Object. Spinal meningiomas occur most frequently in older patients. They are well-circumscribed and slow-growing tumors that are associated with good patient outcomes following surgery. Spinal meningiomas occurring in younger patients may be more aggressive, with a worse prognosis. The authors present their 21-year experience with spinal meningiomas in patients younger than 50 years of age. Methods. The authors reviewed data obtained in 40 patients (age < 50 years) treated at the Mayo Clinic, Rochester, during the past 21 years; in all cases the lesions were histologically confirmed spinal meningiomas. Five men (12.5%) and 35 women (87.5%) (mean age 34.5 ± 10.9 years) underwent 52 operations for 41 tumors. The mean follow-up duration was 82 ± 93 months (range 0–445 months). The data obtained in these patients were compared with those derived from a random control cohort of 40 patients older than age 50 years in whom spinal meningiomas were resected at the Mayo Clinic during a similar period. In this cohort, there were 33 women and seven men whose mean age was 67.1 ± 9.5 years. The mean follow-up duration for the older group was 88 ± 72.3 months (range 18–309 months). Compared with the random cohort of older patients, younger patients there tended to have more tumors located in the cervical spine (39%) as well as a greater number of predisposing factors such as neurofibromatosis Type 2, radiation exposure, or trauma. Nine (22%) of the patients younger than 50 years of age required reoperation for residual or recurrent tumor compared with two (5%) in the older patient control group. The overall mortality rate at the completion of the study for the younger patients was 10%. Conclusions. Spinal meningiomas in younger patients have a worse prognosis than similar tumors in older patients.

Preoperative laboratory and imaging studies are often diagnostically inconclusive in cases of spinal cord lesions with nonspecific features. Biopsies should be considered for patients with progressive symptomatic lesions.

The antinociceptive actions of morphine and tizanidine (an alpha 2-adrenergic agonist) administered intrathecally in a rat model of mononeuropathic pain were investigated. Tizanidine increased to normal levels the intensity of a noxious pressure stimulus required to induce paw withdrawal (p < 0.01) and decreased the duration of limb withdrawal from both normal-temperature and cooled floors in a dose-dependent manner (p < 0.01). Tizanidine had virtually no effect on the latency of paw withdrawal from a noxious heat stimulus. In comparison, morphine significantly decreased, in a dose-dependent manner, limb withdrawal from the normal-temperature and cooled floors and increased to cutoff values the withdrawal latencies of both noxious heat and pressure stimuli (p < 0.01). The effect of tizanidine was limited to the hyperalgesic limb and served to normalize reactive latencies, whereas morphine affected both hindlimbs and increased latencies to supranormal cutoff values. These data suggest that intrathecal tizanidine may be more specific than morphine in reversing the allodynia and hyperpathia associated with neuropathic pain states and may be of value in the management of patients with these clinical syndromes.

Prolactinomas are the most common secretory adenomas of pituitary origin. They typically manifest with symptoms referable to their endocrinologic effects or, if of sufficient size, to visual changes due to compression of the optic chiasm. Pituitary adenomas manifesting with hydrocephalus are rare. To our knowledge, only three such P rolactin-producing tumors of the pituitary gland typically manifest with symptoms related to endocrine disturbances or, if large enough, to visual changes due to compression of visual pathways. We describe a case of a large prolactinoma manifesting with subacute progressive obtundation due to hydrocephalus. This mode of manifestation for pituitary adenomas is rare. To our knowledge, only three cases have previously been reported. We present a review of the literature and also discuss treatment options. REPORT OF CASE An Sl-year-old woman sought medical assessment because of a subacute and progressive decrease in level of consciousness during a 2-week period. Findings on the physical examination were unremarkable except for pronounced somnolence and confusion. The patient was noncooperative for assessment of gait or visual field testing. A computed tomographic scan with use of contrast medium revealed a third ventricular mass with an enlarged sella and associated hydrocephalus. That same day, magnetic resonance imaging confirmed a sellar mass with suprasellar extension filling the third ventricle and obstructing both foramen of Monro (Fig. I). An endocrine evaluation revealed a prolactin level of 6,800 ng/mL; results of other pituitary function studies were considered normal. Laboratory test results are listed in Table I. Bromocriptine was immediately initiated at a dose of 10 mg three times a day. By the next day, her level of consciousness had improved,