A 28-year-old previously healthy woman presented with left-sided pleuritic chest pain of 18 hours duration. The pain started suddenly in the early hours of the morning while she was at a night club. Initially the pain was dull but several hours later it became more severe and was made worse by deep inspiration. Four hours before the pain started she had taken one 'Ecstasy' (methylenedioxymethamphetamine) and one 'Speed' (methylamphetamine hydrochloride) tablet. There was no history of trauma or asthma and she did not complain of any cough, sputum or haemoptysis. She was on the oral contraceptive pill and never smoked.On examination she was apyrexial and rather anxious. Her pulse rate was 82 beats/min and blood pressure was 1 16/80 mmHg. Auscultation of the heart revealed a crunching systolic sound and the chest was clear. Examination of the neck revealed surgical emphysema.Full blood count, erythrocyte sedimentation rate, blood chemistry, arterial blood gases, electrocardiogram and a water-soluble contrast swallow were all normal. The chest X-rays are shown below (figures 1 and 2).The patient was given analgesia and she was closely monitored. The chest pain subsided after four days when she was discharged home. A repeat chest X-ray was performed at two and four weeks.

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Objectives: To assess the correlation between craniovertebral junction)CVJ(abnormalities and syringomyelia in patients with Chiari malformation type-1)CM1(. Methods: This was a retrospective study including patients with CM1. Identification of cases was done by searching a radiology database at a university hospital from 2012 to 2017. Patients were divided Original Article into 2 groups based on whether CVJ abnormalities were present)CVJ+(or absent)CVJ-(. The patients' demographic and clinical data were reviewed. All magnetic resonance imaging studies were examined by a certified neuroradiologist. Results: Sixty-four consecutive patients with CM1 were included. The mean age was 24±17 years; 59% were females. The CVJ+ group had more female patients)p=0.012(. The most frequent CVJ abnormality was platybasia)71%(, followed by short clivus)44%(and cervical kyphosis)33%(. The CVJ abnormalities were more in Syringomyelia cases)p=0.045(. However, the results were not significant when hydrocephalus cases were excluded. Conclusion: Among CM1 patients, CVJ abnormalities were found more in patients with syringomyelia. Future studies with larger sample size are required to further study the correlation between CVJ abnormalities and both syringomyelia and hydrocephalus in CM1 patients.

Background: Cerebellar pilocytic astrocytoma (PCA) is one of the few CNS tumors that can be cured with gross-total removal (GTR). In this series, we had 39 patients diagnosed with cerebellar PCA, 27 patients (70%) had GTR, and mean follow-up period was 62 months with no tumor recurrence.Objective: To assess the long-term outcome of childhood cerebellar PCA treated at our institute during the period 2000-2020 and to highlight our surgical protocol.Methodology: Retrospective review of all patients under 18 years of age who were diagnosed with cerebellar PCA and had surgical excision between 2000 and 2020 at the Medical City of King Saud University.Results: The study included 39 patients: 17 males and 22 females, the mean age was 8.4 years. Radiologically, the tumor was solid in eight patients, cystic in 15 patients, and mixed components were found in 16 patients. The lesion was located in the right cerebellar hemisphere in 12 patients, left cerebellar hemisphere in five patients, and midline 22 patients. The tumor size ranged from 2 to 7 cm in its greatest diameter, it was <5 cm in 13 patients and >5 cm in 26 patients. Thirty-one patients had preoperative hydrocephalus. GTR of the tumor was achieved in 27 patients and subtotal resection (STR) was done in 12 patients, 18 patients required permanent ventriculoperitoneal (V-P) shunt, and five patients had postoperative radiotherapy. Postoperative complications included infection in two patients, cerebellar mutism in two patients, and significant neurologic disability in four patients. The duration of follow-up ranged from 0 to 240 months (mean follow-up period: 62.0 months). The outcome at 10 years was good in 30 patients, fair in four patients, poor in four patients, and one patient died. Recurrence was documented in nine patients, seven of them had GTR and two had STR. Conclusion: GTR, if achievable, is curative for childhood cerebellar PCA. Many posterior fossa surgical complications could be avoided with watertight dural closure. Although new dural substitutes are available we prefer using autologous grafts (pericranium). It is easy to harvest pericranial graft from the external ventricular drain (EVD) site. The insertion of EVD synchronously with GTR of the tumor and gradual weaning of EVD could avoid the insertion of V-P shunt.