11/63. Unexplained fitting in three parturients suffering from postdural puncture headache.We present the cases of three women who, within a 6-month period, suffered post-partum generalized tonic-clonic seizures. All had received an epidural in labour for analgesia and were subsequently diagnosed as suffering from postdural puncture headache. All were treated for that headache with Synacthen and one also received sumatriptan before her seizures. All made satisfactory recoveries and were discharged home. None displayed classical patterns suggestive of pre-eclampsia, meningitis, cortical venous thrombosis or any other pathological process that might explain these events adequately, and the specific precipitating factors were left unidentified.- - - - - - - - - - ranking = 1keywords = meningitis (Clic here for more details about this article) |
12/63. Cranial hypertension as first manifestation of Behcet's disease: a case report.Behcet's disease (BD) is a chronic, multisystem and relapsing vasculitis of unknown etiology. central nervous system (CNS) involvement is reported in 30% of cases, but it is the first symptom of the disease in only 5% of subjects. Neurological manifestations may appear as a parenchymal CNS pattern (the commonest), an intracranial hypertension-like pattern, or a meningitis-like pattern. We describe a 30-year-old Algerian man with BD who developed, as first symptom, a typical intracranial hypertension picture with headaches, bilateral papilledema and raised cerebrospinal fluid (CSF) pressure. magnetic resonance angiography (MRA) revealed a cerebral venous sinus thrombosis (VST). After 1 month of treatment with anticoagulants, prednisone, colchicine and chlorambucil, MRA showed complete recanalization of the cerebral venous sinus and the patient made a full recovery. BD should be routinely looked for in adult patients, especially males in their third and fourth decades, who present with intracranial hypertension syndrome. We therefore advocate the use of MRA for unexplained neurological symptoms in BD, since without it cerebral VST may easily be missed.- - - - - - - - - - ranking = 1keywords = meningitis (Clic here for more details about this article) |
13/63. Enteroviruses and sudden deafness.A young, healthy man presented with sudden severe sensorineural hearing loss and tinnitus. The results of the workup and neuroimaging were normal, as were the auditory brain stem responses. methylprednisolone pulse therapy was associated with significant hearing improvement within 10 days. A history of a short self-limited febrile illness preceding admission (with headache, photophobia, myalgia and fatigue), a raised serum c-reactive protein level and transient leukopenia suggested an infectious cause. Lumbar puncture revealed a mononuclear pleocytosis of the cerebrospinal fluid, with negative cultures but positive polymerase chain reaction test results for enterovirus, which was later cultured from the patient's stool. The patient's wife and baby had had a similar febrile illness without hearing loss 10 days earlier, and an outbreak of enterovirus meningitis was identified in the area, which was associated with familial clustering and echovirus serotype 4 infection. The varied causes of sudden sensorineural hearing loss, which should include enterovirus, are reviewed here.- - - - - - - - - - ranking = 1keywords = meningitis (Clic here for more details about this article) |
14/63. Acute disseminated encephalomyelitis associated with pasteurella multocida meningitis.OBJECTIVE: To describe a case of pasteurella multocida meningitis associated with acute disseminated encephalomyelitis (ADEM). CASE REPORT: A 33-year-old woman employed in a dog pound presented herself to hospital with fever and meningismus and was found to have culture positive pasteurella multocida meningitis. Despite appropriate antibiotic treatment her clinical course was characterized by a persistent fever and worsening encephalopathy, which prompted further neurological investigation. Spinal fluid exam and serial MRI scans as well as her one-year clinical course were found to be compatible with ADEM. CONCLUSION: Persistent fever and worsening encephalopathy in meningitis may indicate a para-infectious immune process such as ADEM, and may serve as indications for further neurological investigation.- - - - - - - - - - ranking = 7keywords = meningitis (Clic here for more details about this article) |
15/63. Cerebellar astrocytoma with repeated episodes of fourth ventricle isolation causing peritoneal shunt tube obstruction--case report.A 9-year-old girl underwent total removal of a cerebellar astrocytoma complicated by hydrocephalus after postoperative meningitis, requiring a ventriculoperitoneal shunt. Five months later, headache, vomiting, and gait disturbance appeared and computed tomography detected enlarged fourth ventricle. A fourth ventriculoperitoneal shunt resulted in immediate relief of all symptoms. After 2 months, obstruction of the peritoneal tube required shunt reconstruction. This recurred three times in 8 months. At the last operation, tumor cells were detected in the cerebrospinal fluid and the substance clogging the tube. This suggested that the tumor had recurred and clogging by tumor cells had caused the repeated episodes of isolated fourth ventricle. radiation therapy prevented further shunt obstruction and achieved remission of all signs and symptoms.- - - - - - - - - - ranking = 1keywords = meningitis (Clic here for more details about this article) |
16/63. Aseptic leptomeningitis in systemic lupus erythematosus. A case report.OBJECTIVE: Systemic lupus erythematosus (SLE) with leptomeningeal involvement is a rare condition. We report a case in a 17-year-old woman. CLINICAL PRESENTATION AND INTERVENTION: The patient was admitted to hospital with the complaints of vertigo, nausea, vomiting, headache, diplopia, ptosis on the left and weakness of the left leg. A diagnosis of SLE was established, with diffuse leptomeningeal involvement demonstrated by cranial magnetic resonance imaging. When treated with steroids, the clinical problems resolved almost completely. CONCLUSIONS: Although rare, leptomeningeal involvement can complicate SLE. Cranial magnetic imaging can demonstrate tissue involvement. The condition responds to steroid therapy.- - - - - - - - - - ranking = 4keywords = meningitis (Clic here for more details about this article) |
17/63. pituitary apoplexy masquerading as meningoencephalitis.BACKGROUND: pituitary apoplexy, a rare but life-threatening disorder, is characterized by the abrupt destruction of pituitary tissue secondary to infarction or hemorrhage of the gland itself. Its clinical features include severe headache, stiff neck, fever, visual disturbances, and symptoms of hypoadrenalism. OBJECTIVES: To assess how pituitary apoplexy may mimic the clinical findings of an infectious meningoencephalitis. methods AND RESULTS: We describe 3 individuals whose clinical profile and paraclinical studies were consistent with a diagnosis of presumed infectious meningoencephalitis. With minimal improvement on antimicrobial therapy, however, an extensive clinical and radiographic reevaluation yielded pituitary apoplexy as the etiology of their acute neurologic event. CONCLUSIONS: pituitary apoplexy is often misdiagnosed as meningitis or subarachnoid hemorrhage due to the presence of leukocytes and erythrocytes in the cerebrospinal fluid. These cases serve to highlight the importance of maintaining a broad differential diagnosis when evaluating patients presenting with an acute headache.- - - - - - - - - - ranking = 1keywords = meningitis (Clic here for more details about this article) |
18/63. The role of the biochemistry department in the diagnosis of pituitary apoplexy.A 47-year-old man presented with severe clinical hypoglycaemia. He had long-standing insulin-dependent diabetes with previously good glycaemic control. Intense headaches and vomiting initiated hospitalization. A brain computed tomography (CT) scan was normal, and a lumbar puncture showed elevated cerebrospinal fluid (CSF) protein [0.67 g/L; normal range (NR) 0.15-0.45 g/L], suggesting resolving viral meningitis. Routine thyroid function tests were abnormal (free thyroxine 10.6 pmol/L, NR 9-22.5 pmol/L; thyroid-stimulating hormone 0.16 mU/L, NR 0.35-5 mU/L). In the absence of evident thyroid therapy, the laboratory policy required an urgent cortisol assay to be added; this was very abnormal (42 nmol/L), suggesting hypopituitarism. Later analysis showed that concentrations of gonadotrophins and adrenocorticotrophin were low. An urgent pituitary magnetic resonance imaging scan revealed an unsuspected pituitary tumour with recent haemorrhage (pituitary apoplexy). The patient was given intravenous hydrocortisone and then stabilized on oral hydrocortisone, thyroxine and mesterolone. He made a full recovery and the hypoglycaemia resolved. The normal brain CT scan was falsely reassuring and the CSF protein was not due to viral meningitis but to haemorrhage into the pituitary tumour. If laboratory policy had not required the urgent cortisol assay be added, the diagnosis of hypopituitarism would have been delayed or even missed altogether. This could have led to the death of the patient.- - - - - - - - - - ranking = 2keywords = meningitis (Clic here for more details about this article) |
19/63. Intraventricular cytarabine in a case of idiopathic hypertrophic pachymeningitis.Idiopathic hypertrophic chronic pachymeningitis (IHCP) is characterised by inflammatory fibrotic thickening of the dura mater. Long term management is controversial. A 28 year old man with craniospinal IHCP and prominent lymphocytic meningitis is reported. cerebrospinal fluid and histological examination suggested a CD4 T cell driven process and B cell stimulation. After surgical, tuberculostatic, and immunosuppressive treatment failed to control the progressive meningeal hypertrophy, causing severe headache and neurological disability, the disease process eventually abated with intraventricular cytarabine treatment.- - - - - - - - - - ranking = 218.35854333929keywords = pachymeningitis, meningitis (Clic here for more details about this article) |
20/63. Steroid responsive late deterioration in cryptococcus neoformans variety gattii meningitis.The authors describe the clinical course of cryptococcus neoformans variety gattii infection in a young immunocompetent man who had a late deterioration characterized by headaches, subarachnoid inflammation, hydrocephalus, and stroke that reproducibly responded to steroids. These findings, in combination with declining markers of CSF infection, are consistent with the late deterioration being caused by sterile arachnoiditis rather than ongoing infection.- - - - - - - - - - ranking = 4keywords = meningitis (Clic here for more details about this article) |
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