HC and MND where abnormality may be found is not likely to be of clinical value, and (8) biopsy of olfactory nasal neurons reveals non-specific changes in IPD and AD and at present will not aid diagnosis.

Benign fibrous histiocytoma of the thoracic spine: case report and review of the literature.

Benign fibrous histiocytoma (BFH) is a rare skeletal tumor, accounting for approximately 1% of all surgically managed benign bone tumors. Spinal location is very rare, and its management can be challenging, involving excision of tumor and spinal reconstruction and stabilization. The prognosis is good after treatment.

Lessons for clinical trials from natalizumab in multiple sclerosis.

The approval of natalizumab and its recall after three months raises questions about the fast tracking of new drugs by the Food and Drug Administration for commercial licensing

The two-week waiting time standard for cancer: a neurosurgical perspective.

The implementation of the two-week wait initiative for cancer referrals in the NHS has had a major impact on outpatient services. A low clinical detection rate among GPs for neurological cancer has resulted in a large number of urgent referrals with a low yield of positive diagnoses. We have devised a strategy for minimizing the impact on outpatient clinics: patients are scanned prior to clinical review and those with normal scans are referred back to the GP without a clinic appointment.

It is not worthwhile to perform ileoscopy on all patients.

Background: It remains controversial whether ileoscopy should be attempted in all patients. Although the ease of ileoscopy and the diagnostic yield have been well described, there have been no studies describing the value of the diagnostic yield in altering clinical management. We carried out a study to ascertain whether it is worthwhile to perform ileoscopy in all patients having a colonoscopy.

Acute obstructive hydrocephalus associated with infratentorial subdural hygromas complicating Chiari malformation Type I decompression. Report of two cases and literature review.

Obstructive hydrocephalus complicating foramen magnum decompression (FMD) for a Chiari malformation (CM) Type I is rare. Two female patients (17 and 55 years old) presented with strain-related headaches. In both cases magnetic resonance (MR) imaging studies confirmed a CM Type I, which was accompanied by syringomyelia in one case.

Are multiple sclerosis patients risk-takers?

Several factors appear to be associated with multiple sclerosis (MS), and each has a postulated immune or environmental explanation, but a common theme is lacking. This article suggests that a unifying premise could be risk-associated behaviour. Evidence is reviewed for associations with smoking, alcohol, recreational drug use, oral contraception, cholesterol intake, risk attitude and behaviour, ultraviolet light and vitamin D exposure, frequency of MS in healthy societies, and viral infection.

Primary extradural epithelioid leiomyosarcoma of the cervical spine: case report and literature review.

Objective And Importance: No case of primary epithelioid leiomyosarcoma involving the spine has been reported previously.

Clinical Presentation: A 61-year-old Nigerian woman presented with progressive spastic quadriparesis and acute urinary retention. Her only medical history included a total abdominal hysterectomy for fibroids 10 years earlier in Nigeria.

Day case anterior cruciate ligament reconstruction: a study of 51 consecutive patients.

We prospectively assessed 51 arthroscopy assisted anterior cruciate reconstructions done over two years as day cases. We looked at the clinical results, postoperative pain control and patient satisfaction. There were 45 males and 6 females, with ages ranging from 18 to 52 years.

Cost-effectiveness of levodopa/carbidopa/entacapone (Stalevo) compared to standard care in UK Parkinson's disease patients with wearing-off.

Background And Methods: A Markov model was developed to evaluate the cost-effectiveness of levodopa/carbidopa/entacapone (LCE;Stalevo), in the treatment of patients with Parkinson's disease (PD) and end-of-dose motor fluctuations (wearing-off). LCE, with or without other antiparkinsonian medications, was compared to UK standard care, comprising traditional levodopa/ dopa-decarboxylase inhibitor (DDCI) with other antiparkinsonian medications (e.g.

Primary isolated amyloidoma of the lumbar spine causing neurological compromise: case report and literature review.

Objective And Importance: We describe a patient with cauda equina compression secondary to amyloidoma to alert other clinicians to this rare cause of a compressive epidural lesion. It is the fourth published report of primary lumbar amyloidoma causing neurological compromise.

Clinical Presentation: A 53-year-old, previously fit salesman presented with several years history of back pain and recent weakness, especially in the left leg.

Experimental model of tibial plateau fracture for biomechanical testing.

Although adequate reduction and stable fixation have been recognized to be the prime goals in the treatment of displaced tibial plateau fractures, the optimal fixation technique remains controversial. The lack of a reliable model and a standard methodology contribute to this situation. The purpose of this study is to develop an experimental model of a tibial plateau fracture and a testing methodology that reproduces the failure mode commonly seen in the clinical setting.

Fibrous dysplasia of the cervical spine presenting as a pathological fracture.

Fibrous dysplasia (FD) is an uncommon benign fibro-osseous abnormality of bone, of unknown aetiology and equal sex incidence, which is most commonly restricted to one bone (monostotic FD: MFD, 70%). Less commonly multiple bones are affected (polyostotic FD: PFD, 27%). Vertebral involvement is uncommon (4%), but more common with PFD (7 - 24%) than MFD (1%).