1/76. Persistent trigeminal neuralgia after removal of contralateral posterior cranial fossa tumor. Report of two cases.BACKGROUND: Contralateral trigeminal neuralgia as a false localizing sign in patients with posterior cranial fossa tumors is rare. Persistent contralateral trigeminal neuralgia after removal of the posterior fossa expanding lesion with microsurgical exploration of the affected trigeminal nerve root has been described in only a few reports. Displacement of the brainstem and the trigeminal nerve root, arachnoid adhesions, and vascular compression of the nerve root entry zone have been reported as causes of persistent contralateral trigeminal neuralgia. methods: One patient developed transformation of the contralateral constant burning facial pain into trigeminal neuralgia after removal of a posterior fossa meningioma. A typical right-sided tic douloureux in our second patient did not disappear after removal of a left acoustic neurinoma. CT scan revealed brainstem displacement to the side of trigeminal neuralgia. Microsurgical exploration in both cases demonstrated the squeezed and distorted trigeminal nerve root and displaced brain stem with no vascular involvement. Both patients underwent partial trigeminal rhizotomy for pain control. RESULTS: Complete disappearance of the trigeminal neuralgia was evident in both cases with postoperative facial sensory loss. The postoperative course in the first case was uneventful; the second patient died from purulent meningoencephalitis. CONCLUSION: Persistent contralateral trigeminal neuralgia after removal of a posterior fossa tumor is caused by distortion of the fifth nerve root by the displaced brainstem. Partial trigeminal rhizotomy can be performed for alleviation of facial neuralgic pain in cases without neurovascular compression.- - - - - - - - - - ranking = 1keywords = nerve (Clic here for more details about this article) |
2/76. A bad eye and a sore lip.A 48-year-old woman developed painful visual loss in the left eye, meningismus, and painful oral ulcers. magnetic resonance imaging of the brain with gadolinium demonstrated enhancement of the left optic nerve. Lumbar puncture showed a lymphocytic pleocytosis, and a biopsy specimen of one of the oral ulcerations was consistent with Behcet's disease. epidemiologic factors and diagnostic criteria for Behcet's disease are discussed.- - - - - - - - - - ranking = 0.2keywords = nerve (Clic here for more details about this article) |
3/76. Idiopathic granulomatous meningoencephalitis presenting as an intracranial tumor.A 2-year-old girl presented with a single episode of generalized seizure. magnetic resonance imaging examination showed an intracranial mass with a diameter of 2.5 cm in the right parieto-occipital region of the cerebrum. These clinicoradiological findings were suggestive of intracranial tumor. Histologically, fibroblastic proliferation of storiform pattern was noted, associated with epithelioid granulomas. The etiological pathogens for the granulomas could not be detected even though investigation of special histochemical staining, immunohistochemical study and dna analysis of mycobacterium tuberculosis by polymerase chain reaction technique was performed. On electron microscopic examination, the area appearing as a storiform pattern consisted of fibroblasts showing much dilated rough endoplasmic reticulum and slender tappering cytoplasmic processes without cellular junctional complex. No organisms were identified in the granulomatous area of the lesion. From those findings the diagnosis as idiopathic granulomatous meningoencephalitis was made.- - - - - - - - - - ranking = 0.10231594310398keywords = organ (Clic here for more details about this article) |
4/76. meningoencephalitis due to blastomyces dermatitidis: case report and literature review.infection of the central nervous system by blastomyces dermatitidis is a rare cause of meningoencephalitis. The existence of exclusive clinical infection of the meninges in the absence of pulmonary or other foci of infection has been debated. We describe a 20-year-old man presenting with meningoencephalitis caused by B dermatitidis. Blastomycotic infection was confirmed by isolation of the organism from brain tissue obtained at biopsy. magnetic resonance imaging demonstrated progressive enhancement of basal meninges with involvement of bilateral basal ganglia and thalami. Treatment with amphotericin b arrested further neurologic decline. However, clinical and radiographic follow-up suggested damage to diencephalic structures. The diagnosis of blastomycotic meningoencephalitis is difficult to establish because no sensitive serologic test exists, and attempts to isolate the organism in cerebrospinal fluid obtained by lumbar puncture generally fail. A biopsy specimen of brain tissue is frequently necessary for the diagnosis. survival is possible with timely initiation of therapy.- - - - - - - - - - ranking = 0.20463188620795keywords = organ (Clic here for more details about this article) |
5/76. The pathology of human west nile virus infection.west nile virus (WNV) was identified by immunohistochemistry (IHC) and polymerase chain reaction (PCR) as the etiologic agent in 4 encephalitis fatalities in new york city in the late summer of 1999. The fatalities occurred in persons with a mean age of 81.5 years, each of whom had underlying medical problems. Cardinal clinical manifestations included fever and profound muscle weakness. autopsy disclosed encephalitis in 2 instances and meningoencephalitis in the remaining 2. The inflammation was mostly mononuclear and formed microglial nodules and perivascular clusters in the white and gray matter. The brainstem, particularly the medulla, was involved most extensively. In 2 brains, cranial nerve roots had endoneural mononuclear inflammation. In addition, 1 person had acute pancreatitis. Based on our experience, we offer recommendations for the autopsy evaluation of suspected WNV fatalities.- - - - - - - - - - ranking = 0.2keywords = nerve (Clic here for more details about this article) |
6/76. A case of balamuthia mandrillaris meningoencephalitis.balamuthia mandrillaris is a newly described pathogen that causes granulomatous amebic encephalitis, an extremely rare clinical entity that usually occurs in immunosuppressed individuals. We report a case of pathologically proven Balamuthia encephalitis with unusual laboratory and radiologic findings. A 52-year-old woman with idiopathic seizures and a 2-year history of chronic neutropenia of unknown cause had a subacute illness with progressive lethargy, headaches, and coma and died 3 months after the onset of symptoms. Cerebrospinal fluid (CSF) glucose concentrations were extremely low or unmeasurable, a feature not previously described (to our knowledge). Cranial magnetic resonance imaging scans showed a single large temporal lobe nodule, followed 6 weeks later by the appearance of 18 ring-enhancing lesions in the cerebral hemispheres that disappeared after treatment with antibiotics and high-dose corticosteroids. The initial brain biopsy specimen and analysis of CSF samples did not demonstate amebae, but a second biopsy specimen and the postmortem pathologic examination showed Balamuthia trophozoites surrounded by widespread granulomatous inflammation and vasculitis. The patient's neutropenia and antibiotic use may have caused susceptibility to this organism. Amebic meningoencephalitis should be considered in cases of subacute meningoencephalitis with greatly depressed CSF glucose concentrations and multiple nodular lesions on cerebral imaging. Arch Neurol. 2000;57:1210-1212- - - - - - - - - - ranking = 0.10231594310398keywords = organ (Clic here for more details about this article) |
7/76. meningoencephalitis caused by histoplasma capsulatum: occurrence in a renal transplant recipient and a review of the literature.A case of meningoencephalitis caused by histoplasmosis in a renal transplant patient is described. The diagnosis was made postmortem. The clinicopathological features of 39 additional cases of central nervous system (CNS) invasion by histoplasmosis were reviewed. In the great majority of instances (92.1%), CNS involvement occurred in the disseminated form of the disease. Diagnosis was proved by culturing the fungus from bone marrow, blood, lymph nodes, or liver. Neurological symptoms and signs and cerebrospinal fluid (CSF) changes did not occur until extensive brain damage had resulted. Difficulty in culturing the organism in the (CSF) caused a further delay in making an early diagnosis of CNS involvement. The use of meningeal and brain biopsy specimens in conjunction with the electroencephalogram (EEG) may help in making an earlier diagnosis of CNS involvement.- - - - - - - - - - ranking = 0.10231594310398keywords = organ (Clic here for more details about this article) |
8/76. Neurological symptoms in patients whose cerebrospinal fluid is culture- and/or polymerase chain reaction-positive for mycoplasma pneumoniae.We describe 13 patients with neurological signs and symptoms associated with mycoplasma pneumoniae infection. M. pneumoniae was isolated from the cerebrospinal fluid (CSF) of 9 patients: 5 with meningoencephalitis, 2 with meningitis, and 1 with cerebrovascular infarction. One patient had headache and difficulties with concentration and thinking for 1 month after the acute infection. M. pneumoniae was detected, by means of PCR, in the CSF of 4 patients with negative culture results. Two had epileptic seizures, 1 had blurred vision as a consequence of edema of the optic disk, and 1 had peripheral nerve neuropathy.- - - - - - - - - - ranking = 0.2keywords = nerve (Clic here for more details about this article) |
9/76. Effects of TENS and methylphenidate in tuberculous meningo-encephalitis.PRIMARY OBJECTIVE: Beneficial effects of transcutaneous electrical nerve stimulation (TENS) on cognition and behaviour were observed in a child with probable herpes simplex Encephalitis. Based on these positive findings, it was examined in the present case study whether a child who had been diagnosed to suffer from tuberculous meningitis would benefit from TENS. Furthermore, as aggression and overactive behaviour were also prominent clinical symptoms, the effects of methylphenidate were investigated. methods AND PROCEDURES: neuropsychological tests were used to assess attention/concentration and visuospatial and visuoconstructive memory. Behaviour, including the level of activity during 24 hours, was assessed by one observation scale and actigraphy. EXPERIMENTAL INTERVENTIONS: TENS and methylphenidate. MAIN OUTCOMES AND RESULTS: TENS particularly improved overall affective behaviour. methylphenidate appeared to have the opposite effect on cognition and hardly any effect on patient's behaviour. CONCLUSIONS: TENS might improve the patient's behavioural functioning. Pros and cons for treatment effects are discussed.- - - - - - - - - - ranking = 0.2keywords = nerve (Clic here for more details about this article) |
10/76. meningoencephalitis caused by bacillus cereus in a neonate.We report on a newborn boy, who was delivered at 26 weeks' gestation by emergency caesarean section because of a prolapsed cord and breech presentation. Grade IV hyaline membrane disease subsequently developed, for which a surfactant was given. On day 8, there were frequent apnoeic attacks, and on day 30, marked irritability developed, as did intermittent stiffening of all four limbs. The anterior fontanelle was bulging and tense, and the cerebrospinal fluid was found to be turbid. Gram staining of the cerebrospinal fluid and blood revealed Gram-positive bacilli. Subsequent culturing yielded bacillus cereus, which was sensitive to amikacin and vancomycin. Severe cerebral oedema developed, however, and computed tomography of the brain showed bright cortical sulci, suggestive of meningitis. The baby died on day 37, and post-mortem histological examination of the brain showed extensive liquefactive necrosis with abundant neutrophilic infiltration. Since infection with bacillus cereus is rapidly fatal, early recognition of infection by this organism is important.- - - - - - - - - - ranking = 0.10231594310398keywords = organ (Clic here for more details about this article) |
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