Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0036572 (seizures)
 80,221 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The objective of this study was to define the severe neurological complications that occur in recipients of an orthotopic liver transplantation, receiving FK 506 as their primary immunosuppressive agent. To accomplish this, 100 consecutive orthotopic liver transplantation patients were followed prospectively from the time of their transplant until the date of their initial post-orthotopic liver transplantation discharge from hospital. All major neurological complications occurring during this period were recorded and assessed. The frequency of severe neurological complications occurring in these severely ill transplant recipients was 34%. Delirium was noted in 16, coma in 9, seizures in 4, and 5 developed focal motor deficits associated with the finding of a brain abscess, transient ischemic attack or central pontine myelinolysis. At the time at which a major neurologic complication was noted, the blood level of FK 506 was recorded. No direct relationship between FK 506 blood levels and the presence or absence of major neurologic complications of orthotopic liver transplantation could be demonstrated. Based upon this series, it can be concluded that although FK 506 may contribute to the pathogenesis of minor neurological complications seen after orthotopic liver transplantation such as tremors and headaches, the pathogenesis of most of the major neurologic complications occurring after orthotopic liver transplantation is multifactorial and cannot be ascribed solely to FK 506 toxicity.
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PMID:Severe neurological complications following orthotopic liver transplantation in patients receiving FK 506 and prednisone. 752 72

The number of brain abscesses has been reduced since the preantibiotic era. This was accomplished by judicious use of antibiotics, by the advent of computed tomography, and by improvements in patient care and surgical techniques. Analysis from 122 patients with brain abscess demonstrated this trend of progress. Our series had a 3.2-to-1 male predominance. The underlying conditions included otolaryngologic infections (26 cases), cyanotic heart diseases (27 cases), implantation abscess (25 cases), lung infections (5 cases), meningitis (4 cases), osteomyelitis (2 cases), decreased immunity from chronic systemic diseases (12 cases), and unknown causes (21 cases). Otolaryngologic subgroups can be detailed as chronic otitis media with cholesteatoma (15 cases), chronic otitis media with mastoiditis (4 cases), sinusitis (2 cases), esophageal stenosis (3 cases), cheek cellulitis (1 case), and nasopharyngeal carcinoma (1 case). The initial symptoms and signs were headache (46 cases), fever (36 cases), altered consciousness (30 cases), neurologic deficits (33 cases), vomiting (11 cases), and seizure (17 cases). Of the brain abscesses treated, multiple brain abscess represented 16.4% of all cases. The overall percentage of patients with full recovery was 52.5%, whereas 84.8% of otolaryngologic subgroup recovered fully. The overall mortality was 19.7%. The mortality rate of brain abscess from otolaryngologic sources was 3.8%, whereas that from nonotolaryngologic sources was 24%.
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PMID:Brain abscess: with special reference to otolaryngologic sources of infection. 760 12

Cerebral phaeohyphomycosis is used to describe the rare clinical syndrome of cerebral infection caused by dematiaceous (i.e. pigmented olivaceous-brown) fungi. It usually presents as brain abscess. In view of the rarity of this fungal infection and its clinical importance, we report a case of cerebral phaeohyphomycosis caused by Xylohypha bantiana. The patient presented with a seizure attack. The MRI study revealed a ring-enhancing lesion with marked perifocal edema in right high frontoparietal junction of the brain. He underwent an initial craniotomy for removal of the lesion and a second craniotomy for recurrence of the lesion 3 months later. The diagnosis was based on successful cultivation of X. bantiana from the surgical specimen and on histopathology. The patient received antifungal drug therapy of 5-flucytosine and itraconazole. He has done well without any symptoms. We think complete surgical removal of the brain abscess combined with antifungal drug therapy is the best management for this rare fungal disease.
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PMID:Cerebral phaeohyphomycosis complicated with brain abscess: a case report. 763 90

A 6-year-old boy esophageal stricture due to the ingestion of caustic 7 months prior to admission. Eight esophageal dilations and a feeding gastrostomy were performed. He presented with seizure, right-sided weakness, fever, and somnolence. Computed tomographic scans revealed multiple brain abscesses. The abscesses were treated by burr-hole drainage. The patient improved and was discharged from the hospital without neurological deficit. Brain abscesses are not very common following esophageal dilation. It should be kept in mind that brain abscess is a potential complication of esophageal dilation.
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PMID:Multiple brain abscesses following esophageal dilation. 767 Dec 72

The successful management of nocardial brain abscess remains problematic. The authors report 11 cases of nocardial brain abscess treated between 1971 and 1993 and review 120 cases reported since 1950. The clinical findings included focal deficits in 55 patients (42%), nonfocal findings in 36 (27%), and seizures in 39 (30%). Extraneural nocardiae were present in 66% of the cases; pulmonary (38%) and cutaneous/subcutaneous (20%) locations were the most frequent. The abscesses were single in 54% of the patients, multiple in 38%, and of unknown number in 8%. Forty-four of 131 patients (34%) were immunocompromised; since 1975, 18 of 40 immunocompromised patients (45%) were transplant recipients and six (15%) had human immunodeficiency virus. The mortality rate was 24% after initial craniotomy and excision (11/45), 50% after aspiration/drainage (17/34), and 30% after nonoperative therapy (7/23); 29 cases (22%) were diagnosed at autopsy. The mortality rate was 33% in patients with single abscesses and 66% in those with multiple abscesses (P < 0.0003). There was no difference in the mortality rates of immunocompromised and nonimmunocompromised patients treated before computed tomography (CT) was available; since the advent of CT, however, the mortality rate has been significantly higher in immunocompromised patients (55% vs. 20%, P < 0.05). Although the mortality rate for nocardial brain abscesses has dropped almost 50% since the advent of CT, it has remained virtually unchanged in immunocompromised patients and is three times higher than that of other bacterial brain abscesses (30% vs. 10%). The authors recommend image-directed stereotactic aspiration for diagnosis; however, craniotomy and total excision are necessary in most cases, because nocardial abscesses are usually multiloculated. Patients with minimal neurological deficits or small abscesses may be treated initially with antibiotics alone. Sulfonamides, alone or in combination with trimethoprim, are most effective and should be continued for at least 1 year. Minocycline, imipenem, or aminoglycoside in combination with a third-generation cephalosporin may be used with reasonably good success as second-line agents in cases of allergy or nonresponsiveness to sulfa agents.
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PMID:Nocardial brain abscess: treatment strategies and factors influencing outcome. 780 4

Despite a reduction in the mortality of patients with brain abscess since the introduction of the computed tomography (CT) scanner, controversy persists as to the preferred method of treatment for this condition. Eleven patients were treated by CT guided stereotactic aspiration of pus and appropriate antibiotic therapy. A total of 14 aspirations were performed. Ten abscesses were supratentorial and one was in the posterior fossa. In 9 patients a bacterial cause was identified while in 2 a fungus was identified. A good outcome was achieved in 7 patients but 3 patients died. Another elderly patient remains disabled at home. The deaths occurred in severely systemically ill patients with poor conscious levels on admission. Only one patient has epilepsy, controlled with anticonvulsants while another has not had further seizures since abscess treatment a year ago. Stereotactic aspiration should be considered the treatment of choice in all but the most superficial and largest cerebral abscesses, although the mortality of this condition in the severely ill remains high.
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PMID:Stereotactic aspiration of brain abscesses: is this the treatment of choice? 847 2

There were 140 cases of brain abscess treated between 1980 (when CT scanning became available) and June 1991. These arose by spread of a contiguous area of infection in 37%, and from another identified cause in 22%; the origin was undetermined in 41%. There were multiple abscesses in 11%. The abscess was < 2 cm in diameter in 21%. In two-thirds of the patients, the intracranial pressure was raised, there were localizing neurologic signs in 33%, and in 28% there were epileptic seizures. The computed tomographic (CT) feature of an abscess in the capsular stage was a thin, regular, and uniform, ring-like enhancement. In the cerebritis stage, nine out of 17 patients showed a uniform enhancement throughout the lesion. Since 1989, 14 cases have been investigated with magnetic resonance imaging (MRI). In 11, the abscess was in the capsular stage. In both T1- and T2-weighted images, the abscess and the surrounding inflammatory area were well demonstrated, and with T2-weighting, the capsule showed a low-intensity signal clearly. In the three abscesses in the cerebritis stage, there was a uniform abnormality with indistinct margins between the abscess, inflammatory edema, and surrounding grey and white matter. All cases received a combination of wide-spectrum antibiotics before the organism was identified; and later the medication was administered according to bacteriologic indication of the organism of 112 cases, organisms were identified in 71%, with anaerobic organisms occurring in 30% of these. In 127 cases, surgical treatment was used: either repeated aspiration, excision or both. We treated 13 cases that had small, early, or multiple abscesses with antibiotics only. The mortality with surgical treatment was 7.9%, and no case treated conservatively died.
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PMID:Review of 140 patients with brain abscess. 848 48

A case of neurofibromatosis type 1 in 15 years old boy is presented. Recurrent intracranial bleedings, epileptic seizures and brain abscess were the main manifestations of the disease. The authors suggest that hamartomatous cerebral lesion with vascular abnormalities might be responsible for such a picture of the disease.
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PMID:[Difficulties in the diagnosis of cerebral abscess in a 15-year old boy with von Recklinghausen disease treated surgically: recovery case report]. 854 41

Ten patients with neurological complications (NC) among a retrospective series of 53 consecutive cases of infective endocarditis were studied: 6 males and 4 females, mean age 60 years. NC were present at admission in 6 cases: 2 generalized seizures, 4 strokes, associated with 2 meningeal syndromes. Four cases of NC occurred during hospitalization: 1 stroke with come, 1 transient ischaemic attack, 2 generalized seizures. Blood cultures were positive in 7 cases: 6 group D Streptococci, 1 Gram negative bacillus. Five digestive portal of entry were identified. Cerebrospinal fluid was purulent in 1 patient, aseptic in 1, haemorragic in 2, and normal in 1. Cranial computed tomography revealed: infarct in 4 cases, brain abscess in 1 case, absence of abnormality in 1 case. There was no angiographic documentation. Antimicrobial therapy was maintained 5 to 6 weeks. Two patients underwent cardiac surgery. Two patients died of subarachnoid haemorrage. Comparison of patients with NC, and the 43 without NC, revealed two different point: vegetations were more frequent in the NC (8 cases out of 10) than without NC (19 cases out of 43) (p = 0.04). Streptoccus was often more found in NC (6 cases out of 6) than without NC (6 cases out of 24) (p < 0.01). Compared with the previously reported studies, where Staphylococcus was usually described, our results showed a higher frequency of Streptococcus D bovis, an older age, a higher frequency of stroke and digestive portal of entry. Vegetations were more frequent with NC than without.
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PMID:[Neurologic complications of infectious endocarditis]. 859 40

It is vital to diagnose brain abscess early, but this can be intricate. Four cases of brain abscess are described, illustrating the diagnostic difficulties. One of the patients had multiple brain abscesses. Important aspects of brain abscess are discussed. Brain abscess should be suspected in cases of increasing intracranial pressure combined with focal neurological signs or epileptic seizures, even with no apparent signs of infection. The characteristic contrast-enhancing ring lesion and surrounding oedema may be sufficient for diagnosis, but biopsy and bacteriological culture are often necessary. Epileptic seizures and various neurological sequelae are common, even if the abscess is treated immediately. Delay in diagnosis may lead to fatal outcome.
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PMID:[Brain abscess. A difficult diagnosis?]. 864 1


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