Pituitary function impairment after moderate traumatic brain injury.

To determine the prevalence of pituitary hormone deficiencies after moderate traumatic brain injury (TBI). We conducted a prospective cohort and included 75 patients with moderate TBI with GCS between 9 and 13 who referred to emergency department of Shariati Hospital, Tehran/Iran, during 2004-2007. Pituitary hormones were assessed 3 and 6 months after injury. In 3(rd) month post-injury, 39 cases had not any pituitary dysfunction; however, deficiencies in one, two and three of the pituitary hormones were found in 26, 8 and 2 patients, respectively. Twenty one patients showed a deficiency in one of the pituitary hormones and only one case with deficiency of two after 6 months. The most prevalent changes occur in IGF-1 and LH/FSH after moderate TBI. However, the whole deficiencies decrease over the time.

Cerebral tuberculoma in pregnancy: overview of the literature and report of a case.

Tubercle bacilli infect about one third of the world's population and over the past decade resurgence of tuberculosis has been a major health threat mainly due to increasing frequencies of immunosuppressive states and drug-resistant organisms. Although tuberculosis is essentially a lung disease, intracranial elements become involved in 5-10% of cases either as meningitis or tumour-like masses (tuberculoma). Tuberculoma is common in endemic areas but its occurrence during pregnancy is occasional and of particular interest is its intriguing clinical picture mimicking toxemia of pregnancy and brain tumor. In addition, the effects of pregnancy on tuberculosis or vice versa have been controversial. We present here a review of the recent literature and discuss a case coming to medical attention with manifestations of intracranial hypertension during 2 consecutive pregnancies; 4 years apart. On operation a dura-attached mass was detected that proved to be a tuberculoma. After 18 months of close observation and under drug therapy she obviously improved with no ensuing complication. Immunodeficiency state associated with pregnancy is likely to play a role in activation of infection. Tuberculoma should be considered in differential diagnosis of eclampsia and brain mass particularly in women coming from endemic areas for this infection even in the absence of pulmonary involvement.

Osteoid osteoma of the first 2 cervical vertebrae. Report of 4 cases.

Osteoid osteoma affects the spine in only 10% of cases. More than 50% of the spinal cases involve the lumbar and cervical vertebrae. Involvement of C-1 and C-2 vertebrae has previously been reported only very rarely in the published literature. The authors report 4 cases of upper cervical osteoid osteoma, 1 involving C-1 and the other 3 C-2, and they discuss different aspects of management in similar cases. The patients were 14, 17, 35, and 46 years old, and all presented with neck pain and various degrees of painful limitation of head rotation not ameliorated by ordinary analgesics. Radionuclide isotope bone scans, CT scanning, and MR imaging were helpful preoperative diagnostic modalities. The first attempt at eradication of the lesions failed in 2 cases and the lesions could be excised totally at a second approach. Postoperatively, the patients all became pain free and gained full range of neck motion. There has been no tumor recurrence and no sign of instability in short- to medium-term follow-up. Among the several etiologies mentioned for neck pain and torticollis, osteoid osteoma of the first 2 cervical vertebrae should be considered as a possible but rare cause. Even though different kinds of management have been mentioned for osteoid osteoma, resection of the lesion remains the best option for achieving a cure.

The prenatal ultrasonographic detection of myelomeningocele in patients referred to Children's Hospital Medical Center: a cross sectional study.

BACKGROUND: To find out about the prenatal diagnosis rate of myelomeningocele (MMC) by ultrasound scan in patients referred to the Children's Hospital Medical Center in Tehran, Iran from July 2004 to July 2005. METHODS: We included 140 children born with MMC and who were referred for management, surgery and treatment of complications associated with it. The ultrasound reports were examined. Data on sex, age, location of MMC, time of prenatal ultrasound and the trimester in which the diagnosis was made along with the results of the diagnosis (MMC, hydrocephalus, or both), were collected. RESULTS: Among the studied patients, 136 (97.1%) cases had prenatal ultrasound, amongst those, 58 (42.6%) sonographic evaluations were diagnostic for hydrocephalus and/or MMC. The prenatal ultrasound was positive for MMC in 16 (11.8%), hydrocephalus in 25 (18.4%) and both MMC and hydrocephalus in 17 (12.5%) cases. Among all cases with prenatal diagnosis of MMC, 3.4% were detected in the first, 31% in the second and 65.5% in the third trimester. Thoracic/thoracolumbar lesions were found prenatally in 40% of cases, which is significantly higher than the detection rate of other locations including cervical/cervicothoracic and lumbar/lumbosacral/sacral regions diagnosed only in 0% and 21% of cases respectively. CONCLUSION: There is a large difference between the detection rate of our population (24.3%) compared to others (68%). Pregnant women should have an ultrasound at 20-22 week for detection of congenital anomalies including MMC.