1/4. 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) |
2/4. The value of white blood cell count in patients with swollen discs.BACKGROUND: A broad differential diagnosis has to be considered in a patient with swollen discs. myeloproliferative disorders such as leukemia and lymphoma can in rare cases cause infiltrative optic neuropathy. history AND SIGNS: Two patients initially presented with slowly progressive severe visual loss. history was unremarkable except for previously noted slightly elevated white blood cell count for which - according to their general physicians - no treatment or work-up was required. At presentation, bilateral disc swelling was present. magnetic resonance imaging showed enhancement of the entire optic nerves sparing the chiasm. No other intracranial lesion was found. cerebrospinal fluid contained no malignant cells. THERAPY AND OUTCOME: After bone marrow aspiration the diagnosis of non-Hodgkin's lymphoma and granulocytic leukemia, respectively, was made. Treatment resulted in visual recovery. CONCLUSION: work-up in a patient with swollen discs should always include white blood cell count. If the result is abnormal further exploration should be pursued. Elevated white blood cell count may be the only hint of optic nerve infiltration caused by a myeloproliferative disorder and its treatment can result in remarkable recovery.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
3/4. Bilateral epidural empyemas in an adolescent.Epidural empyema is an unusual cause of headache that may be encountered in the emergency department. The collection of suppurative fluid usually results from local spread of sinusitis, although many other predisposing factors have also been described. patients with epidural empyema usually present with nonspecific cephalalgia that may be accompanied by fever and leukocytosis but is unlikely to be associated with focal neurological findings. The case of an adolescent who presented to our emergency department twice in 6 days with persistent headache is reported; cranial computed tomography performed on the second visit demonstrated bilateral epidural empyema. This entity is uncommon, but may certainly be encountered by the emergency physician.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
4/4. Agnogenic venous mesenteric thrombosis.One of the most difficult diagnoses to establish is that of agnogenic venous mesenteric thrombosis (AVMT). This disorder occurs chiefly in elderly patients and, unless diagnosed promptly, leads to death in most instances. AVMT may follow surgical operations or occur during a prolonged illness. In the past five years at St. Clare's Hospital and health Center in new york city, this diagnosis was established in five patients. In reviewing these cases, it was noted that some of the signs and symptoms such as those due to hypotension and shock with marked leukocytosis, were out of proportion to those usually observed when the preoperative diagnosis is being considered. The pathologic and radiologic characteristics of this disorder are outlined, and the recommended operative procedure for treatment is discussed. The importance is stressed of prompt, vigorous and prolonged anticoagulation therapy in order to minimize the chance of recurrence in the early postoperative period. Anticoagulant therapy is also effective preoperatively, if the disease is diagnosed sufficiently early. As greater numbers of elderly patients are being treated in hospitals, this dire complication should be uppermost in the minds of physicians and surgeons if a fatal outcome is to be avoided following a successful operative procedure.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |