Screening for hypopituitarism in 509 patients with traumatic brain injury or subarachnoid hemorrhage.

We performed a screening on patients with traumatic brain injury (TBI) or subarachnoid hemorrhage (SAH) to determine the prevalence of post-traumatic hypopituitarism in neurorehabilitation in a cross-sectional, observational single-center study. In addition, the therapeutic consequences of our screening were analyzed retrospectively. From February 2006 to August 2009, patients between 18 and 65 years (n=509) with the diagnosis of TBI (n=340) or SAH (n=169) were screened within two weeks of admittance to neurorehabilitation as clinical routine. Blood was drawn to determine fasting cortisol, free thyroxine (fT4), prolactin, testosterone or estradiol, and insulin-like growth factor I (IGF-I). Patients with abnormalities in the screening or clinical signs of hypopituitarism received further stimulation tests: growth hormone releasing hormone -L-arginine-test and adrenocorticotrophic hormone (ACTH)-test (n=36); ACTH-test alone (n=26); or insulin tolerance test (n=56). In our screening of 509 patients, 28.5% showed lowered values in at least one hormone of the hypothalamus-pituitary axis and 4.5% in two or more axes. The most common disturbance was a decrease of testosterone in 40.7% of all men (in the following 13/131 men were given substitution therapy). Low fT4 was detected in 5.9% (n=3 were given substitution therapy). Low IGF-I was detected in 5.8%, low cortisol in 1.4%, and low prolactin in 0.2%; none were given substitution therapy. Further stimulation tests revealed growth hormone deficiency in 20.7% (n=19/92) and hypocortisolism in 23.7% (n=28/118). Laboratory values possibly indicating hypopituitarism (33%) were common but did not always implicate post-traumatic hypopituitarism. Laboratory values possibly indicating hypopituitarism were common in our screening but most patients were clinically not diagnosed as pituitary insufficient and did not receive hormone replacement therapy. A routine screening of all patients in neurorehabilitation without considering the time since injury, the severity of illness and therapeutic consequences seems not useful.

Inhibitory and facilitatory location priming in patients with left-sided visual hemi-neglect.

In visual search for pop-out targets, reaction times are facilitated when the target on the current trial appears at a previous target location, and inhibited when it appears at a previous distractor location, relative to when it appears at a previously empty (neutral) location (Maljkovic and Nakayama, Perception and Psychophysics 58:977-991, 1996). However, while normal subjects are able to positively/negatively tag selected target/rejected distractor locations to guide search on the next trial, patients with visual hemi-neglect may have a (uni- or bilateral) deficit in these functions that may contribute to their disturbed visual scanning behavior. To examine this, using a pop-out search task, the present study assessed cross-trial facilitatory and inhibitory priming in 14 patients with left-sided visual hemi-neglect and in 14 age-, education-, and IQ-matched control subjects. The group of neglect patients did show significant facilitatory and inhibitory priming. However, while control subjects exhibited balanced effects of facilitation and inhibition, inhibition was relatively reduced in magnitude in neglect patients. In particular, inhibition was virtually absent in two patients with lesions affecting superior regions of the frontal cortex, putatively encroaching on the frontal eye field of the right hemisphere. These findings provide neuropsychological evidence that facilitatory and inhibitory priming effects are based on dissociable mechanisms, consistent with Geyer et al. (Journal of Experimental Psychology: Human Perception and Performance 33:788-797, 2007).