Faculty Bibliography

The craniovertebral (CV) junction can be involved in many diseases, e.g. rheumatoid arthritis, as well as destructive bone pathologies such as tumour and tuberculosis (craniovertebral Pott's disease). While some of these patients present acutely with neck pain and neurological deficits, in others the signs and symptoms may be more subtle. Two patients with CV junction involvement are described. One patient suffered from fracture of the anterior arch of atlas after being involved in a motor vehicle accident and the other had craniovertebral Pott's disease. A detailed history and clinical examination was carried out paying special attention to the situation when patients attempted to recline or while getting up from a reclining position. Patients were further investigated with imaging studies which focused on the CV junction. It was noted that patients with CV junction involvement frequently support their head while attempting to recline or when getting up from a reclining posture. This head supporting sign may be the sole neurological finding in some patients with involvement of the CV junction

Artifacts are signals recorded on the electroencephalogram (EEG) that are not cerebral in origin and can be divided into physiological and non-physiological artifacts. We present here an interesting non-physiological EEG artifact generated by cardiopulmonary resuscitation efforts.

The Uniform Determination of Death Act (UDDA) defines death as irreversible cessation of the functions of the entire brain including the brainstem. Many individuals meeting the clinical criteria of brain death can be documented to have some residual sub-cortical and brainstem function on careful testing. Determination of brain death still remains a persistently unresolved issue in health law and bioethics. The determination of brain death is clinical and involves testing for the integrity of brainstem functions. Documentation of irreversible cessation of brainstem functions when the cause of coma is established is usually sufficient to make a diagnosis of brain death. Confirmatory tests like four-vessel angiogram and electroencephalogram (EEG) are required in cases where the clinical testing is inconclusive or unreliable. EEG criteria for electrocerebral silence (ECS) is absence of any detectable cortical activity above 2 microV in a study performed as per the guidelines developed by the American Electroencephalographic Society. EEG studies carried out for ECS are at times contaminated by electromyographic (EMG) artifacts reflecting scalp motor unit activity. A secure EEG diagnosis of ECS cannot be made in such cases. What exactly is the relevance of scalp EMG activity in these clinically brain dead patients? What is the mechanism of generation of this spontaneous scalp EMG activity and how can the diagnosis of brain death be secured in these patients? These issues are explored in this article by highlighting a case.