Valproic acid induced coma is presented in an adult patient without a history of metabolic disease. Liver biopsy revealed a reduction in activity of carbamyl phosphate synthetase-I, an enzyme obligated for transformation of ammonia to urea in the urea cycle. After recovery CT scan follow-up showed marked cerebral atrophy which did not exist prior to the state of coma. Risk factors are discussed.

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The craniocervical junction was assessed in 700 consecutive unselected patients undergoing CT of the brain or paranasal sinuses, to investigate whether transverse ligament calcification was associated with advanced degenerative changes at the anterior atlanto-odontoid (AO) joint. Calcific deposits within the transverse ligament were seen in 40 patients (5.7%). The prevalence of this condition increased with age. Advanced degenerative changes (marked osteophytes and obliteration of the joint space) at the anterior AO joint were significantly more frequent in patients with transverse ligament calcification than in age-matched controls. We conclude that transverse ligament calcification is seen frequently in the elderly and very frequently with advanced degenerative changes at the anterior AO joint.

We discuss the relationship of atlanto-odontoid (AO) (anterior C1-C2 joint) osteoarthritis to suboccipital pain. A questionnaire regarding suboccipital neck pain was presented to 210 consecutive patients undergoing computed tomography (CT) of the brain or sinuses for a variety of indications. In all patients the AO joint and the lateral scout image of the cervical spine were studied. In 104 (49%) degenerative changes were seen at the AO joint. There were 89 patients (42%) who reported pain in the suboccipital region, although this was not the reason for CT in any patient. Statistical analysis of the prevalence of suboccipital neck pain in all patients showed the presence of AO osteoarthritis seen on CT to be associated with occurrence of these symptoms. This association remained significant in the same study population after excluding patients with a history of rheumatoid arthritis, migraine, stress and neck trauma and patients with signs of degenerative changes of C2-C7 on the computed lateral scout image.