Cases reported "Meningism"

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1/5. December 2002: 19-year old male with febrile illness after jet ski accident.

    The December 2002 COM. A 19-year-old healthy male fell into stagnant water of the intercostal waterway (salt water of South florida), following a jet ski accident. He sustained minor superficial injuries but engulfed significant quantities of water and sediment. A few days later he developed bifrontal headaches, vomiting, a stiff neck and a temperature of 102 degrees F. A CT scan on admission without contrast was negative. The CSF had markedly elevated white count but bacterial and fungal cultures were negative. He became progressively lethargic. On the fifth day he developed seizure activity. He expired the next day despite antibiotics. Gross examination of the brain at autopsy revealed edema, cerebellar tonsillar herniation and purulent meningitis. Microscopic examination revealed a massive leptomeningeal inflammatory infiltrate composed of neutrophils, lymphocytes, and numerous histiocyte-like cells. The inflammatory infiltrate extended into the cerebral parenchyma in numerous areas also involving the cerebellum, brainstem and ventricular system. Given the exposure to stagnant water (later confirmed to be a man-made fresh water lake), and the numerous histiocytic-like cells, suspicion for an amebic etiology of the disease process was raised and the CDC identified the ameba as naegleria fowleri. infection by naegleria fowleri, a free-living ameba, occurs after exposure to polluted water in man-made fresh water lakes, ponds, swimming pools, particularly during the warm weather months when the thermophilic ameba grows well. The pathologic substrate of the infection is an acute hemorrhagic, necrotizing meningo-encephalitis mainly at the base of the brain, brainstem and cerebellum occurring in young, healthy individuals.
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ranking = 1
keywords = headache
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2/5. Meningismus as main symptom in toxic shock syndrome.

    A case of toxic shock syndrome (TSS) with meningismus as main symptom is presented. The case illustrates that, in cases of rigidity of the neck and back, not directly explainable, TSS should be considered as a possible diagnosis. Toxic syndrome (TSS) is a severe, acute infectious disease with great variations in symptomatology (1,2). Its lethality is approximately 5% (3). The prognosis depends on early diagnosis and treatment.
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ranking = 0.11504263243166
keywords = back
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3/5. Spinal subarachnoid haemorrhage presenting as spinal block without meningism.

    A case of spinal subarachnoid haemorrhage with progressive spinal cord compression and without any evidence of meningism is described. Spinal block was demonstrated by myelography and computerized tomography and surgical decompression of the subarachnoid blood clot resulted in almost complete recovery. A diagnosis of spinal subarachnoid haemorrhage should be considered in any patient who presents with acute back pain and slowly or rapidly progressive neurological signs in the limbs, even when meningism is absent.
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ranking = 1.6413548876735
keywords = back pain, back
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4/5. Prolonged myoclonus and meningism following propofol.

    The purpose of this report is to describe a new complication of propofol administration. A previously fit patient underwent intravenous anaesthesia with propofol for removal of dental wires. Postoperatively he developed myoclonic jerking of his limbs. On regaining consciousness he complained of an occipital headache, neck stiffness and photophobia, and was found to have nuchal rigidity on examination. These clinical features resolved over the following week. Subsequent investigations failed to explain the aetiology of the symptoms of meningeal irritation, which suggests that propofol was the causative agent. While prolonged myoclonus has been previously described with propofol administration, this is the first report of meningism occurring with its use.
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keywords = headache
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5/5. neck pain and headache in an afebrile 15-year-old.

    Nuchal rigidity and headache are important signs of bacterial meningitis, although, in the absence of fever other etiologies would be considered. An evaluation of a 15-year-old boy with the above features, focal neurological deficits, and two cerebral contrast enhancing ring lesions is discussed.
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ranking = 5
keywords = headache
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