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

Interhemispheric subdural empyema, secondary to frontal sinusitis in two girls is described. Headache, hemiparesis more marked in the lower extremity, fever, focal seizures, stupor and stiff neck were the principal features of the clinical course. The angiographic appearance of the lesion was the key to the preoperative diagnosis. Surgical evacuation of the purulent collection resulted in complete cure in both cases.
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PMID:Interhemispheric subdural empyema: angiographic diagnosis and surgical treatment. 111 7

Subdural empyema is an intracranial infection that has remained difficult to diagnose and to treat. Seventeen patients with this infection, treated between 1967 and 1974, are analyzed and compared to published series with particular regard to diagnosis using newer procedures and treatment, considering the primary focus of infection. The infection is usually located in the supratentorial spaces, is often bilateral, and results most often from para-nasal sinusitis (single most common cause), otitis, neurosurgical operative infections, and meningitis in infants. Patients suffering from subdural empyema generally present with rapid onset of depressed sensorium, seizures, focal neurological deficits, and signs of increased intracranial pressure, following a period of days to weeks characterized by headache and fever. All 17 of our patients demonstrated localizing neurological signs and 16 manifested either fever or leukocytosis. Diagnostic studies, except for cerebral arteriography, do not reliably corroborate or exclude the diagnosis. Cerebral arteriography established the diagnosis and defined the location and extent of the empyema in all of our cases. The EEG and brain scan produced frequent false-negative and/or non-localizing results in 10 and 8 patients, respectively. The cerebrospinal fluid was abnormal from all 15 patients examined by lumbar puncture, but the findings were similar to those in other infectious and non-infectious central nervous system diseases. Signs of transtentorial herniation developed within eight hours following lumbar puncture in three of seven patients who had exhibited signs of increased intracranial pressure before the procedure was performed. Bacterial cultures were positive in 13 of our cases. A review of our data and that of other studies indicates that the organisms associated with subdural empyema are consistent with those expected from infections of the primary site; e.g. sinusitis, otitis, meningitis, site of prior neurosurgery. A therapeutic approach is suggested which emphasizes specific antibiotic regimens appropriate to the primary site of infection and prompt neurosurgical intervention with evacuation of the subdural spaces bilaterally. In general, combination antimicrobial therapy employing high parenteral doses of penicillin G, a semi-synthetic penicillinase-resistant penicillin and chloramphenicol is recommended.
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PMID:Subdural empyema: analysis of 17 recent cases and review of the literature. 118 92

A retrospective evaluation was performed on 28 cases of paediatric brain abscess (male: female ratio 2.5:1; mean age 9.4 years; range 2.8-16 years) diagnosed between 1967 and 1987. In 46%, congenital cyanotic heart disease was identified as a predisposing factor, likewise sinusitis, otitis media or mastoiditis in 29% and immunodeficiency in 11%. Pathogenesis remained unclear in 14%. Initial symptoms and signs were predominantly nonspecific; loss of consciousness occurred in 32% of cases, neurological deficit and seizures each in 25%. Since the availability of CT, both diagnostic delay after hospital admission and mortality were substantially reduced: mean delay from 8.4 to 3.0 days, and mortality from 23% to 0%. Seventeen patients (61%) had follow up examinations 9.6 years (mean) after the acute illness (range 1-21 years). Neurological sequelae were diagnosed in 35% of cases, epilepsy in 29%, epileptic potentials during EEG in 12%, and CNS scars in 50%. Psychological testing revealed no statistically significant differences compared to normal populations. CNS scars, and epilepsy and/or epileptic potentials were more common after excision (7 patients) when compared to patients treated by aspiration and/or antibiotics alone (21 patients). It is concluded that excision of brain abscess should be avoided whenever possible. Therapy of choice consists of the administration of adequate antibiotics with or without CT-guided needle aspirations.
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PMID:Brain abscess in childhood--long-term experiences. 202 23

A 46-year-old woman with non-Hodgkin's lymphoma presented with a new onset of seizures. A cranial CT was interpreted as normal. Eight months later, she presented with changed mental status and leg weakness, and a repeat CT scan showed multiple ring-enhancing lesions close to the left frontal sinus, with mass effect. A review of the previous CT scan showed a very small area of sinusitis as well as a small ring-enhancing lesion contiguous to it. A short course of intravenous steroids markedly relieved her symptoms, and a stereotactic biopsy confirmed Aspergillus fumigatus to be the cause of the infection. She was successfully treated with Amphotericin B. Central nervous system (CNS) aspergillosis is a potentially fatal disease. The therapeutic success in this case was related to a high index of suspicion at her second presentation. As the early signs of infection might be subtle and easily missed, patients at high risk for opportunistic infection should be studied carefully when new onset of CNS symptoms occur. Early initiation of therapy should improve the prognosis in such cases.
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PMID:Early invasive CNS aspergillosis. An easily missed diagnosis. 204 12

Sinusitis due to unusual fungal pathogens is thought to occur primarily in immunocompromised individuals. However, the fungi Curvularia, Drechslera, and others produce sinusitis in healthy young adults. The signs and symptoms produced by these organisms are usually considered to be complications of sinusitis. Of the three cases that we report, two manifested decreased visual acuity, and the third presented with acute onset of seizures. Computed tomography scans were helpful in delineating the extent of disease and in following the results of therapy. Aggressive surgical treatment is necessary; indeed, two of our cases required a second operation to eradicate all disease. If histopathology shows tissue invasion by the fungus, intravenous amphotericin B is recommended. Fungal cultures and smears should be obtained when healthy patients present with complications of sinusitis.
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PMID:Curvularia/Drechslera sinusitis. 220 56

The clinical and computed tomographic (CT) findings in 15 patients with subdural empyema (SDE) were analyzed. Seven children with meningitis later developed focal neurologic signs of SDE. The CT scans showed prominent subdural lesions with medial membrane enhancement; only one child had a parenchymal lesion, which represented a brain abscess. Two lesions were multiloculated, which was delineated by the CT finding of medial enhancing bands separating the compartments of the hypodense lesions. Of eight adolescents and adults with SDE, seven had sinusitis. These patients presented initially with fever and meningeal signs in addition to altered levels of consciousness. They latter developed focal neurologic signs or seizures. In seven cases, CT showed hemispheric mass effect with a thin subdural lesion and a medial enhancing membrane. One scan showed a prominent subdural lesion with minimal hemispheric mass effect.
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PMID:Subdural empyema. Clinical and computed tomographic correlations. 287 Jun 99

A case of the squamous cell carcinoma of the frontal sinus complicated with osteomyelitis of the frontal bone was reported. A 47-year-old male was admitted to Asahikawa Medical College Hospital because of a bulging of forehead and remittent fever of a six-month history and general convulsive seizures on the day before admission. On physical examination, a bulging of forehead with redness, tenderness and fluctuation was noted. Sense of smell diminished bilaterally. Oto-laryngological examination disclosed paranasal sinusitis. Skull X-P and CT scan suggested osteomyelitis of the frontal bone secondary to frontal sinusitis. However, a frontal sinus tumor with osteomyelitis was also possible. Operation was performed and a granulomatous mass attached to the dura with thick epidural abscess was noted. The mass and affected bone edge were removed. Pathological examination of the specimens disclosed findings of squamous cell carcinoma and osteomyelitis. Recurrence of the tumor rapidly occurred and reoperation was performed a month after the first operation. Postoperative irradiation and chemotherapy with pepleomycin were done but failed to control the growth and recurrence occurred immediately. The tumor penetrated the skin of the forehead and the patient died of cachexy 7 months after the first surgery. Osteomyelitis usually occurred in the metaphysis of long tubular bone and rarely in short bone or flat bone such as a skull. This is attributed to the difference of distribution of the bone marrow vessels. Embolization and subsequent growth of bacteria in the blood flow is less liable to occur in short bone and flat bone.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Squamous cell carcinoma of the frontal sinus caused osteomyelitis of the frontal bone]. 402 54

Subdural empyema is a surgical emergency, which, if not recognized and managed promptly, is rapidly fatal. The clinical features, diagnosis, infecting organisms, treatment and results in 15 patients with subdural empyema admitted to the University and Saskatoon City hospitals between 1956 and 1982 are evaluated. There were 11 males and 4 females; 80% were under 50 years of age. Paranasal sinusitis in six patients was the most common cause of the condition. The most frequent presenting features were fever, headache, vomiting, seizures and motor deficit. Preoperative diagnostic methods included skull roentgenography, cerebrospinal fluid studies, electroencephalography, cerebral angiography and computerized tomography. Cultures of the pus were positive for bacteria in 13 of the 15 patients. Drainage of the empyema was accomplished through multiple burr holes, craniotomy and craniectomy. Follow-up ranged from 1 month to 15 years. Eleven patients recovered with minimal or no neurologic deficit, 2 patients had permanent major deficits and 2 died. Successful management of subdural empyema depends on early diagnosis, prompt evacuation of the pus and appropriate antibiotic therapy.
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PMID:Subdural empyema: a retrospective study of 15 patients. 614 82

In 17 cases of sinusitis-induced subdural empyema, all but 5 occurred in boys or men aged 13 to 33 years. Clinical features were headaches and fever (14 patients), nuchal rigidity (10), and seizures (8). Seven patients had periorbital cellulitis, and 15 had radiographic clouding of at least one sinus. Only five patients had a history of sinusitis. CT identified the empyema accurately in seven patients but failed in two patients who developed subdural empyema while being treated for sinusitis-induced cerebritis. Ten patients had specific bacteriologic etiologies determined by culture of empyema, blood, or sinuses.
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PMID:Sinusitis: induced subdural empyema. 668 53

Because subdural empyema (SDE) is an unusual central nervous system infection, recognition is not always prompt. Consequently delays can allow a serious but curable infection to become irreparably damaging or even fatal. This condition, particularly in the early stages, is relatively easy to treat. Personal experience with six patients during the past 3 years promoted us to review the data from UCLA and its affiliated hospitals. Among the 23 cases of SDE reviewed, the predisposing factor in 16 was sinusitis, mastoiditis, or otitis media. The clinical presentation, encompassing a systemic febrile illness, headache, and neurological deficit, was monotonously uniform. The high incidence of paranasal sinus involvement in the adult, middle ear infections in infants, and seizures in 15 patients comprised further clinical clues suggesting the diagnosis. Although usually diagnosed as an intracranial inflammatory process, an initial failure to suspect a purulent collection in the subdural compartment was typical. Although the findings of definitive diagnostic studies (computed tomography or angiography) are strikingly positive in advanced cases, in the earlier stages of this disorder they may be subtly abnormal. Because the mortality and morbidity rates, in some measure, depend on the stage at which the process is arrested, the real challenge lies in making a prompt diagnosis. The most favorable results are associated with early, decisive surgical treatment.
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PMID:Subdural empyema--importance of early diagnosis. 744 93


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