Cognitive impairment in multiple sclerosis (MS) often involves attentional deficits. The Stroop colour word test, a measure of attention, lacks current normative data for an english-speaking North american MS population. Further some authors suggest the Stroop actually measures processing speed.

To generate normative data for the Stroop colour word test that can be used for a Canadian or North american MS population and to examine the relationship between processing speed tests - the Paced auditory Serial addition Test (PASAT) and Symbol Digit Modalities Test (SDMT) - and the Stroop.

Data from 146 healthy subjects aged 18-56 was collected. age was significantly although weakly correlated with general intelligence (r=0.168, p=0.043) assessed with the North american adult Reading Test (NAART), and education (r=-0.313, p<0.001). No demographic variables were associated with SDMT or PASAT. age had a low-moderate negative correlation (r=-0.403, p<0.001) with Stroop scores. The mean (±standard deviation, SD) Stroop score was 45.4(10.4). The z-score can thus be calculated as [(X-45.4)/10.4]. if adjusted for age, Xadj = [X-(-0.47)(age-37.5)] and is substituted for X. in a comparison MS population consisting of 75 randomly selected patients from the MS Cognitive clinic, Stroop and PASAT performance were not related. a relationship existed between Stroop and SDMT scores but only 12.2% of the Stroop score variance was explained by the SDMT. Therefore, the Stroop measures selective attention independently of processing speed.

This data can be used to determine impaired attention in MS patients.

To report an unusual case of malignant degeneration in a ganglioneuroma of the jugular foramen post stereotactic radiosurgery as well as to systematically review the pertinent literature involving radiosurgery associated malignancies.

Ganglioneuromas are uncommon lesions of the peripheral nervous system and infrequently reported in the head and neck region. There have been no previously described cases of ganglioneuromas occurring in the jugular foramen. Malignant degeneration of these lesions is rarely described, especially in the context of radiosurgery. Radiosurgery associated malignancies overall are exceptionally rare and only a limited number of cases have been reported.

We describe a case of a ganglioneuroma occurring in the jugular foramen and mimicking the appearance of a jugular foramen schwannoma. This lesion underwent stereotactic radiosurgery and developed a delayed degeneration into a malignant nerve sheath tumor. The occurrence of ganglioneuroma in this region has not been previously described and presumed malignant degeneration is even rarer. This case highlights a previously understated risk associated with stereotactic radiation treatments. To date, 33 previous cases of stereotactic radiosurgery associated malignancies have been reported. We review the pertinent details of these cases. We caution that as follow up periods and awareness increases, reports such as this may become increasingly common.

An urgent neurology assessment clinic was created at our institution to improve access to prompt neurological assessment, and has been in operation for over a decade. We assessed its timeliness and impact.

The clinic database was examined retrospectively for trends in the volume and waiting time to assessments, neurologic diagnoses, and whether neurologic assessment changed patients’ diagnoses. Before and after implementation, the frequency of emergency department neurology assessments and hospital admissions for neurological investigation were compared.

In the first decade, 25145 referrals were received; 12460 patients were accepted and assessed within an average of 3.8 working days. The most common problems seen included headache and seizure (20.2% each). Overall, 44.6% of assessments resulted in a change to the referring diagnosis; this proportion varied by the type of problem seen (from 10.5% for seizures to 92.5% for psychiatric disturbances). From the pre- to post-opening periods, there were fewer emergency room neurological assessments (35.7% reduction) and fewer hospital admissions for neurological investigation (4.4/week to 2.2/week, 50% reduction).

The urgent neurology clinic model at our institution has provided excellent service, including wait times of a few days, to a catchment of over two million Canadians for over a decade; clinic assessments have affected diagnoses and patient care.

The spontaneous blink rate (SBR) is variable in humans. It increases rapidly during childhood before reaching a plateau in adulthood at 10-20 blinks/minute. Our aim was to compare the SBR during different visual tasks in children.

Thirty-nine healthy participants (mean age(SD):13.6(3.5)years, M=21), made horizontal and vertical visually-guided saccades, tracked a horizontal and vertical target, performed horizontal and vertical active sinusoidal head rotations in light and darkness while looking straight ahead (VOR task) or fixated straight ahead and in four directions of gaze. The eyes of each participant were videotaped and reviewed twice to determine the SBR. Parametric and non-parametric tests were used to analyze the data.

The median SBR during fixation straight ahead was seven blinks/minute, which was similar to the SBR during horizontal saccades and horizontal smooth pursuit tasks. The median SBR during vertical smooth pursuit and vertical saccades were significantly lower than during fixation (p≤0.042). The median SBR during the VOR task in light and horizontal VOR in darkness were significantly higher than during fixation (p=0.019-0.024).

The median SBR during visual fixation was lower than that reported previously in 5-14 years-old children during rest or 11-20 years-old subjects during quiet conversation. The median SBR was even lower during vertical smooth pursuit and saccades tasks. This may be due to differences in concentration required for visual fixation in general and vertical visual tasks more specifically. The higher SBR during the VOR may be due to drying of the eyes during head shaking.