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Volume 24 - February 1997

Contents

Page 4 of 9

Original Articles

  • Syringomyelia Developing as an Acute Complication of Tuberculous Meningitis

  • Abdu Kader Daif, Al Rajeh, Adesola Ogunniy, Amer Al Boukai, Abdulrahman Al Tahan
  • Published online by Cambridge University Press:
    18 September 2015, pp. 73-76
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  • Background:

    Tuberculosis of the nervous system has protean manifestations. Syringomyelia, though an uncommon complication of it, is usually of late onset.

    Methods:

    We report two patients with tuberculosis meningitis who developed syringomyelia acutely. The diagnosis was supported by neuroimaging and findings at laminectomy.

    Results:

    The two patients developed syringomyelia between 11 days and 6 weeks of the onset of tuberculous meningitis. They both had cord swelling and softening

    Conclusions:

    Acute-onset syringomyelia should be suspected in any patient being treated for tuberculosis meningitis who subsequently develops limb weakness and/or sphincteric dysfunction. Inflammatory edema and cord ischemia appeared to be the underlying mechanisms in these early onset cases rather than arachnoiditis which is important in late-onset cases.

Neurosurgical Practice

  • Current Management of Aneurysmal Subarachnoid Hemorrhage Guidelines from the Canadian Neurosurgical Society

  • J.M. Findlay
  • Published online by Cambridge University Press:
    18 September 2015, pp. 161-170
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  • Published medical evidence pertaining to the management of aneurysmal subarachnoid hemorrhage (SAH) was critically reviewed in order to prepare practice guidelines for this condition. SAH should be considered as a possible cause of all sudden and/or unusual headaches, and every attempt should be made to recognize mild SAHs, as they are still frequently misdiagnosed. The first test for SAH is computed tomography (CT), followed by lumbar puncture when the CT is negative for intracranial bleeding (the case in only several per cent of patients within 24 hours of aneurysm bleeding). Urgent cerebral angiography is necessary to detect the underlying cerebral aneurysm. The advantage of rapid diagnosis of SAH followed by early aneurysm repair is minimizing the risk of catastrophic aneurysm rebleeding. Early surgery for aneurysm repair is often possible and is recommended, unless the aneurysm location or size renders it technically difficult to expose in clot-laden subarachnoid cisterns beneath an acutely swollen brain. Aneurysm ablation is optimally accomplished with open microsurgery and clipping of the aneurysm neck, although other options include proximal parent artery occlusion, “trapping” of the aneurysmal segment of the artery, and embolization of thrombogenic materials (e.g., platinum “microcoils”) directly into the aneurysm dome using endovascular techniques. Neurological outcome following SAH is also optimized through the prevention of secondary SAH complications, and further management specific for ruptured cerebral aneurysms can include anticonvulsants, neuroprotectants, and various agents and techniques to prevent or reverse delayed-onset cerebral vasospasm. All patients with aneurysmal SAH should be treated with the calcium antagonist nimodipine, and in certain circumstances patients should receive anticonvulsants. Induced arterial hypertension, hypervolemia and in some instances percutaneous balloon angioplasty are recommended to reverse vasospasm causing symptomatic cerebral ischemia prior to cerebral infarction.

Abstracts

  • Canadian Association of Neuropathologists

  • Published online by Cambridge University Press:
    18 September 2015, pp. 350-356
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Book Review

Original Articles

  • Proximal Neuropathy in Colles' Fracture

  • Michael Rubin, Carl W. Heise
  • Published online by Cambridge University Press:
    18 September 2015, pp. 77-78
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  • Background:

    Peripheral nerve injury at the wrist following Colles' fracture is rare and usually located in the region of the fracture. Mononeuropathies in the proximal forearm have not been reported.

    Method:

    We present two patients with Colles' fracture with proximal forearm neuropathies.

    Results:

    Both cases were associated with mononeuropathies in the forearm as proximal as the elbow, involving the median, ulnar and radial nerves in one, and the median and ulnar nerves in the other.

    Conclusion:

    Following Colles' fracture proximal nerve involvement may occur and, with increased awareness, this lesion may be identified more frequently.

Book Review

Correspondence

  • Canada Night at the American Academy of Neurology Annual Meeting, Boston honouring Dr. Robert T. Ross

  • R.T. Ross
  • Published online by Cambridge University Press:
    18 September 2015, p. 357
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Neurosurgical Practice

  • Calendar of Events

  • Published online by Cambridge University Press:
    18 September 2015, p. 178
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Book Review

  • Books Received

  • Published online by Cambridge University Press:
    18 September 2015, p. 171
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Book Review

Neurosurgical Practice

  • Notes and Announcements

  • Published online by Cambridge University Press:
    18 September 2015, p. 179
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Correspondence

  • What Effect Does an Untreated Aneurysm Have on Life Expectancy?

  • T.P. Hutchinson
  • Published online by Cambridge University Press:
    18 September 2015, pp. 357-358
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  • Reply from the Authors

  • K.J. Worsley, Richard Leblanc
  • Published online by Cambridge University Press:
    18 September 2015, pp. 358-359
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Book Review

Abstracts

  • Canadian Association of Neuropathologists

  • Published online by Cambridge University Press:
    18 September 2015, pp. 79-86
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Neurosurgical Practice

  • Information for Authors

  • Published online by Cambridge University Press:
    18 September 2015, p. xxii
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Correspondence

  • Early Seizures After Closed Head Injury

  • A.G. Gordon
  • Published online by Cambridge University Press:
    18 September 2015, p. 359
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Book Review

Other

  • Epival

  • Published online by Cambridge University Press:
    18 September 2015, pp. xxix-xxx
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Book Review

Page 4 of 9