Brain biopsy in neurologic decline of unknown etiology

Brain biopsies have an uncertain role in the diagnosis of patients with dementia or neurologic decline of unknown etiology. They are often performed only after an exhaustive panel of less invasive tests and procedures have failed to provide a definitive diagnosis. The objective of this study was to evaluate the sensitivity of brain biopsies in this patient group through the retrospective analysis of 53 brain biopsies performed for neurologic disease of unknown etiology at a single tertiary care institution between December 2001 and December 2011. Patients with known nonlymphomatous neoplasms thought to be associated with the neurologic symptoms or with immunodeficiency were excluded from the study. Furthermore, the clinical presentation, imaging and laboratory tests were compared between diagnostic groups to identify factors more likely to yield a diagnosis. Sixty percent of the biopsies were diagnostic (32 out of 53), with the most common histologic diagnosis of central nervous system lymphoma in 14 of 53 patients (26% of total) followed by infarct in four subjects (7.5%). A few patients were found to have rare and unsuspected diseases such as lymphomatosis cerebri, neurosarcoidosis and neuroaxonal leukodystrophy. Complications from biopsy were uncommon and included hemorrhage and infection with abscess formation at the biopsy site. These results suggest that brain biopsies may be useful in difficult cases in which less invasive measures have been unable to yield a definitive diagnosis

COVID-19 and Spontaneous Resolution of Lumbar Disc Prolapse:A Retrospective Cohort Study of Patients Awaiting Microdiscectomy

INTRODUCTION: Between individual patients with lumbar disc prolapse (LDP), the natural course of disease is significantly variable. Spontaneous resolution is reported to occur in up to 70% of cases. However, we currently cannot predict for whom and when this will occur. Neurosurgical intervention is indicated for LDP patients with non-tolerable pain after at least 8-12 weeks of conservative management, or significant neurological deficit. Channelling essential resources in the National Health Service (NHS) to fight the COVID-19 pandemic led to the postponement of most elective operations, including microdiscectomy. This left many LDP patients previously considered to be surgical candidates with conservative-only options in the interim. To our knowledge, we are the first centre to report the specific impact of the peri- and post-pandemic period on waiting list times, delayed elective microdiscectomy, and the incidence of spontaneous LDP resolution.METHODS: Retrospective case series of a prospectively collected electronic departmental database identified LDP patients that would have been impacted by the COVID-19 pandemic at some point in their care pathway (March 2020 - February 2022). Further information was obtained from electronic patient records.RESULTS: 139 LDP patients were listed for elective microdiscectomy at the time of postponement of elective surgery. Over a third of LDP patients (n=47, 33.8%), in shared decision with the responsible neurosurgeon, had their re-scheduled microdiscectomy cancelled due to clinical improvement (14.1%), radiological regression (6.5%) or both (12.2%).CONCLUSION: Our single-centre retrospective analysis revealed that for over a third of LDP patients, the prolonged post-pandemic waiting list times for elective microdiscectomy resulted in their surgery not taking place either due to spontaneous clinical improvement or proven radiological regression. Considering this, a prolonged conservative approach to LDP may be appropriate in some patients - allowing time for natural resolution, whilst avoiding perioperative risks.</p