1/4. Imaging findings in rabies encephalitis.SUMMARY: rabies encephalitis is perhaps one of the few infectious diseases that command attention and fear not only from the layman but also from physicians. The unique mode of transmission, the virtually exclusive neurotransmission shown by the agent, and the complete hopelessness of the established disease sets rabies apart from other zoonoses transmitted to man. rabies encephalitis is a fatal disease and its diagnosis is usually based on the clinical presentations and findings. Hence, imaging in rabies is seldom done, and imaging findings in rabies encephalitis have rarely been described. We present the imaging findings in two confirmed cases of rabies encephalitis in which antemortem diagnosis was obtained by corneal impression smears showing the presence of viral antigens. The differential diagnosis of the imaging findings as well as the role and the relevance of imaging in the diagnosis of this disease are discussed. The current literature on the subject is also reviewed.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/4. Neurologic complications associated with respiratory syncytial virus.Encephalopathy has been demonstrated to be associated with respiratory syncytial virus bronchiolitis. In this study, the data on all patients less than 14 years of age hospitalized with respiratory syncytial virus bronchiolitis over the past 4 years was reviewed. patients who had concomitant diagnoses consistent with neurologic disease underwent detailed chart review. There were 964 patients (age 0.1 to 13.6 years) with a diagnosis of respiratory syncytial virus bronchiolitis. Thirty-six of these patients had concurrent neurologic diagnoses. Twenty-four patients were excluded because of preexistent neurologic disorders, probable simple febrile seizures, or a history of epilepsy. Twelve respiratory syncytial virus-positive patients had definite neurologic complications without another recognized cause. Seven of these patients had seizures (predominantly generalized tonic-clonic and one with status epilepticus), three had generalized encephalopathy (marked hypotonia and decreased responsiveness) of whom two also developed esotropia. Two patients developed isolated esotropia. There was an incidence of neurologic complications of 1.2% (0.7% seizures) in a total of 964 patients with respiratory syncytial virus bronchiolitis. This percentage does not include presumed simple febrile seizures or exacerbations of preexisting seizure disorder (further 1.3%). Neurologic complications occur with respiratory syncytial virus bronchiolitis, and physicians and other caregivers should be aware of this entity as well as the favorable prognosis.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
3/4. Stymied by seizures. When the clues point to the wrong path.seizures have many causes, and physicians should try not to be shortsighted when an apparent cause seems to leap out. The key is being receptive to the fact that a less obvious source of seizures may exist. In this case, new-onset seizures believed consistent with illicit drug use proved to have an infectious cause.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
4/4. Viral encephalitis masquerading as a fulminant anticholinergic toxidrome.CASE REPORT: Emergency physicians are well versed in the recognition and management of certain poisonings which present with characteristic toxidromes. We present a case of a young pharmacy student who presented with altered mental status, tachycardia, facial flushing, dilated pupils, and dry skin and mucous membranes presumably due to anticholinergic poisoning. She improved with a combination of benzodiazepines and the acetylcholinesterase inhibitor physostigmine. However, following resolution of her initial symptoms, she became ill again and the subsequent neurologic evaluation revealed a diencephalic lesion consistent with a viral encephalitis. The acute anticholinergic signs and symptoms resulted from this lesion in an area of large cholinergic outflow. Although recognition and management of her acute anticholinergic findings were appropriate, they were not the manifestations of an acute anticholinergic ingestion.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |