[A surgical fenestration of an arachnoid cyst in the cerebellomedullary cistern]

Arachnoid cysts originating from the cerebellomedullary cistern are very rare, and their indications for surgical treatment remain controversial. A 41-year-old man with a cystic lesion in the left cerebellomedullary cistern presented with sudden perspiration, palpitations, and vertigo. Subsequently, he complained of numbness of the left extremities and a dull headache. Otolaryngological evaluation revealed no abnormality. Physical examination on admission showed no neurological manifestations, except for left sensory disturbance. MRI revealed a cyst in the left cerebellomedullary cistern. Radiological examination did not reveal direct compression of the brain stem by the cyst, but the left cerebellum was compressed by the cyst. The patient underwent surgical fenestration of the arachnoid cyst via the midline suboccipital approach. The symptoms immediately disappeared after surgery. Patients with an arachnoid cyst in the cerebellomedullary cistern usually present lower cranial nerve dysfunction as a symptom. In our case, there was no cranial nerve dysfunction, but anatomically unexplainable symptoms, such as perspiration, palpitations, dizziness, and numbness of the left limbs, were observed. In conclusion, even if a patient with an arachnoid cyst in the posterior cranial fossa presents unexplainable symptoms, surgical intervention, including fenestration, is one of the therapeutic options.

Anthrax and the etiology of the English sweating sickness

In 2001, spores of Bacillus anthracis were deliberately sent through the United States postal system, resulting in five deaths from inhalational anthrax. Rarely observed clinical symptoms associated with these cases led to a hypothesis about the etiology of the English Sweating Sickness. The disease appeared sporadically in England between 1485 and 1551. Numerous viruses have been proposed as possible causes of the "English Sweat". Anthrax has not previously been considered because, documented cases of inhalational anthrax have been rare and pronounced sweating was not a noted symptom of the more common cutaneous and gastrointestinal forms of anthrax. Victims of the English Sweating Sickness have recently been identified in undisturbed tombs. It may be possible to examine those bodies and coffins for the presence of resilient anthrax spores and DNA using modern genomic tools.

The English 'sweate' (Sudor Anglicus) and Hantavirus pulmonary syndrome

A rapidly fatal viral infectious disease appeared in England in 1485, persisted for the summer months and disappeared as winter approached. This pattern of infection re-appeared in 1508, 1517, 1528, and finally 1551. The epidemic never returned. It had no respect for wealth or rank, and predominantly attacked males between the ages of 15 and 45 years. The incubation period was frighteningly short and the outcome normally fatal. The symptoms of acute respiratory disease and copious sweating were characteristic, providing the name 'the English sweating disease'. It was never in the big league of killer epidemics, such as plague and influenza, but its pockets of instant lethality in communities gave it a special ranking of horror. The infective cause of this disease remained a total mystery until it was compared with Hantavirus pulmonary syndrome (HPS) in 1994. The strength of this theory is examined in this paper, and it is concluded that, although there is a close resemblance, HPS does not match the English sweating disease completely and positive identification of a possible rodent carrier for the latter was not established.