1/92. Infectious meningitis mimicking recurrent medulloblastoma on magnetic resonance imaging. Case report.This report and the accompanying review of the literature address the challenges, when using surveillance magnetic resonance (MR) imaging, of establishing the origin of newly detected central nervous system lesions. Routine surveillance MR imaging in a 16-year-old boy, whose medulloblastoma had been successfully treated, demonstrated asymptomatic nodular leptomeningeal enhancement of the brain and spinal cord, which was consistent with recurrent disease. Examination of the cerebrospinal fluid, however, led to the diagnosis of bacterial meningitis. Two weeks after completion of antibiotic therapy, the original MR imaging findings were seen to have resolved. This case illustrates the importance of considering clinical and laboratory data, including results from a complete examination of the cerebrospinal fluid, when interpreting the origin of new lesions revealed by MR imaging.- - - - - - - - - - ranking = 1keywords = brain, central nervous system, nervous system (Clic here for more details about this article) |
2/92. Brain abscesses from neglected open head injuries: experience with 17 cases over 20 years.We are reviewing our experience with 17 civilian cases with post-traumatic brain abscesses treated in the era of CT scanning over a period of 20 years. The principal cause for this intracranial complication was the neglected compound depressed fracture. One was a newborn infant with left parietal abscess caused by a vacuum extraction. We have used the following methods of treating the abscesses: single burr hole aspiration in the newborn with an excellent result; repeated aspiration, with debridement of the depressed fracture, in 5 cases (1 death); aspiration with early subsequent excision, via craniotomy, in 7 cases (no death), and primary excision, via craniotomy, in 4 cases (1 death). The early subsequent excision of the abscess, 2 or 3 days after the initial aspiration, has proved in our experience very satisfactory. In cases with bone fragment into the abscess cavity the excision of the abscess is indicated. The cultured pus from the abscess cavity showed mixed flora (streptococci and staphylococci) in 7 cases; staphylococcus aureus in 4; staphylococcus epidermidis in 2, and no growth in 4 cases. Antibiotics play an important role in the treatment of post-traumatic brain abscesses.- - - - - - - - - - ranking = 0.89378348995887keywords = brain (Clic here for more details about this article) |
3/92. Response of complicated methicillin-resistant staphylococcus aureus endocarditis to the addition of trovafloxacin.The newer fluoroquinolones have many properties such as safety, bioavailability, and tissue penetration that make them attractive in the therapy of complicated infections. Unfortunately, the rapid development of resistance by Staphylococcus aureus to ciprofloxacin has dampened interest in these agents for serious staphylococcal infections. A patient with right-sided methicillin-resistant staphylococcus aureus (MRSA) endocarditis with a complicated clinical course received trovafloxacin in addition to vancomycin and rifampin. He was initially treated with vancomycin, gentamicin, and rifampin for serious MRSA infection, but because of complications, including septic central nervous system emboli, persistent fever, and leukocytosis, gentamicin was stopped and trovafloxacin begun. After this addition the patient improved and completely recovered. in vitro and animal model data show that many newer fluoroquinolones have excellent activity against S. aureus, including MRSA, and are also less likely to induce resistance. Animal models of endocarditis support their efficacy in serious staphylococcal infections.- - - - - - - - - - ranking = 0.55310825502056keywords = central nervous system, nervous system (Clic here for more details about this article) |
4/92. Community-acquired methicillin-resistant staphylococcus aureus brain abscess in an immunocompetent individual.A 52-y-old woman with a community-acquired methicillin-resistant staphylococcus aureus brain abscess who was successfully treated with surgical drainage and antibiotics is described. The increase in community-acquired methicillin-resistant S. aureus and the impact this will have on empirical treatment of such infections are discussed.- - - - - - - - - - ranking = 2.2344587248972keywords = brain (Clic here for more details about this article) |
5/92. brain abscess caused by methicillin-resistant staphylococcus aureus.A Swedish tourist was admitted to a Cuban hospital due to epileptic seizures caused by brain tumors. Upon return to sweden and admission to our hospital, methicillin-resistant staphylococcus aureus (MRSA) was isolated. He was later considered to be free of MRSA but then developed a brain abscess from which MRSA was isolated.- - - - - - - - - - ranking = 0.89378348995887keywords = brain (Clic here for more details about this article) |
6/92. staphylococcus lugdunensis: report of first case of skin and soft tissue infection in singapore.We report the first case of skin and soft tissue infection due to Staphylococcus lugdunensis in singapore. This is a coagulase negative Staphylococcus species known to cause a wide variety of more serious infections--brain abscess, sepsis, chronic osteomyelitis and infective endocarditis.- - - - - - - - - - ranking = 0.44689174497944keywords = brain (Clic here for more details about this article) |
7/92. Two-staged operation for thoracolumbar osteomyelitis following methicillin-resistant staphylococcus aureus infection of a craniectomy wound--case report.A previously healthy 53-year-old woman developed pyogenic vertebral osteomyelitis (PVO) manifesting as progressive lumbago following wound infection of a decompressive craniectomy performed for brain contusion caused by a traffic accident. magnetic resonance imaging disclosed vertebral osteomyelitis at T-12 and L-1 with paravertebral abscess. Anterior debridement and fusion using autografts were performed at the first operation. methicillin-resistant staphylococcus aureus (MRSA) was cultured from the abscess specimen. Antibiotic therapy resolved the infection. Pedicle screw fixation was performed at the second operation. The patient became free from back pain and no recurrence of infection was seen. The diagnosis of PVO is frequently observed or delayed because of the nonspecific symptomatic presentation in the early stage. Coexistent infection or trauma makes early diagnosis more difficult. Indications and timing of instrumentation for the spinal column infected with MRSA is difficult. Two-staged operation with anterior debridement and posterior instrumentation after eradication of the infection is a safe and effective procedure for MRSA vertebral osteomyelitis.- - - - - - - - - - ranking = 0.44689174497944keywords = brain (Clic here for more details about this article) |
8/92. Encephalopathy with staphylococcal endocarditis: multiple neuropathological findings.BACKGROUND: Infective endocarditis is associated with serious neurological sequelae. OBJECTIVE: Here, we report a patient with Staphylococcus aureus endocarditis, secondary to congenital heart disease, with subacute onset of multiple neurological complications. RESULTS: Despite prompt antibiotic treatment with rapid sterilization of blood cultures, the patient died with brain herniation within 96 hours of admission. Neuropathological examination showed intraparenchymal hemorrhages, mycotic aneurysms, micro-abscesses and septic arteritis with accompanying infarction. Immunocytochemical studies revealed enhanced CD45 and GFAP immunoreactivity, together with adenosine A1 receptor detection on macrophages and microglia. CONCLUSIONS: Infective endocarditis is associated with multiple neuropathological lesions, which may contribute to its poor clinical outcome and activation of cells of monocyte-microglial lineage throughout the brain.- - - - - - - - - - ranking = 0.89378348995887keywords = brain (Clic here for more details about this article) |
9/92. Halo pin intracranial penetration and epidural abscess in a patient with a previous cranioplasty: case report and review of the literature.STUDY DESIGN: Report of a patient with an epidural abscess after halo pin intracranial penetration at the site of a previous cranioplasty. OBJECTIVES: To report a rare case of intracranial penetration at the site of a previous cranioplasty associated with epidural abscess, and to discuss the diagnostic and therapeutic approach to its management. SUMMARY OF BACKGROUND DATA: The most serious complications associated with use of halo device occur when pins penetrate the inner table of the skull, resulting in cerebrospinal fluid leak and rarely in an intracranial abscess. However, no mention of intracranial halo pin penetration at the site of a previous cranioplasty was found in the literature. methods: A 64-year-old man with ankylosing spondylitis had a halo vest placed for management of a fracture dislocation through the C5-C6 intervertebral disc space associated with left C6 radiculopathy. One week later, the patient experienced fever and headache associated with pain, redness, and drainage at the site of the insertion of the left posterior pin. Computed tomography of the brain showed a 1.5-cm intracranial penetration of the halo pin through a previous cranioplasty of the temporal bone, associated with epidural abscess and cerebral edema in the left temporoparietal lobe. The pins and the halo vest were removed, the pin site was cleaned, and a philadelphia cervical collar was applied. staphylococcus epidermidis grew on the culture of drainage from the pin site. The patient started immediate intravenous antibiotic treatment for 2 weeks, followed by oral antibiotics for 2 additional weeks. RESULTS: The patient had gradual improvement of his symptoms within the first 48 hours. At the latest follow-up visit, he had fully recovered and his fracture had healed. CONCLUSIONS: The halo device should not be used for patients with a previous cranioplasty, especially if the pins cannot be inserted at other safe areas of the skull. A thorough medical history and physical examination of the skull are important before the application of a halo device. Computed tomography of the skull may be necessary before elective halo application for patients with concomitant head trauma, confusion, or intoxication and for patients with a previous cranioplasty to ascertain the safest pin sites.- - - - - - - - - - ranking = 0.44689174497944keywords = brain (Clic here for more details about this article) |
10/92. Progressive multifocal leukoencephalopathy in a child with hyperimmunoglobulin E recurrent infection syndrome and review of the literature.Progressive multifocal leukoencephalopathy (PML) is a fatal demyelinating disease due to infection with polyomavirus JC (JCV). PML occurs almost exclusively in immunocompromised patients, and although it has increased markedly in relation to AIDS, remains exceptional in children. We present the case of an immunocompromised child with hyperimmunoglobulin E recurrent infection syndrome (HIES) and pathologically-proven PML. HIES is a rare congenital immunodeficiency that to our knowledge has never before been reported in association with neurological complications. Following a recurrence of bronchopneumonia, the child's motor and cognitive functions deteriorated progressively in parallel with alterations on cerebral MRI. The neurological onset coincided with lymphocyte subset changes. PCR for JCV dna did not detect the virus in CSF, and brain biopsy was required to secure the diagnosis. Antiviral treatment with cidofovir produced no benefit. autopsy revealed the typical neuropathological findings of PML which were associated with inflammatory eosinophilic infiltrate (a marker of HIES). In accordance with the few pediatric PML cases reported and here reviewed, the child died five months after neurological onset.- - - - - - - - - - ranking = 0.44689174497944keywords = brain (Clic here for more details about this article) |
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