Moyamoya vasculopathy in a young Caucasian woman with significant methamphetamine use.

BACKGROUND: Moyamoya is a rare cerebrovascular disorder seen predominantly in Asian populations. Methamphetamine use is a recognised cause of stroke in young people, but its pathophysiology is not fully understood. The incidence of moyamoya vasculopathy in methamphetamine-associated stroke is unknown due to a lack of sufficient data. We present a rare case of moyamoya syndrome in a young Caucasian woman with methamphetamine-associated stroke. CASE: A 31-year-old Caucasian woman presented with progressive right arm weakness, speech disturbance and seizures on a background of escalating methamphetamine use in the 9 months prior to admission. She did not have a personal or family history of stroke. MRI revealed both embolic and watershed infarcts in bilateral frontal regions and CT angiography showed development of new lenticulostriate collateral vessels. Digital subtraction angiography confirmed steno-occlusive disease of the bilateral anterior circulations and a 'puff of smoke' appearance. CONCLUSION: In young patients who present with stroke with unclear aetiology, it is important to obtain a thorough substance use history. Moyamoya vasculopathy should be considered when evaluating the pathophysiology of stroke in young people.

Elite collegiate tennis athletes have lower 2D: 4D ratios than those of nonathlete controls.

The ratio of the length of the second finger (index finger) to the fourth finger (ring finger) (2D:4D ratio) is a putative marker for prenatal hormones. Physiological research has suggested a low 2D:4D ratio correlates with high athletic ability. Athletes of specific sports (e.g., American football) have lower 2D:4D ratios than those of nonathletes, whereas athletes of some sports (e.g., rowing, gymnastics, and soccer) do not. This study investigated the 2D:4D ratios among collegiate tennis athletes, elite collegiate tennis athletes, and nonelite collegiate tennis athletes and compared them with nonathletes of both sexes. The participants included 43 elite collegiate tennis athletes (Level I intercollegiate athletes in Taiwan; 27 males and 16 females), 107 nonelite collegiate tennis athletes (Level II athletes; 55 males and 52 females), and 166 nonathlete college students (80 males and 86 females). The principle findings suggest that (a) regardless of sex, collegiate tennis athletes have lower 2D:4D values than those of nonathletes; (b) elite collegiate tennis athletes have lower 2D:4D values than those of nonathletes; (c) among females but not males, athletes and nonelite athletes have lower 2D:4D values than those of nonathletes; and (d) males have lower 2D:4D values than those of females.

Ultrasound-guided midthigh sciatic nerve block-a clinical and anatomical study.

BACKGROUND AND OBJECTIVES: Ultrasound-guided sciatic nerve block is a relatively new regional anesthesia technique with few descriptions in the literature. The objective of this study was to assess the ease with which the sciatic nerve could be imaged in the midthigh region using ultrasound and to describe the anatomy surrounding the sciatic nerve at this location. METHODS: In this prospective observational study, 40 patients scheduled for surgery where sciatic nerve block was indicated were scanned between the gluteal and the popliteal regions using an ultrasound machine (Vivid-i, GE Healthcare, Chalfont St. Giles, Bucks, UK). Patients then received real time ultrasound-guided sciatic nerve block. Validation of the ultrasound image of the sciatic nerve was achieved using nerve stimulation. Description and confirmation of the anatomy surrounding the sciatic nerve was based on a review of anatomical texts and an anatomical study on 5 unembalmed cadavers. RESULTS: The sciatic nerve was identified with ultrasound and its image validated using nerve stimulation in 38 of 40 patients (95%). In 15 patients (37.5%) nerve stimulation was required to confirm identification of the sciatic nerve. Surrounding muscles (biceps femoris, vastus lateralis, and adductor magnus) and fascial planes (lateral intermuscular septum) were identified as sonographic landmarks and were confirmed in the anatomical study. CONCLUSIONS: Ultrasonic identification of the sciatic nerve at the midthigh level can be achieved; however, in this study, 37.5% of patients required nerve stimulation to confirm its sonographic appearance. Target nerve localization and the subsequent performance of the sciatic nerve block may be enhanced by recognition of surrounding muscular and fascial structures which were also identified using ultrasound.