ABSTRACT
Although hypopituitarism is a known complication of traumatic head injury, it may be under-recognized due to its subtle clinical manifestations. To address this issue, we determine the prevalence of neuroendocrine abnormalities in patients rehabilitating from severe traumatic brain injury (Glasgow Coma Scale < or = 8). 76 patients (mean age 39 +/- 14 yr; range 18-65; 53 males and 23 females; BMI 25.8 +/- 4.2 kg/m2; mean +/- SD) with a severe traumatic brain injury, an average of 22 +/- 10 months before this study (median, 20 months), underwent a series of standard endocrine tests, including TSH, free T4, T4, T3, prolactin, testosterone (males), estradiol (females), cortisol, ACTH, GH, and IGF-I. All subjects also underwent GH response to GHRH + arginine. Growth hormone deficiency (GHD) was defined as a GH response < 9 microg/L to GHRH + arginine and was confirmed by ITT (< 3 microg/L). Pituitary deficiency was shown in 24% of the patients (18/76). 8% (n = 6) had GHD (GH-peak range [GHRH + arginine]: 2.8-6.3 microg/L; GH-peak range [ITT]: 1.5-2.2 microg/L; IGF-I range: 62-174 microg/L). 17% (n = 13) had hypogonadism (total testosterone < 9.5 nmol/L and low gonadotropins in 12 males; low estradiol, and low gonadotropins in 1 female). Total testosterone levels did not correlate with BMI or age. 2 males with hypogonadism also showed a mild hyperprolactinemia (33 and 41 ng/ml). 3% (n = 2) patients had partial ACTH-deficiency (cortisol-peak [ITT] 392 and 417 nmol/L) and 3% (n = 2) had TSH-deficiency. In summary, we have found hypopituitarism in one-fourth of patients with predominantly secondary hypogonadism and GHD. These findings strongly suggest that patients who suffer head trauma must routinely include neuroendocrine evaluations.
Subject(s)
Brain Injuries/complications , Hypopituitarism/etiology , Adolescent , Adrenocorticotropic Hormone/deficiency , Adult , Aged , Female , Growth Hormone/deficiency , Humans , Hypogonadism/etiology , Male , Middle Aged , Prevalence , Prospective Studies , Thyrotropin/deficiencyABSTRACT
Relatively few departments of Music Therapy are found within neurosurgical rehabilitation clinics. In institutions where these departments exist, music therapy has become an integral part of multi-professional treatment and research activities (Gilbertson 1999). The diverse intervention strategies in Music Therapy focus upon auditory, motor, visual, cognitive and affective processing which are all involved in receptive and expressive musical behaviour and which affect related non-musical behaviour. A clear differentiation is made between primary and adjunct therapy roles. The related fields of neuromusicology, neuroanatomy, neuropsychology, music psychology and humanistic psychology are primary sources in the development of models of clinical application (Hodges 1996). Our main interests are focussed on the following issues and areas of clinical application: The initialisation of contact with patients in vegetative status Communicative interaction with patients who can not (initially) use verbal communication (aphasic disorders) Temporal motor organisation with patients with sensomotor disorders Cognitive organisation and mnemonic framework with patients with neuropsychological functional disorders (concentration, memory, perception) Treatment of spatial perception disorders (neglect) Enhancing personal and social integration following individual isolation, social withdrawal. These topics will be discussed and highlighted with clinical examples.
Subject(s)
Music Therapy , Nervous System Diseases/rehabilitation , Nervous System Diseases/surgery , Neurosurgical Procedures , Humans , Music Therapy/methodsABSTRACT
The indication for the transsphenoidal procedure in tumors of the sellar region is being presented. The authors prefer the transseptal - transsphenoidal approach after cut in the orifice of the nasal cavity. ENT-surgeon and neurosurgeon perform the operation together. Advantages and disadvantages as well as the necessity of the transfrontal operation on the one hand and the transnasal approach on the other hand are discussed. There were no severe complications in the cases jointly operated on and thus confirmed the results established by other authors.
Subject(s)
Hypophysectomy/methods , Pituitary Neoplasms/surgery , Sella Turcica/surgery , Humans , Nasal Septum/surgery , Sphenoid Sinus/surgeryABSTRACT
To estimate risks involved in x-ray diagnosis, it is useful to employ the concepts of organ dose and integral dose, whereas the surface dose should be considered as unsuitable. Although the methods of measurement differ from each other, they can lead to comparable results, as is demonstrated in this article, eg, for computerised tomography of the skull.
Subject(s)
Brain/diagnostic imaging , Radiation Monitoring/methods , Tomography, X-Ray Computed/methods , Brain/radiation effects , Humans , Radiation DosageABSTRACT
Most of the hypophyseal adenomas can be removed by extracranial operation techniques. The ENT specialist prepares the approach to the pituitary gland while the neurosurgeon will resect the adenoma after having given the indication for this procedure. In this paper special attention is called to one of the extracranial techniques i.e. the sublabial-transseptal-transsphenoidal approach in hypophysectomy. It seems to be more advantageous than the other because the pituitary gland can be exactly removed oppositely. By that way the damage of the sinus, the carotid artery or the optic nerve can be avoided. The possibility of perforation of the nasal septum, deformation of the nose or atrophic rhinitis is of small importance especially if the otorhinologist will prepare the extracranial part of the operation. Moreover the neurosurgeon meets with a great and clear operation area because the anterior wall of the sella turcica can be resected extremely. Besides further advantages discussed in the paper the transseptal-transsphenoidal approach is rather simple, distinct and shortens the operation time.
Subject(s)
Hypophysectomy/methods , Nasal Septum/surgery , Sphenoid Bone/surgery , Humans , Sella Turcica/surgeryABSTRACT
The study contributes to improve, audiological diagnostics of central auditory path lesions and attempts, through the comparison of audiological and neurosurgical findings of 15 patients, to refer certain auditory lesions caused by cerebral tumors to topodiagnostically characteristic audiological symptoms. The audiological findings obtained through 7 generally accepted test methods from 6 patients with an acusticus neurinoma indicate a labyrinthine but not a central symptomatic picture while 4 patients with a pontine-angle tumor present a chiefly central hearing defect which, as regards the constellation of findings, clearly differs from the central hearing defect of 3 patients with a pontine tumor. Two patients with tumors in the lateral ventricle area merely show, from the audiological point of view, a lack of contralateral dichotic discrimination.
Subject(s)
Brain Neoplasms/physiopathology , Cranial Nerve Neoplasms/physiopathology , Ear/physiopathology , Neuroma, Acoustic/physiopathology , Audiometry , Brain Neoplasms/complications , Cerebellopontine Angle , Cranial Nerve Neoplasms/complications , Hearing Disorders/etiology , Humans , Neuroma, Acoustic/complicationsABSTRACT
Alteration of the metabolism of calcium and phosphate may be associated with symmetric cerebral calcification. Detailed investigations of the function of parathyroid glands including computer tomography of the brain are so far missing. In 6 patients with clinical and biochemical signs of altered function of the parathyroid glands symmetric cerebral calcification could be demonstrated by computer tomography. They are also visible by X-ray examination in one patient. Consequently, functional disturbances of the brain, cerebellum and of the extrapyramidal system may occur. Moreover, the combination of hypoparathyroidism and hypothyroidism also appears to result in the development of symmetric cerebral calcification. The pathogenesis of the calcification as well as therapeutic approaches will be discussed.
Subject(s)
Calcinosis/etiology , Parathyroid Diseases/metabolism , Adult , Calcium/metabolism , Dihydrotachysterol/therapeutic use , Female , Humans , Magnesium/metabolism , Male , Middle Aged , Parathyroid Hormone/metabolism , Phosphorus/metabolism , Thyroid Diseases/drug therapy , Thyroxine/therapeutic use , Tomography, X-Ray Computed , Vitamin D/therapeutic useABSTRACT
The importance of correlation of pathological specimen sections and computer tomograms is postulated emphazising examination of the same sectional level. First results are reported and false positive and false negative diagnoses are discussed.
Subject(s)
Brain Diseases/diagnosis , Brain/pathology , Tomography, X-Ray Computed , Adult , Autopsy , Brain Diseases/diagnostic imaging , Brain Diseases/pathology , Female , Histological Techniques , Humans , Male , Middle AgedABSTRACT
A case is reported where the clinical symptomatology as well as the ophthalmological, radiological, endocrinological, and scintigraphic results offered significant evidence in favor of the presence of a tumor in the sellar region. The diagnosis of a pyocele originating in the sphenoid bone could be established intraoperatively only. Cysts originating in the sphenoid bone are described as what is usually called an "orbital inlet syndrome" from which the present case differs in some respects.
