British journal of neurosurgery
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Comparative Study
Cauda equina syndrome: what is the correlation between clinical assessment and MRI scanning?
The indications for magnetic resonance imaging (MRI) in suspected cauda equina syndrome, and the urgency for this investigation are regularly disputed. In this study we assess the ability of neurosurgical residents to predict on clinical grounds in which patients with cauda equina syndrome (CES) this was due to prolapsed intervertebral disc thereby justifying a request for urgent MR imaging. ⋯ Because it is impossible in a significant proportion of patients to exclude the diagnosis of prolapsed intervertebral disc in the context of referral with suspected cauda equina compromise the authors recommend urgent MRI assessment in all patients who present with new onset urinary symptoms in the context of lumbar back pain or sciatica.
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Biography Historical Article
Hugh Cairns and the origin of British neurosurgery.
Sir Hugh Cairns, the first Nuffield Professor of Surgery in Oxford and consultant neurosurgeon to the Royal Army Medical Corps during World War II, was a leader in helping to establish neurosurgery as a speciality in Britain. After learning the craft from Dr Harvey Cushing in Boston, Cairns fought against the general surgical orthodoxy in London to establish the first specialised neurosurgical unit in a teaching hospital. We review his early life, training with Cushing, his inspiring character and administrative prowess which not only helped to win the battle for neurosurgery in London but also helped to establish the Oxford Clinical School and to save thousands of lives during the Second World War.
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Recently published data from the International Subarachnoid Aneurysm Trial (ISAT) shows that for patients enrolled in the trial there is a 7.4% reduction in the incidence of death or dependency at 1 year if they undergo coiling, rather than clipping. Furthermore, extrapolation of longer-term follow-up data for patient mortality appears to suggest that this advantage will be maintained in the longer term. ⋯ Treatment of aneurysms is a continually evolving field and there is currently no other major source of information concerning management of aneurysms. For these reasons the authors recommend the instigation of a national aneurysm registry to prospectively collect data.