1/30. Simultaneous bilateral painful ophthalmoplegia and exudative retinal detachment in rheumatoid arthritis.A 47-year-old woman who suffered from chronic rheumatoid arthritis presented with bilateral painful ophthalmoplegia with proptosis and exudativeretinal detachment. The painful ophthalmoplegia with proptosis might have been caused by pachymeningitis involving the cavernous sinus bilaterally, or bilateral posterior scleritis spreading to the extraocular muscles and tendons. The exudative retinal detachment might have been a result of bilateral posterior scleritis which had spread to the choroid. These two unusual complications of rheumatoid arthritis occurred simultaneously in this case. Both complications responded to corticosteroid treatment.- - - - - - - - - - ranking = 1keywords = pachymeningitis, meningitis (Clic here for more details about this article) |
2/30. Horizontal conjugate gaze palsy in eosinophilic meningitis.Two cases of eosinophilic meningitis who presented with headache and strabismus are reported. Pertinent physical examination revealed unilateral horizontal conjugate gaze palsy with absence of doll's eye maneuver and hemiparesis. The etiologic agent of eosinophilic meningitis is presumed to be angiostrongylus cantonensis and the infected location that produce horizontal conjugate gaze palsy was a pontine lesion.- - - - - - - - - - ranking = 0.11018809061723keywords = meningitis (Clic here for more details about this article) |
3/30. Leptomeningeal signet-ring cell carcinomatosis presenting with ophthalmoplegia, areflexia and ataxia.We report a very rare case of occult leptomeningeal carcinomatosis (LC) in whom repeated cytological examination did not show malignant cells in cerebrospinal fluid (CSF) and the primary focus was not discovered by extensive survey. The patient presented with ophthalmoplegia, ataxia and areflexia mimicking miller fisher syndrome (MFS) at the initial stage, and later, the clinical profile and laboratory findings including CSF examination simulated tuberculous meningitis. Postmortem autopsy disclosed metastatic signet-ring cell carcinoma infiltrating into cranial nerves and leptomeninges. We would like to emphasize that LC sometimes shows symptoms and signs similar to MFS or tuberculous meningitis.- - - - - - - - - - ranking = 0.036729363539078keywords = meningitis (Clic here for more details about this article) |
4/30. Neuro-ophthalmic sarcoidosis.sarcoidosis is a multisystem disorder in which ocular involvement occurs in about one-quarter and neurosarcoidosis in 7 per cent of patients. When the retina is involved, the reported incidence of central nervous system sarcoidosis is 37 per cent. The patient described had a transient papular eruption of the legs, bilateral hilar lymphadenopathy, polyarthralgia with knee effusions, and bilateral facial and peripheral neuropathy. Ocular involvement was characterized by anterior uveitis (in the initial stages), vitreous flare, bilateral disc oedema, macular oedema, streak haemorrhages, peripheral periphlebitis, nerve fibre bundle defects, and candle-wax spots. fluorescein angiography showed no fluorescence of the candle-wax spots nor of the adjacent vessels. However, there was hyperfluorescence of two retinal lesions. This patient had unilateral internal ophthalmoplegia, only three cases of which have been reported in the literature. Her health was restored by heavy, prolonged corticosteroid therapy. Her family history revealed that an uncle died of sarcoidosis complicated by cryptococcal meningitis. The literature on retinopathy in sarcoidosis is reviewed and the lesions noted in the posterior segment are listed.- - - - - - - - - - ranking = 0.018364681769539keywords = meningitis (Clic here for more details about this article) |
5/30. Rare actinobacillus infection of the cavernous sinus causing painful ophthalmoplegia: case report.OBJECTIVE AND IMPORTANCE: actinobacillus actinomycetemcomitans is a gram-negative coccobacillus that is known to cause a wide array of clinical infections in debilitated patients, including periodontal disease, soft tissue abscess, pleural empyema, endocarditis, cerebral abscess, and meningitis. We report a rare A. actinomycetemcomitans cavernous sinus abscess that caused painful ophthalmoplegia in a healthy man. CLINICAL PRESENTATION: A 34-year-old man presented with a 3-month history of acute onset of left-sided retro-orbital pain that progressed to a complete left Cranial Nerve VI palsy and Cranial Nerve V1 and V2 hypesthesia. magnetic resonance imaging revealed the presence of an enhancing lesion in the left cavernous sinus, which encased and narrowed the ipsilateral intracavernous segment of the internal carotid artery. Routine blood and cerebrospinal fluid analyses were normal. tolosa-hunt syndrome was suspected, and the patient was treated with high-dose corticosteroids. An open biopsy was performed after failed prolonged corticosteroid therapy. INTERVENTION: A left frontotemporal craniotomy and cavernous sinus exploration through an interdural approach were performed. A soft reddish mass was found in the cavernous sinus around Cranial Nerve V1 and V2. Multiple biopsies were obtained. Pathological analysis revealed a purulent infection containing multiple gram-negative coccobacilli. The patient's pain improved immediately, and cranial neuropathy resolved during the next several weeks. After cultures demonstrated growth of A. actinomycetemcomitans, a regimen of orally administered amoxicillin and metronidazole was initiated. Eight months after surgery, the patient was free of symptoms and a repeat magnetic resonance imaging scan was normal. CONCLUSION: We present a rare bacterial abscess of the cavernous sinus causing painful ophthalmoplegia. In patients who present with presumed tolosa-hunt syndrome and do not improve with prolonged high-dose corticosteroid therapy, an open biopsy is recommended to exclude a bacterial infection.- - - - - - - - - - ranking = 0.018364681769539keywords = meningitis (Clic here for more details about this article) |
6/30. Unusual presentation of tuberculous meningitis.We present 4 cases of tuberculous meningitis with atypical clinical features and CSF findings. Two patients had initially normal CSF examination, one developed internuclear ophthalmoplegia, while the other had deterioration of consciousness. The third patient presented with paranoid psychosis, and the fourth had a picture mimicking acute bacterial meningitis and he developed right hemianopia due to a tuberculoma detected by MRI. All recovered completely with anti-tuberculous treatment.- - - - - - - - - - ranking = 0.11018809061723keywords = meningitis (Clic here for more details about this article) |
7/30. Acute sterile meningitis as a primary manifestation of pituitary apoplexy.pituitary apoplexy is a rare and underdiagnosed clinical syndrome. It results from hemorrhagic infarction of the pituitary gland. In its classical form it is characterized by acute headache, ophthalmoplegia, visual loss and pituitary insufficiency. Meningeal irritation signs, clinically indistinguishable from infectious meningitis, are considered rare and have not been reported as presenting signs. We report a 53-yr-old man who was admitted to hospital following acute headache, fever, neck stiffness and paresis of the left oculomotor and abducent nerves. A lumbar puncture revealed an increased number of polymorphs but with a sterile cerebral spinal fluid. magnetic resonance imaging (MRI) showed an intrasellar mass with central necrosis in an enlarged sella. Endocrinological evaluation demonstrated insufficient thyroid, adrenocortical, and gonadal function. necrosis within a chromophobe adenoma was found upon surgical decompression of the sella. After surgery anterior panhypopituitarism did not recover, while ophthalmoplegia subsided. The patient is now in good health under appropriate hormonal replacement therapy.- - - - - - - - - - ranking = 0.091823408847696keywords = meningitis (Clic here for more details about this article) |
8/30. Idiopathic hypertrophic cranial pachymeningitis masquerading as tolosa-hunt syndrome.Idiopathic hypertrophic cranial pachymeningitis is a rare condition. A case of idiopathic hypertrophic cranial pachymeningitis presenting as tolosa-hunt syndrome is being reported. The importance of neuroimaging in patients with suspected tolosa-hunt syndrome is discussed. tolosa-hunt syndrome might represent a focal manifestation of Idiopathic hypertrophic cranial pachymeningitis. Future studies are necessary to further clarify the relationship between these two conditions.- - - - - - - - - - ranking = 7keywords = pachymeningitis, meningitis (Clic here for more details about this article) |
9/30. meningitis following relapsing painful ophthalmoplegia in aspergillus sphenoidal sinusitis: a case report.We report the case of a 58-year-old woman in whom relapsing painful ophthalmoplegia related to a mycetoma of the sphenoid sinus gave origin to meningitis with markedly depressed glucose levels in the cerebrospinal fluid. Surgical exeresis of the mycetoma allowed aetiological diagnosis (aspergillosis) and--together with antimycotic therapy--led to durable clinical response.- - - - - - - - - - ranking = 0.018364681769539keywords = meningitis (Clic here for more details about this article) |
10/30. Internuclear ophthalmoplegia in cryptococcal meningitis.Cranial nerve involvement has been reported in cryptococcal infection of the central nervous system. We report a case of unilateral internuclear ophthalmoplegia developed in one patient with cryptococcal meningitis. The symptom subsided one week after commencement of antifungal treatment. We believe that this is a vasculitic phenomenon of the disease.- - - - - - - - - - ranking = 0.091823408847696keywords = meningitis (Clic here for more details about this article) |
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