Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0042963 (vomiting)
 31,883 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

(1) If left untreated, lymphomatous meningitis leads to gradual neurological deterioration and death within a median of 4 to 6 weeks. Palliative care is usually based on a combination of radiotherapy and intravenous and intrathecal cytarabine and/or methotrexate, postponing death by a few weeks. (2) European approval has been granted for liposomal cytarabine for this indication. (3) An unblinded trial involving 33 patients compared liposomal cytarabine with standard cytarabine. There was no difference between the groups with respect to survival time (between 2 and 3 months), time to neurological deterioration (about two months), general health status, mental health, or quality of life despite the greater frequency of eradication of malignant cells in the cerebrospinal fluid. (4) Patients receiving liposomal cytarabine were more likely to experience headache (27% versus 2% with standard cytarabine), nausea (9% versus 2%), vomiting (8% versus 4%), arachnoiditis (reversible with steroid therapy) (4% versus 0%), and confusion (7% versus 0%). (5) Only 4 injections of liposomal cytarabine are needed during the first two months of treatment, compared with 12 injections of standard cytarabine. (6) In practice, the longer dosing interval with liposomal cytarabine is not associated with a gain in efficacy or quality of life, mainly because adverse effects are more common than with standard cytarabine.
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PMID:Liposomal cytarabine: new drug. Lymphomatous meningitis: no better than standard cytarabine. 1654 98

For more than 20 years intrathecal opioid application with implantable pumps is an option for selected patients with malignant as well as non-malignant pain. In general, most types of pain should be treatable by opioid medication. However, the associated systemic side-effects such as nausea, vomiting, constipation or the risk of suppression of the central nervous system hinder the application of oral or intravenous opioid therapy as a sole, widely applicable treatment. Causes of non-malignant pain that may represent an indication for intrathecal drug-delivery systems include: failed back syndrome, neuropathic pain, axial spinal pain, complex regional pain syndrome, diffuse pain, brachial plexitis, central pain, failed spinal cord stimulation (SCS) therapy, arachnoiditis, poststroke pain, spinal cord injury pain and peripheral neuropathy. Due to the proximity to the receptor sites, the therapeutic effect of intrathecal drug application lasts longer and the rate of systemic side effects is reduced. Before definitive pump implantation, the therapeutic effect of intrathecal opioid therapy is tested with an external pump. If there is no clear and satisfactory effect in this trial application, pump implantation is not indicated. In our patients, with a follow-up exceeding 3 years, the reduction of non-malignant pain (assessed with the Visual Analogue Scale, VAS) was good or excellent (pain decrease >50%) in 71.3% of the patients, fair (VAS 5-6) in 19.8% and poor (VAS 7-10) in 8.9%. After 3 years of continuous treatment, we observed catheter-related technical problems (catheter dislocation, obstruction, kinking, disconnection or rupture) in 17 of 165 patients. Pump malfunctions were very rare (8 of 165 cases) and limited to older pump types. Reversible, specific drug-related side effects of long-term therapy with intrathecal pumps developed in 32 of the 165 patients. In our series, the mean serum/cerebrospinal fluid (CSF) concentration ratio for morphine was 1/3000, which explains the low rate of systemic side effects. Local diffusion difficulties in CSF cause an uneven distribution of morphine in CSF. Therefore the clinical effect is markedly influenced by the position of the catheter tip, a fact that should be kept in mind during catheter implantation. Intrathecal drug application is cost effective and can significantly improve the quality of life in selected patients. An intensive training in this method and awareness of its specific complications is necessary for everyone to participate in the consulting and implanting team. Pumps for chronic intrathecal opioid application should only be implanted in specialized centers.
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PMID:Intrathecal opioids for intractable pain syndromes. 1769 55

An anterior sacral meningocele, a rare congenital anomaly, manifested in a previously healthy 44-year-old woman with findings of meningitis, including headache, vomiting, unconsciousness, and fever. Nontraumatic pneumocephalus, tetraventricular hydrocephalus, fluid-fluid level at the lateral ventricles, and pial enhancement were observed on multidetector computed tomography. A ventricular drainage catheter was placed to decompress the hydrocephalus, and drainage was performed urgently. Escherichia coli was isolated from the drainage material. Whole-spine magnetic resonance imaging and fistulography were undertaken on the third day after admission to evaluate for anal and urinary incontinence and pareses of both upper and lower extremities. Spinal arachnoiditis, tethered cord, dysgenesis of the sacrum, and a rectothecal fistula were demonstrated. Specific antibiotic treatment and surgery for fistula tract excision were performed.
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PMID:Unusual presentation of an anterior sacral meningocele: magnetic resonance imaging, multidetector computed tomography, and fistulography findings of bacterial meningitis secondary to a rectothecal fistula. 2188 98

Diffuse spinal arachnoiditis in neurobrucellosis is a rare manifestation. We report a boy aged 17, presenting with hearing impairment and recurrent vomiting for 18 months, weight loss for 12 months, dysphagia, dysarthria, hypophonia for 6 months, and gait unsteadiness for 5 months. He had bilateral 5th (motor) to 12th cranial nerve palsy, wasting and weakness of limbs, fasciculations, absent tendon reflexes, and positive Babinski's sign. Cerebrospinal fluid (CSF) showed raised protein and pleocytosis. Magnetic resonance imaging (MRI) showed extensive enhancing exudates in cisterns and post-contrast enhancement of bilateral 5th, 6th, 7th, and 8th nerves. Spine showed clumping with contrast enhancement of the cauda equina roots and encasement of the cord with exudates. Serum and CSF were positive for anti-Brucella antibodies. He showed significant improvement with antibiotics. At 4 months follow-up, MRI demonstrated near complete resolution of cranial and spinal arachnoiditis. It is important to recognize such rare atypical presentations of neurobrucellosis.
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PMID:Case Report: Neurobrucellosis with Plastered Spinal Arachnoiditis: A Magnetic Resonance Imaging-Based Report. 2934 23

Neurotuberculosis is a potentially fatal disease which requires prompt diagnosis and immediate multidrug antitubercular treatment as per international guidelines. There is evidence that the bacterial spread can continue even during therapy at least in its initial stages. We monitored our patient not only with chest X-rays but with brain MRI during the first 6 weeks. To our surprise on serial MRI, during treatment, we found several new localization of the disease in a pauci-symptomatic patient. These included vessel wall inflammation (vasculitis), arachnoiditis and hypophysitis. At 4 weeks of treatment, the patient complained of dizziness and vomiting which were first dismissed as treatment side-effects but MRI revealed multiple cortical venous hemorrhagic infarcts. We report this case to emphasize the importance of neuroimaging even in case of the most subtle symptoms and that disease can continue to progress in the initial phase of treatment which may require additional therapeutic intervention.
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PMID:Multifaceted progressive neurotuberculosis in a single patient: from miliary tuberculomas to cortical venous infarct. 3113 Nov 15

Tuberculosis (TB) is the most prevalent infectious disease in the world. In recent years there has been a significant increase in the incidence of TB due to the emergence of multidrug resistant strains of Mycobacterium tuberculosis (M. tuberculosis) and the increased numbers of highly susceptible immuno-compromised individuals. Central nervous system TB, includes TB meningitis (TBM-the most common presentation), intracranial tuberculomas, and spinal tuberculous arachnoiditis. Individuals with TBM have an initial phase of malaise, headache, fever, or personality change, followed by protracted headache, stroke, meningismus, vomiting, confusion, and focal neurologic findings in two to three weeks. If untreated, mental status deteriorates into stupor or coma. Delay in the treatment of TBM results in, either death or substantial neurological morbidity. This review provides latest developments in the biomedical research on TB meningitis mainly in the areas of host immune responses, pathogenesis, diagnosis, and treatment of this disease.
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PMID:Analysis of Tuberculosis Meningitis Pathogenesis, Diagnosis, and Treatment. 3293 8


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