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Cerebral angiography is an invasive procedure associated with a small, but definite risk of neurological morbidity. In this study we sought to establish the nature and rate of complications at our institution among a large prospective cohort of consecutive patients. Also, the data were analysed in an attempt to identify risk factors for complications associated with catheter angiography. Data were prospectively collected for a consecutive cohort of patients undergoing diagnostic cerebral angiography between January 2001 and May 2006. A total of 2,924 diagnostic cerebral angiography procedures were performed during this period. The following data were recorded for each procedure: date of procedure, patient age and sex, clinical indication, referring specialty, referral status (routine/emergency), operator, angiographic findings, and the nature of any clinical complication or asymptomatic adverse event (arterial dissection). Clinical complications occurred in 23 (0.79%) of the angiographic procedures: 12 (0.41%) significant puncture-site haematomas, 10 (0.34%) transient neurological events, and 1 nonfatal reaction to contrast agent. There were no permanent neurological complications. Asymptomatic technical complications occurred in 13 (0.44%) of the angiographic procedures: 3 groin dissections and 10 dissections of the cervical vessels. No patient with a neck dissection suffered an immediate or delayed stroke. Emergency procedures (P = 0.0004) and angiography procedures performed for intracerebral haemorrhage (P = 0.02) and subarachnoid haemorrhage (P = 0.04) were associated with an increased risk of complications. Neurological complications following cerebral angiography are rare (0.34%), but must be minimized by careful case selection and the prudent use of alternative noninvasive angiographic techniques, particularly in the acute setting. The low complication rate in this series was largely due to the favourable case mix.

Background: Spontaneous intracranial hypotension (SIH) is characterised by postural headache and low opening pressure at lumbar puncture without obvious cause. Cranial magnetic resonance imaging often shows small subdural collections without mass effect, dural enhancement, venous sinus dilatation, or downward displacement of the brain. The condition is thought to be benign. Objectives: To evaluate the incidence of subdural haematoma as a serious complication of SIH. Methods: A prospective survey of all cases of SIH presenting to a large neuroscience unit over a two year period. Results: Nine cases of SIH were seen. Four of these were complicated by acute clinical deterioration with reduced conscious level because of large subdural haematomas requiring urgent neurosurgical drainage. Conclusions: SIH should not be considered a benign condition. Acute deterioration of patients’ clinical status may occur secondary to large subdural haematomas, requiring urgent neurosurgical intervention.

Study design: Single case-report. Objectives: To describe subarachnoid haemorrhage; an unusual complication following implantation of an intrathecal baclofen pump in an adult with spinal cord injury. Setting: Princess Royal Spinal Injuries Unit, Sheffield, UK. Methods: Review of the medical notes and literature. Results: A 77-year-old man with an incomplete ASIA-C spinal cord injury at C5 level sustained 2 years previously, developed subarachnoid haemorrhage following implantation of an intrathecal baclofen pump for the management of spasticity that was unresponsive to treatment with oral antispasticity agents. Conclusion: Subarachnoid haemorrhage can occur as a rare complication of insertion of Intrathecal baclofen pump. This need to be considered while evaluating patients who present with headache, confusion and seizures in the post operative period. Sponsorship: Not applicable.

OBJECTIVES To measure the sensitivity and specificity of five MRI sequences to subarachnoid haemorrhage. METHODS Forty one patients presenting with histories suspicious of subarachnoid haemorrhage (SAH) were investigated with MRI using T1 weighted, T2 weighted, single shot fast spin echo (express), fluid attenuation inversion recovery (FLAIR), and gradient echo T2* sequences, and also by CT. Lumbar puncture was performed in cases where CT was negative for SAH. Cases were divided into acute (scanned within 4 days of the haemorrhage) and subacute (scanned after 4 days) groups. RESULTS The gradient echo T2* was the most sensitive sequence, with sensitivities of 94% in the acute phase and 100% in the subacute phase. Next most sensitive was FLAIR with values of 81% and 87% for the acute and subacute phases respectively. Other sequences were considerably less sensitive. CONCLUSIONS MRI can be used to detect subacute and acute subarachnoid haemorrhage and has significant advantages over CT in the detection of subacute subarachnoid haemorrhage. The most sensitive sequence was the gradient echo T2*.

We present a case of sarcoidosis in a 14-year-old girl who presented with a short history of visual disturbance. Computed tomography and magnetic resonance imaging (MRI) demonstrated enlargement of the optic chiasm and prechiasmic optic nerves. Post-contrast MRI showed marginal enhancement of the affected areas of the optic pathways. A diagnosis of optic nerve glioma and arachnoid gliomatosis was made; surgical confirmation was not sought due to the risk to vision associated with biopsy. A rapid clinical deterioration led to repeat MRI which demonstrated extensive enhancing soft tissue throughout the basal cisterns with extension into the brain. Biopsy confirmed a diagnosis of sarcoidosis.

Surgeons utilise various mesh fixation methods during hernia repair which may include tacks/straps and/or sutures. One of these tack/strap choices, is an absorbable fixation device, Securestrap® (ETHICON, Somerville, NJ), consisting of polydioxanone and L (-)-lactide/glycolide copolymer. The 6 month clinical results and patient outcomes with Securestrap® fixation are reported. The International Hernia Mesh Registry, prospective multi-centre registry, designed to collect patient reported, longitudinal data on hernia mesh products and fixation methods. Patients completed the Carolinas Comfort Scale™ (CCS). Symptomatic patient defined as responding >1 to any CCS™ question. P-values obtained by McNemar test and Kaplan Meier methods used to estimate the recurrence rate up to 183 days. Patients enrolled at 17 centres with data on 101 of the 216 patients who had reached the 6 month time point. Demographics were: mean age 53.0 (13.2 SD); mean BMI 33.0 (7.7 SD) kg/m²; females (51.4%); nonsmokers (46.4%). Majority of hernias were incisional/ventral (57.9%) and most were laparoscopic (98.1%). Mesh fixation was with tacks/straps (50.5%) or tacks/straps and sutures (49.5%). Symptomatic CCS™ pains scores improved from baseline to 1 month and improved significantly from 1 month to 6-months (69.1% to 60.6%, p=0.0858; 60.6% to 22.8%, p=0.0002), respectively. Similar results were observed with symptomatic CCS™ movement limitations. The recurrence rate was 1.8% (0.6%-5.4%); 2 medically confirmed; 1 had not yet been assessed. Mesh fixation using absorbable tacks/straps with or without additional sutures results showed statistical significant improvement in patient reported outcomes at 6 months as compared to baseline. Follow-up continues.

In the fistulous type an arterial channel empties directly into a venous channel, while in the plexiform type one or more arterial channels feed a vascular conglomerate that comprises multiple arteriovenous communications from which one or more venous channels emerge as draining veins. 1 The fistulous types are usually supplied by meningeal branches of the external carotid artery and therefore they are also known as dural AVMs. Proptosis and orbital venous engorgement secondary to direct arterialisation of the venous system has also been reported in dural AVMs involving the torcular herophili 2 and the Galenic system. 3 The more common plexiform (pial) AVMs typically present with complications that arise from the massive venous run off that is generated by the associated arteriovenous shunts-namely, intracranial haemorrhage, seizures, and recurrent headache. 4 Symptomatic orbital drainage of plexiform (pial) AVMs is rare and when it does occur the AVM is usually in an anterior location. 5- 8 We describe a patient with a posteriorly located plexiform (pial) AVM who presented with proptosis and vascular engorgement of the left globe as a result of the venous outflow of the AVM being shunted anteriorly through newly opened collateral channels.

1 The syndrome has been defined as the acute onset of neurological or neuropsychiatric symptoms in patients recently recovered from Plasmodium falciparum malaria who have negative blood films at the time of onset. Plasma and CSF concentrations of cytokines (tumour necrosis factor and interleukins 2 and 6) are raised in patients with severe malaria. 5 Tumour necrosis factor has been implicated in neurotoxicity. 6 These cytokines may persist within the circulation even after eradication of the parasites but, more importantly, they can be found in higher concentrations in the serum samples of patients with PMNS compared with concentrations present during the recovery period. 5 The observed time to neurological dysfunction after eradication of the parasite and the reported response to steroid treatment 3 are supportive evidence of an immunological mechanism.