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Query: UMLS:C0085437 (bacterial meningitis)
 4,038 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

We present 4 cases of tuberculous meningitis with atypical clinical features and CSF findings. Two patients had initially normal CSF examination, one developed internuclear ophthalmoplegia, while the other had deterioration of consciousness. The third patient presented with paranoid psychosis, and the fourth had a picture mimicking acute bacterial meningitis and he developed right hemianopia due to a tuberculoma detected by MRI. All recovered completely with anti-tuberculous treatment.
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PMID:Unusual presentation of tuberculous meningitis. 132 91

Cortical visual impairment (CVI) following bacterial meningitis is a very uncommon complication. Two children with CVI following bacterial meningitis are reported. Bacterial agents were Haemophilus influenzae type B in one and meningococci in the other child. Both children showed only insufficient recovery from CVI, mental retardation and residual neurological symptoms. Flash visual evoked potentials (VEP) showed preserved cortical response at onset of CVI. Re-evaluations several months later showed significantly reduced amplitudes, but normal latencies for P100. Thus, flash VEP does not allow prediction of visual outcome. MRI results have not been reported before. MRI at onset of diagnosis showed occipital parenchymal irregularities with enlarged sulci and subarachnoid spaces. Follow up MRI 15 months after onset of CVI in one patient showed marked atrophy of the occipital cortex, hyperintensities of the cortical white matter and no visible optic radiation. The MRI findings indicate hypoxic-ischaemic lesions in the border zone between the distribution of the great cerebral arteries.
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PMID:Cortical visual impairment following bacterial meningitis: magnetic resonance imaging and visual evoked potentials findings in two cases. 142 3

A case of a 3-year-old boy with transethmoidal encephalocele is presented. The patient was found to have bacterial meningitis, which responded well to an intravenous antibiotics therapy. No physical anomaly was evident on examination but plain skull X-ray film showed cloudiness of the left nasal antrum. Coronal CT scan disclosed a defect in the left cribriform plate and soft tissue mass in the left nasal cavity. MRI showed an anterior basal encephalocele protruding into the nasal cavity. Hypothalamic-pituitary system and the optic nerves appeared normal in the sagittal image. CSF rhinorrhea was confirmed by RI cisternography. An operation was performed transcranially. After a left frontal craniotomy, a unilateral bony defect in the cribriform plate and protrusion of the brain was observed subfrontally. The crista galli was intact. The herniated brain substance was transected and partially removed and the bony defect plugged by temporal muscle and covered by lyofirized dura. Microscopic examination of the herniated brain mass revealed gliosis and capillary proliferation. The patient recovered well and there has been no recurrence of CSF rhinorrhea or meningitis. Basal encephalocele is a very rare congenital anomaly. It is reported to constitute 1 to 10% of all encephaloceles. Incidence is estimated as 1 in every 35,000 to 40,000 live births. The anomaly is classified into two subtypes; transethmoidal (TE) and transsphenoidal (TS).(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[A case of transethmoidal encephalocele]. 155 74

Ventriculolumbar perfusion chemotherapy with methotrexate (MTX) and cytosine arabinoside (Ara-C) was performed in six patients with meningeal dissemination of malignant disease. Ten mg of MTX and 40 mg of Ara-C were injected via Ommaya reservoir every 12 hours for 3 days. During perfusion, we observed nausea and vomiting, low grade fever, confusion, nystagmus, paresthesia or numbness of the lower extremities, and multicranial nerve impairment, which disappeared soon after perfusion chemotherapy. After treatment, one patient developed bacterial meningitis, and two developed MTX-induced interstitial pneumonitis, which was cured by steroid therapy. Signs and symptoms due to involvement of the cerebrum, cranial nerves and spinal cord or spinal roots, improved more than by standard intrathecal chemotherapy. Laboratory cerebrospinal fluid (CSF) findings, i.e., cell count and cytological appearance, also improved more than by standard intrathecal chemotherapy. EEG, CT scan and MRI data revealed a worsening of EEG findings in one patient, and a small lesion on MRI, which was not seen by CT scan, disappeared after treatment in two patients.
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PMID:[Ventriculo-lumbar perfusion chemotherapy with methotrexate and cytosine arabinoside for meningeal dissemination of malignant disease]. 205 75

A case of atypical presentation of a post-traumatic intranasal meningo-encephalocele is described in a patient with a history of recurrent bacterial meningitis occurring 5 years after closed head injury. The usefulness of the CT and MRI findings in diagnostic evaluation of this lesion is emphasized.
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PMID:Recurrent bacterial meningitis occurring five years after closed head injury and caused by an intranasal post-traumatic meningo-encephalocele. 206 33

A case of spinal ependymoma showing spinal subarachnoid hemorrhage with findings mimicking subacute meningitis is reported. A 33-year-old man was admitted to our hospital because of headache, low back pain and low grade fever on June 8, 1982. Ten years ago he had experienced an episode of abrupt onset lumbago and headache. Subarachnoid hemorrhage was suspected because of bloody cerebrospinal fluid, but cerebral angiography failed to demonstrate any abnormalities. On admission physical examination revealed nuchal rigidity, Kernig's sign and percussion tenderness on 5th lumbar spine. Lumbar puncture showed bloody cerebrospinal fluid. Cell counts were 217 per cubic millimeter (neutrophil: lymphocyte = 27.73), protein was 396 mg/dl and sugar level was 18 mg/dl. Myelography showed an intradural extramedullary tumor at the spinal level of L1-L2. Spinal MRI and CT scan also demonstrated a spinal tumor at the same level. Laminectomy and total resection of the spinal tumor were performed and a diagnosis of myxopapillary ependymoma was made histologically. He was discharged about a month later without any neurological deficits. The development of subarachnoid hemorrhage due to spinal tumor is rare. There are about 50 cases of spinal subarachnoid hemorrhage due to spinal tumor in the literature, including three cases in Japan. Two cases presenting CSF findings mimicking bacterial meningitis have been reported in the literature, but there is no report of subarachnoid hemorrhage due to spinal tumor that presents findings mimicking subacute meningitis similar to our case. From these results, it is suggested that subarachnoid hemorrhage due to spinal ependymoma may reveal various CSF findings. In cases suggesting bacterial or subacute meningitis with bloody CSF and acute onset, the possibility of spinal subarachnoid hemorrhage due to rupture of a spinal tumor, especially ependymoma, should be considered.
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PMID:[Spinal subarachnoid hemorrhage due to spinal ependymoma presenting findings mimicking subacute meningitis]. 235 Sep 33

A 66-year-old woman with a diagnosis of asymptomatic Rathke's cleft cyst had been observed for almost 2 years and was admitted to our hospital in June 1992 because of high fever and loss of consciousness. Ophthalmological examination revealed right Horner's sign and ophthalmoplegia. A tentative diagnosis of bacterial meningitis was made based on the results of a lumbar puncture. T1-weight MRI showed a marked increase in the size of the suprasellar cystic mass lesion compared to the MRI images obtained 2 years earlier. Hence, the preoperative diagnosis was pituitary abscess. Both transsphenoidal and nasal drainage of the abscess were performed. The pathological findings were consistent with a Rathke's cleft cyst and showed chronic inflammatory cells. The postoperative course was uneventful and the patients eye movements recovered completely. The possible mechanisms of abscess formation in Rathke's cleft cyst are discussed.
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PMID:[Abscess formation in a Rathke's cleft cyst]. 802 40

A case of a large empty sella was reported, which was intrasellar herniation of the third ventricle associated with a prolactinoma. The patient was a 46-year-old female admitted due to consciousness disturbance with pyrexia and vomiting. She had amenorrhea, galactorrhea and sterility in her past history. On admission, physical and neurological examinations revealed severe dehydration, systemic edema, systemic hypotension, nuchal rigidity, papilloedema and goiter. A spinal tap was performed and revealed an increase in CSF pressure. Laboratory data indicated CSF lymphocytosis, an increase in CSF protein content, high titers of serum microsome test, a low concentration of anterior pituitary hormones in serum except for PRL, and an unusually high concentration of PRL in serum and CSF (4680 and 222ng/ml, respectively). Plain films of the skull showed destructive enlargement of the sella turcica. The patient was diagnosed as having non-bacterial meningitis, chronic thyroiditis and a prolactinoma with hypopituitarism and was then admitted to our department. Except for amenorrhea she was asymptomatic under the administration of levothyroxine, hydrocortisone and bromocriptine. CT scan, MRI, pneumoencephalography and CT cisternography as further examinations disclosed the intrasellar herniation of cisterns and the third ventricle, which were surrounded by an intrasellar parenchymal layer. This layer was thought to be still viable prolactinoma tissue. We supposed the third ventricle entered the enlarged sellar cavity following the spontaneous degeneration of the large prolactinoma. Although we could find some documented reports of similar cases, the complete herniation of the third ventricle secondary to degeneration of an adenoma might be rare.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Empty sella as an intrasellar herniation of the third ventricle secondary to spontaneous degeneration of a prolactinoma]. 813 65

We performed a prospective study of neuroimaging studies and temporal lobe pathology in 13 patients with facial asymmetry and intractable partial epilepsy of temporal lobe origin. The 13 patients, derived from 50 consecutive patients with nonlesional medically refractory partial epilepsy, were deemed appropriate candidates for an anterior temporal lobectomy. The facial weakness occurred exclusively, or was most prominent, during emotional expression, ie, spontaneous smiling. The temporal lobe of seizure origin, demonstrated by ictal long-term EEG monitoring, was always contralateral to the side of weakness. All 13 patients had a history of early childhood neurologic disease, eg, complex febrile seizure or bacterial meningitis. Hippocampal formation atrophy was present in all the epileptic temporal lobes by MRI-based volume studies. Twelve of the 13 patients subsequently received an anterior temporal lobectomy, and mesial temporal sclerosis was present in all the surgically excised temporal lobes. Ten of the 12 patients have been seizure-free during short-term follow-up. Facial asymmetry may occur in patients with partial epilepsy related to remote symptomatic seizures and mesial temporal sclerosis.
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PMID:Facial asymmetry, hippocampal pathology, and remote symptomatic seizures: a temporal lobe epileptic syndrome. 846 30

Sudden, explosive headache is rather rare. Though dramatic for the patient and the physician, it does not necessarily herald an intracranial catastrophe. Benign and dangerous thunderclap headaches cannot be distinguished from the features of headache itself, but rather on the basis of the situation, the additional symptoms and the findings. This means that every sudden headache should be considered potentially dangerous and be investigated immediately. The dangerous forms comprise intermittent hydrocephalus, acute bacterial meningitis and above all vascular complications. Subarachnoid hemorrhage frequently must be ruled out by computed tomography and lumbar puncture. Intracerebral, especially cerebellar hemorrhage, as well as hypertensive crisis require immediate treatment. Fatal cerebral embolism complicating spontaneous dissection of craniocervical arteries (carotid or vertebral arteries) can be prevented by early anticoagulant therapy. To confirm diagnosis, additional investigations such as CT, lumbar puncture or cerebrovascular ultrasound, and in rare cases MRI, should be performed early as the available time for effective therapy in many situations is short. Many of the benign forms of sudden headache can be diagnosed with a focused interview (cold or drug induced and food dependent headaches, sinusitis, glaucoma). Others, such as neuralgia, cough and coital headache, can be diagnosed as benign only when additional investigations have ruled out symptomatic forms.
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PMID:[Acute headache]. 848 83


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