In cases of acute spontaneous spinal epidural hematoma producing neurological deficits, emergency surgical evacuation is the standard treatment.

Such a case is presented in which complete resolution of neurological deficits occurred without surgical intervention.

This is the fifth reported case of complete recovery in a patient managed conservatively. In most reports, significant and sustained neurological recovery had occurred within 12 hours of impairment of walking.

In cases of acute spontaneous spinal epidural hematoma in which neurological deterioration is followed by early and sustained recovery, non-operative therapy may be considered.

Tension pneumocephalus, the accumulation of intracranial gas under pressure, is a rare but potentially life-threatening condition which can complicate craniofacial surgery, trauma, or cranial tumor. It presents as an acute or subacute expanding mass lesion.

We present a case of a 40-year-old male who developed tension pneumocephalus as a consequence of a previously detected but untreated frontal sinus osteoma. Despite prompt decompression and repair of the fistulous connection between the sinus and the intracranial compartment, the patient suffered permanent frontal lobe damage with significant neurocognitive sequelae and seizures.

This case illustrates that tension pneumocephalus can be a dangerous entity with potential for early mortality and long-term morbidity. We recommend, therefore, early treatment and close follow up of destructive lesions involving the posterior frontal sinus wall.

Pathological laughter can be a sign of epilepsy, psychiatric illness, effect of toxins or psychotropic drugs or of structural brain disease.

Case Studies.

Two patients developed inappropriate uncontrollable laughter following intravenous sodium valproate for treatment of epilepsy.

Pathological laughter can be a side effect of intravenous sodium valproate.

Intracranial schwannoma involving the XIIth cranial nerve is rare. We report an unusual clinical presentation and pathological verification of a schwannoma, which had become haemorrhagic and necrotic, simulating acute purulent meningitis.

A literature review of intracranial tumors presenting as acute purulent meningitis, with emphasis on schwannomas, was undertaken.

Few cases of hypoglossal schwannoma have been reported; the association with purulent meningitis has not been previously documented.

In patients presenting with sterile purulent meningitis, a necrotic tumor should be considered as a possible etiology.

There are only rare reports of myasthenia gravis complicating human immunodeficiency virus infection. The role of immunomodulatory therapy is unknown.

Case report and literature review.

The diagnosis of human immunodeficiency virus infection followed that of myasthenia gravis in a 35-year-old man. Clinical and electrophysiological features were diagnostic of generalized myasthenia gravis but two edrophonium chloride tests and acetylcholine receptor antibodies were negative. Prednisone therapy and intravenous gamma globulin were associated with rapid clinical recovery.

Prednisone therapy and intravenous gamma globulin may be helpful in patients with generalized myasthenia gravis complicating HIV infection.

Presentation of an unusual case of congenital entrapment of the lateral cutaneous nerve of the calf (LCNC) mimicking a peroneal sensory neuropathy.

We report the case of a 16-year-old girl with a 3 year history of progressive tingling, numbness and pain in her right calf precipitated by athletic activities involving repeated flexion and extension of the knee. A Tinel's sign was present over the common peroneal nerve in the distal popliteal fossa but absent at the fibular neck. Motor and sensory examination of the common peroneal nerve was normal as were electrophysiological studies and MRI.

At surgery, the LCNC, a sensory branch of the common peroneal nerve, was entrapped at a point where it pierced the tendon of the biceps femoris muscle. Transection of the part of the tendon overlying the LCNC resulted in complete and permanent relief of symptoms.

The proximal location of the Tinel's sign, absence of motor or sensory deficits and normal electrophysiology suggested, preoperatively, that this was not an entrapment of the common peroneal nerve at the fibular neck but rather a more proximal abnormality likely involving only a part of the peroneal nerve or one of its sensory branches. As a result, more proximal exposure of the peroneal nerve within the popliteal fossa revealed entrapment of the LCNC due to its anomalous course through the biceps femoris tendon. This case has two noteworthy features. It is a unique example of an entrapment neuropathy of the common peroneal nerve or one of its branches, due to a normal nerve piercing an otherwise normal tendon. Secondly, there are no previously reported cases of surgically documented compression of the LCNC in an otherwise normal patient (i.e., non-diabetic).

The central nervous system is often involved in Behcet's disease. Most common are meningoencephalitic and brain stem syndromes. Although basal ganglia involvement is not an uncommon finding on necropsy, there are only single reports on extrapyramidal syndromes-dyskinesia, chorea and Parkinsonism in patients with Behcet's disease.

We report a patient fulfilling the criteria of the International Study Group for Behcet's disease. He had recurrent oral ulcerations, bilateral posterior uveitis and retinal vasculitis, skin papules and pustules, and recurrent monoarthritis. Neurologic examination revealed pseudobulbar palsy, slight and asymmetric bilateral pyramidal syndrome, muscle rigidity involving the four limbs, bradykinesia, masked face, and impaired postural reflexes. There was postural tremor in the extremities and myoclonic jerks involving the tongue and face muscles. Magnetic resonance imaging demonstrated small bilateral multifocal hyperintense lesions, with right predilection, involving the periventricular white matter, brain stem and basal ganglia.

The Parkinsonian syndrome found in our patient might be due to involvement of both substantia nigra and basal ganglia. This case further emphasizes the wide spectrum of the neurological manifestations of Behcet's disease

The thromobolytic drug, tissue plasminogen activator (tPA) has been approved in the United States for the treatment of acute ischemic stroke amid controversy and concern about the balance of risk and benefit. The Canadian Stroke Consortium (CSC), a national network of neurologists who collaborate on joint projects in stroke medicine, including clinical trials and consensus statements, has developed guidelines for the use of tPA in Canada.

The CSC Board of Directors wrote a preliminary report based on existing publications, including randomized drug trials and the report of a special committee struck by the Stroke Council of the American Heart Association. This draft was circulated to the CSC membership-at-large for suggestions or amendments, to produce this final draft.

The present guidelines have been devised to represent a Canadian viewpoint of management. The Health Protection Branch of the Ministry of Health of Canada has not yet produced an evaluation. Further modification of these guidelines may be necessary when more data from clinical trials and experience with the drug become available.