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Query: UMLS:C0036572 (seizures)
 80,221 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Sixty-eight of 282 neurosyphilitic patients (24.1%) had repetitive adult onset seizures of unknown cause. Serum and CSF FTA-ABS were more accurate diagnostic tests than the non-treponemal serologic tests. The latter tests were reactive in only 54.5% of patients. In addition to standard anticonvulsants, the patients received 20-24 million units procain penicillin G IM during a three week period. The therapeutic failure rate among these patients was 17.3% in contrast to the nonsyphilitic patients who had 21.8-38.6% failure rates. The prognosis of seizures in GPI patients was the worst regardless of the form of treatment. The use of serum and CSF FTA-ABS is recommended as a part of diagnostic evaluation of adult-onset seizure disorders. The use of large doses of penicillin seems to improve the results of treatment.
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PMID:Seizure disorders associated with neurosyphilis. 125 63

Nervous system opportunistic infections are seen in about one fifth of AIDS cases and account for over 40% of the patients with neurological manifestations. Serious infections are seen in severely immunosuppressed patients, usually with CD4 counts of 200 ml-1 or less. The commonest is CMV, which can produce acute encephalitis, sometimes with focal hemisphere or brain-stem signs, dementia, retinitis, optic neuritis and an ascending radiculomyeloencephalitis. Cryptococcal meningitis is the most frequent fungal disease; a high degree of clinical suspicion is required in patients with fever, malaise, headache or seizures. Only CSF cultures are always positive; both serum and CSF cryptococcal antigen tests are highly sensitive and specific. Treatment with amphotericin B and flucytosine is successful in at least 70% of first episodes but side-effects are common. Without maintenance therapy 50% of patients relapse; fluconazole is recommended. Cerebral toxoplasmosis can present with focal cerebral or spinal cord signs but also as a diffuse encephalopathy; negative T. gondii serology is exceptional but positive serum titres are usually unhelpful. Treatment with sulfadiazine, pyrimethamine and folinic acid achieves good results in 90% of the first episodes, but side-effects are common. Appearances on CT scan or MRI may take several weeks to improve. The value of an empirical approach to treatment is well-established; an initial cerebral biopsy is difficult to justify. Without maintenance therapy a relapse rate of 50% can be expected; therapy with sulfadiazine and pyrimethamine may also prevent pneumocystosis. HIV disease appears to increase the likelihood of neurosyphilis, and the risk of relapse after conventional penicillin doses, in patients with syphilis; at least 3-4 weeks of appropriate therapy are recommended. A number of other diseases caused by viruses, fungi, bacteria and parasites are less common; these include progressive multifocal leukoencephalopathy, herpes simplex and zoster infections and tuberculosis.
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PMID:Central nervous system opportunistic infections in HIV disease: clinical aspects. 134 47

We describe two human immunodeficiency virus (HIV)-infected patients with syphilitic cerebral gummas. Both patients presented with a seizure disorder associated with an isolated, peripherally located, contrast-enhancing lesion of the brain on CT. Cranial MRI performed on one patient revealed dural thickening in the region of the lesion. A brain biopsy in that patient revealed a lymphoplasmacytic infiltrate with extensive perivascular inflammation. Clinical manifestations, radiographic resolution of the lesions, and a decline in nontreponemal serologic tests for syphilis followed high-dose aqueous penicillin therapy in both patients. These patients illustrate that (1) cerebral mass lesions occurring with HIV infection may result from syphilis; (2) seizures may be the presenting manifestation of this form of neurosyphilis; and (3) high-dose, intravenous, aqueous penicillin is effective in treating these lesions.
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PMID:Syphilitic cerebral gumma with HIV infection. 162 Mar 34

In a 53-year old male suffering from paretic neurosyphilis, SPECT-investigations were performed before and after treatment with high doses of Penicillin G. The patient was admitted for disturbances of speech and concentration, memory disorder and tonic-clonic seizures. Mental examination showed a mild dysphoria and irritability in mood, but no disturbance of orientation, no euphoria or expansive delusions, and no paranoia. Mini-Mental-State examination was within the normal range (28 points); no abnormalities were found on neurologic examination, and CT and MRI investigations showed normal findings. The diagnosis was verified by CSF-examination (pleocytosis, elevated protein, positive Lues reactions). SPECT investigation with Tc 99m HMPAO (20 mCi, single-head rotating camera) revealed a pronounced bilateral parieto-temporal uptake deficiency as observed in patients with dementia of Alzheimer's type. After 18 months the clinical symptoms had remitted, and laboratory findings were improved. On the other hand, the bilateral parieto-temporal uptake deficiency in SPECT remained unchanged. Possible causes of these findings are discussed in relation to neuropathologic findings. It can be concluded that bilateral parieto-temporal uptake deficiency in SPECT is a nonspecific finding and that there is no correlation between clinical improvement and SPECT pattern in paretic neurosyphilis.
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PMID:[Lack of specificity of single photon emission computerized tomography in dementia--results of a case of progressive paralysis]. 163 20

The computed tomographic (CT) and magnetic resonance (MR) imaging findings in a middle-aged male with cerebral syphilis are described. He presented with convulsive seizures and focal neurological deficits. A CT scan revealed a slightly enhanced, low-density mass in the left parieto-occipital region. MR imaging showed low intensity on T1-weighted images and high intensity on T2-weighted images. He was initially diagnosed as having a low-grade glioma. However, intraoperative histological examination of a small surgical specimen revealed no tumor cells but heavy infiltration of inflammatory cells in the meninges and cerebral parenchyma. Immunostaining for Treponema organisms by the peroxidase-antiperoxidase method was positive. Although the clinical and radiological findings are nonspecific, neurosyphilis should be considered in any patient in whom a nonspecific mass lesion is demonstrated by CT and MR imaging.
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PMID:Neurosyphilis manifesting as a focal mass lesion: computed tomographic and magnetic resonance imaging features--case report. 169 49

Fifty-two patients at various stages of human immunodeficiency virus (HIV) infection who had one or several epileptic seizures in the course of that disease were retrospectively studied from 1985 to 1990. Thirty-five percent of these patients were in overt clinical AIDS at the time of the seizure(s). AIDS was revealed by a seizure in 2 cases. Generalized seizures were observed in 71 percent of the patients, and partial seizures in 29 percent. Electroencephalograms showed signs of brain irritation in only 19 percent of the cases. The cause of epileptic seizure(s) could be determined in 36 patients: cerebral toxoplasmosis in 23 cases; progressive multifocal leucoencephalitis in 2 cases; HIV encephalopathy in 3 cases; iatrogenic cause in 4 cases; meningoencephalitis in 3 cases and neurosyphilis in 1 case. No cause other than HIV infection was found in 16 patients. These findings confirm those of previous studies. In about one-third of AIDS patients epileptic seizures are the only clinical manifestation of viral central nervous system infection.
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PMID:[Epilepsy seizures in HIV infection. 52 cases]. 183 61

A 40-year-old male patient with progressive dementia presented adversive seizures, and CT scan showed an enlarging focal mass lesion in the right cerebral hemisphere. Cerebrospinal fluid examination and brain biopsy confirmed the diagnosis of neurosyphilis. After a course of penicillin therapy there was disappearance of the cerebral mass lesion and the CT scan showed focal atrophy in the right cerebral hemisphere. This case suggests that Lissauer form of paretic neurosyphilis may present as a focal mass lesion.
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PMID:Lissauer form of paretic neurosyphilis with a cerebral mass lesion. 322 35

Approximately 5,000 new cases of neurosyphilis may occur in the United States each year. General paresis and tabes dorsalis, however, have become relatively rare since the introduction of penicillin. Seizures, neuro-ophthalmologic symptoms, stroke and acute meningoencephalitis are currently the most common manifestations of neurosyphilis. In more than a third of patients with neurosyphilis, nontreponemal tests for syphilis (such as VDRL) are negative and should not be used to exclude the diagnosis. Specific treponemal tests are more sensitive and more specific. Examination of the cerebrospinal fluid may show no abnormalities in neurosyphilis and is not an infallible guide to the activity of the infection. Penicillin is the only proven antibiotic treatment of neurosyphilis. However, low-dose regimens do not produce spirocheticidal concentrations in the brain, and high-dose penicillin therapy is recommended to insure eradication of the spirochetes. Doxycycline, a tetracycline derivation that achieves relatively high concentration in the brain, may also be effective.
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PMID:Modern neurosyphilis: a partially treated chronic meningitis. 734 Jan 18

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

Overingestion of isoniazid can cause confusion, slurred speech, seizures, coma, and death. Most cases of a central nervous system toxic reaction due to isoniazid use result from sudden intentional or accidental overdose. We describe a patient taking 1200 mg of isoniazid daily for 6 weeks who presented to the hospital with confusion and lethargy that progressed to coma. Within 30 minutes of receiving 1 g of intravenous pyridoxine hydrochloride, the patient was fully alert and lucid. The diagnosis of a toxic reaction to isoniazid was delayed by the possibility of concurrent active neurosyphilis and the failure to initially consider isoniazid poisoning in a patient without a history of sudden isoniazid overdose.
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PMID:Coma from long-term overingestion of isoniazid. 938 5


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