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Query: UMLS:C0042963 (vomiting)
 31,883 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Eosinophilic meningitis (EOM) associated angiostrongyliasis mostly induced by the nematode Angiostrongylus cantonensis, is a common disease with worldwide prevalence. Heavy infections can lead to chronic disabling disease and even death. This study was conducted to shed light on the overall specific IgG antibody response as well as the specific IgG antibody subclass responses in cerebrospinal fluid (CSF) of patients with EOM. Fifteen patients with EOM associated with angiostrongyliasis were included in the study. Sera were screened by immunoblotting for the presence of IgG antibody to the 29 kDaA. cantonensis antigenic polypeptide. CSF was examined by ELISA for the presence of specific IgG and IgG subclass antibodies. Patients presented with headache (100%), neck stiffness (20%), fever (40%), nausea (87%), vomiting (73%), paresthesia (7%), and muscle weakness (7%). Seven of 15 (47%) patients showed peripheral blood eosinophilia and all patients presented with eosinophils in CSF. A sensitivity of 80 % was obtained by combining the diagnostic values of immunoblotting in sera and IgG and IgG subclasses-based ELISA in CSF. The combination of a history of eating raw or semi-cooked infected foods, clinical features, complete blood count, differential cell counts, CSF profiles, and serum and CSF antibodies to A. cantonensis can be used to increase the sensitivity for the diagnosis of human angiostrongyliasis.
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PMID:Eosinophilic meningitis associated with angiostrongyliasis: clinical features, laboratory investigations and specific diagnostic IgG and IgG subclass antibodies in cerebrospinal fluid. 1753 42

Battered child syndrome can refer to children exposed to harmful, non-accidental and preventable physical treatment by those are responsible for their care which prevents the child's physical, cognitive and spiritual development. A 28 months old boy was submitted to hospital due to abdominal blunt trauma. He had been firstly applied to Isparta Children Hospital by his parents with the complaint of fever. In the first examination, he was conscious, his general condition was poor there was respiratory acidosis, and neck stiffness was present. There were several fresh traumatic lesions on his face and left arm. His complaints were thought due to meningitis and antibiotics were started. He was transported to Suleyman Demirel University Hospital after a day because of vomiting, abdominal pain, tender, distended and silent abdomen, and air-fluid levels in direct abdominal X-rays. An old fracture of the right 9th rib was detected with chest X-ray in university hospital. Additionally, abdominal ultrasound scan showed distended bowel loops filled with fluid. Laparotomy revealed a complete rupture of the junction of the third and fourth parts of the duodenum and several hemorrhagic regions on bowel loops. The patient was discharged after 42 days. This case report described the case through both medical and legal processed in Turkey.
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PMID:A battered child case with duodenal perforation. 1842 61

Primary amoebic meningoencephalitis (PAM) due to Naegleria fowleri was detected in a 36-year-old, Indian countryman who had a history of taking bath in the village pond. He was admitted in a semi comatosed condition with severe frontal headache, neck stiffness, intermittent fever, nausea, vomiting, left hemiparesis and seizures. Computerized tomography (CT) scan of brain showed a soft tissue non-enhancing mass with erosion of sphenoid sinus. However CSF findings showed no fungal or bacterial pathogen. Trophozoites of Naegleria fowleri were detected in the direct microscopic examination of CSF and these were grown in culture on non-nutrient agar. The patient was put on amphotericin-B, rifampicin and ceftazidime but his condition deteriorated and was taken home by his relatives in a moribund condition against medical advice and subsequently died. A literature review of 7 previous reports of PAM in India is also presented. Four of theses eight cases were non lethal. The mean age was 13.06 years with male: female ratio of 7:1. History of contact with water was present in four cases. Trophozoites could be identified in all 8 cases in this series.
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PMID:Primary amoebic meningoencephalitis due to Naegleria fowleri. 1882 27

Spontaneous intracranial hypotension (SIH) is an infrequent clinical entity characterized by cerebrospinal fluid (CSF) hypovolemia due to a CSF leak. The cause of the leak in SIH, however, is largely unknown, though structural meningeal weakness and mechanical stress factors have been postulated. Patients with SIH typically present with postural headaches, and occasionally with other symptomology as well, such as nausea, emesis, neck stiffness, and photophobia. In this case series, we present 4 patients who underwent radionuclide cisternography (RNC) for suspected CSF leak. All patients underwent RNC and MR and/or CT for evaluation. We found that RNC accurately detected and localized a CSF abnormality in all 4 patients, with each patient experiencing symptomatic relief following directed epidural blood patch.
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PMID:Radionuclide cisternography in detecting cerebrospinal fluid leak in spontaneous intracranial hypotension: a series of four case reports. 1954 42

Clinical diagnosis of acute bacterial meningitis may be delayed, either because off lack of sensitivity of clinical signs, or because of a poor vital prognosis; but over diagnosing is also frequent, leading to useless, expensive, and potentially dangerous hospitalizations. We conducted a comprehensive review of English and French literature from 1997 to 2007 by searching MEDLINE to review the accuracy of clinical examination for the diagnosis of meningitis. Additional references were identified by reviewing reference lists of articles back to 1993. We used the keywords "meningitis", "meningitis and clinical features", "cerebrospinal fluid (CSF) pleocytosis", "headache and fever", "Kernig sign", "Brudzinski sign", and "neck stiffness". We excluded nosocomial meningitis. Sensitivity for clinical signs such as headache, vomiting, or fever was low, generally less than 30%, neck stiffness could reach 45%, but the absence of two signs among fever, headache, neck stiffness, and altered mental status eliminated meningitis with a negative predictive value of 95%. Given the seriousness of bacterial meningitis, clinicians perform lumbar puncture (or brain imaging) too often, especially in high-risk patients. Further prospective clinical research is needed to improve the accuracy of bacterial meningitis clinical diagnosis.
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PMID:[Sensitivity and specificity of clinical signs in adults]. 1963 74

Migraine attacks are characterized by unilateral throbbing, pulsating headache associated with nausea, vomiting, photophobia, phonophobia and allodynia. Peripheral sensitization is an acute, chemical-induced form of functional plasticity, which converts high-threshold nociceptors into low-threshold sensory neurons. This form of sensitization occurs when the nerve terminals (meningeal nociceptors) of the neurons of the trigeminal ganglion are soaked with the "inflammatory" soup (prostaglandin E2, bradykinin, serotonin and cytokines) along the vasculature of the cerebral dura mater. Peripheral sensitization in migraine attacks is explained clinically by intracranial hypersensitivity (the headache worsens during coughing or physical activity) and by a throbbing element in the pain of migraine (sensitized nociceptors become hyperresponsive to the otherwise innocuous and unperceived rhythmic fluctuation in intracranial pressure produced by normal arterial pulsation). The essence of central sensitization is that the second-order neurons in the trigeminocervical complex become hyperexcitable. The altered behavior of the second-order neurons is based on the increased glutamate sensistivity of the NMDA receptors and the neuronal nitric oxide synthase activity stimulated by nitric oxide. This process is explained clinically by face and scalp ollodynia and by neck stiffness (extracranial tenderness).
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PMID:[The mechanism of peripheral and central sensitization in migraine. A literature review]. 1973 14

We report a previously healthy 14-month-old boy who developed community-acquired Acinetobacter baumannii meningitis. He had no history of immunodeficiency, and was brought to Konan Kosei Hospital with a high fever and vomiting. His consciousness was clear, but neck stiffness was noted. Examination of the cerebrospinal fluid (CSF) revealed a cell count of 10 112/microl; protein, 216 mg/dl; and glucose, 9 mg/dl. A CSF test kit for bacterial capsular antigens (Pastorex Meningitis; Bio-Rad Laboratories) was positive for Haemophilus influenzae type b antigen. On day 3 of admission, the microorganism isolated by CSF culture was identified as A. baumannii. Therefore, his treatment was changed to meropenem hydrate from the initial therapy with panipenem/betamipron and ceftriaxone sodium hydrate. Because the CSF cell count remained elevated, meropenem hydrate was administered for a total of 19 days. The meningitis resolved with no sequelae.
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PMID:Community-acquired Acinetobacter baumannii meningitis in a previously healthy 14-month-old boy. 1985 71

Since the introduction of magnetic resonance imaging (MRI), spontaneous intracranial hypotension has been diagnosed much more frequently. The aim of this review is to discuss the symptoms and signs of the condition, in particular the characteristics of the associated headache, with sudden onset after sitting or standing, so that it can be included under the rubric of 'thunderclap headache'. This type of headache, like post lumbar puncture headaches, may be caused by cerebral vasodilatation and exacerbated by lowered pressure of the cerebrospinal fluid (CSF). Other symptoms include neck stiffness, nausea, vomiting, vertigo, tinnitus, deafness, and cognitive abnormalities. The clinical picture can sometimes mimic frontotemporal dementia, and the behaviour of some patients can sometimes be described as hypoactive-hypoalert, with somnolence, impaired attention, and stereotyped motor activity. Sagging of the brain, caused by leakeage of the CSF, can cause lesions in the brainstem with stupor, gaze palsies, and cranial nerve palsies. The condition can be a risk factor for cerebral venous thrombosis because of slowing of the blood flow and distortion of the blood vessels. The clinical picture may well suggest the diagnosis, but the headache may possibly indicate a subarachnoid haemorrhage. However, MRI will help to confirm the diagnosis and to localize the site of the CSF leak. MRI myelograms are of particular value, but if they are equivocal a computed tomography myelogram should be performed. The leakage of CSF is due to a tear in the dura, most frequently where the spinal roots leave the subarachnoid space. If this does not heal with bedrest, an epidural blood patch or a percutaneous injection of fibrin glue may be needed. More information is required on long-term follow-up.
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PMID:Spontaneous intracranial hypotension. 1990 7

A previously fit and well 18-year-old woman presented to the accident and emergency department following referral by her general practitioner with a provisional diagnosis of appendicitis. The history obtained from the patient revealed the presence of a bitemporal headache with associated neck stiffness, photophobia and vomiting for approximately 1.5 weeks. The patient complained of abdominal pain localised to her right iliac fossa and anorexia for approximately 1 week. She also noted the presence of a cough productive of green sputum for 3 weeks. A chest radiograph was obtained which showed a large area of consolidation in the right lower lobe consistent with infection and a linear density in keeping with a metallic foreign body. Following review of the chest radiograph, the patient was interviewed further and recalled having inhaled a pushpin approximately 1 year before her presentation. Aspiration of foreign bodies is relatively common in children and is often associated with delayed diagnosis and high morbidity. To prevent delayed diagnosis, characteristic symptoms and clinical and radiological signs of foreign body aspiration should be checked in all suspected cases and a low index of suspicion for ordering additional imaging or using bronchoscopy for diagnostic purposes should be employed.
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PMID:Delayed presentation following accidental inhalation of a pushpin. 2002 18

Secondary headaches are rare though potentially severe. A systematic search of red flags helps to suspect headaches of secondary origin that require further urgent investigation. Main red flags are: sudden onset, exceptionally severe headache, new headache in patient over 50, vomiting or syncope, focal neurological sign or neck stiffness, recent trauma, uncommon headache during pregnancy or anticoagulant therapy, suspicion of glaucoma.
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PMID:[When should a patient with headaches be referred to the emergency ward?]. 2087 30


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