Lymphocytic infundibulo- neurohypophysitis with hypothalamic and optic pathway involvement: report of a case and review of the literature.

BACKGROUND: Lymphocytic adenohypohysitis and lymphocytic infundibulo-neurohypophysitis are rare auto-immune mediated diseases of the anterior and posterior pituitary, respectively. The former usually manifests as insufficiency of anterior pituitary hormone secretion, associated in many patients with disturbances of vision. The latter presents as diabetes insipidus of central origin. They present most commonly in pregnant or postpartum females. There have been infrequent reports in females with no association with pregnancy, and in males. CASE DESCRIPTION: We present a nulliparous female with central diabetes insipidus, pan-hypopituitarism, and severely impaired vision. Magnetic resonance imaging demonstrated a large mass involving the hypothalamus, infundibulum, optic nerves, chiasm, and tracts. At operation, the optic pathways were found to be grossly involved in the inflammatory mass. Histological examination of a biopsy demonstrated a nonspecific, mixed inflammatory infiltrate, composed predominantly of lymphocytes and plasma cells. She responded dramatically to treatment with dexamethasone, with disappearance of the mass on serial imaging studies and improvement in vision. In addition, she received hormone replacement therapy. CONCLUSION: We present a case of lymphocytic infundibulo-neurohypophysitis unique in the degree of optic pathway inflammatory involvement, with a documented response to steroids.

Meningitis following fractures of the paranasal sinuses: accurate, non-invasive localization of the dural defect by direct coronal computed tomography.

A consecutive series of 30 patients admitted with non-meningococcal meningitis is presented. In all there was a history of preceding head injury. All 30 patients were investigated by direct coronal computed tomography (CT) scan to determine whether or not a site of fracture into a paranasal air sinus could be demonstrated. We postulated that such a fracture would correspond to the site of a dural tear. Direct coronal CT demonstrated a fracture in all patients, and this corresponded to the site of a dural tear at operation in every case in which an operation was carried out (28 out of the 30 patients). We propose that this method of investigation is superior to other techniques that have been, or are currently, employed in this clinical situation.

Attitudes and prognosis in chronic low back pain.

Eighteen patients with chronic low back pain were interviewed before and after a programme of conservative treatment and again 4 months later. Measures were made of severity and attitude towards disability, including the Kelly Repertory Grid. The best predictor of improvement was the degree of meaningfulness of the concept 'self in pain' as measured by the Repertory Grid.

Brain stem tuberculoma in adult patients: diagnosis and treatment.

A consecutive series of six adult patients ranging in age from 29 to 53 years is presented. The clinical and radiological features in each patient are described. Attention is drawn to the features demonstrated on computed axial tomography. In only one patient, the first encountered, was surgical excision undertaken and histological verification obtained. One patient died before any form of treatment could be instituted. The remaining four patients were treated with antituberculous chemotherapy alone and their progress monitored by sequential computed tomography. The excellent response and good outcome in this conservatively treated group are documented.

The relationship of antibody levels to the clinical spectrum of human neurocysticercosis.

One hundred proven cases of cerebral cysticercosis were studied with an enzyme linked immunoassay (ELISA) employing cyst fluid as antigen, with a view to detecting specific antibodies in serum and cerebrospinal fluid (CSF). Antibody levels were correlated with the clinical presentation of the patients, the type and number of cysts detected on their brain scans, the anatomical position of these cysts and the presence of lymphocytes in the CSF. Patients could be divided into two distinct categories, one with low levels of antibody in the serum and absent antibody in the CSF, and the other with high levels in both the serum and the CSF. This differentiation matched the clinical presentation of a benign and a malignant group. Antibody levels could not be related to the type of cysts as observed on the brain scan, but depended on the anatomical position of the cyst, being lower if the cysts were confined to the cerebral cortex. A correlation of antibody levels with the number of cysts was only found in the benign group.

Prevalencia de los anticuerpos contra el virus A de la hepatitis (VAH) en donantes de sangre de 13 países y territorios del hemisferio occidental / Prevalence of antibodies to hepatitis A virus (HAV) in blood donors of 13 Western Hemisphere countries and territories

Los resultados de una encuesta con 7.342 muestras de sangre de 13 países y territorios de las Américas indican una elevada prevalencia de los anticuerpos contra el virus A de la hepatitis en esa Región. Los resultados señalan también una correlación significativa entre la ausencia de dichos anticuerpos y la ausencia de marcadores indicativos de infección por el virus B de la hepatitis (AU)

Prevalencia de los anticuerpos contra el virus A de la hepatitis (VAH) en donantes de sangre de 13 países y territorios del hemisferio occidental / Prevalence of antibodies to hepatitis A virus (HAV) in blood donors of 13 Western Hemisphere countries and territories

Los resultados de una encuesta con 7.342 muestras de sangre de 13 países y territorios de las Américas indican una elevada prevalencia de los anticuerpos contra el virus A de la hepatitis en esa Región. Los resultados señalan también una correlación significativa entre la ausencia de dichos anticuerpos y la ausencia de marcadores indicativos de infección por el virus B de la hepatitis (AU)