1/4. Cryptococcal meningitis manifesting as epilepsia partialis continua of the abdomen.We report a case of epilepsia partialis continua that primarily involved the abdominal muscles. Thorough assessment ultimately showed that the condition was due to cryptococcal meningitis. Surface electrode electromyography and electroencephalography were helpful in analyzing this unusual epileptic phenomenon. An 8-week treatment regimen of amphotericin b and a 30-day course of 5-fluorocytosine abolished the epilepsia partialis continua and cured the meningitis. This case should alert physicians to the fact that patients with epilepsia partialis continua may have clonic movements of only the trunk and that the spectrum of neurologic manifestations of cryptococcal infection must now include this seizure disorder.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/4. Warning symptoms of sinister headache.Headache is a common complaint. In most patients, it is usually a problem of migrainous or tension-type headache. It is crucial that a physician is able to differentiate sinister causes of headache from the more benign ones. Six cases are presented to illustrate the fact that there are clues in the history to suggest a sinister cause of headache even though there are minimal or no neurological deficits on physical examination. At some point of time, these cases were examined by a senior physician but they were diagnosed as migrainous or tension-type headaches. The first case is a 41-year-old labourer with cryptococcal meningitis. He presented with severe headaches at a relatively late age. A 20-year-old female complained of the worst headache she ever had and this was due to a subarachnoid haemorrhage. The third case was a young woman with a large parietal meningioma. Her headaches had recently assumed a different character. The fourth case involved an investment manager who developed headaches with transient diplopia and projectile vomiting and investigations revealed an ependymoma. A shipyard worker complained of a constant headache which disturbed his sleep. Two weeks after medical consultation, the character of his headache changed and he developed diplopia in all directions of gaze. He succumbed to pituitary apoplexy. The final case is a 28-year-old woman who had a complicated migraine. CT scan of the brain showed a large arterio-venous malformation.- - - - - - - - - - ranking = 2keywords = physician (Clic here for more details about this article) |
3/4. Two central nervous system infectious diseases in a patient with AIDS.As medical interventions prolong the lives of patients with acquired immunodeficiency syndrome (AIDS), we have begun to observe multiple infections occurring simultaneously in a single patient. This report describes two central nervous system (CNS) infections, cryptococcal meningitis and cerebral toxoplasmosis, coexisting in a patient with AIDS. Although the treatment strategies for these CNS infections are generally established, often the physician must make management decisions based on clinical and statistical data and patient response to empiric trials of therapy rather than on the results of invasive diagnostic tests.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
4/4. Case report of long-term survival in a patient with acquired immunodeficiency syndrome and cryptococcal meningitis.In the era before protease inhibitors were available, the great majority of patients with AIDS died within five years of the diagnosis. This grim reputation may cause both physician and patient to give up hope prematurely when antiretroviral therapy fails. We report a patient who survived five years after the diagnosis of cryptococcal meningitis and AIDS. Although there are now combinations of antiretroviral drugs available that can delay disease progression and extend the lives of AIDS patients, these are associated with a significant failure rate. It is thus important to be aware of the potential to extend life in patients even when antiretroviral therapy is not effective.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |