Published 12 October 2009, doi:10.1136/bmj.b4181
Cite this as: BMJ 2009;339:b4181

Letters

Intracranial pathology

Endgames quiz is worrying

The first 100% of the full text of this article appears below.

In the Endgames quiz on intracranial pathology the diagnosis of a right sided fairly extensive chronic subdural haematoma of the convexity was clear in the initial computed tomogram.¹ A subsequent neurosurgical referral should have ensued. That the patient had a lumbar puncture is worrying and against established clinical practice. The supratentorial mass lesion and clinical evidence of raised intracranial pressure would have put the patient at risk of transtentorial herniation and coning, with leaching of cerebrospinal fluid from a lower compartment.

The question seems unsuitable for the part II examination for membership of the Royal College of Physicians of Ireland. The article should have gone through peer review—or be brought to the attention of the reviewers if it was reviewed—and be modified or removed from the BMJ.

Cite this as: BMJ 2009;339:b4181

¹ Queen’s Medical Centre, Nottingham NG7 2UH

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Competing interests: None declared.

1. Endgames. Intracranial pathology. BMJ 2009;339:b3940. (30 September.)[Free Full Text]

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This article has been cited by other articles:

• Jenkins, D. (2009). Reply from BMJ OnExamination. BMJ 339: b4185-b4185 [Full text]  

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