1/6. brain biopsy in cases of neonatal herpes simplex encephalitis.Neonatal herpes simplex encephalitis (HSE) can represent a difficult diagnostic problem when it occurs without concomitant mucocutaneus lesions and usually requires brain biopsy for diagnosis. Asymptomatic for the initial 2 to 4 weeks of life, the three infants we describe with localized HSE came to medical attention only because they developed persistent seizures and other nonspecific symptoms. Lumbar spinal fluid obtained from these children at clinical presentation showed an encephalitic pattern. Radionuclide brain scans revealed focal uptake of isotope in a variety of cortical areas, and electroencephalograms (EEGs) demonstrated repetitive, high amplitude, polyphasic sharp waves arising from analogous regions. Computed tomography (CT) showed nonspecific ill-defined areas of low density or contrast enhancement that did not correlate well with radionuclide, EEG, or clinical findings in two neonates. No infant had predominant temporal lobe involvement. Because these data suggested a multifocal, encephalitic process, all three infants underwent brain biopsy. A widespread infiltration of leukocytes and macrophages was observed in each specimen, and abundant intranuclear inclusions were present. Electron microscopy revealed abundant herpesvirus particles, and herpes simplex virus (HSV) was subsequently isolated from each sample. From our observations and our review of the literature, we propose the following criteria as indications for brain biopsy: brain biopsy is warranted to rule out HSE when a neonate presents with seizures, cerebrospinal fluid mononuclear pleocytosis with a negative gram stain, and focal, cortical disease on EEG and radionuclide scan.(ABSTRACT TRUNCATED AT 250 WORDS)- - - - - - - - - - ranking = 1keywords = radionuclide (Clic here for more details about this article) |
2/6. Heterotopic ossification and pseudoarthrosis in the shoulder following encephalitis. A case report and review of the literature.Heterotopic bone formation, or myositis ossificans, is common, particularly following trauma, total hip arthroplasty, spinal cord injury, severe head injury, and long-term coma. Although the mechanism is unknown, the pathogenesis is assumed to depend on transformation of mesenchymal cells to bone forming cells in response to a variety of stimuli. The clinical findings, laboratory data, roentgenograms, and radionuclide studies are standard aids in the diagnosis of heterotopic ossification. The treatment usually consists of range-of-motion exercise, nonsteroidal antiinflammatory drugs, x-ray therapy, disodium etidronate (EHDP), and excisional surgery. Reported here is a rare case of periarticular heterotopic ossification in the shoulder of a 38-year-old woman following head injury and 13 months in a coma. The unusual feature was the development of a pseudoarthrosis within the heterotopic bone. The patient's shoulder became markedly stiff with the development of a heterotopic pseudoarthrosis. Excision of the heterotopic bone and pseudoarthrosis was performed to improve the range of motion. Clinical roentgenographic, radionuclide, and pathologic observations are presented on the formation of a synovial joint within the heterotopic bone.- - - - - - - - - - ranking = 1keywords = radionuclide (Clic here for more details about this article) |
3/6. Opportunistic intracranial infection in AIDS detection by technetium-99m DTPA brain scintigraphy.Radionuclide brain scintigraphy and computed tomography (CT) demonstrated cerebral lesions in two patients with acquired immunodeficiency disease syndrome (AIDS) complicated by opportunistic infection of the brain. In the detection of these cerebral lesions, [99mTc]DTPA radionuclide scintigraphy was as reliable as CT. Since malignant lymphoma involving the brain has been seen with increasing frequency in patients with AIDS, the positive brain scan alone is nonspecific and should be correlated appropriately with the clinical setting.- - - - - - - - - - ranking = 0.5keywords = radionuclide (Clic here for more details about this article) |
4/6. Rapid response to acyclovir in herpes zoster-associated encephalitis.A previously healthy patient became acutely encephalopathic, with complete disorientation and amnesia, several days after the onset of thoracic herpes zoster. She had transiently abnormal electroencephalographic results, abnormalities on radionuclide brain scanning, and cerebrospinal fluid pleocytosis. There was no evidence of a toxic/metabolic encephalopathy except for a mildly elevated ammonia level. Intravenously administered acyclovir (30 mg/kg per day) induced a dramatic response, with complete resolution of the encephalopathy within 72 hours and normalization of the electroencephalographic results. The scant clinical experience with the successful use of acyclovir in the treatment of herpes zoster-associated encephalitis is reviewed.- - - - - - - - - - ranking = 0.5keywords = radionuclide (Clic here for more details about this article) |
5/6. Scintiscans and computer assisted tomographic findings of herpesencephalitis.The radionuclide, CAT and angiographic features of a case of herpes simplex encephalitis are present. A dramatic change in the abnormal perfusion and static concentration of tracer activity resulted following chemotherapy with adenine arabinoside. The improvement seen on the dynamic and static scintiscans correlates closely with the patient's clinical course and CAT findings. The radionuclide perfusion study is of particular importance in documenting the diminished activity of the inflammatory process following therapy.- - - - - - - - - - ranking = 1keywords = radionuclide (Clic here for more details about this article) |
6/6. Ventriculitis in an adult delineated by radionuclide brain scan: association with misleading findings on computerized tomography.We describe subacute periventricular encephalitis manifesting as dementia in an adult with a radionuclide brain scan showing "ventriculitis." Cranial computed tomography erroneously indicated an infiltrative tumor. We emphasize the use of conservative management rather than surgical exploration.- - - - - - - - - - ranking = 2.5keywords = radionuclide (Clic here for more details about this article) |