Effects of dexamethasone in primary intracerebral hemorrhage in the south west of Iran

Previous study revealed the value of dexamethasone in the treatment of vasogenic edema associated with brain tumor and abscess. However there are poor documented studies about its usefulness in primary intracerebral hemorrhage. In this study we evaluated dexamethasone effects in primary intracerebral hemorrhage. In a double blind randomized placebo-controlled clinical trial we evaluated 200 intracerebral hemorrhage cases between 40 to 80 years old whom were admitted at Golestan Hospital [Ahwaz, IR] between March 2002 And March 2003. They were divided in two groups; dexamethasone [N=100] and placebo [N=100]. Then mortality, GI bleeding, fever, electrolytes disturbances, hypertension and hyperglycemic status were analyzed in two groups. Ethical considerations were employed and subjects were followed by appropriate statistical methods for 21 days to assess the major outcomes. Mortality was much higher in the dexamethasone group; Dexamethasone group [49.3%] and placebo [23.4%] and also fever was higher seen in the dexamethasone group; dexamethasone group [40.2%] and placebo group [24.7%] but there was not any significant statistical difference between two groups as regards other complications. Dexamethasone is widely used for cerebral edema associated conditions but in this study we saw that it's complications in intracerebral hemorrhage such as increasing fever and mortality are significantly higher. Hence it use for treatment of primary intracerebral hemorrhage should be reconsidered

case of neurobrucellosis mimicking Guillain-barre syndrome

Brucellosis is an infectious disease due to Gram negative bacteria of genus brucella. Involvement of different systems including gastrointestinal tract, the hepatobilliary and skeletal systems has been frequently reported. Involvement of nervous system is not common, and its incidence has been reported to be 3-25% of the cases of generalized brucellosis. In this study, we report a case of Guillain-barre syndrome as an infrequent presentation of neurobrucellosis. A 28-year-old man is reported, who was referred because of acute progressive flaccid paraplegia, ataxia and areflexia. Electrophysiological and cerebrospinal fluid study was identical to Guillain- barre syndrome. Anti- brucella antibody [ELISA] in cerebrospinal fluid, and serum Wright and 2ME tests were positive. The patient underwent plasmaphresis for 7 times with 1.5 lit of plasma per day, but without favorite clinical response. By identification of neurobrucellosis, antimicrobial therapy with Doxycycline, Rifampin and Co-trimoxazole was started. He showed considerable recovery 3 months latter. Brucellosis is considered as a new etiologic agent for Guillain - barre syndrome. In endemic region, neurobrucellosis must be considered in any patient with Guillain- barre syndrome