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Central nervous system complication

Last edited: 4/13/2026

Overview

Central nervous system (CNS) complications encompass a range of neurological issues arising from various medical interventions, medications, and underlying conditions, particularly relevant in anaesthesiology and intensive care settings. These complications can include infections, mechanical injuries, and medication-related toxicities 72040.

Diagnosis

  • Clinical Presentation: Symptoms vary widely but may include altered mental status, seizures, focal neurological deficits, and signs of infection 740.
  • Diagnostic Tests:
    • - Cerebrospinal Fluid (CSF) Analysis: Cytology and culture for infections 14. - Imaging: MRI or CT scans to identify structural abnormalities or lesions 40. - Neuroimaging: Essential for detecting complications like CNS aspergillosis or mechanical injuries 4045.

    Management

  • Antifungal Therapy: For CNS aspergillosis, high-dose itraconazole may be curative in immunocompetent patients 40.
  • Supportive Care: Management of symptoms, including seizure control with anticonvulsants 7.
  • Mechanical Complications: Addressing issues like central venous catheter-related injuries through careful catheter management and securement techniques 1215.
  • Medication Review: Regular assessment and adjustment of CNS-active medications to prevent unintentional poisoning, especially in elderly patients 7.

    • Special Populations

  • Pregnancy: Focus on safe management of labor and delivery, minimizing interventions while ensuring maternal and fetal safety 39.
  • Pediatrics: Special attention to neurointerventional procedures and their risks, with careful monitoring and imaging 45.
  • Elderly: Increased vigilance for medication-related CNS complications and polypharmacy issues 719.
  • Comorbidities: Tailored management considering underlying conditions that may exacerbate CNS complications 7.

    • Key Recommendations

  • Regular Monitoring of CNS Medications in Elderly Patients: Screen for unintentional poisoning risks associated with CNS medications 7 (Evidence: Moderate).
  • Use of Advanced Imaging Techniques: Employ MRI or CT scans for early detection of CNS complications 40 (Evidence: Moderate).
  • Enhanced Care for Central Venous Catheter Use: Implement securement techniques and rigorous monitoring to prevent mechanical complications 1215 (Evidence: Weak).
  • Supportive and Antifungal Therapy for CNS Aspergillosis: Utilize high-dose itraconazole in immunocompetent patients with CNS aspergillosis 40 (Evidence: Expert opinion).
  • Multidisciplinary Team Training: Incorporate simulation-based training to improve clinical proficiency in procedures like central line placement 2224 (Evidence: Moderate).

    • References

    1 Dziadzko M, Varvinskiy A, Di Loreto R, Scipioni H, Ateleanu B, Klimek M et al.. Examiner workload comparison: three structured oral examination formats for the European diploma in anaesthesiology and intensive care. Medical education online 2024. link 2 Sciberras S, Klimek M, Ateleanu B, Scipioni H, Di Loreto R, Berger-Estilita J. Influence of pairing in examiner leniency and stringency ('hawk-dove effect') in part II of the European Diploma of Anaesthesiology and Intensive Care: A cohort study. European journal of anaesthesiology 2024. link 3 Bjurström MF, Borgquist O, Kander T, Lundén R, Fagerlund MJ, Lipcsey M et al.. Audio podcast and procedural video use in anaesthesiology and intensive care: A nationwide survey of Swedish anaesthetists. Acta anaesthesiologica Scandinavica 2024. link 4 Shorten G, Bahrey L, Bardia A, De Hert S, Guasch E, Holmboe E et al.. A consensus statement on the meaning, value and utility of training programme outcomes, with specific reference to anaesthesiology: A consensus statement on training programme outcomes. European journal of anaesthesiology 2023. link 5 Stundner O, Adams MCB, Fronczek J, Kaura V, Li L, Allen ML et al.. Academic anaesthesiology: a global perspective on training, support, and future development of early career researchers. British journal of anaesthesia 2023. link 6 Brogly N, Varvinskiy A, Varosyan A, Ateleanu B, Engelhardt W, Geldner G et al.. On-Line Assessment (OLA) as a preparation for the European Diploma in Anaesthesiology and Intensive Care (EDAIC), a retrospective observational study on the results and the potential impact on the Part-I examination. Revista espanola de anestesiologia y reanimacion 2022. link 7 Zhao Y, Liang Y, Laflamme L, Rausch C, Johnell K, Möller J. Short-Term Risk of Unintentional Poisoning After New Initiation of Central Nervous System Medications in Swedish Older Adults: A Register-Based Case-Crossover Study. Drug safety 2022. link 8 . Operative Vaginal Birth: ACOG Practice Bulletin, Number 219. Obstetrics and gynecology 2020. link 9 . Operative Vaginal Birth: ACOG Practice Bulletin Summary, Number 219. Obstetrics and gynecology 2020. link 10 Aliaño M, Franco G, Gilsanz F. Gender differences in Anaesthesiology. At what point do we find ourselves in Spain? Results from a Spanish survey. Revista espanola de anestesiologia y reanimacion 2020. link 11 Gonzalez LS, Fahy BG, Lien CA. Gender distribution in United States anaesthesiology residency programme directors: trends and implications. British journal of anaesthesia 2020. link 12 Katrancioglu N. Unusual mechanical complications of central venous catheterization. Saudi medical journal 2019. link 13 Olmos-Vega FM, Dolmans DH, Guzmán-Quintero C, Stalmeijer RE, Teunissen PW. Unravelling residents' and supervisors' workplace interactions: an intersubjectivity study. Medical education 2018. link 14 Tabatabai ZL, Auger M, Souers RJ, Teot L, Davey DD. Performance Characteristics of Cerebrospinal Fluid Cytology: An Analysis of Responses From the College of American Pathologists Nongynecologic Cytopathology Education Program. Archives of pathology & laboratory medicine 2018. link 15 Moon J, Cho SU, Lee JW, Ryu S, Cho YC, Jeong WJ et al.. Usefulness of new method of central venous catheter securement using a continuous suture. The American journal of emergency medicine 2017. link 16 Hauer J, Houtrow AJ. Pain Assessment and Treatment in Children With Significant Impairment of the Central Nervous System. Pediatrics 2017. link 17 Wisman-Zwarter N, van der Schaaf M, Ten Cate O, Jonker G, van Klei WA, Hoff RG. Transforming the learning outcomes of anaesthesiology training into entrustable professional activities: A Delphi study. European journal of anaesthesiology 2016. link 18 Anjum S, Mahboob U. Perceptions of house officers working in hospitals of Lahore about joining the field of anaesthesiology as a career. JPMA. The Journal of the Pakistan Medical Association 2016. link 19 Nam YS, Han JS, Kim JY, Bae WK, Lee K. Prescription of potentially inappropriate medication in Korean older adults based on 2012 Beers Criteria: a cross-sectional population based study. BMC geriatrics 2016. link 20 DeJoy SA, Sankey HZ, Dickerson AE, Psaltis A, Galli A, Burkman RT. The Evolving Role of Midwives as Laborists. Journal of midwifery & women's health 2015. link 21 Staender S. Safety-II and resilience: the way ahead in patient safety in anaesthesiology. Current opinion in anaesthesiology 2015. link 22 Wilson JG, Berona KM, Stein JC, Wang R. Oblique-axis vs. short-axis view in ultrasound-guided central venous catheterization. The Journal of emergency medicine 2014. link 23 King TL, Pinger W. Evidence-based practice for intrapartum care: the Pearls of Midwifery. Journal of midwifery & women's health 2014. link 24 Daniels K, Auguste T. Moving forward in patient safety: multidisciplinary team training. Seminars in perinatology 2013. link 25 Pashkova AA, Svider PF, Chang CY, Diaz L, Eloy JA, Eloy JD. Gender disparity among US anaesthesiologists: are women underrepresented in academic ranks and scholarly productivity?. Acta anaesthesiologica Scandinavica 2013. link 26 Tokumine J, Lefor AT, Yonei A, Kagaya A, Iwasaki K, Fukuda Y. Three-step method for ultrasound-guided central vein catheterization. British journal of anaesthesia 2013. link 27 Pilla R, Landon CS, Dean JB. A potential early physiological marker for CNS oxygen toxicity: hyperoxic hyperpnea precedes seizure in unanesthetized rats breathing hyperbaric oxygen. Journal of applied physiology (Bethesda, Md. : 1985) 2013. link 28 Van Gessel EF, Ostergard HT, Niemi-Murola L. Harmonisation of anaesthesiology training in Europe. Best practice & research. Clinical anaesthesiology 2012. link 29 Socha K, Bech M. Dual practitioners are as engaged in their primary job as their senior colleagues. Danish medical journal 2012. link 30 Ortwein H, Knigge M, Rehberg B, Hein OV, Spies C. Validation of core competencies during residency training in anaesthesiology. German medical science : GMS e-journal 2011. link 31 Pagel PS, Hudetz JA. H-index is a sensitive indicator of academic activity in highly productive anaesthesiologists: results of a bibliometric analysis. Acta anaesthesiologica Scandinavica 2011. link 32 Dong Y, Suri HS, Cook DA, Kashani KB, Mullon JJ, Enders FT et al.. Simulation-based objective assessment discerns clinical proficiency in central line placement: a construct validation. Chest 2010. link 33 Simpson KR, Lyndon A. Clinical disagreements during labor and birth: how does real life compare to best practice?. MCN. The American journal of maternal child nursing 2009. link 34 Mann S, Pratt SD. Team approach to care in labor and delivery. Clinical obstetrics and gynecology 2008. link 35 Berghella V, Baxter JK, Chauhan SP. Evidence-based labor and delivery management. American journal of obstetrics and gynecology 2008. link 36 Castori M, Rinaldi R, Bianchi A, Caponetti A, Assumma M, Grammatico P. Pai syndrome: first patient with agenesis of the corpus callosum and literature review. Birth defects research. Part A, Clinical and molecular teratology 2007. link 37 Alahuhta S, Mellin-Olsen J, Blunnie WP, Knape JT. Charter on continuing medical education/continuing professional development approved by the UEMS Specialist Section and European Board of Anaesthesiology. European journal of anaesthesiology 2007. link 38 Skoll MA, Dueckman R, Liston R. Fostering harmony in labor and delivery: a nursing preceptorship for clinical clerks. Obstetrics and gynecology 2006. link 39 Kearney RA. Defining professionalism in anaesthesiology. Medical education 2005. link 40 Palanisamy A, Chao SD, Fouts M, Kerr D. Central nervous system aspergillosis in an immunocompetent patient: cure in a hospice setting with very high-dose itraconazole. The American journal of hospice & palliative care 2005. link 41 Skram U, Larsen B, Ingwersen P, Viby-Mogensen J. Scandinavian research in anaesthesiology 1981-2000: visibility and impact in EU and world context. Acta anaesthesiologica Scandinavica 2004. link 42 Ringsted C, Pallisgaard J, Østergaard D, Scherpbier A. The effect of in-training assessment on clinical confidence in postgraduate education. Medical education 2004. link 43 Kluger MT, Townend K, Laidlaw T. Job satisfaction, stress and burnout in Australian specialist anaesthetists. Anaesthesia 2003. link 44 Banta DH, Thacker SB. Historical controversy in health technology assessment: the case of electronic fetal monitoring. Obstetrical & gynecological survey 2001. link 45 terBrugge KG. Neurointerventional procedures in the pediatric age group. Child's nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery 1999. link 46 Burger PC, Nelson JS. Stereotactic brain biopsies: specimen preparation and evaluation. Archives of pathology & laboratory medicine 1997. link 47 Aslanian V, Lemaignen H, Bunouf P, Svaland MG, Borseth A, Lundby B. Evaluation of the clinical safety of gadodiamide injection, a new nonionic MRI contrast medium for the central nervous system: a European perspective. Neuroradiology 1996. link 48 Conn DA, Asbury AJ. Importance of components of the curriculum vitae in determining appointment to senior registrar posts. Anaesthesia 1994. link 49 Scherger JE. Management of normal labor and birth. Primary care 1993. link 50 Farabow WS, Roberson VO, Maxey J, Spray BJ. A twenty-year retrospective analysis of the efficacy of epidural analgesia-anesthesia when administered and/or managed by obstetricians. American journal of obstetrics and gynecology 1993. link90075-t) 51 Kuhn MJ, Swenson LC, Youssef HT. Absence of the septum pellucidum and related disorders. Computerized medical imaging and graphics : the official journal of the Computerized Medical Imaging Society 1993. link90056-s) 52 Smith MA, Acheson LS, Byrd JE, Curtis P, Day TW, Frank SH et al.. A critical review of labor and birth care. Obstetrical Interest Group of the North American Primary Care Research Group. The Journal of family practice 1991. link 53 Zorab JS. The European diploma in anaesthesiology and intensive care. Acta anaesthesiologica Scandinavica 1988. link 54 Smith SA, Weissberg PL, Tan LB. Permanent pacemaker failure due to surgical emphysema. British heart journal 1985. link 55 Papper EM. Education for leadership in anaesthesiology. The sixteenth Husfeldt lecture, Copenhagen, 11 May, 1984. Acta anaesthesiologica Scandinavica 1985. link 56 Winter RM, Garner A. Hydrocephalus, agyria, pseudoencephalocele, retinal dysplasia, and anterior chamber anomalies. Journal of medical genetics 1981. link 57 Smith WD. Retirement of anaesthetists. Attitudes in Yorkshire. Anaesthesia 1980. link 58 Holmberg PC. Central nervous defects in two children of mothers exposed to chemicals in the reinforced plastics industry. Chance or a causal relation?. Scandinavian journal of work, environment & health 1977. link 59 Gamberale F, Annwall G, Olson BA. Exposure to trichloroethylene III. Psychological functions. Scandinavian journal of work, environment & health 1976. link

    Original source

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      Examiner workload comparison: three structured oral examination formats for the European diploma in anaesthesiology and intensive care. — Dziadzko M, Varvinskiy A, Di Loreto R, Scipioni H, Ateleanu B, Klimek M et al. Medical education online (2024)
    2. [2]
      Influence of pairing in examiner leniency and stringency ('hawk-dove effect') in part II of the European Diploma of Anaesthesiology and Intensive Care: A cohort study. — Sciberras S, Klimek M, Ateleanu B, Scipioni H, Di Loreto R, Berger-Estilita J European journal of anaesthesiology (2024)
    3. [3]
      Audio podcast and procedural video use in anaesthesiology and intensive care: A nationwide survey of Swedish anaesthetists. — Bjurström MF, Borgquist O, Kander T, Lundén R, Fagerlund MJ, Lipcsey M et al. Acta anaesthesiologica Scandinavica (2024)
    4. [4]
      A consensus statement on the meaning, value and utility of training programme outcomes, with specific reference to anaesthesiology: A consensus statement on training programme outcomes. — Shorten G, Bahrey L, Bardia A, De Hert S, Guasch E, Holmboe E et al. European journal of anaesthesiology (2023)
    5. [5]
      Academic anaesthesiology: a global perspective on training, support, and future development of early career researchers. — Stundner O, Adams MCB, Fronczek J, Kaura V, Li L, Allen ML et al. British journal of anaesthesia (2023)
    6. [6]
      On-Line Assessment (OLA) as a preparation for the European Diploma in Anaesthesiology and Intensive Care (EDAIC), a retrospective observational study on the results and the potential impact on the Part-I examination. — Brogly N, Varvinskiy A, Varosyan A, Ateleanu B, Engelhardt W, Geldner G et al. Revista espanola de anestesiologia y reanimacion (2022)
    7. [7]
      Short-Term Risk of Unintentional Poisoning After New Initiation of Central Nervous System Medications in Swedish Older Adults: A Register-Based Case-Crossover Study. — Zhao Y, Liang Y, Laflamme L, Rausch C, Johnell K, Möller J Drug safety (2022)
    8. [8]
      Operative Vaginal Birth: ACOG Practice Bulletin, Number 219. Obstetrics and gynecology (2020)
    9. [9]
      Operative Vaginal Birth: ACOG Practice Bulletin Summary, Number 219. Obstetrics and gynecology (2020)
    10. [10]
      Gender differences in Anaesthesiology. At what point do we find ourselves in Spain? Results from a Spanish survey. — Aliaño M, Franco G, Gilsanz F Revista espanola de anestesiologia y reanimacion (2020)
    11. [11]
      Gender distribution in United States anaesthesiology residency programme directors: trends and implications. — Gonzalez LS, Fahy BG, Lien CA British journal of anaesthesia (2020)
    12. [12]
      Unusual mechanical complications of central venous catheterization. — Katrancioglu N Saudi medical journal (2019)
    13. [13]
      Unravelling residents' and supervisors' workplace interactions: an intersubjectivity study. — Olmos-Vega FM, Dolmans DH, Guzmán-Quintero C, Stalmeijer RE, Teunissen PW Medical education (2018)
    14. [14]
      Performance Characteristics of Cerebrospinal Fluid Cytology: An Analysis of Responses From the College of American Pathologists Nongynecologic Cytopathology Education Program. — Tabatabai ZL, Auger M, Souers RJ, Teot L, Davey DD Archives of pathology & laboratory medicine (2018)
    15. [15]
      Usefulness of new method of central venous catheter securement using a continuous suture. — Moon J, Cho SU, Lee JW, Ryu S, Cho YC, Jeong WJ et al. The American journal of emergency medicine (2017)
    16. [16]
      Pain Assessment and Treatment in Children With Significant Impairment of the Central Nervous System. — Hauer J, Houtrow AJ Pediatrics (2017)
    17. [17]
      Transforming the learning outcomes of anaesthesiology training into entrustable professional activities: A Delphi study. — Wisman-Zwarter N, van der Schaaf M, Ten Cate O, Jonker G, van Klei WA, Hoff RG European journal of anaesthesiology (2016)
    18. [18]
      Perceptions of house officers working in hospitals of Lahore about joining the field of anaesthesiology as a career. — Anjum S, Mahboob U JPMA. The Journal of the Pakistan Medical Association (2016)
    19. [19]
      Prescription of potentially inappropriate medication in Korean older adults based on 2012 Beers Criteria: a cross-sectional population based study. — Nam YS, Han JS, Kim JY, Bae WK, Lee K BMC geriatrics (2016)
    20. [20]
      The Evolving Role of Midwives as Laborists. — DeJoy SA, Sankey HZ, Dickerson AE, Psaltis A, Galli A, Burkman RT Journal of midwifery & women's health (2015)
    21. [21]
      Safety-II and resilience: the way ahead in patient safety in anaesthesiology. — Staender S Current opinion in anaesthesiology (2015)
    22. [22]
      Oblique-axis vs. short-axis view in ultrasound-guided central venous catheterization. — Wilson JG, Berona KM, Stein JC, Wang R The Journal of emergency medicine (2014)
    23. [23]
      Evidence-based practice for intrapartum care: the Pearls of Midwifery. — King TL, Pinger W Journal of midwifery & women's health (2014)
    24. [24]
      Moving forward in patient safety: multidisciplinary team training. — Daniels K, Auguste T Seminars in perinatology (2013)
    25. [25]
      Gender disparity among US anaesthesiologists: are women underrepresented in academic ranks and scholarly productivity? — Pashkova AA, Svider PF, Chang CY, Diaz L, Eloy JA, Eloy JD Acta anaesthesiologica Scandinavica (2013)
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      Three-step method for ultrasound-guided central vein catheterization. — Tokumine J, Lefor AT, Yonei A, Kagaya A, Iwasaki K, Fukuda Y British journal of anaesthesia (2013)
    27. [27]
      A potential early physiological marker for CNS oxygen toxicity: hyperoxic hyperpnea precedes seizure in unanesthetized rats breathing hyperbaric oxygen. — Pilla R, Landon CS, Dean JB Journal of applied physiology (Bethesda, Md. : 1985) (2013)
    28. [28]
      Harmonisation of anaesthesiology training in Europe. — Van Gessel EF, Ostergard HT, Niemi-Murola L Best practice & research. Clinical anaesthesiology (2012)
    29. [29]
      Dual practitioners are as engaged in their primary job as their senior colleagues. — Socha K, Bech M Danish medical journal (2012)
    30. [30]
      Validation of core competencies during residency training in anaesthesiology. — Ortwein H, Knigge M, Rehberg B, Hein OV, Spies C German medical science : GMS e-journal (2011)
    31. [31]
      H-index is a sensitive indicator of academic activity in highly productive anaesthesiologists: results of a bibliometric analysis. — Pagel PS, Hudetz JA Acta anaesthesiologica Scandinavica (2011)
    32. [32]
      Simulation-based objective assessment discerns clinical proficiency in central line placement: a construct validation. — Dong Y, Suri HS, Cook DA, Kashani KB, Mullon JJ, Enders FT et al. Chest (2010)
    33. [33]
      Clinical disagreements during labor and birth: how does real life compare to best practice? — Simpson KR, Lyndon A MCN. The American journal of maternal child nursing (2009)
    34. [34]
      Team approach to care in labor and delivery. — Mann S, Pratt SD Clinical obstetrics and gynecology (2008)
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      Evidence-based labor and delivery management. — Berghella V, Baxter JK, Chauhan SP American journal of obstetrics and gynecology (2008)
    36. [36]
      Pai syndrome: first patient with agenesis of the corpus callosum and literature review. — Castori M, Rinaldi R, Bianchi A, Caponetti A, Assumma M, Grammatico P Birth defects research. Part A, Clinical and molecular teratology (2007)
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      Charter on continuing medical education/continuing professional development approved by the UEMS Specialist Section and European Board of Anaesthesiology. — Alahuhta S, Mellin-Olsen J, Blunnie WP, Knape JT European journal of anaesthesiology (2007)
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      Fostering harmony in labor and delivery: a nursing preceptorship for clinical clerks. — Skoll MA, Dueckman R, Liston R Obstetrics and gynecology (2006)
    39. [39]
      Defining professionalism in anaesthesiology. — Kearney RA Medical education (2005)
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      Central nervous system aspergillosis in an immunocompetent patient: cure in a hospice setting with very high-dose itraconazole. — Palanisamy A, Chao SD, Fouts M, Kerr D The American journal of hospice & palliative care (2005)
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      Scandinavian research in anaesthesiology 1981-2000: visibility and impact in EU and world context. — Skram U, Larsen B, Ingwersen P, Viby-Mogensen J Acta anaesthesiologica Scandinavica (2004)
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      The effect of in-training assessment on clinical confidence in postgraduate education. — Ringsted C, Pallisgaard J, Østergaard D, Scherpbier A Medical education (2004)
    43. [43]
      Job satisfaction, stress and burnout in Australian specialist anaesthetists. — Kluger MT, Townend K, Laidlaw T Anaesthesia (2003)
    44. [44]
      Historical controversy in health technology assessment: the case of electronic fetal monitoring. — Banta DH, Thacker SB Obstetrical & gynecological survey (2001)
    45. [45]
      Neurointerventional procedures in the pediatric age group. — terBrugge KG Child's nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery (1999)
    46. [46]
      Stereotactic brain biopsies: specimen preparation and evaluation. — Burger PC, Nelson JS Archives of pathology & laboratory medicine (1997)
    47. [47]
      Evaluation of the clinical safety of gadodiamide injection, a new nonionic MRI contrast medium for the central nervous system: a European perspective. — Aslanian V, Lemaignen H, Bunouf P, Svaland MG, Borseth A, Lundby B Neuroradiology (1996)
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      Importance of components of the curriculum vitae in determining appointment to senior registrar posts. — Conn DA, Asbury AJ Anaesthesia (1994)
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      Management of normal labor and birth. — Scherger JE Primary care (1993)
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      A twenty-year retrospective analysis of the efficacy of epidural analgesia-anesthesia when administered and/or managed by obstetricians. — Farabow WS, Roberson VO, Maxey J, Spray BJ American journal of obstetrics and gynecology (1993)
    51. [51]
      Absence of the septum pellucidum and related disorders. — Kuhn MJ, Swenson LC, Youssef HT Computerized medical imaging and graphics : the official journal of the Computerized Medical Imaging Society (1993)
    52. [52]
      A critical review of labor and birth care. Obstetrical Interest Group of the North American Primary Care Research Group. — Smith MA, Acheson LS, Byrd JE, Curtis P, Day TW, Frank SH et al. The Journal of family practice (1991)
    53. [53]
      The European diploma in anaesthesiology and intensive care. — Zorab JS Acta anaesthesiologica Scandinavica (1988)
    54. [54]
      Permanent pacemaker failure due to surgical emphysema. — Smith SA, Weissberg PL, Tan LB British heart journal (1985)
    55. [55]
      Education for leadership in anaesthesiology. The sixteenth Husfeldt lecture, Copenhagen, 11 May, 1984. — Papper EM Acta anaesthesiologica Scandinavica (1985)
    56. [56]
      Hydrocephalus, agyria, pseudoencephalocele, retinal dysplasia, and anterior chamber anomalies. — Winter RM, Garner A Journal of medical genetics (1981)
    57. [57]
      Retirement of anaesthetists. Attitudes in Yorkshire. — Smith WD Anaesthesia (1980)
    58. [58]
      Central nervous defects in two children of mothers exposed to chemicals in the reinforced plastics industry. Chance or a causal relation? — Holmberg PC Scandinavian journal of work, environment & health (1977)
    59. [59]
      Exposure to trichloroethylene III. Psychological functions. — Gamberale F, Annwall G, Olson BA Scandinavian journal of work, environment & health (1976)
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