Bilateral simultaneous optic nerve dysfunction after pariorbital trauma: Recovery of vision in association with chiropractic spinal manipulation therapy

Objective: To discuss the recovery of optic nerve function after chiropractic spinal manipulation in a patient with loss of vision as a result of facial fracture from a fall. Clinical Features: In a fall down a stairwell, a 53-year-old woman with migraines fractured her right zygomatic arch, which was later treated surgically. Approximately 3 weeks after the accident, vision in her contralateral eye became reduced to light perception. Electrophysiologic studies revealed that the function of both optic nerves was diminished, the right significantly more than the left. Single photon emission tomography showed pancerebral ischemic foci. Intervention and Outcome: Chiropractic spinal manipulation was used to aid recovery of vision to normal over a course of 20 treatment sessions. At times, significant improvement in vision occurred immediately after spinal manipulation. Progressive recovery of vision was monitored by serial visual field tests and by electrophysiologic studies. Unfortunately, the patient refused a further single photon emission tomographic study when visual recovery was complete. Conclusion: This case report adds to previous accounts of progressive and expeditious recovery of optic nerve function in association with spinal manipulation therapy. (J Manipulative Phsyiol Ther 1999;22:615–21)     

Lack of Efficacy of Bevacizumab Plus Irinotecan in Children with Recurrent Malignant Glioma and Diffuse Brainstem Glioma:A Pediatric Brain Tumor Consortium Study

PURPOSE:A phase Ⅱ study of bevacizumab(BVZ) plus irinotecan(CPT-11) was conducted in children with recurrent malignant glioma(MG) and intrinsic brainstem glioma(BSG).PATIENTS AND METHODS:Eligible patients received two doses of BVZ intravenously     

The Effect of Rigid Cervical Collars on Internal Jugular Vein Dimensions

Objectives:  Prior research has demonstrated that rigid cervical collars cause an increase in intracranial pressure (ICP). The mechanism for this effect is unclear and one proposed mechanism involves obstruction of venous outflow in the neck. Ultrasound (US) allows assessment of internal jugular vein dimensions and may yield information regarding the mechanism for the increase in ICP seen with rigid collar application.
Methods:  Forty-two healthy volunteers underwent US examination of the internal jugular vein before and after cervical collar application. Internal jugular vein cross-sectional areas were compared with and without the cervical collar in place.
Results:  The cross-sectional area of the internal jugular vein increased significantly (p < 0.0001) after application of the cervical collar. The mean percentage increase in cross-sectional area was 37% (95% confidence interval [CI] = 20% to 53%).
Conclusions:  Internal jugular vein cross-sectional area increases after application of a rigid cervical collar. This supports the hypothesis that venous obstruction in the neck may contribute to the increase in ICP seen after rigid collar application.
ACADEMIC EMERGENCY MEDICINE 2010; 17:100–102 © 2009 by the Society for Academic Emergency Medicine     

National Association of Medical Examiners position paper: Recommendations for the investigation and certification of deaths in people with epilepsy

Sudden unexpected death of an individual with epilepsy can pose a challenge to death investigators, as most deaths are unwitnessed, and the individual is commonly found dead in bed. Anatomic findings (eg, tongue/lip bite) are commonly absent and of varying specificity, thereby limiting the evidence to implicate epilepsy as a cause of or contributor to death. Thus it is likely that death certificates significantly underrepresent the true number of deaths in which epilepsy was a factor. To address this, members of the National Association of Medical Examiners, North American SUDEP Registry, Epilepsy Foundation SUDEP Institute, American Epilepsy Society, and the Centers for Disease Control and Prevention constituted an expert panel to generate evidence‐based recommendations for the practice of death investigation and autopsy, toxicological analysis, interpretation of autopsy and toxicology findings, and death certification to improve the precision of death certificate data available for public health surveillance of epilepsy‐related deaths. The recommendations provided in this paper are intended to assist medical examiners, coroners, and death investigators when a sudden unexpected death in a person with epilepsy is encountered.