Vertical Fracture of the Odontoid Process.

Fractures of the odontoid process of the axis usually occur transversely at the neck or base of the odontoid, are often displaced, and frequently require surgical fixation. Sagittal or coronal fractures are uncommon and can best be visualized on coronal or sagittal reconstruction of CT scans. Routine radiographs may not allow precise diagnosis. Vertical fractures, either sagittal or coronal, generally do not require operative treatment. This report describes an unusual fracture of the odontoid process sustained by a 56-year-old male after falling down a flight of stairs. He was neurologically intact, and the fracture healed with immobilization in a rigid cervical brace. Only 11 other case reports have been identified in a literature review. Both coronal and sagittal reconstructions should be obtained in suspected cases of odontoid fracture. Without instability on flexion/extension views or ligamentous injury on an MRI scan, a rigid brace or halo vest can be used to promote healing of the fracture, which may occur in 12 weeks.

Cerebrovascular Neurosurgery in Canada: An Historical Review.

Canadian contributions to cerebrovascular neurosurgery have been disproportionately large and, with some exceptions, relatively unrecognized. In this review, some of the efforts in the advancement of cerebrovascular neurosurgery by Canadian neurologists and neurosurgeons are described.

Anterior clinoid mucocele presenting with orbital apex syndrome.

BACKGROUND: Pneumatized anterior clinoid process is a common anatomic variant. Mucocele formation is a known complication of clinoid drilling during certain intracranial operations; however, mucoceles of pneumatized anterior clinoid processes have been found to spontaneously occur. CASE DESCRIPTION: A 44-year-old male presented with complaints of left-sided retro-orbital pain, double vision, and numbness over the upper face and scalp on the left side of 1-week duration. On examination, he was found to develop cranial nerve III, IV, and VI palsies with pupillary sparing, ophthalmic division cranial nerve V dysfunction, and eventually, the onset of vision loss. CONCLUSIONS: We report a case of spontaneous anterior clinoid process mucocele presenting with orbital apex syndrome. This was treated successfully with anterior clinoidectomy for decompression.

Brachial neuritis: an under-recognized cause of upper extremity paresis after cervical decompression surgery.

STUDY DESIGN: Case series. OBJECTIVE: To identify an alternative etiology for the development of upper extremity weakness after cervical spine surgery. SUMMARY OF BACKGROUND DATA: The development of proximal upper extremity paresis after cervical decompression surgery is commonly diagnosed as postoperative C5 palsy. Symptoms most commonly consist of weakness involving the deltoid and/or biceps brachii muscles, and in many patients there is also associated pain in the shoulder region with or without sensory deficits. Interestingly, the onset of symptoms is often delayed until days to weeks after surgery. The pathogenic mechanisms underlying postoperative C5 palsy remain unclear, although direct injury to the nerve root during surgery or a traction injury from a tethering phenomenon are frequently cited. These explanations seem unlikely, however, given the delayed onset of symptoms. METHODS: Two patients who underwent cervical decompression surgery with subsequent development of shoulder pain associated with proximal upper extremity weakness are presented. RESULTS: Based on clinical presentation and nerve conduction/EMG studies, both patients were diagnosed with brachial neuritis. This article describes an alternative diagnosis for the constellation of symptoms typically attributed to postoperative C5 palsy. Specifically, brachial neuritis is a type of peripheral neuropathy that involves the sudden onset of pain in the shoulder girdle followed by weakness, most commonly of the deltoid and spinati muscles. CONCLUSION: Brachial neuritis appears to be an under-recognized cause of delayed-onset shoulder pain associated with upper extremity weakness that develops as a consequence of the stress of surgery rather than as a complication of surgical technique.

Well-circumscribed, minimally enhancing glioblastoma multiforme of the trigone: a case report and review of the literature.

Glioblastoma multiforme (GBM) is known to present within the lateral ventricle but is relatively infrequent and predominantly found in the frontal horn or body of the ventricle. A GBM located within the trigone is rare, and one that appears well-circumscribed, homogeneous, and minimally contrast enhancing, as demonstrated in this patient, is highly unusual.