71/475. Abducent nerve palsy during treatment of brucellosis. brucellosis is an infectious disease with multisystem involvement caused by the genus brucella. Neurological complications including meningitis, meningoencephalitis, myelitis-radiculoneuritis, brain abscess, epidural abscess, and meningovascular syndromes are rarely encountered. We present here a patient with sixth cranial nerve palsy that occurred during treatment for brucellosis, a form of presentation rarely been reported in English-language literature. We conclude that neurobrucellosis, pseudotumor cerebri, and side effects of tetracyclines which are frequently used in brucellosis should be kept in mind when considering intractable headaches and cranial nerve palsies in patients with brucellosis. ( info) |
| A 32-year-old asymptomatic woman was found to have unilateral papilledema on routine ophthalmological examination. Subsequent visual field, neuroimaging, and cerebrospinal fluid examinations were consistent with the diagnosis of pseudotumor cerebri. This case demonstrates that pseudotumor cerebri may present as unilateral papilledema in any asymptomatic patient and illustrates the need for thorough neuro-ophthalmological evaluations to allow early detection of cases with atypical presentations to increase the efficacy of therapeutic intervention and prevent progressive visual loss. ( info) |
| A woman with history of bifrontal headache, vomiting and loss of vision was diagnosed as a case of pseudotumor cerebri based on clinical and MRI findings. Bilateral abducens and facial nerve palsies were detected. pseudotumor cerebri in this patient was not associated with any other illness or related to drug therapy. Treatment was given to lower the raised intracranial pressure to which the patient responded. ( info) |
74/475. Purulent meningitis due to aspergillosis in a patient with systemic lupus erythematosus. We report a 39-year-old female patient with systemic lupus erythematosus under immunosuppressive therapy who developed persistent neutrophilic meningitis, for which no infectious agent could be identified. Intensifying the immunosuppressive therapy induced a short amelioration of the clinical picture. At autopsy, basal meningitis was found to be due to aspergillus sp. ( info) |
| pseudotumor cerebri (PC) is a condition that occurs predominantly in obese women, and long lists of putative causes and associations have been reported. We describe here the case of a woman in whom PC coexisted with familial mediterranean fever (FMF). A review of the literature revealed no report of an association of these two conditions. ( info) |
76/475. Benign intracranial hypertension due to A-hypervitaminosis in adults and adolescents. Three new cases of chronic vitamin a intoxication are reported and a review of the literature with special reference to chronic intoxication in adolescents and adults is presented. The most prominent features are intracranial hypertension, skin and hair deviations, pain in the musculoskeletal system, and fatigue. intracranial hypertension occurs in 50% of chronic intoxications, but is not invariably linked with the other symptoms. Young women are the major age group represented. There seems to be no relation between the severity of the clinical picture and the vitamin a serum level. Discontinuance of vitamin a intake is sufficient for cure. ( info) |
77/475. Changes of cerebral haemodynamics during rebleeding subsequent to subarachnoid haemorrhage with vasospasm. A 40-year old patient with spontaneous subarachnoid haemorrhage and vasospasm in whom an acute rebleeding occurred during transcranial Doppler ultrasonography monitoring is reported. The Doppler recordings of the middle cerebral artery displayed an extreme modification in their configuration in the form of an orthograde systolic flow component with zero diastolic flow or an oscillating flow immediately after occurrence of rebleeding. Reoccurrence of a diastolic flow component in still markedly raised cerebrovascular resistance index could be demonstrated a short time later. Rebleeding in subarachnoid haemorrhage with preexisting vasospasm leads to a severe temporary disturbance of cerebral perfusion. The vasospasm is likely to lead to a delayed normalization of perfusion and thus to prolonged ischaemia. ( info) |
| Among 24 arteriovenous malformations (AVMs) involving the choroid plexus, 11 were plexal type AVMs predominantly located in the choroid plexus of the lateral ventricle, and 13 were parenchymal type AVMs mainly situated in the paraventricular cerebral parenchyma. 83% of all AVMs involved both the choroid plexus and the paraventricular cerebral parenchyma. Most cases presented with intracranial hemorrhage, particularly intraventricular hemorrhage. The most serious surgical problem was a small residual nidus unrecognized at the initial operation causing postoperative hemorrhage. Five parenchymal type AVMs presented residual niduses in the choroid plexus, causing death in two cases. Two plexal type AVMs resulted in residual AVMs supplied by the cisternal segment of the anterior choroidal artery, situated in the medial temporal lobe. To prevent postoperative hemorrhage from a small residual nidus, immediate postoperative angiography while the patient is still under general anesthesia should be performed to identify any residual nidus. ( info) |
| actinomycosis is a very rare cause of orbital abscess usually attributable to direct spread from adjacent structures. A case of actinomycosis of the orbit is presented, which was treated as orbital pseudotumour for 3 months before progression of signs and symptoms, despite high dose steroids, led to the diagnosis being reconsidered. ( info) |
| We report three patients with arachnoid cysts treated by cyst-peritoneal shunting in whom intracranial hypertension occurred during episodes of shunt malfunction. In one case this was associated with re-expansion of the arachnoid cyst, whilst in the other two cases this did not occur. The similarities between these two cases and patients with pseudotumor cerebri suggest a common pathogenic mechanism--specifically, a disturbance of the cerebrospinal fluid circulation. ( info) |