Objectives-Organophosphates are effective pesticides which are frequently used in several agricultural settings. Although their acute effects are well characterised, it remains unclear whether long term exposure can damage the human nervous system. This study sought to investigate their long term effects by comparing abnormalities on neurological examination between groups ofworkers exposed to organophosphates and an unexposed group. Methods-146 exposed sheep farmers and 143 unexposed quarry workers were recruited into a cross sectional study of symptoms and neuropsychological effects of long term exposure to organophosphates in sheep dip. From a symptom questionnaire given immediately after dipping the 10 most symptomatic and 10 least symptomatic farmers were selected. Several months later each of these, along with 10 of the unexposed quarry workers, underwent a standardised neurological examination similar to that which might be used in clinical practice, at a time as remote as possible from recent exposure to organophosphates so as to exclude any acute effects.Results-All 30 selected subjects agreed to participate. The components of the examination which showed a significant difference were two point discrimination on the dorsum of the hand (symptomatic farmers 22 mm; asymptomatic farmers 13 mm; quarry workers 8 mm) and the dorsum of the foot (symptomatic farmers 34 mm; asymptomatic farmers 10 mm; quarry workers 11 mm), and mean calf circumference (symptomatic farmers 35-0 cm; asymptomatic farmers 36*3 cm; quarry workers 38-6 cm). Overall the prevalence of neurological abnormalities was low.Conclusions-The differences in neurological examination detected between groups were subtle and their clinical significance was unclear. However, they do suggest evidence of an adverse neurological effect from exposure to organophosphates. Further, larger scale studies will be required before it is possible to confirm or refute the differences detected.(Occup Environ Med 1996;53:520-525)

Idiopathic intracranial hypertension is a rare condition that usually affects overweight women. It is a diagnosis of exclusion in a pregnant woman presenting with headache. It is important to understand the medical and surgical treatment options in pregnancy. The mode of delivery is usually decided by obstetric factors. The risk of visual impairment is the same in pregnant and non-pregnant women with idiopathic intracranial hypertension. Learning objectivesTo identify how idiopathic intracranial hypertension presents in pregnancy.To know how to monitor and manage women with this condition during pregnancy. To understand the intrapartum, postpartum and long-term implications of this condition. Ethical issuesWhat is the extent of investigation before reaching the diagnosis of idiopathic intracranial hypertension? Do we need a high index of suspicion in all pregnant women presenting with headache? What is the preferred mode of delivery in idiopathic intracranial hypertension -do they all need a caesarean section?

No abstract

Acute occlusion of the major intracerebral arteries produces brain ischaemia and cerebral oedema with an attendant rise in intracranial pressure producing an intracranial compartment syndrome (‘malignant’ stroke). Over the course of 2003, three patients referred to the authors' unit underwent craniectomy for space-occupying malignant cerebral oedema following acute middle cerebral artery infarction. Each case deteriorated acutely following the initial event. Details regarding each patient’s initial clinical state, mode of deterioration and clinical outcomes are briefly described. On each occasion the preoperative computed tomography (CT) scan showed signs of a large middle cerebral artery territory infarction and was consistent with space occupation and mass effect. The postoperative CT scans demonstrated evidence of expansion of the oedematous brain tissue, most pronounced in case 2. These findings are illustrated in Figures 1a and b.