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Query: UMLS:C0018991 (hemiplegia)
 3,997 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

In the third year of life of a girl vaccinated neonatally against tuberculosis an abscess of the associated lymph nodes appeared which contained acid-fast bacilli. After extirpation of the lymph nodes weeks later an intestinal BCG-dissemination was observed which seemed to be cured under a brief tuberculostatic therapy. At the age of 22 years a left sided hemiplegia due to aneurysms and thrombosis of 2 cerebral arteries was seen. At autopsy in the adventitia of the arteria basilaris macrophages were discovered which showed intracellular acid-fast bacilli. A paralysis of the oculomotor nerve appearing later was also caused by this brain lesion. Towards the end of a pregnancy a serious BCG-dissemination in the intestines relapsed. A healthy premature child was born. Massive tuberculostatic therapy was inefficient. The woman died in her 27th year of life. A defective function of the macrophages is suggested for the immunological abnormality.
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PMID:[BCG-induced inflammation during childhood and in pregnancy. Additionally a contribution to BCG-induced necrotising cerebral arteritis]. 221 88

Thirty-seven consecutive adults and 2 children with tuberculosis of the nervous system were studied. Twenty-eight patients (72%) had intracranial or intraspinal tuberculomas and only 11 patients (28%) had tuberculous meningitis. Of the 14 patients (36%) with intracranial tuberculomas 6 presented with epilepsy of late onset including convulsive status epilepticus(2). The 6 patients with multiple tuberculomas some of which were situated in the infratentorial compartment were surprisingly free of major neurological disability of systemic disturbance. Thirteen patients (33%) presented with spinal cord compression due to tuberculoma. Eight of these had associated bony abnormalities such as collapsed vertebrae and loss of pedicles usually regarded as characteristic of malignant disease and 2 presented with clinical features of acute transverse myelitis. Eleven patients (28%) had tuberculous meningitis. One of these died, 1 had a protracted illness with gait ataxia and hydrocephalus and 1 other patient was disabled by hemiplegia, dysphasia and epilepsy but the remaining 8 recovered fully. Tuberculosis outside the nervous system was found in 13 patients (33%) in 12 (31%) of whom it was pulmonary. Acid fast bacilli were demonstrated by Ziehl-Neelsen stain in 16 patients (52%) out of 31 from whom specimens were available. Mycobacterium tuberculosis was eventually cultured from only 6 specimens. These data suggest that the clinical and radiological features of tuberculosis of the nervous system in Saudi Arabia may differ substantially from those reported from other countries. In our study there was low morbidity and low fatality rate. Two patients had infratentorial tuberculomas, and 8 patients had bony abnormalities in the vertebral column, typical of malignant disease.
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PMID:Tuberculosis of the nervous system. A clinical, radiological and pathological study of 39 consecutive cases in Riyadh, Saudi Arabia. 272 75

Hemiplegic forms of human African trypanosomiasis are unusual. From 1963 to 1987, 14 cases have been reported in the literature. One may be mistakenly led to look for a space-occupying lesion when clinical features include hemiplegia, vascular shift from median line during arteriography, focal EEG anomalies and intracranial hypertension. The discussion on diagnosis also covers subacute or chronic meningo encephalitis (tuberculosis syphilis or fungal infection). CT scanner findings suggest the association of a massive demyelination of centrum semiovale, with cerebral oedema.
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PMID:[Hemiplegic forms of human African trypanosomiasis]. 305 54

A case of intracerebral tuberculoma treated surgically was reported. A 47-year-old man was admitted to our hospital because of progressive left hemiaparesis over the previous 5 months. A computerized tomography scan showed a well enhanced mass associated with a marked perifocal edema. T1 weighted magnetic resonance imaging (MRI) revealed an isosignal ring around the heterogenous low intensity mass. A low intensity area just interior to this ring was also visualized both in T1 and T2 weighted images. Although the clinical course was unusually long, this was diagnosed as a metastatic brain tumor. He underwent a right frontal craniotomy and a well circumscribed, yellowish, firm mass was totally extirpated. Pathohistologically, this mass was considered to be a tuberculoma though the tuberculous bacilli could not be identified in Ziehl-Neelsen staining. His hemiplegia improved much and his ambulation was restored. Since tuberclomas are quite rare in developed countries, the diagnosis of intracerebral tuberculomas would be extremely difficult unless tuberculosis was verified in some other organs. The auxiliary examinations even by using MRI have often given little information which would assist diagnosis. However, based on pathological findings, the ring appearance and low intensity area medial to the ring in the outer part of the tuberculoma shown in MRI of our patient seemed to represent a chronic granulomatous inflammation and gave a clue to rule out the suspicion of metastatic brain tumors. To make a correct diagnosis of intracerebral tuberculomas, multidisciplinary consideration is mandatory.
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PMID:[A case of intracerebral tuberculoma: clinical characteristics and MRI findings]. 811 12

A 49-year-old male patient with an intracranial tuberculoma who presented with motor aphasia and right sided hemiplegia is discussed. Although tuberculosis is common in the country, to date antemortem histologically confirmed case has not been reported in Ethiopia. It is recommended that intracranial tuberculoma should be considered in the differential diagnosis of central nervous system mass lesions.
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PMID:Intracranial tuberculosis mimicking brain tumour: case report. 818 51

We report two cases of AIDS whom we have recently experienced. One patient was a 54-year-old man who admitted our hospital due to third degree burn. In this case, we did not know whether or not he was suffered from AIDS, when he was delivered by the ambulance. In autopsy, pneumocystis carinii pneumonia and renal tuberculosis were found in addition to marked decrease of T cells in lymph nodes. The other patient was a 40-year-old man with remarkable symptoms of central nervous system. Route of infection of HIV is unknown. He had dementia, left hemiplegia, bulbar palsy, progressed to rigid decorticate posture and died of respiratory arrest due to involvement of the brain stem, despite of treatment including use of 3'-azido-2',3'-dideoxythymidine (AZT). Magnetic resonance (MR) images showed progressive cerebral atrophy and a diffuse high signal intensity area of cerebral white matter on T2-weighted MR images, suggesting the diagnosis of HIV-induced encephalopathy.
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PMID:[Two cases with acquired immunodeficiency syndrome in our hospital]. 822 67

Tuberculosis of the craniovertebral region is very rare. Neural deficit in this region is reported in between 24% and 64% of cases, and mainly takes the form of quadriparesis. Hemiplegic and monoplegic presentation among this set of patients is rarer. Out of 32 patients treated at our institution between May 1989 and February 2001, only one had hemiplegia, while two had monoplegia. These three cases are discussed. Case 1 involved a 45-year-old woman who presented with hemiplegia following a trivial fall. Plain radiographs and computed tomographic (CT) scans of the skull appeared normal, but CT scans of C1-C2 and the craniovertebral junction revealed destruction of the dens and atlantoaxial subluxation. The patients in cases 2 and 3 had monoplegia. Plain radiographs in both cases showed an increased prevertebral soft tissue shadow in front of C1-C2. CT in case 2 and magnetic resonance imaging (MRI) in case 3 revealed destruction of the arch of C1 and the dens, with subluxation. All three patients were successfully treated with rest, skull traction, anti-tubercular drugs and suitable braces. Case 3 required stabilization. All three patients achieved complete neural recovery. Patients 1, 2 and 3 had 22, 48 and 4 months' follow-up respectively. Patient 3 was subsequently transferred to a neurosurgery ward for stabilization of the occipito-C3 vertebrae. Hemi/monoplegic presentation is extremely rare; no author in the literature is able to give reason for the rarity or the pathomechanics of the condition. We believe that if medullary cervical junctional involvement extends slightly higher (in rare circumstances), with involvement of one of the branches of the vertebral or lower basilar artery, medial medullary syndrome will occur, sparing medial lemniscus and emerging hypoglossal nerve fibres. Thus the pyramids will be involved, causing contralateral hemiparesis, and if the pyramids are selectively involved, it will cause contralateral monoparesis.
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PMID:Hemiplegic/monoplegic presentation of cervical spine (C1-C2) tuberculosis. 1180 97

We report eight cases of brain tuberculoma. The clinical presentation was polymorphous: partial epilepsy (n=4), headache (n=3), hemiplegia (n=1), meningitis (n=1), cerebellar syndrome (n=1). Six patients also had pulmonary tuberculosis, one had tuberculosis of the genital organs, and one had HIV co-infection. The brain CT scan and MRI were highly contributive to diagnosis and follow-up. Despite good compliance with an anti-tuberculosis regimen for at least 14 months, the course was favorable in only six patients. Adjunction of corticosteroids led to radiological improvement. Assessment of cell immunity demonstrated a diminished immunomodulator ratio. Cerebral tuberculoma should be searched for in patients with unexplained neurological manifestations and several intracerebral lesions, particularly if pulmonary or visceral tuberculosis and/or immunodepression is part of the clinical picture.
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PMID:[Cerebral tuberculomas]. 1367 25

Iatrogenic meningitis (IM) is a rare complication of diagnostic and therapeutic lumbar puncture (LP). This study includes cases of IM managed in the Departments of Neurology, of two referral hospitals, in India between January 1984 and April 2002. The diagnosis of IM was made when symptoms of meningitis occurred 24 h to 21 days after LP. All the procedures were performed in the peripheral hospitals before they were referred to the two centres. There were 17(63%) women and 10(37%) men. The age range was 19-50 years with a mean age of 31. The precipitating event was spinal anaesthesia for pelvic and intra-abdominal surgeries (Caesarean section 11 cases, hysterectomy three cases, herniorraphy two cases, appendicectomy two cases, anal fissurectomy one case, varicocelectomy one case and hydrocelectomy one case) laminectomy in two and diagnostic myelogram in four patients. The cerebrospinal fluid (CSF) culture was positive in six (22%) patients. The organisms were Pseudomonas aeruginosa in one case, Staphylococcus aureus in three cases, Acinetobacter spp. in one case and Mycobacterium tuberculosis in one case. In five individuals, mycotic aneurysms with subarachnoid haemorrhage due to invasive aspergillosis was documented at autopsy. The mean follow-up was 10.6 months (range 1-18). Seventeen (63%) patients received conventional antibiotics alone, while 10 patients received antibiotics and anti-tuberculous drugs when the meningitis became chronic. The mortality was 36%. The poor prognostic factors were women who underwent Caesarean section (P < 0.04) presence of hemiplegia (P < 0.04) and altered mental status (P < 0.0004). This study shows high morbidity and mortality of IM after LP. Simple aseptic precautions under- taken before the procedure can prevent IM. The urgent need for increasing the awareness among medical personnel in peripheral hospitals of developing countries cannot be over emphasized.
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PMID:Iatrogenic meningitis after lumbar puncture-a preventable health hazard. 1501 23

Diagnosis of tuberculoma is difficult because of its tumorlike aspects. This report describes the case of a male who displayed a hemiplegia revealing an intracranial mass. Neuroimaging was consistent with a glioblastoma; however, the definite diagnosis was a tuberculoma. Clinical features of tuberculomas are nonspecific. Even though the neuroimaging features are sensitive, they are much less specific, with variability related to the tuberculoma course. Investigations leading to the diagnosis are histologic analysis showing a granuloma with or without caseating necrosis, and the microbiologic identification of Mycobacterium tuberculosis. Every intracranial tumor with malignant radiologic and clinical appearance must evoke a suspicion for tuberculoma.
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PMID:Pseudotumor presentation of intracerebral tuberculomas. 1589 33


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