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

A 16 year-old girl was admitted to our hospital complaining of headache and vomiting. She was born with an orbital lymphangioma, which was resected partially at a younger age. On admission she had mild confusion and light neck stiffness as neurological positive findings. Enhanced CT scan showed an eight-figure enhancement at the straight sinus and a linear enhancement at the vermis. Angiography showed venous thrombosis spreading in the deep cerebral veins and the right superior ophthalmic vein. Furthermore a medullary venous malformation (MVM) was disclosed in the posterior fossa. Administration of urokinase and glycerol relieved her symptoms gradually. After that treatment, partial recanalization of the deep cerebral veins and the straight sinus and disappearance of the MVM were recognized in the second angiography. In the present case, the MVM played an important role as collateral channel. But, in general, when venous thrombosis occurs, collateral circulation is maintained by cork-screw vessels, not by MVM. In the light of the presence of the lymphangioma, the present case was thought to be a rare condition in the venous system. It appears that residual fetal vessels have existed in the posterior fossa from birth. It is considered that the residual fetal vessels opened and dilated temporally and were recognized as an MVM in angiography, when cerebral venous flow was disturbed by the venous thrombosis.
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PMID:[A case of venous thrombosis associated with medullary venous malformation]. 157 70

A case is reported of ruptured dissecting aneurysm of the intracranial vertebral artery (VA) operated on with VA trapping and bilateral posterior inferior cerebellar artery (PICA) side-to-side anastomosis. A 42-year-old male suddenly developed severe headache and vomiting. On admission, 3 hours later, he was in a state of moderate confusion (Japan Coma Scale 3) and had neck stiffness. Computed tomography (CT) revealed diffuse subarachnoid hemorrhage, especially thick in the posterior fossa with right side dominance. Right vertebral angiography disclosed a fusiform dilatation with proximal narrowing of the right VA which originated just proximal to the VA-PICA junction. Lateral suboccipital craniectomy was undertaken with the patient in a left park bench position. Right VA was dilated and discolored black, and right PICA arose from the proximal portion of this aneurysmal dilatation. Since it was impossible to clip the VA distal to the PICA for the proximal clip-occlusion, the VA including the VA-PICA junction was trapped. Considering the risk of developing infarction at the PICA territory, bilateral PICA was anastomosed at their posterior medullary segment in a side-to-side fashion because the occipital artery (OA) had been cut at the skin incision and could not be used for the OA-PICA anastomosis. The postoperative course was benign, but a mild lateral medullary syndrome developed. CT revealed no abnormal low density area and left vertebral angiography demonstrated the patency of the bypass. Thereafter, the deficit subsided gradually and the patient was discharged. He is presently working without neurological deficit.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Vertebral dissecting aneurysm treated with trapping and bilateral posterior inferior cerebellar artery side-to side anastomosis; case report]. 188 26

We present a case of hemiballismus related to cryptococcal meningitis. A 23 year-old man was hospitalized because of involuntary movements of his left side, confusion, hyperpyrexia, neck stiffness, bilateral papilledema, right hemiparesis and bilateral pyramidal signs. Diagnosis was made by CSF examination demonstrating cryptococci by india ink. CT with contrast showed hyperdense lesions in the head of the right caudate nucleus, in the left internal capsule and in the frontal and occipital lobes. After treatment with amphotericin B, 5-fluorocytosine and haloperidol, he experienced rapid recovery with disappearance of hemiballismus. To our knowledge, this is the first report of hemiballismus caused by cryptococcal meningitis.
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PMID:[A case of hemiballismus during cryptococcal meningitis]. 232 Aug 19

The records of 16 consecutive patients with proven cryptococcosis, admitted to the two referral hospitals in Harare over a 15-year period, were reviewed. 15 were cases of meningitis, one with spinal cord granuloma, and the 16th was an orbital osteomyelitis. There were eight children and eight adults with a marked male preponderance. There was an absence of any predisposing conditions. The common clinical signs and symptoms were headache, neck stiffness, fever, confusion or drowsiness, cranial nerve lesions and long tract signs. The diagnosis was rarely suspected on admission but was discovered during life in 15 patients, in 12 by finding the organism in the (CSF) cerebrospinal fluid, and in three by biopsy of affected tissue. 50% of patients presented with a predominance of polymorphs in the CSF. The mortality rate was very high (57%) but most died before adequate treatment could be given.
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PMID:Cryptococcosis in Zimbabwe. 399 44

The authors report a case of mixed pial-dural arteriovenous malformation (mixed pial-dural AVM), which had feeders from both cortical branches of the internal carotid artery and middle meningeal artery of the external carotid artery. A clinical course of this case is presented and literatures are reviewed. Moreover the authors stress the rete mirabile anastomoses as an important factor in the genesis of the mixed pial-dural AVM. The patient, 30-year-old female, suddenly suffered from a severe headache on December 31, followed by gradual deterioration of consciousness. She was admitted to Otaru Second City Hospital one hour after the episode and neurological examination disclosed moderate confusion, right hemiparesis and neck stiffness. CT scan revealed a massive hematoma in the bilateral ventricles and left parietal lobe and skull plain film showed an enlargement of the groove of the middle meningeal artery. Angiography revealed a mixed pial-dural AVM in the left parietal lobe, which had feeders from both cortical branches of the left internal carotid artery and middle meningeal artery of the left external carotid artery. Two weeks later the admission, an operation was performed. A ligation of the external carotid artery at the neck was performed before a craniotomy, and the bleeding from the dura was minimal, and the AVM in the parietal lobe was removed completely. The patient recovered satisfactorily without any trouble and she was discharged with only a mild weakness at the right side. The clinical finding of the mixed pial-dural AVM is discussed and the rete mirabile anastomoses is emphasized as an important factor in the genesis of the mixed pial-dural AVM.
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PMID:[Mixed pial-dural arteriovenous malformation. Case report]. 646 43

Two hundred and eighty-two consecutive surgical operations were performed over a period of 11 months, February-September, 1991, December 1991-February 1992 at two private medical centres. Anaesthesia was conducted by the surgeon assisted by the theatre nurses. Intravenous ketamine was given in 72% of operations, xylocaine infiltration in 12.8%, spinal anaesthesia in 11.3% and intravenous thiopentone anaesthesia in 4% of the patients. Major and minor surgical operations were performed on 180 (63.9%) and 102 (36.2%) patients, respectively. With ketamine anaesthesia side effects included transient intra-operative hypertension in 76.8%, delirium/confusion in 56.7% and dreams in 5.4% of the patients. Hypotension at induction and postoperative headache/neck stiffness were the principal side effects in spinal anaesthesia occurring in 59.2% and 12.8%, respectively. Reversible apnoea occurred in three patients and cardiac arrest in one patient of those who had intravenous thiopentone. It appeared, therefore, that where there is no anaesthetist as is often the case in under-doctored areas, after careful patient selection, intravenous ketamine, spinal and local infiltration anaesthetic techniques are safe and useful for many surgical procedures. There is the need to avoid intravenous thiopentone by untrained personnel and in settings poorly equipped for cardiopulmonary resuscitations.
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PMID:Where there is no anaesthetist: a study of 282 consecutive patients using intravenous, spinal and local infiltration anaesthetic techniques. 1041 88

A 17-year-old man with a high fever, confusion and neck stiffness was diagnosed to have tuberculous meningitis, and was immediately placed on prednisolone (40 mg/day) as well as standard antituberculosis drugs (isoniazid, rifampicin and pyrazinamide). The clinical symptoms improved rapidly and the number of cerebrospinal fluid(CSF) cells decreased from 1837/mm3 on admission to 76/mm3 on the 7th day. Thereafter the dosage of prednisolone was gradually reduced. As a result, however increased nuchal rigidity, papilloedema and an increase in the number of CSF cells of 934/mm3 were all observed on the 35th day. Prednisolone thus again administered at the original dosage and the patient quickly showed a clinical improvement. CSF cells decreased to 271/mm3 on the 70th day. When prednisolone was again tapered down, increased nuchal rigidity, abducent nerve palsy and papilloedema appeared again with a marked increase in the number of CSF cells of 1309/mm3 on the 91th day. Therefore, we continued to treat the patient with prednisolone, in addition to the standard antituberculosis treatment, at a dose of 80 mg/day and tapered off very slowly over six months. This treatment resulted in a marked recovery with no recurrence. In this case, prednisolone was indispensable for treating tuberculous meningitis in combination with appropriate antituberculosis drugs, though the role of corticosteroids has remained controversial over the years. This case might be an example of paradoxical progression in tuberculous meningitis.
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PMID:[Repeated deterioration of tuberculous meningitis due to a reduction in the corticosteroid dosage during chemotherapy]. 1129 66

During the summer of 2000, 35 patients with West Nile Virus Fever were admitted to our hospital. Of these, the 26 (21 adults, mean age 56 (19-86) and 5 children (aged 9-15)) presented have neurological involvement, 33% with meningitis, 52% with meningoencephalitis, 10% with encephalitis and 5% with acute polyneuropathy. Presenting clinical features were fever in 95% of cases, headache in 90%, nausea/vomiting in 52%, confusion in 48%, somnolence in 38%, neck stiffness in 33%, a skin rash in 19%, diarrhea in 14%, cervical pain in 14%, seizure in 9%, photophobia in 9% and limb weakness in 4%. Leucopenia was not found. Two patients diagnosed with meningoencephalitis died. Three patients had signs of an acute polyneuropathy, this being the only complaint of one patient. The EEG was abnormal in all cases of meningitis or meningoencephalitis, except in three cases. Outbreaks of West Nile Virus Fever are emerging as a worldwide disease with high rates of neurological involvement and death. It should be considered in cases presenting with aseptic meningoencephalitis, meningitis and acute polyneuropathy, especially during the summer months and in areas along bird migration pathways.
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PMID:Neurological features of West Nile virus infection during the 2000 outbreak in a regional hospital in Israel. 1212 78

Aseptic meningitis is a rare but well-recognized complication of drug therapy. The clinical presentation of drug-induced aseptic meningitis (DIAM) is distinct. Symptoms typically include fever, neck stiffness, headache, confusion, nausea and vomiting. The major categories of causative agents are non-steroidal anti-inflammatory drugs, antimicrobials and also intravenous immunoglobulins, monoclonal antibodies and vaccines. These drugs most commonly implicated as causes of aseptic meningitis act more likely through an immunological mechanisms. However, the exact pathogenetic mechanism of DIAM is still unknown. The diagnosis of drug-induced aseptic meningitis is difficult and infectious etiologies must be excluded. In some cases the diagnosis has been confirmed by rechallenging the patient with the suspected agent. In this case, informed written consent is necessary and rechallenge must be medically supervised both to document the response and to offer medical care and advice, if required. The outcome of DIAM is generally good, usually without long term sequelae.
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PMID:Drug-induced aseptic meningitis. 1276 86

West Nile virus is an arbovirus known to cause meningo-encephalitis in immuno-competent as well as in immunocompromised patients. Herein, we describe a kidney transplant recipient in whom meningo-encephalitis infection was caused by the West Nile virus. The clinical presentation was fever, headache, photophobia, confusion, neck stiffness, and positive Kerning test. The patient was treated with IV acyclovir, cefuroxime, ampicillin, and fluids. During hospital stay, the patient did not experience any episode of allograft rejection. Fever resolved and at follow up he was doing well. West Nile virus infection should be considered in immunocompromised patients including transplant recipients with meningo-encephalitis, especially during epidemic outbreaks.
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PMID:West Nile meningo-encephalitis infection in a kidney transplant recipient. 1469 42


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