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Query: UMLS:C0027497 (nausea)
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We studied 36 patients (24 males, 12 females), all of whom had definite subacute sclerosing panencephalitis with typical periodic complexes in their electroencephalograms and increased titers of measles antibody in serum and cerebrospinal fluid. Their clinical and laboratory findings on admission were reviewed retrospectively. The age at onset of symptoms varied from 4 to 23 years. The average age at onset of disease was 13.1 +/- 4.18 years. The mean of the duration from the infection to the onset of subacute sclerosing panencephalitis was 9 years. Unusual symptoms, especially in the early periods of disease, included hemiparesis (7 patients), headache (3), generalized tonic-clonic seizures (6), absence seizure (1), nausea (3), and vomiting (3). Twenty-six cranial magnetic resonance imaging (MRI) and 12 computed tomography examinations were performed. Nine patients had normal MRI. In the early stages, lesions usually involved parieto-occipital corticosubcortical regions asymmetrically. In time, symmetric periventricular white-matter changes became more prominent. In addition to the common clinical findings in cases of subacute sclerosing panencephalitis reported in the literature, there were some different clinical features of the disease. Eventually, we concluded that there seems to be no correlation between the clinical stages and either the duration from the onset of subacute sclerosing panencephalitis or the MRI findings.
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PMID:Subacute sclerosing panencephalitis: clinical and magnetic resonance imaging evaluation of 36 patients. 1191 65

Rhombencephalitis due to listeria monocytogenes is an uncommon and serious form of brainstem infection. The disease has a characteristic biphasic course: a nonspecific prodrome of headache, nausea or vomiting, and fever lasting for a several days is followed by progressive asymmetrical cranial-nerve palsies. We report two cases of Listeria monocytogenes rhombencephalitis. The first case is a previously healthy 20 year-old-man who developed fever, headache, nausea and vomiting, followed by numbness in left trigeminal nerve. The second case is an immunosuppressed 77 year-old-man, who developed sudden left hemiparesis, followed by fever and severe brainstem dysfunction with ophthalmoplegia and dysphagia. In both cases, a brain magnetic resonance imaging (MRI) scan, showed increased intensity on T2-weighted lesions in the brainstem that enhanced after contrast on T1-weighted sequences. Both patients had a favorable outcome with full clinical recovery. We conclude that MRI aids in the early detection of parenchymal infections, therefore, MRI is crucial for early diagnosis and is very useful for follow-up examinations.
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PMID:[Listeria rhombencephalitis. Neuroradiological findings]. 1259 Mar 80

Although diving with compressed air is generally safe, neurological problems resulting from infarction in SCUBA diving are well known, including arterial gas embolism and decompression sickness (caisson's disease, bends) involving the brain and spinal cord. While air gas embolism forms the overwhelming majority of causes for stroke in divers, internal carotid artery (ICA) dissection is another potential mechanism for central nervous system infarction in the setting of SCUBA diving. A 38 year-old female, who presented with complaints of headache, nausea, vomiting, and left sided hemiparesis after rapid ascent to the surface from a depth of 120 feet of seawater was initially treated for decompression illness in a hyperbaric chamber. Further neurological workup revealed a right ICA dissection. This case demonstrates the dangers of ICA dissection following rapid ascent to the surface from underwater and emphasizes an interesting presentation of stroke associated with SCUBA diving.
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PMID:Internal carotid artery dissection in stroke from SCUBA diving: a case report. 1267 Jan 19

Cryptococcus neoformans affections during HIV-infection are frequent and serious. The aim of this study was to analyse the epidemiological, clinical, biological and therapeutic characteristics of cryptococcal meningitis in HIV-positive patients, admitted into the Center for Tropical Diseases Ho Chi Minh City (Vietnam), during a 5-month period (May-September 2001). Twenty-one patients (20 men and one woman) were included (identification of C. neoformans from the cerebrospinal fluid). The mean age was 28 years. The majority of patients had been living in Ho Chi Minh City (48%). The use of drugs and unprotected sexual relations were the principal risk factors of HIV-infection. The paucity and the confusion of clinical signs and symptoms, along with a high frequency of meningitis have been analysed. Clinical presentation features included: headache (95%), emaciation (90%), oro-pharyngeal candidiasis (90%), stiff neck (80%), nausea/vomiting (70%), fever (67%), coughing (38%), diarrhoea (33%), skin lesions (5%), convulsion (5%), photophobia (5%), and hemiparesis (5%). The severity of the prognosis was mainly linked to the delay before hospitalization, to the possible association with other opportunistic infections, and to the availability of appropriate treatment.
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PMID:[Cryptococosis and HIV/AIDS: a review of 21 cases reported in the Tropical Diseases Centre, Ho Chi Minh City (Vietnam)]. 1504 39

Spontaneous intracranial hypotension (SIH) is a rare disease which is associated with variety of symptoms and signs including cranial neuropathies. Though diplopia occurred reportedly in about one fourth of SIH cases, trochlear nerve palsy has been reported only one case in the literature. A 71-year-old previously healthy male developed postural headache and nausea. After 15 days, he began to have diplopia caused by right trochlear nerve palsy. He consulted our hospital 2 months later because only diplopia was not recovered. Magnetic resonance imaging (MRI) showed bilateral thin chronic subdural hematoma (CSDH), brain sagging and downward brain stem displacement, but not ischemic change in brain stem. We suspected SIH for right trochlear nerve palsy, and he had symptomatic therapy. Two months later, he had burr hole surgery because of disturbance of consciousness and right hemiparesis due to progressive bilateral-CSDH. To say nothing of disturbance of consciousness and right hemiparesis, his trochlear nerve palsy was completely recovered after surgery at once. Follow-up MRI showed brain sagging and downward brain stem displacement were recovered.
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PMID:[Spontaneous intracranial hypotension associated with trochlear nerve palsy and bilateral chronic subdural hematoma]. 1509 63

To investigate clinical characteristics of early central nervous system (CNS) complications after reduced-intensity stem cell transplantation (RIST), we reviewed the medical records of 232 patients who had undergone RIST for hematologic diseases at our institutions between September 1999 and June 2003. All patients had received purine analog-based preparative regimens. Stem cell sources comprised granulocyte colony-stimulating factor-mobilized blood from HLA-identical or 1 locus-mismatched related donors (n = 151), unrelated bone marrow (n = 44), or unrelated cord blood (n = 37). Graft-versus-host disease prophylaxis incorporated cyclosporine with or without methotrexate. Diagnosis of CNS complications was based on clinical, radiologic, and microbiological findings. CNS complications occurred in 18 patients (7.8%), with a median onset of 22 days, and were infectious (n = 1), metabolic (n = 15), or cerebrovascular (n = 2). Symptoms included seizures (n = 7), visual disturbance (n = 2), headache (n = 8), nausea (n = 8), vomiting (n = 6), impaired consciousness (n = 16), and hemiparesis (n = 3). Complications improved promptly in 10 patients, and 8 patients died without improvement within 30 days. Multivariate analysis with logistic regression identified umbilical cord blood transplantation as a significant risk factor for early CNS complications (odds ratio, 14.5; 95% confidence interval, 3.7-56.9; P <.0001). CNS complications are a significant problem after RIST, particularly with umbilical cord blood. Limbic encephalopathy is an unrecognized subtype of neurotoxicity after umbilical cord blood transplantation.
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PMID:Early central nervous system complications after reduced-intensity stem cell transplantation. 1528 34

We report a case of a dissecting vertebral aneurysm with subarachnoid hemorrhage (SAH) after ischemic onset on the same day. A 48-year-old man had abrupt vertigo and nausea. CT & MRI on admission showed no abnormality, but he complained of left hemiparesis after admission. Twelve hours after the ischemic onset he suddenly complained of severe headache and his consciousness deteriorated. The follow-up CT showed diffuse SAH. Cerebral angiography showed occlusion of the right vertebral artery at the origin of the posterior inferior cerebellar artery (PICA) and segmental stenosis of the left vertebral artery at the portion distal to the vertebral PICA junction. We treated the patient conservatively. Four days later, he suddenly fell into a coma, but CT showed no bleeding. Because of this we suspected brain stem ischemia due to deterioration of vertebral dissection. The patient died 8 hours after the ischemic reattack. We report difficulty of treatment of a dissecting vertebral aneurysm with simultaneous ischemia and subarachnoid hemorrhage.
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PMID:[Dissecting vertebral aneurysm with subarachnoid hemorrhage after ischemic onset on the same day: a case report]. 1546 62

A 50-year-old woman presented with a rare case of contrecoup epidural hematoma (EDH) associated with coup EDH. She was hit by a car while riding a bicycle, and struck the left parietal region of her head on the ground. She was dazed for a few minutes. On admission, she complained of nausea but exhibited no neurological deficits. Skull radiography revealed a linear fracture of the left temporal bone. Computed tomography (CT) demonstrated acute EDH in the right frontal region due to contrecoup injury, and thin EDH in the left temporal region due to coup injury. She vomited repeatedly after admission. She became lethargic and exhibited right hemiparesis. CT, taken 2 hours later, revealed enlargement of the left coup EDH, but no enlargement of the right contrecoup EDH. An emergent evacuation of the enlarged coup EDH was performed. Immediately after the operation, she became alert and the right hemiparesis subsided. The contrecoup EDH was conservatively treated, in the absence of enlargement. She was discharged 12 days after the injury without neurological deficits.
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PMID:Acute epidural hematoma caused by contrecoup head injury--case report. 1568 77

We describe the first case of Weber's Syndrome to present as a manifestation of decompression illness in a recreational scuba diver. Weber's Syndrome is characterized by the presence of an oculomotor nerve palsy and contralateral hemiparesis. The patient was a 55 year-old male with a past medical history of a pulmonary cyst, in whom symptoms developed after a multilevel drift dive to a depth of 89 feet for 53 minutes, exceeding no-decompression limits. Symptom onset was within 30 minutes of surfacing and included the Weber's Syndrome, a sixth nerve palsy, dizziness, nausea, sensory loss, and ataxia. The patient received four U.S. Navy Treatment Tables with complete resolution of all neurological signs and symptoms. The mechanism of injury remains unclear, but may involve aspects of both air gas embolism and decompression sickness. Individuals with pre-existing pulmonary cysts may be at increased risk for dive-related complications.
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PMID:Weber's syndrome and sixth nerve palsy secondary to decompression illness: a case report. 1592 1

Dural arteriovenous fistulae(dAVF) in the anterior cranial fossa comprise about 6% of all dAVFs, and is usually detected after intracranial hemorrhage. However, non-hemorrhagic symptoms are uncommon. We encountered two patients with hemorrhagic and non-hemorrhagic dAVF in the anterior cranial fossa. Both cases were successfully treated using craniotomy and histopathological examination was performed. A 71-year-old male experienced sudden onset of nausea and headache, followed by progression of left hemiparesis and disturbance of consciousness due to intracerebral and subdural hematoma in 2005. Intracerebral venous aneurysm adjacent to the intracerebral hematoma originated from the draining cortical red vein was identified and successfully treated by operation. Histopathological examination revealed disappearance of the internal elastic lamina and scant muscle tissue in the venous aneurysmal wall originating from draining cortical vein. A 69-year-old male suffered sudden onset of mild headache, followed by progression of bruits in 2005. MRI suggested dAVF in the left anterior cranial fossa. 123I-IMP SPECT revealed an area of low perfusion in the left frontotemporal region. Histopathological examination after surgical treatment revealed thickening of the intima and an indistinct lamina elastica interna, indicating progressive degenerative changes of the arterialized vein likely to result in hemorrhage. Surgical obliteration of fistulae is reasonable even in the dAVF of the anterior cranial fossa with ischemic onset.
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PMID:[Two surgically treated cases with dural arteriovenous malformation in the anterior cranial fossa]. 1635 34


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