When symptoms permit, it is feasible to manage patients conservatively in the short-term after this unusual event to allow recovery from the initial insult and planning of future surgery. However, definitive treatment is surgical and colonoscopic management should not delay this once the patient is fit for surgery.

Introduction: Pseudoexfoliation syndrome is a systemic condition with eye manifestations. Ocular manifestations of PXS include iris depigmentation, phacodonesis or lens subluxation caused by zonular dehiscence. Loss of lens zonular support makes intraocular surgeries challenging with the potential for vitreous loss, lens subluxation or even lens dislocation. Current study was done to study the eyes with pseudoexfoliation, its association with cataract and its implications in cataract surgery. Material and Methods: A hospital based prospective study was conducted in 290 eyes (with PXF) of 170 patients attending ophthalmology OPD over a period of 3 years. Cataract surgery was performed for 156 eyes. Results: In the study, 54% (156 eyes) had cataract in association with PXF, out of which 62% (97eyes) were nuclear cataract. Complications associated with cataract surgery included vitreous loss, posterior capsular rent, zonular dialysis. Conclusion: PXS presents challenges that need careful preoperative planning and intraoperative care to ensure safe surgery and a successful post-operative outcome.

LE JOURNAL CANADIEN DES SCIENCES NEUROLOGIQUESSuppl. 2 -S37 respectively). No differences were identified for all other clinical and radiological factors assessed. Conclusions: This study supports the growing body of evidence for anterior fixation alone for flexiondistraction injuries. Findings suggest that measurements including segmental translation and kyphosis may predict radiographic failure and need for further surgical stabilization in some patients. Assessment for independent risk factors for anterior approach failure with a validated predictive scoring model should be considered. P.092Hirayama Disease: a diagnostic and therapeutic challenge Background: Hirayama disease (HD) is characterized by progressive cervical myelopathy caused by repetive neck flexion leading to forward displacement of the posterior dural sack with compression and injury of the spinal cord. Typically, the C7-T1 myotomes become weak and atrophic, while sparing sensation. Here we present two Canadian cases of this rare entity. Methods: Two cases of HD are presented and literature reviewed, showing the diagnostic and therapeutic challenges of this disease. Results: Case 1 is a 17-year-old male professional singer and musician. He presented with bilateral progressive hand weakness, which was aggrevated while playing the violine. Cervical MRI showed increased T2-weighted signaling at C5-7, but a correct diagnosis could not be identified. Eventually, dynamic cervical MRI showed the compression and he underwent an anterior cervical discectomy and fusion (ACDF) at C5-C6 and C6-C7 without complications.Case 2 is a 19-year-old female with progressive right hand weakness. After numerous investigations, a dynamic cervical MRI diagnosed her with HD with classic findings and she underwent an ACDF at C6-C7 without complications. Conclusions: Hiryama's disease is rare, but should be kept in mind when cervical cord signal changes cannot be explained by standard MRI. Dynamic MRI is imperative to correct diagnosis and anterior fusion shows good outcomes in its management.

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