Background: Biomarkers can assist in outcome prediction and therapeutic decision making after traumatic brain injury (TBI). The aim of this study was to evaluate the role of ischemiamodified albumin (IMA) in the prediction of mortality in patients with TBI.Methods: In this observational study IMA was measured on admission to intensive care unit (D0) and 24 hours later (D1) in a cohort of patients with mixed TBI severity. The primary outcome was the correlation between IMA and 28-day mortality. Secondary outcomes included the incidence of elevated IMA, and the correlation between the severity of TBI and IMA, and between IMA and change in Glasgow coma score (GCS). The area under receiver operating characteristic curve analysis was performed to detect optimal IMA cut-off value for the detection of mortality.Results: Fifty-four patients were included in the study; IMA was elevated in 49 (90.7%) on admission to the intensive care unit. Of the 49 patients with elevated IMA, 22 had a decrease in IMA while 27 had an increase by 24 hours. IMA levels were higher at D0 and D1 (P < 0.001 for both) in patients who died compared with those who survived. Twenty-one patients died (mortality rate 38.9%); all had elevated IMA on D0 and D1 and higher IMA levels at D1 compared with D0. Optimal cut-off values for IMA predicted mortality with 76.2% sensitivity and 81.8% specificity at D0 and with 100% sensitivity and specificity at D1. IMA values at D0 and D1 were correlated with D0 and D1 GCS, respectively (both P < 0.001). Conclusion:IMA levels were elevated in patients following TBI, and can predict mortality with high sensitivity and specificity.

BACKGROUND:The spinal epidural space, covering the dural sac, is located along the posterior longitudinal ligament anteriorly, the ligamentum flavum and the periosteum of laminae posteriorly, and the pedicles of the spinal column by the intervertebral foramina containing their neural elements laterally. It could be affected variably by different types of diseases, either as primary lesions or as an extension from a disease process in the nearby tissues and organs.AIM:We aimed to present clinically and surgically patients with spinal epidural masses operated in the Neurosurgery Department of Cairo University Hospitals, Cairo, Egypt, along a time interval of one year.METHODS:In this prospective cohort study, we analysed motor deficits, sensory deficits, and bowel and bladder dysfunction. We have performed decompressive laminectomy on 19 patients with spinal epidural masses together with mass excision as long as the tumour was accessible, with or without fixation.RESULTS:All patients were radiologically assessed by MRI over the affected side of the spine. D10 was the commonest site in our study to be affected in 10 cases of our participants (23%), followed by D5, D7, and D12 each of them was affected in 6 cases (14%), in another word spinal segments by order of frequency to be affected were dorsal followed by lumbar spine. All patients included in this study (100%) showed an obvious improvement as regard pain and tenderness.CONCLUSION:Surgical interventions have improved the quality of life for our patients with spinal epidural masses.

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Primary central nervous system lymphoma (PCNSL) is a rare subtype of extranodal non-Hodgkin's lymphoma that accounts for 4% of newly diagnosed central nervous system (CNS) tumors. Most primary lymphomas of the central nervous system are of the subtype of diffuse large B-cell lymphomas, which have highly aggressive behavior and may involve the brain, leptomeninges, eyes or spinal cord without evidence of systemic disease. Primary CNS lymphomas are very rare in immunocompetent patients, but their rates are increasing. So far, only 11 primary Gasser ganglion lymphomas have been reported, with an incidence of 2.5 cases per 30,000,000 inhabitants. However, B cell lymphomas of the marginal zone of the Gasserian ganglion have been very rarely reported. We report here a clinical presentation characteristic of B cell lymphoma of the marginal zone of the Gasser ganglion in an immunocompetent patient who was treated with surgery and radiotherapy, evolving with improvement of symptoms and without recurrence in 3 months of follow-up.

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