Subarachnoid haemorrhage due to intracranial vertebral artery dissection presenting with atypical cauda equina syndrome features: case report.

BACKGROUND: Failing to recognise the signs and symptoms of subarachnoid haemorrhage (SAH) causes diagnostic delay and may result in poorer outcomes. We report a rare case of SAH secondary to a vertebral artery dissection (VAD) that initially presented with cauda equina-like features, followed by symptoms more typical of SAH. CASE PRESENTATION: A 55-year-old man developed severe lower back pain after sudden movement. Over the next 5 days he developed paraesthesiaes in the feet, progressing to the torso gradually, and reported constipation and reduced sensation when passing urine. On day six he developed left facial palsy, and later gradual-onset headache and intermittent confusion. Magnetic resonance imaging of the brain showed diffuse subarachnoid FLAIR hyperintensity, concerning for blood, including a focus of cortical/subcortical high signal in the left superior parietal lobule, which was confirmed by computed tomography. Digital subtraction angiography demonstrated a left VAD with a fusiform aneurysm. CONCLUSION: We present a very rare case of intracranial VAD with SAH initially presenting with spinal symptoms. The majority of subsequent clinical features were consistent with a parietal focus of cortical subarachnoid blood, as observed on neuroimaging.

Case series of posterior instrumentation for repair of burst lumbar vertebral body fractures with entrapped neural elements.

BACKGROUND: Burst fractures of the lumbar vertebrae and laminar fractures associated with dural tears and entrapment of neural elements have been reported in the past as a relatively rare occurrence. To the best of our knowledge, there is no consensus on the approach to repairing these types of fractures. The objective of this study is to describe a method of repair for traumatic burst fractures of the lumbar spine and vertical laminar fractures associated with entrapped neural elements. METHODS: Seventeen patients with lumbar burst fractures were treated from June 2015 through April 2017. Dural tear was detected in all cases included in this study (confirmed intra-operatively). All other burst fractures were excluded. In all cases, unilateral posterior fixation was performed with no distraction initially. The spinal canal was then decompressed; and the entrapped neural elements released. Formal distraction was performed after canal decompression to allow for ligamentotaxis, followed by reduction of the retropulsed fractured segments back into the vertebral body. RESULTS: Using this method we achieved satisfactory results in that none of the patients had further deterioration of neurological deficit and the fixation allowed for early mobilization. Continued improvement was seen at the time of follow up for each of the studied patients with improved neurology, pain and no CSF leak. CONCLUSIONS: Our institution has demonstrated successful use of a posterior instrumentation, spinal canal decompression, release of entrapped nerve roots, and reduction of the retropulsed segment, in patients with traumatic burst fracture of the lumbar vertebrae complicated by entrapped neural elements.

Postprogression survival in patients with glioblastoma treated with concurrent chemoradiotherapy: a routine care cohort study.

Glioblastoma is the commonest malignant brain tumor in adults. Most patients develop progressive disease before they die. However, survival after developing progressive disease is infrequently reported. We identified patients with histologically proven disease who were treated with concurrent chemoradiotherapy during 2006-2013. We analyzed overall survival (OS), progression-free survival and postprogression survival (PPS) in relation to age, O6-methylguanine-DNA methyltransferase promoter methylation and extent of surgical resection. We identified 166 patients. Median survival was 13.5 months; 2-year OS was 21.7%. Median progression-free survival and PPS were 7.03 and 4.53 months, respectively. Age and extent of surgical resection were correlated with OS. Only the extent of surgical resection was associated with PPS. Our work suggests that the established prognostic factors for glioblastoma do not appear to help predict PPS.

Estimating progression-free survival in patients with glioblastoma using routinely collected data.

Glioblastoma (GBM) represents 80% of all primary malignant brain tumours in adults. Prognosis is poor, and there is a clear correlation between disease progression and deterioration in functional status. In this pilot study we assess whether we can estimate disease progression and progression free survival (PFS) from routinely collected electronic healthcare data. We identified fifty patients with glioblastoma who had chemo-radiotherapy. For each patient we manually collected a reference data set recording demographics, surgery, radiotherapy, chemotherapy, follow-up and death. We also obtained an electronic routine data set for each patient by combining local data on chemotherapy/radiotherapy and hospital admissions. We calculated overall survival (OS) and PFS using the reference data set, and estimated them using the routine data sets using two different methods, and compared the estimated measures with the reference measures. Overall survival was 68% at 1 year and median OS was 12.8 months. The routine data correctly identified progressive disease in 37 of 40 patients and stable disease in 7 of 10 patients. PFS was 7.4 months and the estimated PFS using routine data was 9.1 and 7.8 months with methods 1 and 2 respectively. There was acceptable agreement between reference and routine data in 49 of 50 patients for OS and 35 of 50 patients for PFS. The event of progression, subsequent treatment and OS are well estimated using our approach, but PFS estimation is less accurate. Our approach could refine our understanding of the disease course and allow us to report PFS, OS and treatment nationally.