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

Subdural empyema, a collection of pus in the space between the dura and arachnoid, is a rare type of intracranial infection. We report on 23 patients, aged 8 months to 70 years, with subdural empyema who were treated in our clinic between 1989 and 1994. The sources of subdural empyemas were meningitis in five patients, middle ear in five, trauma in four, paranasal sinus in three, complications of surgery and subdural tap in four, and unknown in two patients. The common presentations were headache, focal neurologic deficit, fever, vomiting, seizures, and neck stiffness. Diagnosis was achieved by computerized tomography and neurologic examinations in all cases. Treatment was effected by burr hole or small craniotomy with catheter drainage, and antibiotics were administered to all patients. The mortality rate was 8.7%; the remaining patients made a good recovery without sequelae. We therefore recommend burr hole with catheter drainage plus antibiotics as a method of treating subdural empyema.
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PMID:Treatment of subdural empyema by burr hole. 875 81

Clinical diagnosis of subarachnoid hemorrhage (SAH) is frequently misdiagnosed with intracerebral hemorrhage (ICH) or cerebral infarction (CI), which delays appropriate referral. This study was undertaken to create a clinical index to select, among stroke patients, those with the highest probability of having a SAH. Clinical data of patients with acute stroke were evaluated with the X2 and the Fisher exact test; a p value < 0.05 was considered significant. Significant variables were included in a "log-lineal regression analysis" where those with an odds ratio (OR) 95% confidence limits not including the unit were considered to construct an index using the odds ratio coefficient (C). The results indicated that of 197 records which were included, 22 cases of SAH and 175 of ICH or CI were demonstrated. Kappa coefficients for observer variation in clinical data retrieval was 0.91. After "log-lineal regression analysis" was carried out the following variables were significant: neck stiffness (C = 3, OR = 21); lack of focal neurologic signs (C = 2, OR = 6.88); and age < or = 60 years (C = 1.5, OR = 4.35). A fourth variable, seizures (C = 1, OR = 3.25), was marginally significant (p = 0.07), but added predictive value to the index. The positive predictive values of the sum of the coefficients were: 0 = 0%; 1-2 = 3%; 2.5-3.5 = 21%; 4-5 = 40%; 6.5 = 75%; 7.5 = 100%. In conclusion, when a stroke patient shows neck stiffness, or any combination of young age, lack of focal neurologic signs or seizures (a score > or = 2.5, the index has a 91% sensitivity and 82% specificity), he/she must be referred to a tertiary care center.
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PMID:Predictive value of signs and symptoms in the diagnosis of subarachnoid hemorrhage among stroke patients. 885 95

Chart review of 41 adult patients with group A streptococcal (GAS) meningitis in The Netherlands revealed that this is a community-acquired disease and occurs mainly in patients with predisposing factors: of the 41 patients in this case series, 24 (60%) of 40 evaluable patients had otitis or sinusitis. Fever and neck stiffness were the most common clinical manifestations of disease, but, in addition, high rates of seizures (12 [32%] of 38 patients), focal neurological findings (13 [36%] of 36 patients), and hyponatremia (20 [58%] of 35 patients) were found. In contrast with data from the literature that describes 27 adult cases, we found that GAS meningitis is a fulminant disease with a mortality rate of 27% (10 of 37 patients), and that neurological sequelae occur in 36% (12 of 38) of surviving patients.
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PMID:Group a streptococcal meningitis in adults: report of 41 cases and a review of the literature. 1194 69

During the summer of 2000, 35 patients with West Nile Virus Fever were admitted to our hospital. Of these, the 26 (21 adults, mean age 56 (19-86) and 5 children (aged 9-15)) presented have neurological involvement, 33% with meningitis, 52% with meningoencephalitis, 10% with encephalitis and 5% with acute polyneuropathy. Presenting clinical features were fever in 95% of cases, headache in 90%, nausea/vomiting in 52%, confusion in 48%, somnolence in 38%, neck stiffness in 33%, a skin rash in 19%, diarrhea in 14%, cervical pain in 14%, seizure in 9%, photophobia in 9% and limb weakness in 4%. Leucopenia was not found. Two patients diagnosed with meningoencephalitis died. Three patients had signs of an acute polyneuropathy, this being the only complaint of one patient. The EEG was abnormal in all cases of meningitis or meningoencephalitis, except in three cases. Outbreaks of West Nile Virus Fever are emerging as a worldwide disease with high rates of neurological involvement and death. It should be considered in cases presenting with aseptic meningoencephalitis, meningitis and acute polyneuropathy, especially during the summer months and in areas along bird migration pathways.
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PMID:Neurological features of West Nile virus infection during the 2000 outbreak in a regional hospital in Israel. 1212 78

A 14 year old male developed a subdural empyema with a leptomeningeal infection of sinogenic origin. Initially, there were none of the expected neurological symptoms such as worsening headaches, vomiting, alteration in the level of consciousness and neck stiffness. Later, focal neurological deficits and seizures occurred. An endonasal sinus drainage was performed simultaneously with a neurosurgical exploration. We started an antibiotic therapy. All neurological deficits disappeared rapidly.
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PMID:[An endocranial complication of sinogenic origin without initial classical neurological symptoms]. 1530 55

A patient is suspected of suffering from a potentially life threatening headache according to the following typical warning signs: sudden onset headache, worst headache, neurological findings, fever, neck stiffness, epileptic seizures and deterioration of vigilance. It is far more dangerous not to recognize potentially life threatening headaches like subarachnoid bleeding, meningitis, encephalitis, arterial dissection or epidural hematoma than to over diagnose it. Immediate and specific neurological and radiological investigations (CT, MRI, CSF) are necessary in each patient presenting with those findings. The morbidity and mortality of those patients mainly depend on the beginning of the therapy. This article focuses on the diagnosis of potentially life threatening headache disorders.
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PMID:[Symptomatic headache. Essential differential diagnosis]. 1531 63

We investigated clinical features of juvenile patients presenting non-herpetic viral acute encephalitis (4 men and 7 women, aged of onset; 23.7 +/- 3.3 years) without malignancy and immunodeficiency. We divided the patients into two groups according to initial neurological symptoms: psychiatric symptoms mimicking schizophrenia (group P, n=5), seizure (group S, n=6), and compared clinical manifestations among the two groups. Symptoms frequently seen in initial phase of the illness were neck stiffness (4 cases, 36%), involuntary movement (7 cases, 64%) and convulsion (8 cases, 73%). There were no significant difference among the groups except seizure. Patients in group P had more CSF cells and CSF lymphocytes compared with other groups (p < 0.05 and p < 0.01, respectively). Abnormal intensities in T2-weighted magnetic resonance images were found in 4 cases (36%). The term from the onset to leaving hospital of group P (213 +/- 227 days) was longer than that of group S (98 +/- 85 days), although it did not reach a significant difference. These findings indicate that juvenile acute non-herpetic encephalitis initially presenting psychiatric symptoms was serious and had relatively poor prognosis.
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PMID:[Acute non-herpetic viral encephalitis of juvenile onset: analysis of 11 cases based on initial clinical symptoms]. 1609 21

This study investigated the clinical manifestations and outcomes of central nervous system (CNS) infection by enteroviruses. Cases with CNS involvement among all enterovirus-culture-positive cases from January 1995 to June 2003 were retrospectively reviewed. Among 1028 enterovirus-culture-positive cases, there were 333 cases involving the CNS. Of these, the ratio of male to female subjects was 1.78, and the mean (+/- standard deviation) age was 6.83 +/- 5.9 years; 21 were premature neonates, and 10 failed to thrive. Disease entities included 282 cases of aseptic meningitis (84.7%), 44 cases of encephalitis (13.2%), and 7 cases of encephalomyelitis/polio-like syndrome (2.1%). Of these cases, 97.9% (326/333) had fever with peak body temperature at 38.9 degrees C, 85% had headache and vomiting, 70% had meningeal signs, 64% had neck stiffness, 16.6% (55/333) had change of consciousness, 5.4% (18/333) had seizures and 5.2% (17/333) had myoclonic jerks. Mannitol was administered in 77.2% of patients (257/333), along with intravenous immunoglobulin in 6.6% (22/333). Twelve cases received ventilator support. One patient died of hand-foot-and-mouth disease, encephalitis plus cardiopulmonary failure, and 2 premature neonates died of hepatic failure, disseminated intravascular coagulation, sepsis-like syndrome and myocarditis. Eighteen had neurologic sequelae, including 7 with limb weakness, 5 with epilepsy, 2 with sixth cranial nerve palsy, 3 with cerebral palsy, 4 with psychomotor retardation, 2 with spasticity, and 1 with hearing loss. Factors associated with unfavorable outcomes (death or sequelae) included younger age (p=0.0003), higher peak white blood cell count (WBC) [p=0.0009] and skin rash (p=0.005). Younger age and higher peak WBC were poor prognostic factors of severe enterovirus CNS infection. Death was related to neonatal enterovirus infection and enterovirus 71 infection in young children.
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PMID:Clinical features and factors of unfavorable outcomes for non-polio enterovirus infection of the central nervous system in northern Taiwan, 1994-2003. 1634 42

Cerebral venous thrombosis is a relatively uncommon condition afflicting mostly young adults. Thrombosis of cerebral veins or sinuses results in variable and nonspecific clinical features, including headache, lethargy, motor or sensory deficits, seizures, neck stiffness and sometimes fever. A multitude of conditions have been attributed as risk factors for CVT. The more common conditions include hereditary thrombophilia, pregnancy and purperium, postoperative state, intracranial and local infections and the use of oral contraceptives. Frequently, the cause of CVT is multifactorial, and in less than twenty percent of cases no clear risk factor is identified. In this review, we have focused on relatively rare and unusual causes of cerebral venous thrombosis. Many of the conditions described have very few reported cases and the causal relationship is not well established.
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PMID:Unusual causes of cerebral venous thrombosis. 1718 76

After implementation of programmes for active immunization against Haemophilus influenzae b, Streptococcus pneumoniae and Neisseria meningitidis became the most common agents of bacterial meningitis in childhood. Over a 9-year period, children showing clinical and laboratory findings of meningitis on the basis of their positive cultures of blood or cerebro-spinal fluid (CSF) for S. pneumoniae were enrolled. Predisposing conditions, clinical and laboratory findings, and microbiological and imaging studies were considered. Meningitis-related death or neurological sequelae defined an unfavourable outcome. Sixty-four patients met the inclusion criteria. Thirty-one (48%) children had predisposing conditions to pneumococcal meningitis. Fever and neck stiffness were the main symptoms; 14 patients (22%) reported seizures before admission. Twenty-one patients required treatment in the intensive care unit (ICU). Streptococcus pneumoniae strains were penicillin susceptible in 54 cases (84%). Forty-eight children (75%) showed complete recovery. Two patients (3%) died, and 14 (22%) had sequelae. Patients with a low CSF cell count, low neutrophils, early admission to ICU or infection by penicillin-nonsusceptible strains of S. pneumoniae had an unfavourable outcome more frequently. Low blood neutrophils, low CSF cell count, early admission to ICU and infection by penicillin-nonsusceptible strains are the main factors predicting an unfavourable outcome in children with pneumococcal meningitis.
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PMID:Pneumococcal meningitis in childhood: a longitudinal prospective study. 1787 32


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