Forty one patients with the clinical diagnosis of Behçet's syndrome from two teaching hospitals in Kuwait were studied. There were 34 male and seven female patients. Age at presentation ranged from 14 to 48 years. Neurological manifestations were present in 24 patients. Eleven patients showed evidence of increased intracranial pressure, and 10 of these had radiologically confirmed dural sinus thrombosis. Five patients presented with a meningoencephalitic or meningomyelitic picture, three with a stroke-like picture, and three with primarily brain stem signs. One patient developed trigeminal neuritis, and five patients exhibited (along with other features) variable degrees of psychological manifestations. All patients with neurological involvement were treated with steroids, and some also had courses of other immunosuppressant drugs and colchicine. The disease took a relatively benign course, except those patients with meningoencephalitic and meningomyelitic presentation, one of whom died from the disease. Those treated early had a better prognosis. The incidence of dural sinus thrombosis in this series of patients is unusually high. In most patients, the course of the disease was more favourable than reported in the literature. This may be attributed to early and aggressive treatment. (J Neurol Neurosurg Psychiatry 1998;64:382-384)

Single fibre electromyography (SFEMG) is a sensitive diagnostic method for neuromuscular transmission disorders,' 2 and its diagnostic yield in myasthenia gravis is significantly higher than that of repetitive nerve stimulation and determination of acetylcholine receptor antibodies.3 In a recent study of 450 myasthenic patients,3 the jitter was abnormal in 95%, when two muscles were studied. In patients with moderate to severe generalised symptoms, abnormal findings were obtained in 100%, and in those with mild generalised weakness in 95%. However, in patients with the ocular form of myasthenia and in those in clinical remission the jitter was only abnormal in 61% and 51%, respectively. A facial muscle (frontalis) had a higher diagnostic yield than limb muscles (extensor digitorum communis), the jitter being more abnormal in the former in 72% of 156 patients compared to 17% with more pronounced abnormality in the latter. This is consistent with earlier observations.1 45 In our experience with a small series of patients with mild generalised disease and patients in

Iatrogenic femoral neuropathy is an uncommon surgical or obstetric complication that may be underreported. It results from compression, stretch, ischemia, or direct trauma of the nerve during hip arthroplasty, self-retaining retractor use in pelvicoabdominal surgery, lithotomy positioning for anesthesia or labor, and other more rare causes. Decreasing incidence of this complication after abdominal and gynecologic surgery but increase in its absolute numbers after hip arthroplasty has emerged over the last decade. We describe two illustrative cases related respectively to lithotomy positioning and self-retaining retractor use. The variability in clinical presentation of iatrogenic femoral nerve lesions, some new insights in their diverse pathophysiology, and in the diagnostic and treatment options are discussed with an update from the literature.

HRUS confirms clinically diagnosed CTS in about half of the patients with normal NCS.

Electrical microstimulation of motor axons in conjunction with single fiber EMG (SFEMG) is increasingly used to measure the jitter of the motor endplates. This study examines the jitter of the stimulation site on the axon when stimulus strength is at threshold. In the absence of spurious blocking, this was found to be 5 microseconds on the average. With intermittent blocking, however, a mean additional jitter of 40 microseconds was obtained. The latter is considered to result from changing propagation velocity in the muscle fiber due to irregularity of activation rate. In clinical jitter studies, inadvertent threshold stimulation can result in significant error when associated with intermittent blocking.