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The overall mortality of patients with CNS tuberculosis is still signi cant (about 10 percent), infants and the elderly being at greatest risk Among HIV-infected patients, the mortality from tuberculous meningitis is considerably higher (21 percent in the series of Berenguer et al) the result of delays in diagnosis and, more importantly, of resistance to antituberculous drugs in some patients (Snider and Roper) (see also page 1061) Early diagnosis, as one might expect, enhances the chances of survival In patients who are treated late in the disease, when coma has supervened, the mortality rate is nearly 50 percent Between 20 and 30 percent of survivors manifest a variety of residual neurologic sequelae, the most important of which are diminished intellectual function, psychiatric disturbances, recurrent seizures, visual and oculomotor disorders, deafness, and hemiparesis A detailed account of these has been given by Wasz-Hockert and Donner

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PROGRAMMING WITH PERL print "What is your name [Anonymous] \n"; eval { local $SIG{ALRM} = sub { die "Timeout" }; alarm 10; chomp($answer = <STDIN>); alarm 0; }; if ($@ and $@ =~ /Timeout/) { $answer = "Anonymous"; } print "Hello $answer!\n";

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The eval block is required so that the die statement that forms the signal handler drops out of the eval setting the value of $@ rather than terminating the whole script You can then test that and decide how to proceed Of course, if the user provides some input; then the alarm is reset to zero, disabling the alarm timer and allowing you to drop out of the eval block normally We ll be looking in more detail at signals and signal handlers in 14, and at the use of the eval function in 15

The infectious etiology of sarcoidosis has never been established, but the disease may suitably be considered at this point because of its close resemblance pathologically and clinically to tuberculosis and other granulomatous infections Indeed, one still credible theory of causation considers sarcoidosis to be a modi ed form or product of the tubercle bacillus This has not been proved, and the same can be said for various other infectious and noninfectious etiologies that from time to time have been proposed as the underlying cause Current opinion favors the idea that sarcoidosis represents an exaggerated cellular immune response to a limited class of antigens or autoantigens (Crystal) The essential lesion in sarcoidosis consists of focal collections of epithelioid cells surrounded by a rim of lymphocytes; frequently there are giant cells, but caseation is lacking The sarcoid tubercles may be found in all organs and tissues including the peripheral and CNS, but the most frequently involved are the mediastinal and peripheral lymph nodes, lungs, liver, skin, phalangeal bones, eyes, and parotid glands Sarcoidosis is accompanied by nervous system involvement (neurosarcoidosis) in approximately 5 percent of cases according to the worldwide surveys of Delaney and of Siltzbach and colleagues It may take any one of several forms As indicated in Chaps 13, 46 and 47, isolated sarcoid granulomas may involve peripheral or cranial nerves, giving rise to a subacute or chronic neuropathy or plexopathy of asymmetrical type (Jefferson) Polyneuropathy may occur but is rare; Zuniga and colleagues have summarized our own experience Of the cranial nerves, the facial is the most frequently involved, either as part of the uveoparotid syndrome (Heerfordt syndrome) or independently The facial palsy may be unilateral or bilateral; if the latter, the nerves may be affected simultaneously or in succession The occurrence of hyperacusis indicates that the lesion is central to the stylomastoid foramen Blindness may follow basal in ltration that encompasses the optic nerves (Fig 32-4) CNS sarcoidosis is said to be infrequent, but we encounter one or more cases yearly Several syndromes are known that are due to localized involvement of the meninges, brain, and spinal cord (Table 32-5) In Scadding s series of 275 patients, only 3 developed CNS lesions; in other large series, the incidence of CNS involvement was greater, but most are in the range of 5 to 10 percent (10 of 145 patients studied by Mayock et al; 14 of 285, by Chen and McLeod; and 33 of 649, by Stern et al) Delaney, in his review of the literature, found the neurologic involvement in sar-.

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As we saw in 4, Perl provides an interface to the environment variables of the current Perl interpreter using the %ENV built-in variable For example, to access the PATH value, you would use the following:

Table 32-5 Nervous system manifestations of sarcoidosis Aseptic meningitis: chronic or relapsing, with or without headache Pachymeningitis: hydrocephalus Brain Focal tumor-like mass: seizures, hemiparesis Cortical and subcortical in ltration; amnestic-dementing syndrome, encephalopathy, headache Hypothalamic-basilar in ltration: diabetes insipidus, abulia Spinal cord and roots Granulomatous meningomyelitis, subacute or chronic Cauda equina syndrome Peripheral nervous system Lumbar or brachial plexopathy Sensory-predominant polyneuropathy Mononeuropathy Mononeuritis multiplex Cranial neuropathy Visual loss Papillitis Facial palsy, unilateral, bilateral, or sequential Hearing loss, vertigo Facial sensory loss or neuralgia

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