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Query: UMLS:C0018681 (headache)
 56,091 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Seventy to eighty percent of HIV-infected patients exhibit neurological disorders at an advanced stage of the disease. In almost 90% of cases anatomical examination of brains shows histological lesions. Even when often reversible neurological disorders occur during the HIV primary infection, most of the manifestations of central nervous system (CNS) damage remains the prerogative of severe immunodepression. The principal CNS lesions associated with HIV infection are presented here with the clinical and biological elements that lead to the diagnosis. Cerebral toxoplasmosis holds a privileged place in these manifestations since it responds to an efficient curative and prophylactic treatment with a well-codified medical care based on the test treatment. Biological data, therefore, only have a contributing value. HIV encephalopathy is frequent, but the dementia syndrome is less frequent than the finding of associated imaging and pathological anatomy: atrophy and lesions of the white matter. Thus, the dementia complex is an elimination diagnosis. Cryptococcosis must be systematically considered, not only in patients with meningeal symptoms and headaches, but also with those with isolated fever. The demonstration of cryptococcus and cryptococcic antigen in the CSF has an almost absolute diagnostic value; imaging plays a very small diagnostic role, looking for an exceptional cryptococcoma. Multifocal progressive leukoencephalopathy benefits from the accuracy of MRI, and the diagnosis is usually based on clinical data, MRI and evidence of the virus in the CSF by PCR, even though the only mean of obtaining full proof is, in theory, stereotaxic biopsy. Primary cerebral lymphoma is the diagnostic alternative to toxoplasmosis.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Clinical and paraclinical diagnosis of AIDS neurologic lesions]. 747 28

The patient was a 35-year-old man with confusional state and headache. Analysis of cerebrospinal fluid (CSF) showed 1,383/mm3 cell count, the protein level of 300mg/dl and glucose level of 42 mg/dl. Cryptococcus neoformans was disclosed by India ink preparation. The cryptococcal antigen test was positive at 1:125 by latex agglutination. The diagnosis of cryptococcal meningoencephalitis was determined. Antifungal treatment with amphotericin B resulted in improvement of neurologic signs, CSF findings and cryptococcal antigen test. But two months later, brain MRI demonstrated low intensity areas on T1 weighted image and high intensity areas on T2 and proton weighted images in the cerebral cortical region. Gd-DTPA MRI showed enhanced areas in the cerebral leptomeninges. It was considered that these MRI lesions corresponded to pseudocysts and Gd-DTPA enhanced lesion indicated dilated vessels or destructed blood-brain barrier. After administration of larger doses of amphotericin B, these lesions on MRI disappeared. It is suggested that brain MRI is useful in diagnosis of cryptococcal meningoencephalitis to detect pseudocysts at the cortical region which may imply the early stage of procrastinating process.
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PMID:[A case of cryptococcal meningoencephalitis with the cerebral superficial cystic lesions detected on magnetic resonance imagings]. 761 62

Opportunistic infections of the central nervous system (CNS) in immunocompromised patients often represent a diagnostic and therapeutic challenge due to the variety of possible infectious agents causing CNS disease. We report the case of a severely immunocompromised 43-year-old woman presenting with headache, confusion, abnormal CSF findings (cell count 237/mm3 with 50% eosinophils and elevated protein), multiple contrast enhancing lesions on CT and MRI in the basal ganglia, and serologic findings compatible with latent or reactivated toxoplasmosis with high IgA and IgG antibody titers against Toxoplasma gondii in whom a final diagnosis of CNS cryptococcosis was made. This case illustrates the considerable difficulties in the differential diagnosis of opportunistic CNS infection in the immunocompromised host. We conclude from our report that (1) the diagnosis of toxoplasma encephalitis should not be based on serological findings but rather be proven by either PCR, mouse inoculation or brain biopsy, (2) CNS cryptococcosis can be associated with marked CSF eosinophilia and multiple cryptococcomas, and (3) cryptococcomas can persist on CT and MRI despite successful antifungal treatment.
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PMID:An unusual case of central nervous system cryptococcosis. 778 68

Reported is one case of cerebral cryptococcosis in a 12-year-old girl. The diagnosis was confirmed by the detection of Cryptococcus neoformans with both India ink preparation of the cerebrospinal fluid and Sabouraud's media culture. Clinical presentation included progressive severe headache, vomiting, left eye pain, diplopia, dizziness and unstable gait. Fever was absent as a symptom. Initial brain magnetic resonance imaging revealed a focal lesion over the right cerebellar hemisphere with better demonstration than contrast-enhanced computed tomography. The patient was treated with amphotericin B and 5-flucytosine with good final outcome. Early diagnosis and proper therapy are necessary in order to decrease the motality of cerebral cryptococcosis.
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PMID:Cerebral cryptococcosis in a child. 779 79

Central nervous system compromise is a major cause of morbidity and mortality in SLE. The clinical picture of cerebral cryptococcosis is non-specific and can be mistaken for lupic activity. A retrospective study was undertaken with 10 patients with SLE and cryptococcal meningitis compiled in a 23-year period. The most common symptoms were fever and headache. Lymphocyte counts ranged from 169 to 912 cells/mm. An average delay of 13.6 days in diagnosis was observed in patients with cryptococcal meningitis with no complications and an average delay of 52.4 days in patients with complications. Low lymphocyte counts, observed in all patients, was considered a possible risk factor for cerebral cryptococcosis. To note the association between the delay in the correct diagnosis and complications derived from cerebral cryptococcosis.
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PMID:[Central nervous system cryptococcosis in 10 patients with systemic lupus erythematosus]. 787 60

Chronic meningitis is an uncommon manifestation of candidiasis. We present the case of an elderly woman who had symptoms such as headache, malaise, and fever for 8 months and was found to have Candida albicans meningitis, and we review 17 similar cases. An underlying illness or risk factor for candidiasis was present in only 13 (72%) of the 18 patients. Headache, fever, and nuchal rigidity were the predominant clinical findings. Analysis of CSF showed either mononuclear or neutrophilic pleocytosis, an elevated protein level, and a decreased level of glucose. Only 17% of CSF smears were positive, and only 44% of initial CSF cultures yielded Candida species. In four cases, Candida species grew only after special techniques were used; in three cases, CSF cultures remained negative. The overall mortality associated with candidal meningitis was 53%, but among 12 patients who were treated and followed, the rate was 33%. In addition to acute meningitis seen with disseminated infection, Candida species can cause chronic meningitis that mimics tuberculosis and the more common fungal meningitides, such as cryptococcosis.
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PMID:Chronic candidal meningitis: an uncommon manifestation of candidiasis. 794 59

A patient with acquired immune deficiency and antecedents of pancreatitis presented with headaches, fever, dyspnea and bilateral decrease of vision. A diagnosis of disseminated cryptococcosis was made by lumbar puncture, alveolar washing and elevated cryptococcal antigen in blood, urine and stool. Bilateral chorioretinitis with ischaemic maculopathy was responsible of the low vision and attributed to cryptococcal infection after vitreous puncture and isolation of yeast from the vitreous. Systemic treatment with Amphotericin led to resolution of the chorioretinitis. A retinitis due to cytomegalovirus was associated short time before the patient died. Post-mortem anatomopathologic analysis revealed cryptococcus in high number in the choriocapillaris.
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PMID:[Cryptococcal chorioretinitis and acquired immunodeficiency syndrome: apropos of a case]. 795 65

In Malawi, a physician from Queen Elizabeth Central Hospital in Blantyre and one from Kamuzu Central Hospital in Lilongwe retrospectively analyzed laboratory records to determine the clinical features, cerebrospinal fluid (CSF) findings, treatment, and outcome of 31 patients with cryptococcal meningitis admitted to the hospitals between July, 1991, and January, 1993. Cryptococcal meningitis is a common manifestation of cryptococcosis in people with AIDS. It has become prevalent in Malawi in the last 5 years. The incidence of cryptococcal meningitis cases among medical admissions at both hospitals was 0.1%/year. The median ages of the 16 men and 15 women were 38 and 28 years, respectively. Symptoms lasted from 1 day to 5 months (median, 2 weeks). The leading signs and symptoms included headache (97%), neck stiffness (74%), fever (61%), altered consciousness (58%). The records revealed nonspecific readings for CSF white blood cell count and glucose and protein concentrations. 81% of the cases did not receive antifungal chemotherapy because they could not afford it. None of these untreated patients survived longer than 30 days after diagnosis of cryptococcal meningitis. Most died within the 1st 4 days. In fact, the median survival time after diagnosis for all 31 patients was 4 days. The patients who could afford antifungal chemotherapy survived 4 to at least 9 months. Diagnosis helps clinicians to make more accurate prognoses and keeps them from prescribing unnecessary treatment, especially if tuberculosis meningitis is the other diagnosis. As the prevalence of AIDS increase in Malawi, so should cryptococcal meningitis.
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PMID:Cryptococcal meningitis in Lilongwe and Blantyre, Malawi. 816 34

A 58-year-old man was admitted to our hospital with suspicion of aseptic meningitis. He had been well until the day before admission, when he became suffering from headache and nausea. Cerebral spinal fluid (CSF) analysis on admission revealed Cryptococcus neoformans. Neurological examination and brain CT scan showed no abnormality. On the 5th hospital day, he noticed ataxia and weakness in his right extremities and soon fell into drowsy to comatose state. CSF study revealed marked elevation of pleocytosis and oligoclonal IgG bands. The T2 weighted image of brain MRI showed multiple high intensity areas, mainly in the white matter, in cerebellar hemisphere, vermis, left medulla oblongata, left occipital lobe and parieto-occipital lobe. Steroid pulse therapy remarkably improved neurological deficit as well as MRI abnormalities. He became alert at the next day. Ataxia and motor weakness disappeared in a week. Laboratory examination before the pulse therapy revealed impairment of T cell response to mitogens and reduced number of CD8-positive cells. These abnormalities in the cell-mediated immunity were completely corrected by the steroid pulse therapy. It was hypothesized that cryptococcus infection induced the autoimmune mechanism which resulted in the ADEM-like exacerbation.
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PMID:[Acute disseminated encephalomyelitis (ADEM)-like exacerbation in the patients with cryptococcus meningitis treated successfully by steroid pulse therapy]. 866 39

Eleven cases of cryptococcal meningitis were diagnosed and biotyped from September 1991 to August 1992 in Papua New Guinea (PNG). Seven isolates were Cryptococcus neoformans var. gattii from paediatric and adult patients, one with diabetes mellitus and 4 were C. neoformans var. neoformans from adults, of whom 2 had human immunodeficiency virus type 1 (HIV-1) infection, and one each had tuberculosis and Plasmodium vivax malaria. Significant clinical findings were headache, fever, meningism, vomiting, photophobia, papilloedema and cranial nerve lesions. Five patients (45.5%) died; 3 of these were adults with var. gattii and 2 were men with both var. neoformans and HIV-1 infections. This prospective tropical study documents the emergence of C. neoformans var. neoformans in patients with HIV-1 infection in a country where previously var. gattii had predominated in the immunocompetent. There has been no earlier report of cryptococcosis in an HIV-1 seropositive patient in PNG. Despite presumed exposure to both varieties of C. neoformans, var. gattii infections had been most frequent. As HIV-1 spreads, the proportion of hosts infected with var. neoformans may rise. The course of meningitis caused by the 2 varieties of C. neoformans may differ, with mortality in the tropics remaining particularly high. In PNG the environmental source of C. neoformans remains elusive.
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PMID:Meningitis caused by Cryptococcus neoformans var. gattii and var. neoformans in Papua New Guinea. 873 Mar 14


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