Tuberculosis remains endemic in the United States with an estimated incidence of 15.9 cases per 100,000 population. In North America and Saudi Arabia tuberculosis of the spine is primarily a disease of adults. In Saudi Arabia the average age on presentation is 41 years. Spinal tuberculosis begins classically in the anterior inferior portion of a vertebral body. The infection spreads beneath the anterior longitudinal ligament to involve adjacent vertebral bodies. Disc space narrowing is a secondary phenomenon, occurring when destruction of the cancellous bone permits herniation of the disc into the affected vertebral body. Initially the lesion is purely lytic, so that in the early phase bone scanning, both with technetium polyphosphate and gallium, is often negative. With combination chemotherapy virtually all patients are curable, but early treatment demands early diagnosis. As the incidence of Pott disease has decreased so too has the medical awareness of this condition. Many physicians now believe it to have been totally eradicated. Particularly in the older age group, in whom other infections, tumours, and metabolic conditions are common, the differential diagnosis of a spinal lesion should include tuberculosis. The grossly destructive changes observed characteristically in children tend to develop only late in adults, making recognition of the early manifestations of the infection in the older patient much more important.

The authors report 20 cases of giant craniopharyngioma in children operated on during the 6-year period from 1978 through 1984. The tumor size (maximal diameter) ranged from 5 to 11 cm. These patients presented with increased intracranial pressure, severe visual loss, and neurological and endocrinological deficits. Tumor growth had occurred in several directions, causing displacement of the circle of Willis, the optic apparatus, and the hypothalamus, as well as encroachment into the interpeduncular and prepontine cisterns and into the frontal, temporal, and posterior fossae. The surgical technique for total removal of these giant tumors in the last 10 cases is described. Emphasis is placed on the use of microsurgical technique during the first operation, close endocrinological follow-up, and early reevaluation by computed tomographic scanning.

A 23-year-old, right-handed female was admitted to the King Faisal Specialist Hospital and Research Centre because of inability to talk.Seven years prior to admission, she had sudden inability to talk, lasting two days. She was four months pregnant at that time and went into spontaneous abortion. Subsequently, the patient had three, normal, uneventful pregnancies. Eleven months prior to this admission she had another sudden, one week episode of inability to talk associated with awkwardness on the right side, from which she recovered. She was eight months pregnant and delivered a normal child one month later. Six months following delivery, she again developed sudden onset of inability to talk, associated with right-sided awkwardness. This time, she did not improve and was referred to us for investigation, three months later. The patient gave no previous history of serious illnesses. She was never on contraceptive pills. Her father and mother were distant cousins. There was no family history of a similar condition.On examination, her blood pressure was 120/70 mmHg in both arms. Carotid and peripheral pulses were normal and no bruits were heard over the neck or supraclavicular regions. Examination of the heart did not reveal any murmurs, and the lungs were clear. Abdominal examination was normal, and no skin lesions were seen. On neurological examination, the patient appeared awake and alert. She could say a few words but was unable to understand complex commands, name objects, or repeat after the examiner. Her pupils were equal and reactive and her discs were sharp. She had a questionable right homonymous hemianopsia. A right seventh cranial nerve weakness was noted. No gross weakness was detected on the right, but she was unable to perform fine movement. Stretch reflexes were slightly brisk on the right. Sensory examination was uninterpretable.Complete blood count (CBC) showed a hemoglobin of 12.8 g/dl and a white blood count of 5800/cmm. Platelet count was 380,000/cmm with a sedimentation rate of six millimeters during the first hour. Rapid plasma reagin (RPA) test results were negative and antinuclear antibody test results were negative at 1: 10 dilution. Sickling test results were positive but hemoglobin electrophoresis showed hemoglobin A, 58.6%, hemoglobin S 38.7%, and hemoglobin A 2 2.7%. SMAC-20™ blood analysis was within normal limits. Cerebrospinal fluid examination and urinalysis were normal.Chest radiograph and electrocardiogram were normal. Echocardiogram was normal. Radiograph of the knees was normal.Computed tomographic (CT) scan of the head revealed multiple areas of encephalomalacia in the left hemisphere. Digital subtraction angiography (DSA) showed normal internal carotid and vertebral arteries. Cerebral angiogram showed occlusion of the anterior ascending branches of the left middle cerebral artery. Hemostatic function studies were performed. Philip Weaver MD:This lady had three normal sets of radiographs, a chest study, a skull radiographic examination, and radiographs of her knees. The reason...