1/23. coccidioidomycosis meningitis with massive dural and cerebral venous thrombosis and tissue arthroconidia.To our knowledge we report the first case of meningitis from coccidioides immitis associated with massive dural and cerebral venous thrombosis and with mycelial forms of the organism in brain tissue. The patient was a 43-year-old man with late-stage acquired immunodeficiency syndrome (AIDS) whose premortem and postmortem cultures confirmed C immitis as the only central nervous system pathogenic organism. Death was attributable to multiple hemorrhagic venous infarctions with cerebral edema and herniation. Although phlebitis has been noted parenthetically to occur in C immitis meningitis in the past, it has been overshadowed by the arteritic complications of the disease. This patient's severe C immitis ventriculitis with adjacent venulitis appeared to be the cause of the widespread venous thrombosis. AIDS-related coagulation defects may have contributed to his thrombotic tendency.- - - - - - - - - - ranking = 1keywords = meningitis (Clic here for more details about this article) |
2/23. Diagnostic value of immunocytochemistry in leptomeningeal tumor dissemination.Differentiating chronic aseptic meningitis from leptomeningeal carcinomatosis or gliomatosis can be difficult, particularly when the differentiation is based solely on routine cytologic examination. The diagnosis of cerebrospinal fluid tumor dissemination in at-risk patients requires cytologic examination of cerebrospinal fluid and radiography of the leptomeninges. Routine cytologic examination alone has proven less than desirable, in most instances providing confirmation in as little as 50% of cases in the first lumbar puncture. This percentage increases to 85% to 90% after multiple lumbar punctures. We retrospectively reviewed 2 cases of leptomeningeal dissemination (one gliomatosis, the other carcinomatosis) with initial false-negative test results. However, after further examination of the cerebrospinal fluid by selected battery of immunocytochemical stains, both cases were identified as positive for malignancy (ie, false negatives). Immunocytochemistry can be useful in distinguishing chronic aseptic meningitis from leptomeningeal carcinomatosis or gliomatosis in patients at risk or when abnormal cells are seen on routine cerebrospinal fluid cytologic examination.- - - - - - - - - - ranking = 0.33333333333333keywords = meningitis (Clic here for more details about this article) |
3/23. flushing in relation to a possible rise in intracranial pressure: documentation of an unusual clinical sign. Report of five cases.This report documents clinical features in five children who developed transient reddening of the skin (epidermal flushing) in association with acute elevations in intracranial pressure (ICP). Four boys and one girl (ages 9-15 years) deteriorated acutely secondary to intracranial hypertension ranging from 30 to 80 mm Hg in the four documented cases. Two patients suffered from ventriculoperitoneal shunt malfunctions, one had diffuse cerebral edema secondary to traumatic brain injury, one was found to have pneumococcal meningitis and hydrocephalus, and one suffered an intraventricular hemorrhage and hydrocephalus intraoperatively. All patients were noted to have developed epidermal flushing involving either the upper chest, face, or arms during their period of neurological deterioration. The response was transient, typically lasting 5 to 15 minutes, and dissipated quickly. The flushing reaction is postulated to be a centrally mediated response to sudden elevations in ICP. Several potential mechanisms are discussed. flushing has clinical importance because it may indicate significant elevations in ICP when it is associated with neurological deterioration. Because of its transient nature, the importance of epidermal flushing is often unrecognized; its presence confirms the need for urgent treatment.- - - - - - - - - - ranking = 0.16666666666667keywords = meningitis (Clic here for more details about this article) |
4/23. Idiopathic hypertrophic cranial pachymeningitis with perifocal brain edema--case report.A 51-year-old female presented with an extremely rare case of idiopathic hypertrophic cranial pachymeningitis manifesting as markedly thickened frontotemporal meninges with expanding perifocal edema. magnetic resonance imaging with gadolinium revealed enhancement of the thickened dura mater protruding into the brain parenchyma accompanied by focal edema causing a mass effect. Histological examination of a biopsy specimen revealed thickened dura with infiltrating lymphocytes. Serological and immunological tests were normal. No inflammatory response or evidence of malignant tumors was observed. The patient was treated with predonisolone, resulting in marked improvement of the mass effect. High-dose steroid therapy appears to be effective for intracranial pachymeningitis associated with expanding perifocal brain edema.- - - - - - - - - - ranking = 7.7348614630451keywords = pachymeningitis, meningitis (Clic here for more details about this article) |
5/23. Pachymeningitis in microscopic polyangiitis (MPA): a case report and a review of central nervous system involvement in MPA.A case of microscopic polyangiitis (MPA) with pachymeningitis is described. The patient had renal, skin, gallbladder and peripheral nervous system involvement, simultaneously with pachymeningitis. Necrotizing glomerulonephritis with crescent formation, and necrotizing small vessel vasculitis in the kidney and skin were confirmed by biopsy. A highly elevated titer of antineutrophil cytoplasmic antibody for myeloperoxidase (MPO-ANCA) was observed. All of the clinical and laboratory abnormalities improved with high-dose pulse and conventional steroid therapy. The literature on central nervous system involvement in MPA and perinuclear-ANCA (p-ANCA)-related vasculitis is reviewed. This case serves to emphasize that pachymeningitis can occur as one of the features of MPA.- - - - - - - - - - ranking = 4.5340973981892keywords = pachymeningitis, meningitis (Clic here for more details about this article) |
6/23. Sudden death in a 35-year-old man with occult malformation of the brain and aseptic meningitis.A 35-year-old man was found dead by his wife. He was reported to have had symptoms of a common cold the week preceding his death. The medicolegal autopsy yielded signs of central dysregulation (ectasia of the urinary bladder and rectum, dystelectasis of the lungs) together with marked brain edema and fresh bite marks on the tongue. The cause of death was presumed to be lethal epileptic seizure. Neuropathologic examination revealed neuronal nodular heterotopia as well as discrete lymphocytic meningitis (aseptic meningitis). The death was most probably caused by the combination of the meningitis with the occult malformation, leading to a lowered seizure threshold and subsequent lethal seizure. The morphologic findings of this case are presented, and the probable mechanisms of death are discussed.- - - - - - - - - - ranking = 1.1666666666667keywords = meningitis (Clic here for more details about this article) |
7/23. Extrapontine myelinolysis in a pediatric case of diabetic ketoacidosis and cerebral edema.Central pontine and extrapontine myelinolysis are characterized by symmetric demyelination following rapid shifts in serum osmolality, although in extrapontine myelinolysis, demyelination is confined to the supratentorial compartment. We present a case of extrapontine myelinolysis in a 17-year-old female that occurred in the setting of diabetic ketoacidosis, cerebral edema, mannitol therapy, and meningitis. The rate of correction of this patient's glucose and electrolyte levels was within well-accepted limits. Extrapontine myelinolysis is rare in pediatric patients: there are only 12 reports of extrapontine myelinolysis in children under age 20 years and no pediatric cases of extrapontine myelinolysis or central pontine myelinolysis associated with diabetic ketoacidosis. We review the published cases of extrapontine myelinolysis and examine the underlying etiologies and electrolyte disturbances that characterize these cases. This case expands the list of conditions in which extrapontine myelinolysis occurs to include pediatric patients with complicated diabetic ketoacidosis, emphasizing the importance of sudden osmolar shifts in the genesis of this disorder.- - - - - - - - - - ranking = 0.16666666666667keywords = meningitis (Clic here for more details about this article) |
8/23. Severe symptomatic aseptic chemical meningitis following myelography: the role of procalcitonin.Symptomatic aseptic, chemical meningitis is a rare complication of myelography. Its acute clinical course and standard laboratory findings are indistinguishable from those of bacterial meningitis. The authors present a case of severe postmyelographic chemical meningitis and compare CSF and serum inflammatory markers to a group of seven patients with proven bacterial meningitis. As in viral meningitis, procalcitonin might be able to discriminate between bacterial and chemical causes of CNS inflammation.- - - - - - - - - - ranking = 1.5keywords = meningitis (Clic here for more details about this article) |
9/23. Uncal herniation secondary to bacterial meningitis in a newborn.A newborn with bilateral uncal herniation secondary to acute bacterial meningitis is reported. The findings of previous neuropathologic studies of neonatal bacterial meningitis are reviewed and the factors most likely responsible for the relative rarity of herniation in this disease in newborns are discussed.- - - - - - - - - - ranking = 1keywords = meningitis (Clic here for more details about this article) |
10/23. Idiopathic hypertrophic cranial pachymeningitis with perifocal brain edema.Idiopathic hypertrophic cranial pachymeningitis (IHCP) consists of meningeal thickening due to chronic inflammation for which no cause such as infection, specific granulomatous disease, or malignancy is demonstrable. We present a case of IHCP with perifocal brain edema suggesting mass lesion with its magnetic resonance imaging (MRI) and pathologic findings. A 36-year-old woman was admitted to our hospital in August 2001 with a complaint of motor weakness in her left leg for 1 month. magnetic resonance imaging with gadolinium revealed enhancement of the thickened dura mater and perifocal edema in the right frontoparietal region suggesting a mass lesion. Histological examination of the biopsy specimen revealed a dense fibrous cellular tissue. There was no obvious inflammatory infiltrate but in some areas between fibrous bundles one or two lymphocytes were detected. According to our knowledge, our patient is the second report in the literature of IHCP with focal edema causing a mass effect.- - - - - - - - - - ranking = 6.4457178858709keywords = pachymeningitis, meningitis (Clic here for more details about this article) |
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