Lumbo-peritoneal shunting improved spinal cord compression due to a large anterior sacral meningocele.

OBJECTIVE: Lumbo-peritoneal shunt was used as an alternative treatment in a large anterior sacral meningocele, a rare congenital malformation, is illustrated. CLINICAL PRESENTATION: A 48-year-old female patient presented with a two-month history of progressive paraparesis, leg pain and numbness of both legs. The investigation demonstrated spina bifida with a huge sac of meningocele, protruding anteriorly into the pelvic cavity. On two previous surgical operations for closure, the fistula through the posterior transsacral approach failed 20 years ago at another hospital, but her symptoms had subsided spontaneously without explanation. She came to Thammmasat Hospital with an episode of spinal cord compression for 2 months. MANAGEMENT: Because of the old surgical scar and high pressure of the meningocele, a lumbo-peritoneal shunt was selected to drain the cerebrospinal fluid from the meningocele to the peritoneal cavity. CONCLUSION: Lumbo-peritoneal shunting is an optional treatment for a large sacral meningocele, especially in a large fistula with unsuccessful surgical closure.

Ecstasy (MDMA) ingestion related with severe hyponatremia in patients with mild head injury.

The occurrence of severe hyponatremia is an unusual complication in patients with a mild head injury. Between December 2001 and January 2003, 1147 patients with a mild head injury were reviewed Only patients who presented with deterioration of consciousness or seizure due to hyponatremia, confirmed by serum investigation, were further evaluated, presenting features and clinical courses. The results revealed only 3 patients developed severe hyponatremia following a mild head injury. Surprisingly, all of them had a recent history of ecstasy (MDMA) use, as well as hyponatremia which didn't develop until the episode of a mild head injury. In the present report, the associated mechanisms of both conditions of severe hyponatremia are discussed and the literature is reviewed.