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A 28-year-old woman developed puerperal sinus sagittalis superior thrombosis that caused hemorrhagic cerebral infarction and death by cerebral herniation.

A 50-year-old female nurse with an unremarkable medical history experienced acute midthoracic pain, irradiating to the chest and increasing during inspiration. Initial physical examination, laboratory tests, chest X-ray and electrocardiography all were normal. Pulmonary scintigraphy could not be performed in the early stage after admission. The clinical diagnosis of probable pulmonary embolism was made, and anticoagulant therapy was started. The following day, the patient gradually developed a spinal cord syndrome, eventually including paraplegia, bladder dysfunction and an incomplete sensory deficit with an upper level at the 5th thoracic dermatome, predominantly affecting temperature and pain sensation. Magnetic resonance imaging revealed a large anterior spinal epidural haematoma, extending from C7 down to T8. Urgent decompressive laminectomy and subsequent partial evacuation of the haematoma were performed, approximately 24 hours after the onset of neurological signs. No bleeding source was found during operation. The patient made a remarkable postoperative recovery.

Objective: To determine the seroprevalence of human T-cell leukaemia virus (HTLV) type I and predictive variables in Curaçao., Design: Descriptive., Setting: St. Elisabeth Hospital, Curaçao., Methods: A total of 2531 sera were randomly collected from a total population of approximately 145,000 over a period of three months (of seven the sex was not known). An initial ELISA test was performed to detect anti-HTLV-I antibodies. If this test was positive an ELISA re-test (in duplicate) was performed. If one of these re-tests was found positive a western blot confirmation test was performed. The association with age, sex, social class and history of syphilis were analysed with multiple logistic regression models and adjusted for confounding., Results: The estimated prevalence of HTLV-I was 1.9% (49/2524). No significant sex differences were observed (odds ratio (OR): 1.13; 95% confidence interval (95% CI): 0.62-2.05). Increasing age (p for trend = 0.0003) and lower social class (OR: 1.86; 95% CI: 1.03-3.38) were important predictive factors for HTLV-I infection. Members of the lower social classes and persons 50 years or older were at relatively high risk (OR: 3.91; 95% CI: 2.21-6.94)., Conclusion: HTLV-I infection is endemic in the island of Curaçao, as in other Caribbean islands. The estimated prevalence is 1.9%. Age and lower social class were important predictive factors for HTLV-I infection.

Two patients with tardive dystonia are presented. Tardive dystonia is a late-onset side effect of dopamine antagonist, which occurs in approximately 2% of the patients in the course of treatment with neuroleptic medication. The dystonia usually starts by affecting the musculature of face and (or) neck and is often progressive to a segmental localization. Of differential diagnostic importance are: conversion disorder, acute dystonia, Wilson's disease, idiopathic dystonia and dystonia triggered by other agents. Treatment starts with reevaluation of the need for ongoing neuroleptic treatment. Investigation of the pharmacotherapy of the dystonia concerns mostly treatment with dopamine depletors or with high doses of anticholinergic agents. Improvement of 50% of the patients is reported, although total recovery is rare. Many other substances and also some physical methods (ECT and surgery) have been used with varying results.

With increasing abuse of cocaine and purity of this drug, the incidence of strokes in relatively young people is also increasing. We describe two patients, one 29 years, the other one 33 years old. Both were well-known cocaine users. The first patient presented with an intracranial haemorrhage; the computed tomography of the brain is shown. The second patient showed a cerebral ischaemic infarction. The most frequent vascular complications are described. The physiological backgrounds of cerebrovascular accidents are given. Use of cocaine can be suggested by the presence of benzoylecgonine in urine samples.