1/15. prochlorperazine-induced extrapyramidal effects mimicking meningitis in a child.Certain medications, such as the phenothiazines, may cause side effects that result in neck stiffness and may actually mimic the presentation of meningitis, especially in children. Despite the controversial use of antiemetics, they continue to be used in children with viral gastroenteritis. I describe the case of a child who had a febrile seizure and meningismus during the course of a viral gastroenteritis, not due to meningitis but to the untoward side effect of an antiemetic. Clinicians must be aware that these medications may cause extrapyramidal side effects that may mimic other more serious diseases and lead to unnecessary evaluations; therefore, their use cannot be strongly encouraged. If antiemetics are prescribed, physicians should emphasize possible side effects so that corrective treatment can be initiated promptly.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/15. Eosinophilic meningitis: a case series report and review of the literature.Prompted by a case of eosinophilic meningitis (EM), a review of the literature was performed to evaluate the strength of the diagnoses associated with EM and compares these results with our hospital's experience. Articles were critically reviewed for supporting evidence, method of diagnosis, and established standards for specific diagnosis. EM has been defined as > or = 10 eosinophils per mm3 or > or = 10% eosinophils of total cell count. Sixty-two cases of EM were found at our institution and reviewed. The results of this case series review concur with those found in the literature. It also suggests the importance of considering infectious and noninfectious etiologies when faced with eosinophils in the cerebrospinal fluid. This review and case study analysis provides the clinician with a critically established set of differential diagnoses and a concise definition of EM that may assist the physician in the evaluation of patients presenting with eosinophils in the cerebrospinal fluid.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
3/15. tinnitus in childhood.All of 1,420 children seen for clarification of a hearing disorder or to follow up for known difficulty in hearing were questioned as to whether they experienced tinnitus. The interview was carried out after a hearing test was conducted, which was based on play audiometry or normal pure-tone threshold audiometry, depending on the age of the child. When being interviewed, 102 children reported that tinnitus had appeared or was still present. Seventy-five children (73.5%) demonstrated difficulty in hearing in one or both ears, whereas 27 children (26.5%) had normal hearing in both ears. The most frequently obtained information (29.4%) was the progression of an existing hearing loss. meningitis is an important cause of hearing loss and of tinnitus and could be identified in 20% of our patients. We also considered as a cause of tinnitus skull or brain trauma, acute hearing loss, and stapes surgery. However, the mechanisms of tinnitus development were not immediately clear in a large proportion of the children studied: Problems included central sensory perception (14.7%) and emotional factors (11.8%). No additional information that might lead to an understanding of the hearing loss was available for 14.7% of the patients studied. tinnitus is a frequent symptom in childhood and, because children seldom complain about their tinnitus, such hearing problems that they report must always be taken seriously. The diagnosis should exclude metabolic disturbances, possible damage to the sensory level of the central nervous system, and circulatory disturbances. In addition, the physician should always consider emotional problems and disturbances of perception.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
4/15. Too quiet.The child with a fever (or a reported fever, as in this case) has a wide range of potential illnesses that must be considered. The pediatric community approaches children in three age groups: those younger than three months, those between 3-24 months, and those over 24 months. Those under three months of age are most at risk for serious problems, and the physical examination of the child is most unreliable. Infants most at risk for infection have smaller birth weights, mothers with infectious diseases such as chlamydia or hiv, and labor following premature rupture of membranes. Infants cannot offer complaints; have poorly functional muscles that do not allow the demonstration of neck stiffness or stiff joints; and cannot cough productively to demonstrate pneumonia. The most strenuous activity for an infant is eating, so ill infants will often feed poorly. The emergency physician or pediatrician will want the prehospital emergency provider to observe the behavior of an ill child to gain an indication of the seriousness of the illness. The Yale observation Scale uses six criteria to stratify the ill child. The ill child will have poor color, a weak or high-pitched cry, poor hydration (dry diaper and mucous membranes), little reaction to parental stimulation, little arousal or continuous sleeping and no smile. This child demonstrated many criteria of an ill child. Her temperature was likely high at the onset of illness (while in her crib), which was not detectable by the time the EMS crew did its evaluation. Difficulty breathing is a common observation in ill infants by their parents, and the child had a dry diaper. A quiet child is not to be considered a healthy child, and like many EMS situations, the crew was appropriately "worried most about the quiet one."- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
5/15. Rapid evolution of acute mastoiditis: three case reports of otogenic meningitis in adults.Otogenic meningitis is the most common intracranial complication of neglected otitis media. In the western world, such complications seldom occur in children and young adults and are extremely rare in adults and elderly people. The current use of antibiotics and of more sophisticated surgery has greatly diminished the incidence of otogenic meningitis in comparison with the past. This has resulted in physicians having less experience concerning diagnosis and treatment of this complication. The authors reported 3 consecutive cases of otogenic meningitis in adults, which occurred in the space of 3 months after a 6-year absence of such pathology at their institution. In all 3 cases, conventional antibiotic therapy proved ineffective; the course of the disease worsened rapidly in contrast with the lack of symptoms during the period before treatment. Emergency surgical treatment was mandatory.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
6/15. Brucella meningitis.A 36-year-old Hispanic man came into the emergency department with nonspecific symptoms (headache, myalgias, low-grade temperature, and low white blood cell count) and was diagnosed with brucella meningitis. The patient said he had consumed unpasteurized goat's milk and cheese in mexico, and had been treated 3 months previously for a febrile illness diagnosed as malta fever (brucellosis). Cultures of both the blood and cerebrospinal fluid yielded brucella melitensis. Blood agglutinin results for B abortus were positive at greater than 1:160. Unpasteurized milk and cheese are consumed in many countries where brucellosis is endemic. Emergency physicians are occasionally confronted with patients from developing countries with diseases that require rapid and specific diagnosis for optimal treatment.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
7/15. neisseria gonorrhoeae dissemination and gonococcal meningitis.Disseminated infection is a serious complication in approximately 2 percent of primary gonococcal infections. Meningeal infection is very rare; only 23 cases have been reported since 1922. We report a sexually active teenager with an acute febrile illness. From her cerebrospinal fluid cultures, neisseria gonorrhoeae was identified. She recovered completely after treatment with ceftriaxone and penicillin. Possible explanations for gonococcal dissemination include unique strains of the organism as well as particular complement deficiencies of the host. Aggressive efforts by physicians to prevent, identify, and treat primary gonococcal diseases should continue because this will reduce the frequency of serious complications.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
8/15. Intracranial complications of sinusitis.sinusitis is a common problem that is routinely diagnosed and treated by most primary care physicians. Although most cases usually respond to appropriate therapy, some occasionally progress to the development of intracranial complications, including meningitis, osteomyelitis, epidural and subdural empyema, intracranial mucocele or polyps, and frank brain abscess. It is important to develop a rational approach to the diagnosis and treatment of these conditions. A high clinical index of suspicion must always be maintained, since symptoms are often masked by previous antibiotic therapy. Radiologic evaluation must always include computerized tomography (CT) for accurate diagnosis and surgical planning. Therapy includes surgical drainage and high doses of appropriate intravenous antibiotics. cefuroxime and metronidazole provide excellent broad spectrum antibacterial coverage. Only early recognition and appropriate therapy can reduce the potential morbidity and mortality associated with these life-threatening complications.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
9/15. The patient with suspected meningitis.When meningitis presents acutely, therapy should be instituted within 1 hour, based on the patient's age and risk factors. When the presentation is subacute, clinical assessment, with analysis of the cerebrospinal fluid, allows the physician to decide among empiric antimicrobial therapy, observation, or further diagnostic studies.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
10/15. Mania with cryptococcal meningitis in two AIDS patients.Two AIDS patients with mania were found to have cryptococcal meningitis. In patients with AIDS or aids-related complex, physicians must thoroughly investigate the possibility of an organically based psychiatric syndrome.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
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