Extremely Elevated Cerebrospinal Fluid Protein and Glucose Level in a Neonate with Hypernatremic Dehydration

2020 ◽  
Author(s):  
Arti Maria ◽  
Tapas Bandyopadhyay
Keyword(s):  
Cerebrospinal Fluid ◽  
Neurodevelopmental Outcome ◽  
Neurological Sequelae ◽  
Glucose Levels ◽  
Csf Analysis ◽  
First Case ◽  
Time Of Admission ◽  
Cerebrospinal Fluid Protein ◽  
Hypernatremic Dehydration

AbstractWe describe the case of a term newborn who presented with hypernatremic dehydration on day 19 of life. The baby was otherwise hemodynamically stable with no evidence of focal or asymmetric neurological signs. The laboratory tests at the time of admission were negative except for hypernatremia and the extremely elevated levels of cerebrospinal fluid (CSF) protein (717 mg/dL) and glucose levels (97 mg/dL). The hypernatremic dehydration was corrected as per the unit protocol over 48 hours. Repeat CSF analysis done after 5 days showed normalization of the protein and glucose levels. Serial follow-up and neuroimaging showed no evidence of neurological sequelae. Unique feature of our case is this is the first case reporting such an extreme elevation of CSF protein and glucose levels that have had no bearing on neurodevelopmental outcome at 1 month and 3 months of follow-up.

scholarly journals Uncommon complications of ventriculoperitoneal shunt surgery: review of four cases and literature review

2020 ◽  
Vol 35 (1) ◽  
Author(s):  
Aliyu Muhammad Koko ◽  
Nasiru Jinjiri Ismail ◽  
Ali Lasseini ◽  
Sahabi M. Saddiku
Keyword(s):  
Cerebrospinal Fluid ◽  
Ventriculoperitoneal Shunt ◽  
Abdominal Wound ◽  
Distal Catheter ◽  
Excellent Outcome ◽  
Post Surgery ◽  
First Case ◽  
Ventriculoperitoneal Shunting ◽  
Shunt Procedure

Abstract Background Ventriculoperitoneal shunt is one of the most popular cerebrospinal fluid diversion procedures worldwide. Complications are common, but uncommon complications are rarely reported in the literature making a standardized guideline on management of unusual complications unavailable. We report this series of uncommon complications managed in our centre to share our experience and contribute to the pool of literature on the management of these weird complications of ventriculoperitoneal shunting. Case presentation The first case was a 10-year-old girl who presented with headache, early morning vomiting and itching over the tract of the shunt in the neck. She has had ventriculoperitoneal shunt and excision and repair of encephalocele at the age of 3 months in our facility. On physical examination, she was conscious with a Glasgow coma score of 15, and shunt valve was hardened. She had removal of the shunt with intraoperative finding of calcified shunt tubing and the valve, and also cerebrospinal fluid was under high pressure that warranted re-insertion of another medium pressure shunt. She remained stable at last follow-up 3 months post-surgery. We managed two cases of shunt extrusion via the anus (a 1-year-old female infant and 9-year-old boy). None of the patients presented with evidence of peritonitis or shunt tract infection. The extruded shunts were removed under aseptic technique, and both patients had ventriculoperitoneal shunt re-inserted because of progression of hydrocephalus. They remained stable at last follow-up visits 6 months after surgery. The fourth case was a 9-month-old infant that presented with shunt extrusion via the abdominal wound site 3 weeks after ventriculoperitoneal shunt procedure. The child developed an abscess at the abdominal wound that ruptures spontaneously with extrusion of distal catheter, had no features of peritonitis and had shunt removed and re-inserted after 3 months. The child has remained stable. Conclusion Although ventriculoperitoneal shunt calcification and extrusion are rare, they do occur. None of our patients had peritonitis. Shunt removal and subsequent reinsertion in the presence of raised intracranial pressure from hydrocephalus confirms an excellent outcome.

scholarly journals SHUNT MALFUNCTION IN TUBERCULOUS MENINGITIS- WHETHER GRADE AND CSF PICTURE AFFECT OUTCOME

2020 ◽  
pp. 137-140
Author(s):  
Shivender Sobti ◽  
Sachin Singh ◽  
Amit Kumar Singh ◽  
Laxmi Narayan Gupta ◽  
Suryanarayanan Bhaskar ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Cell Count ◽  
Tuberculous Meningitis ◽  
Shunt Malfunction ◽  
Shunt Surgery ◽  
Grade Ii ◽  
Time Of Admission ◽  
Ventriculo Peritoneal Shunt ◽  
Grade Iii

BACKGROUND Tuberculosis remains a major global problem and a public health issue of considerable magnitude. The World Health Organisation (WHO) estimates that one third of the world’s population is infected with mycobacterium tuberculosis, with the highest prevalence of tuberculosis in Asia. Shunt surgery for hydrocephalus associated with tuberculous meningitis has proven to be highly efficacious. Few studies have addressed the issue of outcome of shunt surgery and impact of CSF (Cerebrospinal fluid) picture in post tuberculous meningitis hydrocephalus shunt surgery. MATERIAL AND METHODS The study was a prospective study conducted in Department of Neurosurgery, PGIMER, Dr. RML Hospital, New Delhi. The duration of follow up was of 6 months. 70 patients were enrolled in the study. All patients who underwent ventriculo-peritoneal shunt surgery for hydrocephalus with tuberculous meningitis in Neurosurgery department at PGIMER & Dr.RML hospital were included in the study. All the patients who had hydrocephalus following tuberculous meningitis were evaluated using Modified Vellore grading of TBM and hydrocephalus. All the patients who underwent ventriculo-peritoneal shunt surgery had have their CSF analysis (cytology, protein, sugar, Gram stain, ZN stain, India ink and aerobic culture) done. Outcome of the surgery were evaluated based on Glasgow outcome score (GOS), radiological parameters and complications. Statistical analysis was performed by the SPSS program for Windows, version 17.0. RESULTS The age of patients enrolled into the study varied from 2 months to 87 years with 44.3% of patients in 1-5 years age group. Patients were divided into 4 grades according to Modified Vellore Grading. Grades at the time of admission were compared with the final Glasgow outcome scale. At the time of admission 6 patients were in Grade I, 13 patients in Grade II, 45 patients in Grade III and 6 patients in Grade IV. GOS was 5 in Grade I, 4.69 +/- in Grade II, 4.50 +/- IN Grade III and 2.17+/- in Grade IV. Outcome was compared according to Cerebrospinal fluid (CSF) cell count, sugar and protein levels but none was found to be significant. Number of shunt revisions were compared to CSF cell count and sugar level but none was found to be significant. Mean FH/ID ratio before surgery was 60.89% which was reduced to 43.70% after 6 months follow up. CONCLUSION Ventriculo-peritoneal shunt surgery is a safe and effective treatment modality to treat tuberculous meningitis with hydrocephalus in all grades of patients except in Grade IV. CSF protein, sugar levels and cell count neither affect the outcome nor increase the risk of shunt malfunction

Cerebrospinal fluid protein findings during prophylaxis and treatment of neuromeningosis in leukaemic patients

1987 ◽  
Vol 47 (8) ◽  
pp. 765-769
Author(s):  
R. Marra ◽  
L. Pagano ◽  
S. Storti ◽  
A. Massaro ◽  
L. Teofili ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Cerebrospinal Fluid Protein

When fever is more than infection: two cases of vancomycin-induced drug reaction with eosinophilia and systemic symptoms (DRESS)

2021 ◽  
Vol 14 (1) ◽  
pp. e238006
Author(s):  
Mitchell Cox ◽  
Sophie Paviour ◽  
Sophie Gregory ◽  
Rusheng Chew
Keyword(s):  
Drug Reaction ◽  
Cytomegalovirus Reactivation ◽  
First Case ◽  
Metropolitan Hospital ◽  
Orthopaedic Ward ◽  
Systemic Hypersensitivity ◽  
Systemic Symptoms ◽  
Inflammatory Syndrome ◽  
Intravenous Glucocorticoids

Drug reaction with eosinophilia and systemic symptoms (DRESS) is a rare, but serious systemic hypersensitivity reaction associated with a range of medications. We present two cases of vancomycin-induced DRESS, which occurred simultaneously in the orthopaedic ward in an outer metropolitan hospital. These cases demonstrate the complexity in the diagnosis and management of this inflammatory syndrome on the background of known infection as well as evidence for linezolid as an alternative to vancomycin. The first case was managed conservatively, but developed progressive renal and liver injury along with demonstrated cytomegalovirus reactivation and recurrent colitis, and was eventually palliated. The second was commenced on intravenous glucocorticoids and achieved remission, although had ongoing renal dysfunction at the time of discharge from outpatient follow-up.

Complete resolution of acute pancreatitis-induced chylous ascites following transhepatic portal vein stenting

2020 ◽  
Vol 13 (12) ◽  
pp. e235986
Author(s):  
Alexander Tindale ◽  
James Jackson ◽  
Darina Kohoutova ◽  
Panagiotis Vlavianos
Keyword(s):  
Portal Vein ◽  
Complete Resolution ◽  
Chylous Ascites ◽  
Biliary Pancreatitis ◽  
Acute Biliary Pancreatitis ◽  
Portal Vein Stenosis ◽  
First Case ◽  
Vein Stenosis ◽  
Inflammatory Changes

We introduce a case of a 73-year-old man who developed intractable chylous ascites due to portal vein compression as a result of peripancreatic inflammatory changes after acute biliary pancreatitis. After stenting the portal vein stenosis, the chylous ascites improved from requiring weekly paracentesis to requiring no drainage within 4 months of the procedure and at the 15-month follow-up. To our knowledge, it is the first case reported in the literature where portal vein stenting has successfully been used to treat pancreatitis-induced chylous ascites.

Penile Lymphoepithelioma-Like Carcinoma: A Rare Case With PD-L1 Expression

2021 ◽  
pp. 106689692098834
Author(s):  
Raquel Machado-Neves ◽  
Bernardo Teixeira ◽  
Elsa Fonseca ◽  
Pedro Valente ◽  
Joaquim Lindoro ◽  
...  
Keyword(s):  
Human Papillomavirus ◽  
Tumor Cells ◽  
Rare Case ◽  
Malignant Tumors ◽  
Squamous Cell Carcinomas ◽  
The Third ◽  
The Past ◽  
First Case ◽  
Lymphoplasmacytic Infiltrate

Most malignant tumors of the penis are squamous cell carcinomas (SCC), being divided in 2 groups, one human papillomavirus (HPV)-related and another non-HPV-related, with lymphoepithelioma-like carcinoma (LELC) being one of the rarest HPV-related SCC. In this article, we report a case of a 50-year-old man who presented testicular swelling and pain for the past 3 months. A penile mass was identified, and the patient was submitted to a total penectomy. The penectomy specimen showed an ulcerated lesion at the glans reaching the cavernous bodies. Microscopic examination showed undifferentiated epithelial cells with syncytial growth pattern mix with a dense lymphoplasmacytic infiltrate, consistent with LELC. The tumor cells expressed p16 and all 3 different clones of PDL1 (22C3, SP263, and SP142). The patient is alive and well with a follow-up of 3 months. To our knowledge, this is the third LELC of the penis reported in literature and the first case reported with PDL1 expression.

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