Spontaneous cervical epidural hematoma is an uncommon cause of acute spinal cord compression. This is a rare idiopathic condition that leads to acute onset of neurologic deficits, which if not recognized early can have catastrophic consequences. Acute cervical epidural hematoma is definitely a condition of neurologic emergency. Although it is a rare condition, it must be considered in nontraumatic patients with sudden onset of neurologic deficits. Patients with spontaneous spinal epidural hematoma typically present with acute onset of severe back pain, and they rapidly develop signs of compression of the spinal cord or cauda equina. Here, we present a case of a 31-year-old man who presented with acute onset of neck pain with radicular component with progressive neurologic deficit. Emergent magnetic resonance imaging revealed cervical extradural hematoma with cord compression that was promptly evacuated. Functional recovery was achieved within 48 hours. The level of preoperative neurologic deficit and its severity, as well as operative interval, are important factors significantly affecting the postoperative outcome.

According to the results and presence of 36/46 MCs in patients with lumbar disc herniation, positive for P. acnes suggests that P. acnes can lead to edema on the vertebrae endplates near to infected area.

BackgroundTraumatic brain injury (TBI) is a major health problem worldwide. Secondary injuries after TBI, including diffuse axonal injury (DAI) often occur, and proper treatments are needed in this regard. It has been shown that glibenclamide could reduce secondary brain damage after experimental TBI and improve outcomes.ObjectivesWe aim to evaluate the role of glibenclamide on the short-term outcome of patients with DAI due to moderate to severe TBI.Patients and MethodsIn this controlled randomized clinical trial, 40 patients with moderate to severe TBI were assigned to glibenclamide (n = 20) and control (n = 20) groups. Six hours after admission the intervention group received 1.25 mg glibenclamide every 12 hours. The Glasgow coma scale (GCS) was administered at admission, in the first 24 and 48 hours, at one week post-trauma and at discharge. The Glasgow outcome scale (GOS) was also administered at discharge. All results were evaluated and compared between groups.ResultsPatients treated with glibenclamide compared to the control group had a significantly better GCS score one week post-trauma (P = 0.003) and at discharge (P = 0.004), as well as a better GOS score at discharge (P = 0.001). The glibenclamide group also had a shorter length of hospital stay compared to the control group (P = 0.03). In the control group, two patients (10%) died during the first week post-trauma, but there was no mortality in the glibenclamide group (P = 0.48).ConclusionsTreatment with glibenclamide in patients with DAI due to moderate to severe TBI significantly improves short-term outcomes.

SUMMARY -Ocular symptoms are regularly observed in patients with cavernous sinus dural arteriovenous fistulas (cDAVF).

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Within eleven minutes on 11 August 2012, twin earthquakes measured 6.3 and 6.4 on the Richter scale jolted Ahar and Varzaqan in northwestern Iran, claiming 300 lives and leaving thousands of injured in rural villages. 12 The magnitude of the earthquakes was so immense that more than a hundred villages were 70-90% destroyed, while 20 being totally flattened. The primary estimations were suggestive of low number of casualties compared to the last major earthquakes that have recently happened in Iran. This could be attributed to the incident happening in the middle of the day when men had been working their fields.The official rescue operations started after the event searching for the victims trapped under the rubble and providing emergency shelters for the survivors. However, people from the unaffected neighboring towns arrived much earlier to offer their assistance to their compatriots. Nonetheless, the death toll increased as the rescuers failed to reach the areas which were inaccessible by road and to dig the victims out of rubble in the entirely-leveled areas.Thanks to the early establishment of triage team consisting of experienced medical staff, 961 severely injured were transferred to and underwent life-saving operations in the nearest referral hospitals in Tabriz, the capital of East Azerbaijan Province, of which 38 died.Despite making all humanly possible attempts, there were some shortcomings and lessons to be learned for future natural disasters.Firstly, in the aftermath of the earthquakes, telecommunication was disrupted due to telephone network traffic overloading which in turn led to discoordination among the rescuers. This could have been avoided by providing special telecommunication equipments for the coordinators in the front line. 3 Secondly, inadequacy of medical air assistance particularly during the night slowed down the speed of search and rescue. 4 And the last, but not the least, the facilities devoted for health services should be resistant to the earthquakes as they would be considered the sole safe places for the injured and the ones in need. For instance, the two-year old hospital building in Heris, the closest city to the crisis, which was supposed to host the injured people, was destroyed in the same earthquakes.The initial shock has now abated, though precautionary measures are still required to be taken especially considering the forthcoming cold season. Funding StatementNone. Competing InterestsThe authors declare that no competing interests exist. Corresponding AuthorPlease direct correspondence to Dr. Samad EJ Golzari: dr.golzari@hotmail.com Lessons from the Recent Twin Earthquakes in Iran Brief Incident ReportWithin eleven minutes on 11 August 2012, twin earthquakes measured 6.3 and 6.4 on the Richter scale jolted Ahar and Varzaqan in northwestern Iran, claiming 300 lives and leaving thousands of injured in rural villages. 12 The magnitude of the earthquakes was so immense that more than a hundred villages were 70-90% destroyed, while 20 being totally flattened. The prim...