Central Nervous System Infections as a Cause of an Altered Mental Status? What is the Pathogen Growing in Your Central Nervous System?

IntroductionCervical cancer (CC) is the most common malignancy throughout developing countries, although considered rare, central nervous system metastasis (CNSm) does occur.ObjectiveThis study aimed to describe our experiences and compare them to other published cases.Materials and MethodsFrom May 2009 to August 2015, the files of all patients with CC treated at our referral center were reviewed.ResultsWe found 27 patients with CC and CNSm. Mean age at the time of CNS diagnosis was 50 ± 11 years, mean interval between initial CC and CNSm was 46 months; the most frequent initial International Federation of Gynecology and Obstetrics stage was IIB with 17 patients followed by IB in 4. Fifty-nine percent of patients had lung metastases at the time CNSm were diagnosed. Headache was the most common symptom, followed by weakness, altered mental status, and ataxia/cerebellar. Mean survival was 8.2 months after CNSm was discovered; 3 patients are still alive.ConclusionsThe present study describes the largest series of patients with CNSm from CC; this rare complication should be suspected in patients with CC who present with headache, ataxia, cranial nerve palsy, visual disturbance, altered mental status, focal weakness, or other neurological symptom, without other plausible explanation.

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Clinical and Laboratory Findings That Differentiate Herpes Simplex Virus Central Nervous System Disease from Enteroviral Meningitis

Canadian Journal of Infectious Diseases and Medical Microbiology ◽

10.1155/2016/3463909 ◽

2016 ◽

Vol 2016 ◽

pp. 1-8 ◽

Cited By ~ 3

Author(s):

Layli Sanaee ◽

Monica Taljaard ◽

Tim Karnauchow ◽

Jeffrey J. Perry

Keyword(s):

Central Nervous System ◽

Cerebrospinal Fluid ◽

Nervous System ◽

Herpes Simplex Virus ◽

Herpes Simplex ◽

Mental Status ◽

Altered Mental Status ◽

Neurological Deficits ◽

Simplex Virus ◽

Csf Findings

Background. It can be difficult for clinicians to distinguish between the relatively benign enteroviral (EnV) meningitis and potentially lethal herpes simplex virus (HSV) central nervous system (CNS) disease. Very limited evidence currently exists to guide them.Objective. This study sought to identify clinical features and cerebrospinal fluid (CSF) findings associated with HSV CNS disease.Methods. Given that PCR testing often is not immediately available, this chart review study sought to identify clinical and cerebrospinal fluid (CSF) findings associated with HSV meningitis over a 6-year period. In cases where PCR was not performed, HSV and EnV were assigned based on clinical criteria.Results. We enrolled 166 consecutive patients: 40 HSV and 126 EnV patients. HSV patients had a mean 40.4 versus 31.3 years for EnV,p=0.005, seizures 21.1% versus 1.6% for EnV,p<0.001, altered mental status 46.2% versus 3.2% for EnV,p<0.001, or neurological deficits 44.7% versus 3.9% for EnV,p<0.001. CSF neutrophils were lower in HSV (median 3.0% versus 9.5%,p=0.0002); median lymphocytes (87.0% versus 67.0%,p=0.0004) and protein (0.9 g/L versus 0.6 g/L,p=0.0005) were elevated.Conclusion. Our study found that HSV patients were older and more likely to have seizure, altered mental status, or neurological deficits than patients with benign EnV meningitis. HSV cases had lower CSF neutrophils, higher lymphocytes, and higher protein levels.

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Delirium Associated with Salicylate and Acetaminophen Overdose in a Patient with COVID-19: A Case Report

Clinical Practice and Cases in Emergency Medicine ◽

10.5811/cpcem.2020.8.48559 ◽

2020 ◽

Vol 4 (4) ◽

pp. 517-520

Author(s):

Tyler Wen ◽

Jason Chu ◽

Danielle Allenspach ◽

David Van

Keyword(s):

Emergency Department ◽

Central Nervous System ◽

Nervous System ◽

Case Report ◽

Mental Status ◽

Clinical Manifestations ◽

Altered Mental Status ◽

Psychosocial Stressors ◽

Acetaminophen Overdose ◽

Wide Range

Introduction: The coronavirus disease 2019 (COVID-19) pandemic has created numerous clinical challenges for physicians, in part due to its wide range of clinical manifestations and associated complications. Case Report: Here we present the case of a 69-year-old man who was admitted to the emergency department with fever, dyspnea, and altered mental status. We believe the patient’s condition was precipitated by a COVID-19 infection-induced delirium, a setting in which he ingested aspirin and acetaminophen in overdose that required lifesaving interventions. Conclusion: This case illustrates the potential for neuropsychiatric effects in COVID-19 patients due to both direct viral central nervous system pathology and pandemic-related psychosocial stressors.

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Listeria Monocytogenes Brain Abscess in Crohn’s Disease Treated with Adalimumab

Case Reports in Gastroenterology ◽

10.1159/000481165 ◽

2017 ◽

Vol 11 (3) ◽

pp. 675-679 ◽

Cited By ~ 3

Author(s):

Amporn Atsawarungruangkit ◽

Fernando Dominguez ◽

Gustavo Borda ◽

Nikolaos Mavrogiorgos

Keyword(s):

Central Nervous System ◽

Nervous System ◽

Crohn’S Disease ◽

Listeria Monocytogenes ◽

Crohn's Disease ◽

Brain Abscess ◽

Mental Status ◽

Altered Mental Status ◽

Tnf Alpha ◽

Gram Positive

Listeria monocytogenes is a gram-positive bacterium that causes listeriosis. Brain abscess is a very uncommon manifestation of listeriosis and has not been reported to be associated with adalimumab (humira), one of the approved medications for treating Crohn’s disease. A 45-year-old female with Crohn’s disease presented with sudden onset of fever, headache, nausea, vomiting, and altered mental status for 1 day. She was on prednisone and 6-mercaptopurine. She had started taking adalimumab 17 days prior to admission. She had signs of toxicity, confusion, and nuchal rigidity, but showed neither central nervous system deficits nor focal deficits. The laboratory results revealed Gram-positive coccobacillus, positive blood and cerebrospinal fluid culture for Listeria monocytogenes, and a 5 × 5 mm ring-enhancing lesion of brain abscess on MRI. After holding off 6-mercaptopurine and adalimumab, her mental status improved on the next day. Finally, she was discharged on day 7 of hospitalization with ampicillin 2 g intravenously every 4 h for a total of 2 weeks. Two weeks later, the follow-up MRI showed a 2-mm area of residual enhancement in the left temporal lobe at the site of the previous brain abscess. Adalimumab, as a tumor necrosis factor (TNF)-alpha inhibitor, carries a risk of triggering opportunistic infection, such as listeriosis. With an altered mental status or neurological signs in patients receiving TNF-alpha antagonizing agent, physicians should suspect bacterial infection in the central nervous system and promptly initiate treatment for brain abscess if needed.

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Poisoning due to ingestion of amatoxin-containing mushrooms in South Korea: a systematic review and meta-analysis

10.22514/sv.2021.089 ◽

2021 ◽

Keyword(s):

Systematic Review ◽

Central Nervous System ◽

Nervous System ◽

South Korea ◽

Mental Status ◽

Meta Analysis ◽

Case Series ◽

Altered Mental Status ◽

Watery Diarrhea ◽

Mushroom Poisoning

Objective: Poisoning caused by the ingestion of amatoxin-containing mushrooms is life-threatening and requires urgent attention. However, only few studies have evaluated the factors that predict mortality owing to mushroom poisoning. We conducted a systematic review of amatoxin poisoning in South Korea and meta-analysis of the association between severe early-stage central nervous system symptoms and mortality in cases of amatoxin poisoning. Methods: The Embase, MEDLINE, Web of Science, KMbase, and Korean Studies Information System databases were searched for articles up to July 2020. We included case reports, case series, and observational studies on Amanita poisoning in South Korea. Outbreak area, incubation time, clinical course, management, and outcomes were evaluated. We then conducted a meta-analysis of the association between severe central nervous system symptoms and mortality. Results: Sixteen articles were included in the review and five in the meta-analysis. Outbreaks occurred principally in Gyeongbuk and in the western part of Gangwon. All patients had gastrointestinal symptoms, such as watery diarrhea. Liver failure occurred 2-3 days after mushroom intake in most patients, and ingestion of amatoxins from mushroom consumption was associated with high mortality risk. The risk of mortality among patients with altered mental status or seizures was 10 times higher than that among patients without these symptoms (risk ratio = 10.56, 95% confidence interval = 2.73-40.83). Conclusions: Amanita mushrooms are often mistaken for edible mushrooms, and their ingestion is frequently fatal. Aggressive treatment must be pursued in patients with severe central nervous system symptoms, such as altered mental status or seizures.

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Isolated neurological symptoms in a teenager with COVID-19

Journal of Clinical Images and Medical Case Reports ◽

10.52768/2766-7820/1131 ◽

2021 ◽

Vol 2 (3) ◽

Author(s):

Pezad N Doctor ◽

◽

Sowkya Rangarajan ◽

Jocelyn Ang ◽

◽

...

Keyword(s):

Central Nervous System ◽

Nervous System ◽

Severe Acute Respiratory Syndrome ◽

Children And Adolescents ◽

Mental Status ◽

Respiratory System ◽

Altered Mental Status ◽

Neurological Symptoms ◽

Neurological Manifestations ◽

Inflammatory Syndrome

Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV2) predominantly affects the respiratory system. However, COVID-19 associated Multisystem Inflammatory Syndrome in Children (MIS-C) is a state of hyper inflammatory shock affecting the cardiovascular, gastrointestinal, hematologic and central nervous system. Isolated neurological manifestations have rarely been reported, especially in children and adolescents. We describe a 17-year-old boy presenting with intermittent headaches, altered mental status and right sided weakness, was found to be positive for SARS-COV2 from nasopharyngeal sampling. His neurological symptoms lasted for three weeks and subsequently improved spontaneously. Keywords: SARS-CoV2; Encephalitis; Headaches.

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