Unstable traumatic cervical spine fracture is a commonly encountered neurosurgical issue. Concomitant vertebral artery injuries present a challenge in surgical decision-making regarding the timing and order of surgical intervention with respect to endovascular intervention and internal fixation of the unstable fracture. Currently, there are no studies that have specifically examined stroke rate or outcomes for patients who have vertebral artery injuries and unstable cervical spine fractures with respect to temporal treatment course. The purpose of this paper is to review the current evidence for the standards of diagnosis and management of vertebral artery injuries with coinciding unstable cervical spine injuries and propose an evidence-based algorithm for workup and treatment. Copyright © 2020, Merrill et al.Coarctation of the aorta (CoA) is a congenital condition, usually diagnosed and corrected early in life. Long-term survival with untreated coarctation is uncommon and is associated with high mortality rates in the fifth decade. A patient with CoA may present with problems while undergoing cardiac or non-cardiac surgical procedures which could pose considerable challenges in their anaesthetic management. Hence, the choice of anaesthetic technique plays an important role in determining the perioperative course and postoperative outcome in patients with CoA. This report discusses a case of middle-age man, recently diagnosed with CoA while undergoing a preanaesthetic assessment prior to the surgery for gastric adenocarcinoma involving proximal gastro-oesophageal junction. It highlights the successful anaesthetic management of CoA scheduled for laparoscopic-assisted gastrectomy for gastric adenocarcinoma. Perioperative management goals of the patient included general anaesthesia, epidural analgesia to avoid pain-associated adverse effects and efficient control of blood pressure distal to coarctation to limit the risk of intraoperative morbidity. It also demonstrates a major impact on anaesthesiologists who serve the most important role in managing such patients undergoing surgery with 'red flag' features. Copyright © 2020, Jahangir et al.Miller Fisher syndrome (MFS) is a rare variant of Guillain-Barre syndrome (GBS) which usually presents with descending paralysis. Common symptoms are ophthalmoplegia, ataxia, and areflexia. Our case presented with an atypical presentation. A 52-year old lady presented to the neurology outpatient department with frequent falls, blurring and doubling of vision and difficulty swallowing. These symptoms followed mild non-bloody diarrhea for two weeks ago. She had bilateral ptosis, lateral gaze palsy in both eyes, absent gag and cough reflex; she was unable to walk in a straight line and had right-hand grip weakness. Other motor and sensory examination were normal. She was admitted, kept under observation and investigated accordingly. Cerebrospinal fluid (CSF) analysis showed albuminocytologic dissociation. Nerve conduction studies showed slowed conduction in abducent, glossopharyngeal, vagus, and the right ulnar nerve. Blood analysis showed antiganglioside GQ1b antibodies; hence, the diagnosis of MFS, a variant of GBS, was made. Empirically plasmapheresis and then after confirmation intravenous immunoglobulins (IVIG) were used as treatment options. She recovered gradually within four weeks. Copyright © 2020, Rashid et al.Numerous anomalous muscles of the forearm and hand have been reported in the literature. The majority were encountered in cadaver dissections and some were incidentally detected during tendon transfer surgery. Because of the limited number of motors available for transfer, it may be advantageous if an anomalous muscle with favorable anatomy can function as a potential donor in a suitable clinical environment. Although several authors have illustrated various anomalies and their functional significance, the reports of actual utilization of such muscles as donors for tendon reconstructions are sparse. The aim of the study is to conduct a systematic review of the clinical applications of anomalous muscles in the upper extremity. After a thorough search of PubMed, Web of Science, Scopus, and Cochrane Library databases, only three out of 106 studies were found to be relevant. Two of them discussed the anomalous radial wrist extensor tendon transfer for thumb flexion. The third study described the usage of anomalous flexor carpi ulnaris (FCU) for thumb opposition and index finger flexion, and also proposed a classification. This is the first systematic review of the clinical application of anomalous muscles as donors in the upper extremity tendon transfer surgical procedures. Knowledge of the above classification helps in intraoperative evaluation of the type of the anomaly and the possible consideration of anomalous muscle as a source of transplant material in an appropriate clinical setting. Copyright © 2020, Metikala et al.Antiphospholipid syndrome (APS) is a multisystem autoimmune condition characterized by recurrent thrombosis and/or recurrent pregnancy loss. Clinical manifestations include minor clots to clots involving multiple organ systems, termed catastrophic antiphospholipid syndrome (CAPS). The interaction of several autoantibodies, anti-beta-2-glycoprotein 1 antibodies, lupus anticoagulant, and anticardiolipin antibody with plasma proteins is associated with a heightened procoagulant state. As a result, physicians need to recognize this syndrome in a patient presenting with thrombosis in multiple organs. Not only this, but physicians must be aware of traditional cardiovascular risk factors that increase a patient's risk of atherosclerosis, such as diabetes, hypertension, hypercholesterolemia, and smoking that increase these patient's clot risk. Primary care doctors must be diligent in recognizing and aggressively controlling traditional risk factors to prevent further endothelial and vascular injury that can precipitate thrombosis. We present here a case of a 69-year-old female who presented with thrombosis in several organs, which proved to be secondary to CAPS.  https://www.selleckchem.com/products/nvp-bgt226.html  Unfortunately, she also had several cardiovascular risk factors that put her at an increased risk of clot formation and propagation. After the resolution of her acute thrombotic event, she was sent home on anticoagulation but returned with clot propagation. Copyright © 2020, Parsi et al.