BMJ 2012; 344 doi: https://doi.org/10.1136/bmj.e1588 (Published 07 March 2012) Cite this as: BMJ 2012;344:e1588

A solitary demyelinating lesion can lead to progressive myelopathy similar to primary progressive multiple sclerosis (Neurology 2012;78:540-4, doi:10.1212/wnl.0b013e318247cc8c). Seven patients in whom magnetic resonance imaging showed a lesion compatible with a demyelinating plaque in the brainstem or upper cervical spinal cord were monitored over six years. All of them had progressive motor impairment but they did not meet the imaging criteria for dissemination in space.

The risks and benefits of using clopidogrel before coronary artery bypass surgery are explored in a systematic review in the Journal of Thoracic and Cardiovascular Surgery (2012;143:665-75, doi:10.1016/j.jtcvs.2011.01.069). Three randomised studies and 17 observational studies were included in the analysis, but all were suboptimal in some way. Despite randomised trials showing a trend towards reduced cardiovascular complications, the observational studies showed that recent exposure to clopidogrel put patients undergoing bypass surgery at a significantly …

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