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

Acute herpes simplex encephalitis (HSE) has a grave outcome, and detection of prognostic features is of clinical importance. Thirty patients with HSE were assessed in a retrospective study. Diagnosis was confirmed by serological methods using the indirect immunofluorescence technique (IFT). Antiviral treatment was given to 23 of the patients. Focal convulsions were more frequent in patients below 18 years of age, while confusion and memory disturbances were prevalent among patients above 18. The final outcome was influenced by the degree of severity of the disease at the peak and the state of consciousness and duration of disease prior to the initiation of anti-viral treatment. No correlation was found between antibody levels in serum or in CSF and the outcome. We conclude that the clinical degree of severity the duration of illness prior to treatment and state of consciousness at the initiation of anti-viral treatment are of prognostic importance.
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PMID:Acute herpes simplex encephalitis: clinical assessment and prognostic data. 874 Nov 35

A 69-year-old man developed confusion and disorientation, following intravenous administration of acyclovir for herpes zoster at the right C5 area. His consciousness was disturbed four days after the beginning of acyclovir therapy (daily dose: 500 mg, every 12 h), and the symptoms resolved two days after cessation of acyclovir. Neuroradiological examination revealed no intracranial abnormality, and the routine CSF examination was within the normal range of values except for a mild elevation of IgG (7.4 mg/dl). An electroencephalogram showed diffuse slow activities without paroxysmal waves on admission, but the findings of electroencephalograms were gradually normalized in parallel with the recovery of consciousness. Fever, signs of meningeal irritation, involuntary movement or renal dysfunction were not observed during the course of illness. Although the serum concentration of acyclovir was not elevated, we considered the adverse effects of acyclovir had resulted in his consciousness disturbance. Acyclovir is greatly useful for herpes simplex and varicella-zoster virus infections, and its complications are extremely rare. However, several reports described various neuropsychiatric side effects in patients receiving acyclovir. Most of such cases had an association with severe renal failure or malignant tumor; actually, an intense malignancy surveillance over our case revealed thyrogenic papillary adenocarcinoma without metastasis. The excretion of acyclovir is mainly through the kidney, so that the neurotoxicity of acyclovir in cases with renal insufficiency stems from its excessive accumulation in the body. In malignancy complicated patients, on the other hand, some authors surmised about the influences from the co-use of other neurotoxic drugs or radiation therapy, but reasons for such conditions remain obscure. The neuropsychiatric manifestation caused by acyclovir is an entity distinguishable from viral encephalitis, and a careful surveillance for malignancy is required in such cases.
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PMID:[A patient with thyroid carcinoma who developed consciousness disturbance during acyclovir administration for herpes zoster]. 881 Aug 56

We report a 64-year-old Japanese man with oculo-neuroborreliosis. His clinical features consisted of polyarthralgia, keratoconjunctivitis, chorioretinitis, optic neuritis, confusion, and polyradiculitis. Assay of antibodies to Borrelia species detected IgG-antibody to B. garinii in both serum and CSF. Progressive declining of serum IgG antibody titer against Borrelia garinii, in parallel with clinical improvement, was observed after administration of ceftriaxone.
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PMID:Occurrence of Borrelia garinii oculo-neuroborreliosis in Japan. 890 39

Eight patients affected by central nervous system tumours disseminating via cerebrospinal fluid received rIL-2 immunotherapy according to three different protocols involving intrathecal administration followed or not by systemic infusion. Immunological monitoring included serial evaluation of CSF leukocytes, CSF and peripheral blood CD3-CD56+ cells, and NK activity. The most marked rise in CSF leukocyte levels was induced by daily intrathecal rIL2 administration, which also induced increased PB NK activity. Systemic rIL2 infusion following intrathecal treatment maintained a high percentage of CSF CD3-CD56+ cells, but not CSF leukocytes at high levels. Clinical conditions improved after treatment in two patients, worsened in one and remained substantially unchanged in the remaining five. The side effects of intrathecal rIL2 treatment included fever, confusion, and seizures, and there were marked interindividual variations in the immunological response.
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PMID:Intrathecal immunotherapy in CNS tumors disseminating via CSF: preliminary evaluation using different treatment schedules. 891 57

We studied the effects of escalating doses of recombinant human IL-1 beta in patients receiving high-dose chemotherapy and ABMT for metastatic breast cancer or malignant melanoma. Sixteen patients received IL-1 beta, 4 to 32 ng/kg/day administered subcutaneously for 7 days beginning 3 h after bone marrow infusion. Three patients at the highest dose level also received G-CSF following completion of IL-1 beta. All patients completed the 7 days of therapy. The majority of patients experienced chills and fever following one or more injections, and seven had severe pain at the injection site. There was one episode of hypotension and one episode of transient confusion at the highest dose level; other significant toxicity was not identified. Recovery of neutrophils to > 0.5 x 10(9)l and platelet transfusion independence occurred at a median of 23 and 22 days, respectively, which was comparable to historical controls. The mean number of bone marrow colony-forming unit granulocyte-macrophage (CFU-GM) per 10(5) mononuclear cells on day +21 post-ABMT was more than twice that of control patients or patients receiving G-CSF or GM-CSF. A linear correlation was found between the dose of IL-1 beta and endogenous concentrations of several cytokines. These patients also displayed significantly higher concentrations of endogenous G-CSF compared to historical controls receiving GM-CSF. While IL-1 beta was moderately toxic and had no effect on recovery of peripheral blood counts after ABMT, the increased number of bone marrow CFU-GM suggests that the addition of G- or GM-CSF to a short course of IL-1 beta may accelerate hematologic recovery.
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PMID:A phase I trial of recombinant human interleukin-1 beta (OCT-43) following high-dose chemotherapy and autologous bone marrow transplantation. 905 Dec 40

Two weeks after vaccination against tick-borne encephalitis (TBE), a 57-year-old female suddenly developed mental confusion and hemiparesis of the left side. Cranial MRI demonstrated extensive bilateral lesions in the fronto-parietal white matter of both hemispheres, suggesting an acute inflammatory demyelinating disease following vaccination. Despite administration of high-dose corticosteroids, the patient died 3 weeks after onset of neurological symptoms. Autopsy revealed diffuse infiltrates of a primary cerebral pleomorphic T-cell lymphoma of medium and large cell type. PCR on brain tissue for HTLV-I and serology for anti-HTLV-I antibodies in CSF and serum were negative; immunocytochemistry on brain tissue did not detect EBV-related antigen. This is the first recorded observation of a diffusely infiltrating primary central nervous system T-cell lymphoma, clinically and radiologically mimicking a fatal acute inflammatory demyelinating complication after vaccination.
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PMID:Non-HTLV-I associated pleomorphic T-cell lymphoma of the brain mimicking post-vaccinal acute inflammatory demyelination. 906 89

Two patients underwent acoustic schwannoma surgery by transmastoid approach. Petrous bone defect was filled in with aluminium-containing bone cement (Ionocem). A pseudomeningocele by CSF accumulation in subcutaneous temporoparietal area appeared after the procedure and, in subsequent weeks, encephalopathy with confusion and seizures. MRI showed cerebral involvement with herpes-like disposition. Temporal stereotactic biopsy in a case did not confirm viral encephalitis but disclosed cellular accumulation of lipofucsin and particles highly suggestive of aluminum-inclusions. Aluminium's levels in blood and CSF of both patients were very high and confirm the brain's toxic involvement. Aluminium's toxicity would be advocated in patients with neurologic disorders who have undergone maxillofacial or skull bone-cementoplasty by an aluminum-containing biomaterial, if this cement is in contact with CSF.
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PMID:[Toxic aluminum encephalopathy. Predominant involvement of the limbic system on MRI]. 909 10

A 40-year-old conductor was admitted because of increasing drowsiness and confusion. Two years before admission he had had a first seizure. One year before admission he had a generalized convulsive status epilepticus; the following months he was less able to concentrate. A second status epilepticus was followed by transient weakness of his left arm and a depressed level of consciousness for several weeks. After awakening, he had delusions, and his wife found him demented. In the following months his confusion and drowsiness gradually deteriorated. He had previously had gonorrhoea, an episode of fever and exanthema, and was found to have oligospermia as cause of his infertility. On examination he was disoriented, and he had dysarthria. His left pupil was smaller, but both pupils reacted normally. There was left hemianopia and cerebellar ataxia. CT and MR showed large ventricles and periventricular diffuse lesions in the white matter. CSF examination revealed leucocytosis and increased protein content. Further examination were focussed on serological evidence of syphilis, and finally neurosyphilis was diagnosed. After treatment with penicillin, the patient started to recover.
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PMID:[Clinical judgment and decision making in clinical practice. A music conductor with epilepsy followed by memory disorders]. 921 89

A 60-year-old man developed disorientation, euphoria, hyperactive behavior, mental confusion, and a moderate decrease of cognition during the course of relapsing polychondritis with bilateral auricular chondritis, sensorineural hearing loss, episcleritis and nasal chondritis. An electroencephalogram showed diffuse slow wave abnormality. The CSF analysis revealed pleocytosis and increased protein. MRI with contrast showed enhancement and edema in bilateral medial temporal regions. These abnormal findings improved markedly with the treatment of corticosteroids. This is the first Japanese case report of relapsing polychondritis presenting as mental disorders.
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PMID:[Relapsing polychondritis with mental disorders: a case report]. 921 25

Studies of bacterial meningitis have documented a peak of incidence among persons age 60 and older. The most common bacterial pathogens in these patients differ from those seen in children. Presentation of meningitis in older patients may be atypical; fever is not a consistent finding, and nonspecific symptoms such as confusion are often seen. Nuchal rigidity is not as sensitive nor as specific a sign as in younger patients. Definitive diagnosis relies on interpretation of CSF studies. Ampicillin plus a third-generation cephalosporin should be administered for community-acquired meningitis until Gram's stain and culture results return. Cases of S pneumoniae meningitis may require varying strategies, based upon the degree of penicillin resistance.
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PMID:Meningitis in older patients: how to diagnose and treat a deadly infection. 926 Dec 85


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