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 21,692 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A case of meningeal carcinomatosis associated with cerebral metastases from an adrenal neuroblastoma is described. The clinical picture was ushered-in by bilateral sciatic pain in a 50 years old female and was followed by rapidly progressive sensory-motor deficits of the arms and legs, leading to flaccid quadriplegia associated with paralysis of cranial nerves and episodes of mental confusion. Death occurred 4 months alter, in cardiac failure. At autopsy, a bilateral tumor of the adrenal glands was found. No metastases were detected anywhere except in the central nervous system. Histology identified the tumor as a neuroblastoma; meningeal carcinomatosis, radicular infiltration by tumor cells and parenchimal metastases were found in the central nervous system. Neuroblastoma is typically a tumor of childhood, only 13% of them being found in adult's according to Russell and Rubinstein. Meningeal metastases from adrenal neuroblastoma have not hitherto been reported in the literature. In our opinion, the most likely mode of spread of tumor cells to the central nervous system was hematogenous because of the presence of small multiple intraparenchimal metastases; however, possible spread through the perineural lymphatics, as proposed by others, cannot be excluded, due to the prominent localization of tumor cells at spinal roots level. The main differential diagnostic problems (paraneoplastic neuropathy (Wyburn-Mason) and infectious subacute or chronic meningitis) are discussed. The authors stress the emportance of complete cerebro-spinal fluid examination including a careful search for tumor cells.
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PMID:[Meningeal carcinomatosis: clinical and anatomical study of a case of suprarenal neuroblastoma (author's transl)]. 6

To date only 9 culture-proven cases of herpes simplex virus Type 2 meningitis have been recorded. Presented here is the 10th case with a review of the literature. Although generally a benign disease, its recognition in association with herpes progenitalis must be appreciated to avoid confusion in the treatment of this common veneral disease.
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PMID:Herpes simplex virus type 2 meningitis. 19 71

This appears to be the first report of meningitis due to Pseudomonas paucimobilis and the first report of a clinically significant isolate of this species in the UK. Characteristics by which the species may be recognised are given, and attention is drawn to the possible confusion of Ps. paucimobilis with other yellow-pigmented pseudomonads and Flavobacterium species.
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PMID:Meningitis caused by Pseudomonas paucimobilis. 51 57

A 46-year-old female presented with a 1-week history of mental change, confusion and headaches. Investigations revealed evidence of sterile meningitis. CAT scanning of the brain demonstrated marked contrast enhancement around the ependyma, and later examinations showed extension of the process deep into the white matter, Cerebral biopsies were non-diagnostic and, despite ventricular drainage and treatment with antibiotics and high dose steriods, the patent died. At postmortem there was extensive tumour tissue distributed in a butterfly shape around the ventricles, and microscopy revealed typical apperances of primary CNS lymphoma. On the basis of the experience of this case and a review of recent literature, it is suggested that the CAT scan appearances of this tumour are quite typical, and that cranial irradiation may be justified in the absence of specific histological diagnosis.
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PMID:Primary lymphoma of the central nervous system: a case report. 55 Sep 37

A patient developed symptomatic lymphocytic meningitis with hypoglycorrhachia after two intrathecal injections of methylprednisolone acetate. Chills, fever, and confusion occurred ten days after the second injection, and were brief in duration. There were no obvious sequelae. Hypoglycorrhachia secondary to intrathecal steroids has not been previously reported. Steroid-induced chemical meningitis should be considered in any patient who develops CNS symptoms and an abnormal CSF after receiving intrathecal steroids. Obviously, the more common causes of lymphocytic meningitis with or without hypoglycorrhachia must be excluded.
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PMID:Chemical meningitis related to intrathecal corticosteroid therapy. 57 89

Histoplasma meningitis (HM) has been reported to occur primarily in association with disseminated histoplasmosis (DH). We report a case of histoplasma meningitis occurring in a patient with common variable hypogammaglobulinemia (CVH) in which no manifestations of DH were observed. L. L., a 66-year-old Caucasian male, clerical worker, developed occasional episodes of dizziness and tinnitus in mid-1971. During 1972, increasing frequency of these episodes and gradually progressive confusion were noted. In January 1973, vomiting, forther confusion, obnubilation, and a left central facial paresis developed and he was hospitalized. Physical examination revealed no pulmonary abnormalities, lymphadenopathy or hepatosplenomegaly. Over the ensuing 6-week evaluation, there was occasional fever to 38.5 degrees C. Chest roentgenogram was normal. Cerebral angiography suggested a mass in the left cerebellar hemisphere. EEG was diffusely slow. Multiple CSF examinations revealed: Glucose 7-18 mg/with a normal blood glucose, protein 109-256 mg/and cells 66-140 (95 + % mononuclear). Histoplasma capsulatum was cultured from CSF but not from sputum, urine, blood or bone marrow. Skin tests for PPD, histoplasmosis, coccidiodomycosis, blastomycosis, mumps, dinitrochlorobenzene and streptokinase-streptodornase were negative then and 6 months later. Histoplasma serum antibody was absent. Immunoglobulin analysis revealed IgG 430 mg %, IgA 46 mg %, and IgM 35 mg %, which with the history and skin test results suggested CVH. Treatment with 2.51 gm of amphotericin B given intravenously over a 3-month period resulted in complete reversal of all neurologic signs and clearing of the confusion. The remission has been maintained for two years. This case represents a primary infection of the CNS by histoplasma. The relationship between the HM and the CVH will be discussed.
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PMID:Histoplasma meningitis with common variable hypogammaglobulinemia. 61 43

Angiostrongyliasis is an infectious disease caused by nematode parasites of the genus Angiostrongylus. The rat lung worm Angiostrongylus cantonensis, primarily a parasite of rodents, is largely responsible for human cases of eosinophilic meningitis, or meningoencerphalitis, which occurs on many Pacific islands and in Southeast Asia. The disorder, which frequently occurs in epidemic extent, is caused by invasion of the central nervous system by developing larvae of the parasite. The infection is most frequently due to ingestion of food containing the infective, third-state, larvae. Meningitic and ocular forms of the disease have been recognized. The disease has been described or referred to under a variety of synonyms. The terms eosinophilic meningitis, eosinophilic meningoencephalitis, and epidemic eosinophilic meningitis were first used to describe the disease before its etiology was known. These terms, however, lack specificity, because the eosinophilic meningitic syndrome may accompany many other parasitic as well as nonparasitic diseases of the central nervous system. Nevertheless, they are still being widely used, since in most cases only the epidemiology of the disease points to the etiologic role of A. cantonensis. Direct clinical or laboratory evidence of the etiologic agent is usually not established because reliable tests are not yet available. The term angiostrongylosis, or angiostrongyliasis, if used without the adjective, also may give rise to confusion, since the same term is applied to the pulmonary infection of dogs by A. vasorum and might be used for infection by any other Angiostrongylus species. Even the term cerebral or ocular angiostrongyliasis may prove in the future to have similar disadvantages. The scientifically correct term angiostrongyliasis cantonensis has been used recently. It is sufficiently specific and formed in analogy to the names of other parasitic diseases of man, like schistosomiasis japonica, schistosomiasis mansoni, schistosomiasis haematobia. For the murine infection, as well as for the disease produced experimentally in animals, the term angiostrongylosis cantonensis ought to be reserved because of the preferential use by veterinarians of the ending osis for designation of pathological changes produced in animals by parasites. After the recent discovery of A. costaricensis, another rat parasite causing human disease in Costa Rica, it becomes necessary to distinguish between angiostrongyliasis cantonensis (eosinophilic meningitis) and angiostrongyliasis costaricensis (intra-abdominal eosinophilic granulomatosis). A potential disadvantage of these terms may be encountered in case of a systemic revision or reclassification of the parasite. This has happened at intervals. A. cantonensis was named Pulmonema cantonensis by its discoverer and later was described under the name Haemostrongylus ratti.
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PMID:Angiostrongyliasis cantonensis (eosinophilic meningitis, Alicata's disease). 109 93

A 44-year-old patient presented with increasing confusion. He was first diagnosed as having intermittent pressure hydrocephalus but a further evaluation showed CSF pleocytosis and hypoglycorrhachia. Five weeks later, his physical examination was unrevealing. Nuclear imaging techniques were conflicting, with negative gallium- and indium-labelled white blood cells scans but a Tc scan pointing towards a vertebral infection. A well-demarcated lesion in the T9 vertebral body, demonstrated by CT scan, confirmed the diagnosis of vertebral osteomyelitis. Although we were unable to recover the causative organism, antibiotic treatment for presumed staphylococcal osteomyelitis resulted in full recovery. This case indicates that vertebral osteomyelitis may cause significant meningeal inflammation even in the absence of epidural or subdural abscess. We recommend that in patients with meningitis without a clear etiology vertebral osteomyelitis should be considered and pursued with CT scannings of the vertebrae, a procedure that can yield positive findings even when other scanning modalities are negative.
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PMID:Confusion as the presenting manifestation of vertebral osteomyelitis: a case report. 128 69

2 AIDS patients are described who had cryptococcal meningitis accompanied by increased intracranial pressure (ICP) and visual complications, a finding thought to be relatively rare in AIDS. Of the 2-6% of AIDS patients who develop cryptococcal meningitis, many have disseminated and recurrent infections. The 1st case was a 45-year old Ugandan woman who presented with stiff neck, and right VIth cranial nerve palsy. She was treated with amphotericin B and flucytosine with some improvement, but on the 9th day she awoke with headache, drowsiness, and total blindness, although no papilledema. Her CSF pressure was 40 cm H20. She recovered after a month of intravenous chemotherapy and acetazolamide, but remained blind. Her sudden blindness was thought to be due to bilateral optic nerve infarction. The 2nd case was a 32-year old male homosexual, admitted with headache, vomiting, confusion, and drowsiness. He had stiff neck, and a CSF of 40 cm containing Cryptococcus neoformans. He was given amphotericin B, flucytosine, and has CSF drained every other day. On day 21 papilledema was seen in the right eye, and acetazolamide was started to lower CSF pressure. This patient recovered without loss of vision. 3 published series of cryptococcus meningitis in AIDS patients remarked about the low incidence of raised ICP, while 1 reported 9 of 27 with neurological and ophthalmic complications. The visual complications and increased ICP in these patients was thought to be due to inflammatory arachnoiditis or direct cryptococcal infiltration.
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PMID:Raised intracranial pressure and visual complications in AIDS patients with cryptococcal meningitis. 156 10

A prospective study of the neurological manifestations in all patients with systemic lupus erythematous (SLE) was conducted between February 1985 to January 1989. Excluding herpes zoster infection of peripheral or cranial nerves, post-herpetic neuralgia and migraine, 36 neurological episodes occurred in 33 patients. The presenting symptoms were mental confusion (10), psychosis (five), seizures (six), focal neurological deficit (three), coma (two), headache (five), blurring of vision (three), neuropathy (one) and myelopathy (one). Of these manifestations, only eight episodes were due to primary involvement by SLE: psychosis (two), seizure (two), multiple cerebral infarcts (one), papillitis (one), neuropathy (one) and myelopathy (one). Infection was the most common secondary cause of neurological episodes: all 10 episodes of mental confusion (fungal seven, pyogenic two, tuberculous one, nocardial one); two of six seizures (tuberculous one, pyogenic one); all five headaches (tuberculous meningitis three, cryptococcal meningitis two). The other secondary causes included steroid psychosis (two), hypertensive encephalopathy with seizure (one) and hypertensive retinopathy (one). Three of five cases of focal neurological deficit were due to macrovascular disease rather than to vasculitic infarction. We concluded that cerebral psychosis was a relatively rare presentation in our patients with SLE. In patients who presented with a neurological problem, especially mental confusion, efforts should be made to ascertain the underlying cause, especially if this may be an infection.
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PMID:Neurological manifestations of systemic lupus erythematosus: a prospective study. 180 Oct 58


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