Optic nerve metastasis simulating optic neuritis.

A 68-year-old man developed subacutely bilateral loss of visual acuity without any other neurological sign. Magnetic resonance images showed some small scattered periventricular white matter T2 hypersignals. On spinal fluid analysis a mononuclear pleocytosis and an oligoclonal gamma-pattern was found. Treatment with intravenous corticosteroids had no effect. The clinical situation deteriorated and the patient died of bronchopneumonia. Postmortem examination revealed manifest metastatic invasion of both the optic nerves by a non-detectable primary tumor.

[Clinical thinking and decision-making in practice. A nurse with low back pain radiating to both legs]. / Klinisch denken en beslissen in de praktijk. Een verpleegster met pijn onder in de rug uitstralend in beide benen.

A 50-year-old nurse with chronic back pain developed painful paraesthesia in the legs and saddle region during walking. Because pain in the legs could not be provoked by standing erect, the orthotic-lordotic cauda syndrome or neurogenic intermittent claudication (spinal canal stenosis) became unlikely and vascular intermittent claudication likely. The femoral pulses were absent. Angiography showed severe stenosis of the distal aorta which was successfully treated by percutaneous transluminal angioplasty.

[Surgical treatment of carpal tunnel syndrome: endoscopic or classical (open)? A prospective randomized trial]. / Operatieve behandeling wegens carpaletunnelsyndroom: endoscopisch of klassiek (open)? Een prospectief gerandomiseerd onderzoek.

OBJECTIVE: To compare the results of open with endoscopic release of the carpal tunnel in patients with the carpal tunnel syndrome. DESIGN: Randomised prospective study. SETTING: General hospital Zeeuws-Vlaanderen, Oostburg and Terneuzen, the Netherlands. METHOD: 178 patients were randomised for open or endoscopic release. The symptom severity score and functional status score were completed before and three months after the procedure. One week after the operation the patients' postoperative pain was measured on a 10-point visual analogue scale. Differences were analysed using the Chi-square test or the t-test. RESULTS: Randomisation failed in two patients; 85 patients had an endoscopic release and 91 patients had an open release. The postoperative pain was significantly less in the endoscopic group. Improvement in symptom severity score and functional status score was the same in both groups. There was no difference in absence from work. Two local complications occurred in the endoscopically treated group. Of the patients 25% were not or only slightly satisfied with the results. CONCLUSION: Endoscopic release of the carpal tunnel is as effective as the open release but it gives less postoperative pain. Because of the risk of complications and the additional costs, the endoscopic release is not the preferred method for treatment of the carpal tunnel syndrome, however.