Radioisotope cisternography was performed and the erythrocyte and hemoglobin contents of the cerebrospinal fluid (CSF) were determined within the first 4 days after subarachnoid hemorrhage in 42 patients. The clinical condition of the patients was related to the severity of the CSF circulation disturbances. Thirty-five patients had some degree of disturbance of CSF flow, and only 2 of the 42 patients had normal flow. In 5 cases the cisternograms were inconclusive. The severity of CSF circulation disturbances correlated well with clinical condition. No relationship was found between the number of erythrocytes in the CSF and the development of CSF circulation disturbances. The CSF erythrocyte content did not correlate with the clinical condition. It is suggested that flow disturbances of the CSF during the acute stage of subarachnoid hemorrhage might play an important role in the pathomechanism of the disease.
The authors report a review of 1808 patients admitted for the treatment of craniocerebral injuries. Eighty-four (4.6%) developed the syndrome of inappropriate secretion of antidiuretic hormone (SIADH). Two types of SIADH (severe and mild) were defined on the basis of laboratory findings and clinical signs. SIADH occurred in 0.6% of the patients with mild head injury, 10.6% of those with moderate head injury, and 4.7% of the patients with severe head injury. Regular measurements of serum electrolytes, osmolality, and urinary sodium depletion should be made during the treatment of patients suffering from head trauma because unexpected clinical deterioration may often have a reversible cause: SIADH.
The authors report a review of 290 patients admitted for the treatment of subarachnoid hemorrhage. Twenty-seven (9.3%) patients developed the syndrome of inappropriate secretion of antidiuretic hormone (SIADH). The diagnosis was established by means of daily laboratory investigations (serum electrolytes and osmolality; urine sodium and osmolality; and fluid balance). The patients were divided into two groups (severe and mild SIADH) on the basis of clinical symptoms and signs and laboratory findings. High values of urine osmolality and sodium concentration in patients with low values of serum osmolality and sodium concentration were demonstrated. Thirteen (4.5%) patients had severe and 14 (4.8%) patients had mild SIADH. The source of bleeding was not discovered in 14 patients (4.8%). Nearly 10% of the patients with an aneurysm on the anterior communicating artery developed SIADH. Fluid therapy for these patients is described, and the treatment of SIADH is discussed.
We report a secretory meningioma with metastasis from a pulmonary adenocarcinoma in a 48-year-old woman. Secretory meningioma can simulate metastatic disease both clinically and pathologically. Secretory meningioma and tumour-to-tumour metastasis are each rare, and we believe this to be the first report of their coincidence.
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