David Brazier

Intracranial Hypotension Caused By Cervical Cerebrospinal Fluid Leak: Treatment With Epidural Blood Patch.

UNLABELLED This report describes treatment with cervical epidural blood patch of low cerebrospinal fluid (CSF) pressure headache resulting from spontaneous CSF leak via a tear in a cervical dural cuff. The leak was diagnosed by a dynamic computed tomography (CT)-myelography study followed by gadolinium enhanced magnetic resonance imaging(MRI)-scan. The epidural needle was inserted with the aid of image intensifier and CT-scan to guide the needle to the precise site of the CSF leak. Blood mixed with gadolinium was injected, and subsequent MRI scanning provided the first description of spread of blood after cervical epidural blood patch. IMPLICATIONS Low cerebrospinal fluid (CSF) pressure may cause severe posturally-related headache. In the patient, a vertebral disc protrusion in the neck seems to have contributed to a CSF leak. An injection of blood into the epidural space at the precise site of the CSF leak was followed by complete and lasting resolution of the headache.

Utilizing 18F‐fluoroethyl‐l‐tyrosine positron emission tomography in high grade glioma for radiation treatment planning in patients with contraindications to MRI

Patients with high grade glioma (HGG) and contraindications to magnetic resonance imaging (MRI) are dependent on contrast‐enhanced computerized tomography (CT) scan imaging for radiation therapy (RT) target volume delineation. This study reviews the experience with the utilization of 18F‐fluoroethyl‐l‐tyrosine positron emission tomography (FET‐PET) to define residual disease post craniotomy and optimize RT planning.

Survival improvements with adjuvant therapy in patients with glioblastoma

Evaluate survival of patients diagnosed with glioblastoma multiforme (GBM) managed with adjuvant intensity modulated radiation therapy and temozolomide since the introduction of the European Organisation for Research and Treatment of Cancer and National Cancer Institute of Canada Clinical Trials Group (EORTC‐NCIC) protocol.

Injuries sustained while surfboard riding

The origins of surfboard riding are proposed to be in ancient Polynesia, where it was fundamental in the culture. Owing to Western colonization and influence, surfing all but disappeared, but was revived by the Hawaiians at Waikiki at the beginning of the twentieth century [1]. Surfing was introduced to California in 1907 by George Freeth and to Australia in 1915 by Duke Kahanamoku, a Hawaiian Olympic champion swimmer [1]. Today, surfboard riding is a popular recreational activity and sport worldwide, particularly in the USA and Australia. Between 5 and 23 million people worldwide participate in surfboard riding [2]. There has been significant evolution of surfboard and surfing equipment over the past 15 years. Boards are lighter, shorter, and more maneuverable. As a result, the “tricks” performed by surfers have become more complicated and potentially injurious. Two recent retrospective studies have been undertaken at Royal North Shore Hospital (Sydney, Australia) to assess the spectrum of injuries sustained to the head and spine while surfboard riding [3]. These results have also been presented at the Asian Oceanian Congress of Radiology in Sydney in August 2012. Injuries sustained while surfing

Inflammatory trigeminal nerve and tract lesions associated with inferior alveolar nerve anaesthesia.

Inferior alveolar nerve blocks are commonly performed for dental anaesthesia. The procedure is generally safe with a low rate of complications. We report a patient with a reproducible, delayed-onset sensory deficit associated with contrast-enhancing lesions in the trigeminal nerve, pons and medulla following inferior alveolar nerve local anaesthesia. We propose that this previously undescribed condition is a form of Type IV hypersensitivity reaction.