In a prospective double-blind study, we compared dexamethasone and placebo in 33 subjects with lumbosacral radicular pain. Of subjects with resting pain, 7/21 improved on dexamethasone, and 4/12 improved on placebo. Of subjects with pain on straight-leg raising, 8/19 improved on dexamethasone and 1/6 on placebo. Of 27 subjects evaluated 1 to 4 years after treatment, 8/16 who had received dexamethasone were asymptomatic or had only occasional mild low-back pain, compared with 7/11 who had received placebo. Thus, dexamethasone is not superior to placebo for either early or long-term relief of lumbosacral radicular pain, but may reduce pain evoked by stretch of acutely inflamed spinal nerve roots.

A young man developed a tumor in the pineal region that grew along ventricular surfaces and caused obstructive hydrocephalus. Cytologic examination of cerebrospinal fluid demonstrated malignant cells consistent with germinoma. Following a ventriculoperitoneal shunt and radiotherapy, the tumor and the hydrocephalus regressed. Three years later, an intraperitoneal tumor appeared that was diagnosed by transcutaneous biopsy specimen as a germinoma. The abdominal germinoma also regressed after radiotherapy. While extracranial metastases of intracranial germinomas via shunts are probably rare, their occurrence, as exemplified by this case, argues for including protective filters in the shunts.

No abstract