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Intramedullary haemangioblastoma of the spinal cord may be associated with overlying pial varicosities. Wyburn-Mason (1943) referred to 10 cases in the literature and added four of his own. The degree of development of the varicosities is variable but occasionally the cord is completely obscured by abnormal vessels which may give rise to the radiological and operative appearances of intradural venous angioma (Black and Faber, 1935; WyburnMason, cases 53 and 55;Craig and Horrax, 1949). The following case of this type is of practical interest in view of a recent suggestion that more attempts should be made to remove spinal intradural angiomas in order to lessen the dangers of haemorrhage and of cord compression and degeneration (Shephard, 1960 She was re-admitted in May 1960 with complete motor and sensory paraplegia below T1O, root pains in segments T8 and T9 on the left, painful flexor spasms, and a distended bladder with dribbling incontinence. Laminectomy was performed exposing segments T6 to T9. A large intradural angiomatous malformation extended upwards, downwards, and laterally beyond the limits of the operative exposure. In an effort to abolish the root pains the left seventh and eighth thoracic sensory roots were exposed and divided, a difficult procedure as they were enveloped in a thick sheath of enlarged vessels. A week later 0 7 ml. of phenol was injected intrathecally as the flexor spasms were still troublesome. After this the spasms were much improved and the patient was able to return home.She was again admitted in a very much worse state in October 1960 and an attempt was made to excise the lesion. The old laminectomy wound was re-opened and extended to expose segments T4 to Tll. The cord was hidden by abundant enlarged and tortuous vessels which extended from the top to the bottom of the exposure, through the intervertebral foramina, and laterally as far as could be seen. Troublesome bleeding was encountered on attempting to define the main vessels and as excision was clearly technically impossible the operation was abandoned.Post-operatively the patient had an exacerbation of her urinary tract infection and developed severe bronchopneumonia despite active antibiotic therapy. She died three days after the operation from respiratory failure.Pathological Findings.-Permission was granted only for examination of the spinal cord, which was removed from C3 to L5. Beneath the dura the dorsal and lateral surfaces of the cord between T2 and L2 were covered with a plexiform conglomeration of blood vessels resembling a venous angioma (angioma racemosum venosum). These blood vessels, which gradually became less numerous towards the upper and lower limits of the lesion, were in places obscured by adherent blood clot and gelatin sponge (Fig. 1). Segments T7 and T8 were firm and enlarged. Their cut surfaces (1-7 x 1-4 cm.) were reddish-brown and flecked with irregular yellow areas; dilated blood vessels extended into the cord tissue and the normal markings were not recognizable (Fig. 2B).

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The authors administered the growth hormone-releasing factor (GRF) stimulation test to 19 patients with major depression and 19 age- and sex-matched control subjects to test the hypothesis that a blunted growth hormone (GH) response to clonidine reflects a central alpha 2-adrenergic receptor subsensitivity in depression. GH response to GRF was significantly higher in patients with depression than in control subjects. This group difference was mainly attributable to three of the 19 depressed patients who exhibited markedly high GH responses to GRF. These results suggest that the blunted GH response to clonidine seen in patients with depression is not due to a pituitary defect in GH secretion.