1/11. Idiopathic pinealitis. Case report.This 63-year-old man presented with complaints of "having a feeling of falling backward" over a 3-month period. Results of his general physical examination, laboratory studies, and neurological examination were unremarkable. A magnetic resonance image revealed a 1.8 x 1.4 x 1.2-cm enhancing mass in the posterior third ventricle just above the corpora quadrigemina. The pineal gland was found to be diffusely enlarged at operation and separable from the posterior thalamus and was totally resected. The patient had an uneventful postoperative course but continues to be somewhat confused. The lesion consisted of a remarkable chronic inflammatory cell infiltrate permeating the pineal lobules and was composed of T and B lymphocytes, macrophages, eosinophils, and mast cells. Immunoperoxidase studies did not demonstrate langerhans cells, and a search for microorganisms was unrevealing. There was no evidence of neoplasia; results of immunostaining for germ cell markers and other tumor-associated antigens were negative.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
2/11. Serial perfusion brain tomographic scans detect reversible focal ischaemia in Rasmussen's encephalitis.A 39-year-old man with advanced adult-onset Rasmussen's encephalitis was treated with prednisolone and long-term, high-dose, human intravenous immunoglobulin. A pretreatment, semiquantitative interictal brain perfusion single photon emission computed tomography (SPECT) scan using (99)Tc(m) HMPAO (hexamethylene propylene amine oxime) showed hypoperfusion in the clinically affected right frontal, parietal and temporal lobes and contralateral perfusion defects. A second scan 8 months later revealed significant improvements (more than two standard deviations) in perfusion of the right frontal and temporal lobes despite serial magnetic resonance imaging evidence of permanent brain damage. This was associated with useful recovery of the patient's physical and cognitive function. We conclude that serial perfusion brain SPECT scanning is a useful method to demonstrate improvement in patients with Rasmussen's encephalitis in response to therapy.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
3/11. Multimodality functional imaging evaluation in a patient with Rasmussen's encephalitis.Rasmussen's encephalitis (RE) is a cryptogenic progressive inflammatory disorder of the brain that causes severe neurological problems, including intractable focal epilepsy. In select patients, aggressive treatment using cerebral hemispherectomy may ameliorate the devastating cognitive decline that accompanies this disease, even if the epileptic focus appears broadly distributed. We present a case of histopathologically-confirmed RE evaluated using a multimodal process that explored the physical and functional aspects of the associated epilepsy. This process included magnetic resonance imaging, single photo emission computed tomography, electroencephalography, and magnetoencephalography (MEG). The findings indicate that functional brain imaging data may greatly assist the surgical treatment decision-making process in RE, especially when structural imaging fails to reveal definitive localizing information. In addition, MEG may provide insights about the cortical reorganization of somatosensory cortex following hemispherectomy.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
4/11. cat-scratch disease: an unusual cause of combative behavior.Acute encephalitis is an unusual manifestation of cat-scratch disease. The authors present the case of a 27-year-old man who exhibited the acute onset of encephalitis manifested by violent behavior and confusion. The diagnosis of drug abuse was presumed initially, but a careful examination revealed the true cause to be cat-scratch disease. Emergency physicians are frequently faced with the challenging task of evaluating confused and combative patients. This case demonstrates the importance of a complete physical examination and a thorough laboratory evaluation.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
5/11. Rasmussen encephalitis: epilepsia partialis continua secondary to chronic encephalitis.Rasmussen encephalitis is a disease consisting of chronic encephalitis with progressive neurologic deficits and focal intractable seizure activity. The etiology is unknown, but pathologic specimens revealed changes consistent with viral encephalitis. Even though neuro-imaging techniques, such as positron emission tomography and magnetic resonance imaging, offer the prospect of specific, presurgical diagnostic criteria, the initial diagnosis usually is made on a clinical basis. Treatment modalities, including a wide variety of antiepileptic drug therapies and surgical interventions, may result in significant physical and mental impairments. We summarize the clinical presentation, diagnostic considerations, and different treatment protocols in a patient with this rare and debilitating disorder.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
6/11. A case study of the cognitive and behavioral deficits of temporal lobe damage in herpes simplex encephalitis.herpes simplex viral encephalitis is a fairly common nonepidemic encephalitis which produces severe neurological sequelae in survivors. Most viral infections of the central nervous system produce diffuse damage, but the herpes simplex virus demonstrates a predilection for localization in the temporal and orbitofrontal regions of the brain. This case study illustrates the highly significant language difficulties, marked memory deficits, and propensity for physical aggression following temporal lobe damage brought about by herpes encephalitis, and presents the usefulness of a new diagnostic measure in delineating such a variable cognitive pattern.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
7/11. cytomegalovirus infection in the normal host.CMV mononucleosis often resembles EBV infectious mononucleosis; however, certain features of the history and physical may help to distinguish CMV from EBV. While CMV mononucleosis is usually self-limited, certain laboratory abnormalities may persist for months or years after the patient has recovered. Previous reports on CMV in the non-immunocompromised host have rarely described systemic complications. We have reviewed 10 cases of CMV with systemic manifestations at one institution over a 15-year period. These patients had prolonged fevers (often greater than three weeks) and the diagnosis was often unsuspected during the early part of the illness. While two patients required mechanical ventilation, all patients had self-limiting disease and survived. When CMV is suspected and diagnosed early in the course, numerous diagnostic (and potentially dangerous) tests can be avoided in a viral illness in which prolonged fever is common.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
8/11. Cysticercotic encephalitis: a severe form in young females.Clinical and computerized tomography findings in patients with miliary infestation of cysticerci in brain parenchyma are presented. Cysticercotic encephalitis produces a severe and frequently fatal neurological disorder. Although parenchymal cysticercosis is common in endemic areas, in the cases reported here, the pathology is induced by a severe inflammatory response in brain parenchyma rather than by the physical presence of multiple cysts. As a result of diffuse brain edema, all cases develop subacute severe intracranial hypertension and compromise of visual function. One important feature of this form of neurocysticercosis is that it particularly affects young women.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
9/11. Acute viral encephalitis complicating a first manic episode.The diagnosis of viral encephalitis in a patient with acute mania was difficult because of symptom overlap and inconclusive laboratory evaluations. Final differentiation was made clinically. Despite the generally assumed usefulness of diagnostic tests for encephalitis, only the electroencephalogram showed consistent sensitivity in this patient and in similar previously reported cases. diagnosis was further complicated by the potential side effects of neuroleptic medications, which may mimic infection through extrapyramidal symptoms, fever, or altered blood counts. In addition, legitimate physical complaints were discounted as a result of the patient's psychiatric status.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
10/11. pancreatitis with normal serum amylase associated with sodium valproate: a case report.The patient was a 1-year-old infant with severe postencephalitis syndrome. diarrhea and elevation of the pancreatic enzymes, except for serum amylase (elastase 1 > 1, 5000 ng/dl (100-400); lipase, 885 IU/I/37 degrees C (10-48); trypsin, > 900 ng/ml (110-460)), were observed starting 70 days after starting valproate (dose, 70 mg/kg; serum level, 83.8 micrograms/ml). These findings as well as those obtained by abdominal ultrasonography suggested a diagnosis of pancreatitis, which was thought to be caused by sodium valproate. Important signs of valproate-induced pancreatitis may be easily overlooked in patients with neurological impairment, such as in ours. Because the blood half-life of amylase is short, not only amylase but some other pancreatic enzymes should be promptly investigated when valproate-related pancreatitis is clinically suspected in physically or mentally handicapped children.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
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