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Background Musculoskeletal (MSK) pain from the five most common presentations to primary care (back, neck, shoulder, knee or multi-site pain), where the majority of patients are managed, is a costly global health challenge. At present, first-line decision-making is based on clinical reasoning and stratified models of care have only been tested in patients with low back pain. We therefore, examined the feasibility of; a) a future definitive cluster randomised controlled trial (RCT), and b) General Practitioners (GPs) providing stratified care at the point-of-consultation for these five most common MSK pain presentations. Methods The design was a pragmatic pilot, two parallel-arm (stratified versus non-stratified care), cluster RCT and the setting was 8 UK GP practices (4 intervention, 4 control) with randomisation (stratified by practice size) and blinding of trial statistician and outcome data-collectors. Participants were adult consulters with MSK pain without indicators of serious pathologies, urgent medical needs, or vulnerabilities. Potential participant records were tagged and individuals sent postal invitations using a GP point-of-consultation electronic medical record (EMR) template. The intervention was supported by the EMR template housing the Keele STarT MSK Tool (to stratify into low, medium and high-risk prognostic subgroups of persistent pain and disability) and recommended matched treatment options. Feasibility outcomes included exploration of recruitment and follow-up rates, selection bias, and GP intervention fidelity. To capture recommended outcomes including pain and function, participants completed an initial questionnaire, brief monthly questionnaire (postal or SMS), and 6-month follow-up questionnaire. An anonymised EMR audit described GP decision-making. Results GPs screened 3063 patients (intervention = 1591, control = 1472), completed the EMR template with 1237 eligible patients (intervention = 513, control = 724) and 524 participants (42%) consented to data collection (intervention = 231, control = 293). Recruitment took 28 weeks (target 12 weeks) with > 90% follow-up retention (target > 75%). We detected no selection bias of concern and no harms identified. GP stratification tool fidelity failed to achieve a-priori success criteria, whilst fidelity to the matched treatments achieved “complete success”. Conclusions A future definitive cluster RCT of stratified care for MSK pain is feasible and is underway, following key amendments including a clinician-completed version of the stratification tool and refinements to recommended matched treatments. Trial registration Name of the registry: ISRCTN. Trial registration number: 15366334. Date of registration: 06/04/2016.

Recently there have appeared several reviews of the neurological complications of infectious mononucleosis. The commonest complication is that of a lymphocytic (serous) meningitis or meningoencephalitis. The rarer complications include neuritis and polyneuritis of the Guillain-Barre type. Silversides and Richardson were able to collect from the literature seven cases of the Guillain-Barre type of polyneuritis with infectious mononucleosis. Subsequent to that review there have appeared case reports by Klovstad and Vinje and Graham, Schwartz, and Chapman. Following is the report of another case, bringing the total number of cases of the Guillain-Barre type of polyneuritis associated with infectious mononucleosis to 10. Of the total, four were fatal. An 18-year-old university student was admitted to the Illinois Neuropsychiatric Institute on Jan. 1, 1951, with a history of many upper respiratory infections since the beginning of the fall term. About Dec. 23, 1950, he noticed that his legs felt somewhat weak and his

This is an anatomical study of veins of the brain stem and the base of the brain. The author has examined fifty brains in which the arteries were injected with a solution of India ink, water, and gelatin. The arteries and veins were dissected under a stereoscopic microscope, and, with a complete injection, he was able to classify the veins and to determine the relative independence of the path of the superficial veins in relationship to the path of the arteries. The most valuable part of this book is the excellent photographs showing in great clarity not only the veins, but also arteries and their relationship with structures of the brain. This small book, which in reality is an atlas, will be of great value to the neuroanatomist, neuroradiologist, and the neurosurgeon who is expert in microsurgery.

This is an extensive collection of short reports that were given at a symposium in 1971. The first major area consists of the basic mechanisms of cerebral spinal fluid formation and circulation. The second contains a series of reports regarding experimental hydrocephalus with alterations that occur in this condition, as well as theories regarding the production of such abnormalities. The third large area, which is quite technical and detailed, consists of reports on the radiopharmaceuticals and methodology for cisternography. There is a large group of reports regarding clinical studies of hydrocephalus, particularly normal tensive hydrocephalus, with results of shunt procedures and an attempt to evaluate scanning with relation to the therapeutic adjuncts. From this series, scanning was considered a useful adjunct, but it did not give a definite answer regarding those patients who may improve with shunt use. The last group covers the clinical aspects of children with hydrocephalus and

The editors of this book have done an excellent job. They present in one readable volume the most important modern information on epilepsy in a multidisciplinary approach. All of the contributors are British except for two from the United States. The entire volume is devoted to the patient with epilepsy and the problems, including medical, psychological, social, educational, and rehabilitative, that arise from the unpredictable nature of his attacks. It is emphasized that there are many questions regarding epilepsy about which we are still ignorant. After an introduction the first chapter is by a family physician who describes well the problems that occur for both the patient and the family when seizures occur. Another chapter describes in detail the clinical description of seizures, as well as various etiologies and prognoses, and gives a classification used throughout the book, but also has an appendix with the international classification. One entire chapter

Aspirin ingestion was followed by hyperventilation, cerebellar signs, and fatal brain stem dysfunction in a patient with sickle cell disease. Autopsy showed a swollen, recently infarcted cerebellum with tonsillar herniation compressing the medulla. We propose that hypocapnea from aspirin-induced hyperventilation caused carotid artery constriction and focal cerebral hypoxia, resulting in cerebellar sickling and infarction. Hypocapnea should be treated promptly to prevent brain damage in patients with sickle cell disease. (Arch Intern Med138:148-149, 1978)

• The effects of prednisolone were studied in 22 patients with neurological symptoms resulting from cerebral tumors. The primary lesion was mammary carcinoma in 15 cases and bronchogenic carcinoma in 2; in one patient each it was uterine carcinoma, malignant melanoma, and pancreatic carcinoma. Two patients had inoperable primary tumor of the brain: one acoustic neurinoma and one craniopharyngioma. The basic dose was 50 mg. of prednisolone twice daily by mouth, generally continued for three or four months. Remarkable temporary improvement in neurological symptoms was seen in 14 patients. This effect usually was not explained by any actual regression of the tumors or by any simple relation to the nature of the primary lesion. It seemed most likely that the relief afforded by prednisolone depends on its anti-inflammatory effect and that lesions surrounded by edema improve somewhat while those surrounded by hemorrhage are unaffected. The favorable effects lasted several weeks to several months, but in one patient still continue after 15 months of therapy.

PORENCEPHALY has been defined as a defect in cerebral or cerebellar structure appearing as a cystlike cavity communicating with the ventricles or separated from them only by a thin layer of brain tissue, covered on the outside by the pia-arachnoid and filled with a clear, colorless fluid. 1 The etiologic factors in this condition, which is usually initiated during the developmental period, may be various—inflammatory process, embolism or thrombosis, internal hydrocephalus or trauma. 2 Most probably, whatever the fundamental cause, the porencephalic cyst results from ischemic necrosis of the brain tissue and resorption of the products of liquefaction. 3 A history of birth injury, failure of growth and paresis of one side of the body, and of convulsive seizures, together with physical findings of spastic hemiparesis, with sensory (particularly topognostic) defect and hypoplasia, is common in cases of porencephaly, since most often this defect of the brain lies in the