ABSTRACT
Cerebral vasospasm considered to be a serious cause of morbidity and mortality following subarachnoid haemorrhage [SAH].Despite several available therapeutic options, current protocols do not prevent major consequences of vasospasm. Inflammation is believed to play an important role in post-haemorrhagic vasospasm. Meloxicam is a non-steroidal anti-inflammatory drug. The aim of this study was to compare the efficacy of meloxicam versus placebo on vasospasm in patients with SAH. In this randomized, double-blind, placebo-controlled trial, SAH patients randomly received 7.5 mg meloxicam or placebo twice daily for 7 days. End points were, middle cerebral artery velocity obtained with transcranial doppler, in-hospital mortality, hospital stay and discharge Glasgow Outcome Scale. Eighty-one patients enrolled in the study. [40 received meloxicam, 41 received placebo]. Baseline characteristics were similar between the groups. There were no differences in length of hospitalization [17.4 +/- 3.1 vs 18.6 +/- 4.2 days; p = 0.145], in-hospital mortality rate [15 vs 22%; p-value=0.569], or GOS [p = 0.972] between the two groups. MCA velocity were slightly less in patients who had received meloxicam, but not to a significant degree [p-value=0.564[. No side effect has been detected for meloxicam. This study did not prove meloxicam efficacy in vasospasm of SAH patients. But it demonstrated that clinical trial of meloxicam in these patients is feasible and probably safe. The effectiveness of meloxicam on cerebral vasospasm has to be studied in larger trials
Subject(s)
Humans , Female , Male , Thiazoles , Placebos , Vasospasm, Intracranial , Subarachnoid Hemorrhage , Double-Blind MethodABSTRACT
Guillain Barre Syndrome [GBS] is an inflammatory, usually demyelinating, polyneuropathy; clinically characterized by acute onset of symmetric progressive muscle weakness with loss of myotatic reflexes. Thirty five patients with GBS, defined clinically according to the criteria of Asbury and Cornblath, were recruited from three hospital affiliated to Tehran University of Medical Sciences. Controls: As a control group 35 age and sex matched patients with other neurological diseases admitted to the same hospital at the same time, were included in our study. Serum samples were collected before treatment from each patient [within 4 weeks after the disease onset] and controls, and stored frozen at -80°C until serologic assays were done. Serologic testing of pretreatment serum was performed in all patients. Positive titer of virus specific IgM antibody against cytomegalovirus [CMV] was found in 6 cases and 2 controls. 34 patients and 31 controls had high titer of anti Haemophilus influenzae IgG and one patient had serologic evidence of a recent Epstein Barr virus [EBV] infection. The mean titer of IgG antibody against Haemophilus influenzae in cases and controls was 5.21 and 2.97 respectively. Although serologic evidence of all these infections were more frequent in cases than in controls, only Haemophilus influenzae infection appeared to be significantly related to GBS [P=0.002]. Eleven cases and 3 controls had high titers of IgG antibody against Haemophilus influenzae type B [titer >8]. There is significant association between high titer of IgG antibody against Haemophilus influenzae and GBS [MX017]. Our results provide further evidence that Haemophilus influenzae and probably CMV, can be associated with GBS
ABSTRACT
The authors present a rare case of lumbar vertebral hemangioma extending to the epidural space with a bisected appearance and impinging on thecal sac. This 52-year-old lady presented with one year history of low back pain and bilateral leg radiation. Plain radiography showed vertical linear streaks at L2 vertebral body and axial computed tomography [CT] scan revealed small "polka dot" appearance within the vertebral body. Magnetic resonance imaging [MRI] showed low signal intensity on T1-weighted images in L2 vertebral body which was not characteristic for hemangioma. The patient underwent an L2 laminectomy, spinal canal decompression and posterior spinal instrumentation. This study indicates that lumbar vertebral hemangioma can extend to the epidural space and cause neurologic symptoms. Magnetic resonance imaging may not show diagnostic features, especially in active lesions and plain radiography and CT scan may be helpful