British journal of neurosurgery
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We report the case of a 14-month-old infant presenting with unresponsiveness and seizure following thoracic surgery. Imaging showed full territory left middle cerebral artery infarct and signs of raised intracranial pressure (ICP) that required emergency decompressive craniectomy (DC). The child made a good functional recovery. We discuss the case.
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We describe a case of spontaneous spinal extradural haematoma presenting as cardiac chest pain. Although a neurosurgical emergency, the diagnosis is initially missed until neurological deficit develops. Prompt MRI scans of the spine followed by rapid transfer to a neurosurgical unit for definitive intervention increase the chances of full recovery.
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Because of potential risks of poor outcome, lumbar puncture (LP) is recommended to exclude the presence of blood breakdown products in patients with suspected subarachnoid haemorrhage (SAH) and a normal CT scan. The aim of this study was to document how often this test proved useful. ⋯ LP-driven decision making in patients with a normal scan and suspected SAH is suboptimal in over a third of cases. Patients with a non-diagnostic LP harboured five aneurysms that merited treatment. These results support the need for secondary investigations following suspected SAH, but suggest that these could take the form of secondary imaging rather than a lumbar puncture.
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Cranial reconstruction with a cranioplasty is performed to repair skull defects after decompressive craniectomies. ⋯ Cranioplasty has significant complications. A thorough understanding of factors that contribute to the different types of complications will benefit the management of cranioplasty patients.
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Acute headache is among the commonest presenting complaints to emergency departments. While it is estimated that only 1-3% result from subarachnoid haemorrhage (SAH), because the disease carries such significant morbidity and mortality if missed, most clinicians have a low threshold for investigation. A recent prospective cohort study in Canada determined a number of high-risk clinical characteristics for SAH in patients with acute headache. We investigated the potential impact of incorporating the Canadian clinical decision rules on British practice. ⋯ The present study shows that application of the Canadian clinical decision rules for SAH would lead to more patients with acute headache being investigated than current British practice. However, much larger prospective studies are required to determine whether such clinical decision rules may identify patients at risk who would otherwise have been missed.