Granulomatous hypophysitis by Mycobacterium gordonae in a non HIV-infected patient.

Lymphocytic or granulomatous hypophysitis is a rare entity with a difficult diagnosis. Our objective was to report a patient with non-tuberculous granulomatous hypophysitis. An HIV-negative 45-year old man with confusional state, subacute ophthalmoplegia, and clinical and laboratory findings of panhypopituitarism was seen in the emergency unit. A cranial MRI showed a sellar mass suggestive of hypophysitis. After an unsuccessful attempt with steroids and antituberculous drugs the patient died. Post-mortem histopathology revealed granulomatous lesions and restriction fragment length polymorphism analysis confirmed the presence of Mycobacterium gordonae's DNA. In conclusion, we should consider granulomatous hypophysitis in the differential diagnosis of non-secreting hypophyseal tumors. The etiology of a pituitary granuloma by a non-tuberculous mycobacteria is best reached by histopathological techniques and molecular assays. The optimal therapy is yet to be established.

Hypertensive intracerebral hemorrhage in the very elderly.

BACKGROUND: The number of persons reaching the age 80 years and over is increasing in most populations. Literature focusing on hypertensive intracerebral hemorrhage (ICH) in this age group is lacking. Therefore, we aimed to analyze the main clinical characteristics of ICH of the advanced old age, in the context of hypertension. METHODS: From 1999 to 2003 we studied 56 hypertensive very elderly patients presenting with ICH (50% women; age 80-99 years). As controls, 168 hypertensive gender-matched persons with ICH, aged <80 years, were randomly selected by a 3:1 factor for clinical comparisons. RESULTS: Compared with their younger counterparts, the very elderly patients had a trend for fewer cases of obesity (34 vs. 49%, p = 0.05) and diabetes mellitus (12 vs. 24%, p = 0.06), had lower systolic, diastolic and mean blood pressure measures (in all, p < 0.01) and more cases with hematoma extension into ventricles (p = 0.02). Thalamic hemorrhage was more frequent in the very elderly patients than in controls (43 vs. 28%, p = 0.04). In multivariate analysis, age, Glasgow coma scale score at hospital admission, ICH volume and infratentorial location were independent predictors of in-hospital mortality, in all persons combined. In the very elderly group exclusively, Glasgow coma scale score was the only factor independently associated with mortality. CONCLUSIONS: ICH occurring in hypertensive patients aged > or =80 years has several differences from that seen in younger people; however, these differences do not seem to impact on early outcome.

Grading scale for prediction of outcome in primary intracerebral hemorrhages.

BACKGROUND AND PURPOSE: This study aimed to independently derive an intracerebral hemorrhage grading scale (ICH-GS) for prediction of 3 outcome measures. METHODS: We evaluated 378 patients with primary ICH at hospital arrival and during the next 30 days. Independent predictors were identified by multivariate models of in-hospital and 30-day mortality. Points were allotted to each predictor based on its prognostic performance. ICH-GS was also evaluated to predict good 30-day functional status and ICH-GS was compared with the ICH score as the reference scoring system. RESULTS: Independent predictors were age, Glasgow Coma Scale, ICH location, ICH volume, and intraventricular extension, all components of the ICH score. Nevertheless, different cutoffs and scoring improved substantially the prognostic power of the predictors. Compared with the ICH score, ICH-GS explained more variance in the 3 outcome measures, had higher sensitivity in predicting in-hospital and 30-day mortality, and performed equally well in predicting good functional outcome at 30 days follow up. CONCLUSIONS: The derived ICH-GS is a simple yet robust scale in predicting in-hospital and 30-day mortality, as well as good 30-day functional status, with equivalent performance.

Brucellosis and polyneuroradiculomyeloencephalitis: a case report

Reports on simultaneous central and peripheral nervous system involvement in a patient with brucellosis are very rare. We report of one young female patient with a long history of consumption of non-pasteurized dairy products in which clinical and laboratory findings confirmed the existence of an active brucellosis with nervous system impairment. Cerebrospinal fluid were negative. Elctrophysiology and positive findings on sural nerve biopsy complemented the diagnosis of polyneuroradiculomyelo encephalitis. Treatment with a combination of doxycycline and rifampin for 2 months was successfully applied. No relapse or sequelae occurred in the patient after 12 monts of follow up