British journal of neurosurgery
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A 62-year-old man was admitted to our hospital after attempting to commit suicide with a pneumatic nail gun. Six nails were launched. Because the nail head acted as a brake, the launched nail could make a hole in the skull but could not entirely pass it.
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Lowering the blood pressure (BP) of patients with intracerebral haemorrhage (ICH) can prevent haematoma enlargement but may also promote secondary infarction in areas adjacent to the haematoma, which can lead to neurological deterioration. Little is known about the effects of low BP on early neurological deterioration (END). We conducted a retrospective study to determine whether low BP after admission was associated with END in patients with acute ICH. ⋯ Our findings suggest that a minimum SBP of approximately 120-125 mmHg after admission is associated with a beneficial impact on a reduced risk of END.
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Cauda equina syndrome (CES) is a neurological syndrome presenting with non-specific symptoms and signs that often leads to diagnostic confusion and delay. Acute onset CES is a surgical emergency. The common aetiology is a prolapsed lumbar disc. ⋯ Presence of saddle sensory deficit was the only clinical feature with a statistically significant association with MRI positive CES (p = 0.03). This series shows that saddle sensory deficit has a higher predictive value than other clinical features in diagnosing a CES. However, as there is no symptom or sign which has an absolute predictive value in establishing the diagnosis of CES, any patient in whom a reasonable suspicion of CES arises must undergo urgent MRI to exclude this diagnosis.
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A logical, rational and reasonable guideline for the management of patients with suspected cauda equina syndrome (CESS) is proposed. This article is intended to promote debate. Ideally spinal surgeons can agree a standard of care that can be applied nationally to the benefit of our patients, our colleagues and, as neurosurgeons and spinal surgeons, ourselves.