British journal of neurosurgery
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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.
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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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Microdialysate fluid from 145 severely injured NSICU-patients, 88 with subarachnoidal haemorrage (SAH), and 57 with traumatic brain injury (TBI), was collected by microdialysis during the first 7 days following impact, and levels of the neurotrophins fibroblast growth factor-2 (FGF2) and vascular endothelial growth factor (VEGF) were analysed. The study illustrates both similarities and differences in the reaction patterns of the 2 inflammatory proteins. ⋯ This is the first report presenting in some detail the human cerebral response of FGF2 and VEGF following SAH and TBI. Apart from increasing the understanding of the post-impact inflammatory response of the human brain, the study identifies potential threshold values for these chemokines that may serve as monitoring indicators in the NSICU.