1/10. Cerebral Whipple's disease: clinical and cerebrospinal fluid findings.The case of a patient who had a relapse of cerebral Whipple's disease (WD) one year after discontinuation of a two-years' antibiotic treatment is reported. Neither the clinical course nor the results of magnetic resonance imaging (MRI) and routine examination of the cerebrospinal fluid (CSF) allowed the caring physician to predict the relapse. Retrospective analysis of serial specimens of CSF showed that slight CSF leucocytosis and intrathecal synthesis of IgA might have suggested persistence of infection. The decision to stop antibiotic therapy in cerebral WD is difficult, but evaluation of cell counts and of intrathecal synthesis of IgA may help in the decision. Some patients may need to take treatment indefinitely.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/10. cat-scratch disease: an unusual cause of combative behavior.Acute encephalitis is an unusual manifestation of cat-scratch disease. The authors present the case of a 27-year-old man who exhibited the acute onset of encephalitis manifested by violent behavior and confusion. The diagnosis of drug abuse was presumed initially, but a careful examination revealed the true cause to be cat-scratch disease. Emergency physicians are frequently faced with the challenging task of evaluating confused and combative patients. This case demonstrates the importance of a complete physical examination and a thorough laboratory evaluation.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
3/10. Computerized tomography in infantile encephalitis.Although computerized tomographic (CT) findings are well recognized in numerous neurologic diseases of children, CT scan abnormalities of encephalitis have only been associated with herpes simplex infection. We describe two infants, one with coxsackievirus B2 meningoencephalitis and one with clinical encephalitis, whose CT scans were similarly abnormal during the acute phase of their illness. In both infants, recovery of both neurologic and developmental deficits was accompanied by resolution of the abnormalities of the initial CT scan. Speculation is offered as to the role of the CT scan in the assistance of the physician who must evaluate both the diagnosis and prognosis of infants who have a clinical picture of encephalitis.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
4/10. Echogenic vasculature in the basal ganglia of neonates: a sonographic sign of vasculopathy.The vessels that supply the basal ganglia and thalami are not normally conspicuous on the cranial sonograms of neonates. Twelve neonates with abnormally echogenic or "bright" vessels on cranial sonograms were studied. Records of these 12 patients were reviewed and were correlated with the neuropathologic findings available in four. The clinical diagnoses were cytomegalovirus infection (five patients), rubella (two patients), congenital syphilis (one patient), and trisomy 13 syndrome (three patients). No diagnosis was made in one infant. At neuropathologic examination, perforating medium-sized arteries to the basal ganglia and thalami had thickened hypercellular walls, with deposits of amorphous basophilic material in three infants. Results of computed tomography and radiography of brain sections were normal in these areas. Sonography is helpful in detecting early noncalcific inflammation and mineralization in vasculitis. Although nonspecific, these findings should alert the physician to the possibility of congenital infection or chromosomal abnormality.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
5/10. When to worry about headache. Head pain as a clue to intracranial disease.Careful evaluation of headache is important to detect potentially morbid but treatable causes. Although such causes represent only 10% of all emergency department visits for headache, the consequences of a missed diagnosis can be severe. Unfortunately, the cost of performing computed tomography or magnetic resonance imaging for every patient with headache is prohibitive. However, familiarity with the differential diagnostic considerations, together with a high index of suspicion, should allow physicians to perform efficient, cost-effective examinations of all patients who seek treatment for headache.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
6/10. Acute hemorrhagic leukoencephalitis: a cause of acute brainstem dysfunction.A 37-year-old female physician was admitted to the hospital with severe headache, facial and hand paresthesias, dysarthria, and ataxia. neurologic examination disclosed signs of brain stem dysfunction. There was rapid neurologic deterioration, and she died in 28 hours. Postmortem studies showed the characteristic features of acute hemorrhagic leukoencephalitis.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
7/10. Idiopathic hypertrophic cranial pachymeningitis.We evaluated 3 patients with biopsy-proven hypertrophic cranial pachymeningitis apparently unrelated to any systemic disease. Each patient had chronic headache, cranial neuropathy, an elevated ESR, and a mild CSF pleocytosis. Neuro-ophthalmic findings included bilateral sixth nerve palsies in two patients and the third had bilateral optic neuropathies. MR imaging revealed thickened dura that enhanced with Gd-DTPA administration. Histologic examination showed thickened, fibrotic dura with a sterile, chronic, nongranulomatous inflammation. The response to treatment was variable with corticosteroids, immunosuppressive drugs, or radiation. The distinctive MR appearance should help physicians recognize this rarely reported disease.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
8/10. Progressive rubella panencephalitis: clinical course and response to 'isoprinosine'.This report describes the clinical course of a 16-year-old Canadian-born Chinese boy who has progressive rubella panencephalitis. The progression, the lack of response to 'Isoprenosine', and the additional finding of myopathy are discussed. The clinical and pathological features of this rare, progressive neurological disorder are also summarized. In view of the last major rubella pandemic occuring in the mid-60s, it is likely that during the next few years physicians will diagnose an increased number of patients with this distinct neurological entity.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
9/10. Acute disseminated encephalomyelitis: an unusual cause of encephalitic syndrome in childhood.Acute disseminated encephalomyelitis is a rare central nervous system demyelinating disease that occurs most frequently in children. It usually runs a monophasic course, beginning with fever, headache, and meningeal signs and rapidly progressing to coma when appropriate diagnosis and treatment are not provided. We report a case of a 14-year-old patient to alert emergency physicians to consider acute disseminated encephalomyelitis when presented with any child with encephalitic signs with nonspecific cerebrospinal fluid findings, failure to detect any causative agent, and only mild alterations on computerized tomography scan. The role of magnetic resonance imaging for the diagnosis is emphasized.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
10/10. Severe encephalopathy in a child: an uncommon cause.Cat scratch disease (CSD) is usually a self-limited disease. Although extremely uncommon, the involvement of the central nervous system has been previously reported in CSD. The intention of this paper is to make physicians aware that CSD could be complicated by encephalopathy. seizures in some patients could be the only clinical manifestation and are resistant to the common anti-epileptic therapy. The seizures resolve with supportive care.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
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