1/14. Pachymeningitis in microscopic polyangiitis (MPA): a case report and a review of central nervous system involvement in MPA.A case of microscopic polyangiitis (MPA) with pachymeningitis is described. The patient had renal, skin, gallbladder and peripheral nervous system involvement, simultaneously with pachymeningitis. Necrotizing glomerulonephritis with crescent formation, and necrotizing small vessel vasculitis in the kidney and skin were confirmed by biopsy. A highly elevated titer of antineutrophil cytoplasmic antibody for myeloperoxidase (MPO-ANCA) was observed. All of the clinical and laboratory abnormalities improved with high-dose pulse and conventional steroid therapy. The literature on central nervous system involvement in MPA and perinuclear-ANCA (p-ANCA)-related vasculitis is reviewed. This case serves to emphasize that pachymeningitis can occur as one of the features of MPA.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
2/14. Fatal bowel infarction and sepsis: an unusual complication of systemic strongyloidiasis.A 58 year old Chinese male, one week after arriving in canada from hong kong, presented with acute abdominal pain and diarrhoea which was rapidly followed by escherichia coli infection causing septicaemia and meningitis. His past history revealed bronchial asthma for 15 years treated with steroids. At laparotomy, 7 days after the onset of symptoms, he was found to have extensive haemorrhagic infarction of the small bowel and right colon. Examination of the fibrosed mesenteric vessels revealed numerous filariform larvae of strongyloides stercoralis, within the walls, and in all layers of bowel wall. The role of the parasite in the production of obliterative arteritis in this fatal case of haemorrhagic enteropathy is discussed. Clinical strongyloidiasis, in uncomplicated cases, varies from mild to severe with gastroenteritis, nausea, colicky abdominal pain, electrolyte imbalance and symptoms of malabsorption syndrome (MARCIAL-ROJAS, 1971). In malnourished individuals and patients with debilitating infections, either newly acquired or asymptomatic latent infection with S. stercoralis can assume severe dimensions (BROWN and perna, 1958; HUGHTON and HORN, 1959). Similarly, in patients on steroid (CRUZ et al., 1966; WILLIS and MWOKOLO, 1966; NEEFE et al., 1973) and immunosuppressive therapy for lymphomatous diseases or deficient in immune response (ROGERS and NELSON, 1966; RIVERA et al., 1970), systemic strongyloidiasis is often fatal. The increased frequency of auto-infection in such patients with a breached immune barrier is, however, unclear. Further complications of this infection due to severe enterocolitis result in sepsis, bacteraemia and meningitis (BROWN and perna, 1958; HUGHTON and HORN, 1959). This paper presents a fatal case of S. stercoralis infection which illustrates an uncommon if not unique, mechanism in its production of haemorrhagic enteropathy leading to sepsis and death.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
3/14. Esophageal erosion as a possible bacterial entry site in an acute lymphoblastic leukemia patient with sepsis.A 69-year-old man with relapsed acute lymphoid leukemia was treated with adriamycin, vincristine, and prednisolone. During this chemotherapy, the patient developed sepsis and meningitis. Although many kinds of antimicrobial drugs, including imipenem, meropenem, amphotericin-B, and gamma-globulin were administered, the patient died of respiratory failure. A positive result for enterococcus faecalis was obtained in both blood and cerebrospinal fluid culture. autopsy revealed multiple small erosions in the lower esophagus. Histopathological examination showed multiple nuclear inclusion bodies of herpes simplex virus in the squamous epithelial cells at the edge of the erosions. Moreover, proliferation of micrococci was observed at the base of the erosions and in the lumina of the submucosal small vessels. These findings suggested that E faecalis entered the blood circulation from this lesion. In many patients with febrile neutropenia, the pathogenesis of infection remains unclear. Our case seems significant for clarifying the focus and pathogenesis of febrile neutropenia.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
4/14. Rheumatoid meningitis: an autopsy report and review of the literature.We report the clinical and autopsy findings of a 71-year-old Japanese woman with rheumatoid meningitis. This patient developed subacute meningitis during an inactive stage of rheumatoid arthritis (RA), and despite intensive examinations no causative agents or underlying disease could be identified except for RA. Based on persistent hypocomplementaemia and increased serum levels of immune complexes she was suspected of having vasculitis, and was treated with intravenous methylprednisolone (1000 mg/day for 3 days) followed by oral prednisolone. Soon after beginning treatment with corticosteroid her symptoms improved, in parallel with a decrease in cell counts and interleukin-6 in the cerebrospinal fluid. During tapering of oral prednisolone she died of a subarachnoid haemorrhage which was ascribed to a relapse of the meningitis. autopsy demonstrated infiltration of mononuclear cells, including plasma cells, in the leptomeninges, mainly around small vessels, leading to a definite diagnosis of rheumatoid meningitis. When RA patients manifest intractable meningitis with a subacute course, this disease is important as a possible diagnosis even if the arthritis is inactive, and intensive treatment, including corticosteroid and immunosuppressants, should be positively considered as a therapeutic option as soon as possible because of the poor prognosis.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
5/14. Hypertrophic pachymeningitis as an initial and cardinal manifestation of microscopic polyangiitis.The authors describe a 68-year-old man who developed hypertrophic pachymeningitis as an initial and cardinal manifestation of microscopic polyangiitis. The patient had a high titer of antineutrophil cytoplasmic antibody for myeloperoxidase. Biopsies revealed necrotizing glomerulonephritis in the kidney, small vessel vasculitis in the sural nerve, and infiltration of plasma cells and eosinophils in the thickened dura mater.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
6/14. Neoplastic angioendotheliomatosis (NAE) of the CNS in a patient with AIDS subacute encephalitis, diffuse leukoencephalopathy and meningo-cerebral cryptococcosis.A 12-year-old, hemophilic boy died with acquired immune deficiency syndrome (AIDS) after a clinical course characterized by progressive psycho-organic syndrome and opportunistic infections. Postmortem neuropathological examination revealed a cerebral form of neoplastic angioendotheliomatosis (NAE), leukoencephalopathy, giant cell encephalitis and meningo-cerebral cryptococcosis. The most unusual finding was the presence of proliferated neoplastic cells within lumina of some blood vessels throughout the central nervous system (CNS). These cells displayed cytologic features of malignancy and stained positively for common leukocyte antigen. Coronal sections showed diffuse cerebral and cerebellar leukoencephalopathy with most pronounced loss of myelin and axons in deep white matter, while the subcortical arcuate fibers and the corpus callosum were partially spared. In these areas numerous small foci of severe myelin loss were present. Microglial nodules and distinctive multinucleated giant cells (MGC) were numerous. Intracytoplasmic and intranuclear acidophilic inclusions were found in a few multinuclear and mononuclear cells. Close contact between mononuclear and multinuclear cells suggesting their fusion was also observed. As far as we know this is the first case of NAE encountered in AIDS, one of the rare primary cerebral forms and the youngest reported case of NAE up to now. This case could be considered as one proof more that NAE is a special form of malignant lymphoma.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
7/14. Cryptococcal meningitis presenting as uveitis.A patient presented with a posterior uveitis. An inferior plaque of retinal exudation was seen. Full investigation failed to establish a cause until six weeks later, when cryptococcal meningitis developed. The patient was immunocompetent. Exudation in relation to retinal vessels is unusual in idiopathic posterior uveitis, and cryptococcosis should be considered in the differential. diagnosis is by lumbar puncture or vitreous aspiration.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
8/14. Virchow-Robin space: a path of spread in neurosarcoidosis.Three cases of documented sarcoid meningoencephalitis were reviewed. Computed tomography (CT) showed enhancing, perivascular, linear, and nodular areas along the subarachnoid space, extending deep into the white matter. In one case the perivascular granulomatous infiltration, which caused small vessel periangiitis, gave rise to a CT pattern closely resembling that of arteriovenous malformation or infarction with gyral enhancement. This infiltrative pattern might be seen in other chronic meningeal processes. The pathophysiology responsible for the unusual CT appearance and the differential diagnosis are discussed.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
9/14. Rhino-orbital zygomycosis.A 63-year-old diabetic man presented with sinusitis with orbital and intracranial signs progressing over one week, due to zygomycosis. Despite control of the diabetes, surgical excision of infected tissue and antifungal therapy he died in the fifth week of illness. Pathological study showed extensive fungal infiltration of periorbital structures and mycotic thrombosis of many blood vessels with associated necrosis and infarction of fat and extraocular muscles.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
10/14. Stab wounds at the craniocervical junction.Between 1976 and 1984, 11 patients with stab wounds at the craniocervical junction were seen in the Department of neurosurgery at Groote Schuur Hospital. The injury usually occurred in males, and the left side was predominantly involved. Because of the anatomical features of this region, the penetrating instrument is deflected by the occipital squama into the atlantooccipital or atlantoaxial interspace, and an almost predictable syndrome occurs. The dura mater is penetrated, so that cerebrospinal fluid leakage and meningitis are common complications (meningitis occurred in 5 patients). A meningocele may develop at this site and did occur in 4 patients, but only 2 required surgical repair. Because of the exposed position of the vertebral artery at this level, this vessel was injured in 4 patients; an arteriovenous fistula developed in 2, vertebral artery occlusion occurred in 1, and a false aneurysm developed in another patient. The neurological deficit varied in magnitude, was often transient, affected the upper limbs more than the lower, was asymmetrical (suggestive of lateralized injury), and at times showed a remarkable tendency to recover. awareness of the existence of this syndrome may help in forestalling complications. The only warning sign may be an insignificant wound in the suboccipital or retromastoid region.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
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