Characterisation of methicillin-resistant Staphylococcus aureus isolates from dogs and their owners.

Ten methicillin-resistant Staphylococcus aureus (MRSA) isolates from healthy owners and their pets were characterised by susceptibility testing, staphylococcal chromosome cassette (SCC)mec and agr typing, and detection of the Panton-Valentine leukocidin (PVL) genes. Two human and three dog isolates harbouring SCCmec type III appeared to be of hospital origin. The five remaining isolates carried SCCmec type IV, with three being multidrug-resistant. One type IV isolate was PVL-positive and a prototypic agr type 3, typified by strain MW2. This is the first report of this type in association with nasal carriage. Drug resistance may be increasing among community isolates of MRSA.

Early surgery for posterior circulation aneurysms following subarachnoid haemorrhage.

A retrospective analysis of 32 patients with posterior circulation aneurysms operated on within three days of subarachnoid haemorrhage is presented. The cases were treated at two Australian neurosurgery units over a five year period (1988-1992), both units having a policy of treating patients of all grades and all ages with early surgery. No patients suffered rebleeding. Five patients developed clinical vasopasm. Twenty-four patients (75%) had a good outcome (Glasgow Outcome Score 1-2), three had a poor outcome (GOS 3), and five died (16%). Of the five deaths, three presented as Hunt and Hess grade V. The results are considered in detail and the literature regarding the timing of surgery for posterior circulation aneurysms is reviewed.

Experience with nimodipine in aneurysmal subarachnoid haemorrhage.

OBJECTIVES: To assess the efficacy of nimodipine in preventing delayed ischaemic deficit in aneurysmal subarachnoid haemorrhage. DESIGN: A continuous prospective audit of all patients with aneurysmal subarachnoid haemorrhage admitted to the joint neurosurgery units of Prince Henry's and Alfred hospitals, Melbourne. Patients were divided into two groups--135 in the pre-nimodipine group during 1986 to 1989, and 73 in the nimodipine group during 1989 and 1990. MAIN OUTCOME MEASURES: Outcome was measured according to the Glasgow outcome scale and the incidence of delayed ischaemic deficit was recorded. RESULTS: A substantial reduction in the overall incidence of poor outcome was observed, from 37% of patients in the non-nimodipine group, to 20% in the nimodipine group (P = 0.022). Delayed ischaemic deficit occurred in 41% and 21% (P = 0.005), and poor outcome due to delayed ischaemic deficit occurred in 18% and 8% (P = 0.09) respectively. CONCLUSIONS: In our experience, nimodipine appears to have substantially reduced the incidence of delayed ischaemic deficits in patients with aneurysmal subarachnoid haemorrhage, with a resultant improvement in overall patient outcome.

Malignant prolactinomas.

Six cases of malignant prolactinoma have been reported; an additional two cases are presented here and the literature is reviewed. Diagnosis rests upon evidence of metastasis rather than histological criteria per se. Cases have arisen from known adenomas, particularly the invasive type. Bromocriptine is a useful palliative. The features and treatment of malignant prolactinoma are discussed.

Neurofibromatosis 2: report of an affected kindred, with a discussion of imaging strategy.

Three cases of neurofibromatosis 2 occurring in one family are presented. Features distinguishing this condition from the more common neurofibromatosis 1 are discussed and the important role of radiological screening in case detection and follow-up is emphasised.

Middle fossa arachnoid cysts in association with subdural haematomas. A review and recommendations for management.

Subdural haematomas occur in association with arachnoid cysts. Six cases of subdural haematoma are reported in 18 patients with previously asymptomatic middle fossa arachnoid cysts. A review of this patient population and the literature in respect of pathogenesis and treatment of arachnoid cysts was made. Cysto-peritoneal shunt is recommended as the surgical treatment after evacuation of the haematoma. The aetiology of haematoma formation has not been conclusively described, but may partly result from a high pressure intracranial system with decreased compliance.

Intracranial subdural hematoma after lumbar myelography.

Two cases of intracranial subdural hematoma after lumbar myelography are reported. This complication should be considered in patients who complain of prolonged headache or who develop neurological signs after lumbar puncture.

Delayed traumatic intracerebral haematoma: case report.

A case of delayed intracerebral haematoma following closed head injury in a young male is reported. The patient was treated surgically with a satisfactory result. The problem of the unsuspected delayed traumatic intracerebral haematoma is highlighted.