Tuberculosis of the skull

Twenty-two cases to tuberculosis of the skull (14% of 156 cases of chronic osteomyelitis) verified by demonstration of tubercle bacilli in the discharge of cutaneous sinuses or histological examination of bone or granulation tissue are reported. Most of these patients had multiple operations elsewhere and non-healing sinuses. Three types of radiological lesion were noticed; circumscribed lytic, diffuse lytic and circumscribed sclerotic. Surgical treatment was followed by antituberculous therapy for at least 18 months. Results were excellent.

Plasma biogenic amines in head injury

The circulating levels of plasma catecholamines (norepinephrine and epinephrine) and serotonin (5-HT) were estimated in 65 cases of head injury. The plasma levels of these amines of patients were compared with those of normal healthy volunteers. The levels were significantly higher in severe head injuries as compared to mild injuries and have prognostic significance.

Cerebral oedema and blood-brain and blood-CSF barriers in experimental brain trauma: effect of indomethacin-A prostaglandin synthetase inhibitor

Cerebral oedema often occurs following trauma to the brain. Recently several biogenic amines have been suggested for their possible mediation in the pathophysiology of traumatic brain oedema. The present investigation indirectly indicates that prostaglandins of E series are also involved in the etiology of cerebral oedema, since administration of a potent PG synthetase inhibitor, indomethacin significantly diminished oedematous swelling of traumatised rat brain.

Recurrent oculomotor palsy due to haemorrhage in pituitary adenoma

Haemorrhage in pituitary adenoma is an unusual cause of recurrent oculomotor palsy. Three episodes of right oculomotor palsy are reported from a patient having haemorrhage in pituitary adenoma. Early operation and decompression of haemorrhagic pituitary adenoma should be performed so that vision may be preserved and recovery of oculomotor palsy be assured.

Radiation myelopathy

Five cases of radiation myelopathy were found in a total of 10,000 cases given radiotherapy from 1968 to 1977. The clinical presentation and treatment details including the total dose, treatment volume, number of fractionations, overall time, and the RET value at the spinal cord were calculated and compared with other reports on this subject. The total number of fractionations ranged from 20 to 26 with an overall time of 32 days to 37 days. The dose received by four patients ranged from 1030 to 1900 RET, a little higher than the tolerance level of the spinal cord as compared to reported values. Two patients in this series had high blood pressure. The incidence of radiation myelopathy, already acceptably low, could possibly be reduced further by meticulous planning of radiation.

Intradural enterogenous cyst

A 23 year old woman with an intradural extramedullary enterogenous cyst in the cervical region, unassociated with vertebral cleft, presented with two episodes of neurological disturbance at an interval of five years. Subtotal excision of the anteriorly placed cyst at C6 vertebral level was followed by rapid and complete recovery.

Tuberculous abscess of the brain

A bacteriologically confirmed case of tuberculous abscess of the brain is reported. Tuberculous brain abscess unlike tuberculoma does not exhibit the typical granulomatous changes and the diagnosis is confirmed by demonstration of tubercle bacilli either by staining or culture. An antituberculous regime should be started immediately the diagnosis has been established.

Predictive value of serum lactate dehydrogenase in head injury

Serum total lactate dehydrogenase (LDH) was estimated serially for up to 15 days in 110 patients with head injuries who had no extraneural injury. Increase in LDH activity generally indicated the degree of parenchymal brain damage. The prognostic value of LDH was established by correlating its activity with clinical criteria such as duration of unconsciousness and post-traumatic amnesia, type of brain damage, and quality of survival. A significant rise in LDH activity suggested severe brain damage and poor prognosis.

Haemorrhage into pituitary adenomas

Seventy cases of pituitary adenoma were analysed for evidence of haemorrhage. It was present in 18 cases. These are classified into four groups, acute, acute on chronic, chronic, and late sequelae of pituitary apoplexy, and an example of a patient in each group is given. The diagnosis and management are discussed.

A large cirsoid aneurysm of the scalp associated with epilepsy

A large cirsoid aneurysm of the scalp that was present since birth in a 1 1/2 year old baby is reported. For six months the patient had been suffering from generalized seizures and mental retardation. After excision of the aneurysm, the patient became seizure free.