A Man With Recurrent Headache and Focal Neurologic Deficits

2021 ◽  
pp. 222-224
Author(s):  
Jaclyn R. Duvall ◽  
Jerry W. Swanson
Keyword(s):  
Cerebrospinal Fluid ◽  
Cerebral Angiography ◽  
Blood Cells ◽  
White Blood Cells ◽  
Severe Headache ◽  
First Episode ◽  
Benign Condition ◽  
Left Hand ◽  
Neurologic Deficits ◽  
Symptomatic Management

A 42-year-old healthy man sought care for transient episodes of neurologic deficits followed by severe headache. The first episode began with left hand weakness, numbness, and dysarthria, followed approximately 1 hour later by a right temporal headache. His symptoms spontaneously resolved after 8 hours. He had a second episode 2 days later manifested by confusion and bilateral lower extremity numbness, again followed by severe headache with symptoms resolving within 12 hours. A total of 8 episodes occurred over 3 weeks, each lasting 8 to 24 hours, with spontaneous resolution each time. His most recent episode occurred during cerebral angiography. Cerebrospinal fluid evaluation showed opening pressure, 190 mm H2O; white blood cells, 205/μ‎L, 97% lymphocytes; protein, 95 mg/dL; and glucose, 40 mg/dL. Electroencephalography demonstrated right greater than left generalized slowing, with increased-voltage rhythmic delta wave activity, in the frontal regions predominantly. Conventional cerebral angiography findings were normal, but the test appeared to provoke the patient’s previous episode. Neurologic examination was normal after his most recent episode resolved, and no further episodes were reported. This case highlights a typical presentation of transient headache and neurologic deficits with cerebrospinal fluid lymphocytosis. Because the disorder was self-limited, treatment was aimed at symptomatic management of headache. In this case patient with a secure diagnosis of headache and neurologic deficits with cerebrospinal fluid lymphocytosis and stereotypical episodes limited to 3 months after the initial presentation, additional testing was not indicated. Headache and neurologic deficits with cerebrospinal fluid lymphocytosis is a rare, self-limited, benign condition with migrainelike headache episodes accompanied by transient neurologic deficits usually lasting more than 4 hours, with some deficits lasting more than 24 hours.

HaNDL Syndrome: Case Report and Literature Review

2018 ◽  
Vol 34 (3) ◽  
pp. 161-167 ◽  
Author(s):  
Amy Armstrong-Javors ◽  
Kalpathy Krishnamoorthy
Keyword(s):  
Cerebrospinal Fluid ◽  
Literature Review ◽  
Severe Headache ◽  
Resonance Imaging ◽  
Neurologic Deficits ◽  
Elevated Protein ◽  
Episodic Nature ◽  
Magnetic Resonance Imaging Mri ◽  
Fundoscopic Examination ◽  
Pathophysiologic Mechanisms

Headache and Neurologic Deficits with cerebrospinal fluid Lymphocytosis (HaNDL) syndrome is a rare stroke mimicker characterized by moderate to severe headache temporally associated with transient neurologic deficits, typically hemiparesis, hemisensory disturbance, and/or aphasia. Cerebrospinal fluid studies reveal a lymphocytosis and elevated protein. Episodes recur over a period no longer than 3 months. Here we describe the case of a 16-year-old boy who presented with 3 episodes of self-resolving neurologic deficits, papilledema on fundoscopic examination, and leptomeningeal enhancement on magnetic resonance imaging (MRI). We additionally review the 30 previously reported pediatric cases of HaNDL syndrome, with a focus on possible etiologic and pathophysiologic mechanisms of disease. The reported case and literature review highlight the benign episodic nature of this likely underrecognized syndrome as well as the higher than expected frequency of abnormal neuroimaging findings.

Cephalosporium Meningitis

PEDIATRICS ◽  
1970 ◽  
Vol 46 (1) ◽  
pp. 161-162
Author(s):  
Walter T. Hughes
Keyword(s):  
Cerebrospinal Fluid ◽  
Newborn Infant ◽  
Blood Cells ◽  
Chemical Constituents ◽  
White Blood Cells ◽  
Patient Reported ◽  
Physical Findings

I find it necessary to comment on the paper "Cephalosporium Meningitis" (Pediatrics, 44:749, 1969) in order to emphasize a word of caution to physicians who may encounter patients under circumstances similar to those described by Drs. Papadatos, Pavlatou, and Alexiou. The patient reported was a newborn infant who on day 15 of life became irritable, listless, and refused feedings. In the absence of abnormal physical findings, the cerebrospinal fluid was examined and found to be slightly xanthochromic with 20 white blood cells per cu mm, and with normal chemical constituents.

scholarly journals Cerebrospinal Fluid Total Protein Reference Intervals Derived from 20 Years of Patient Data

2017 ◽  
Vol 63 (12) ◽  
pp. 1856-1865 ◽  
Author(s):  
Christopher R McCudden ◽  
John Brooks ◽  
Priya Figurado ◽  
Pierre R Bourque
Keyword(s):  
Cerebrospinal Fluid ◽  
Quantile Regression ◽  
Total Protein ◽  
Blood Cells ◽  
White Blood Cells ◽  
Age Groups ◽  
Reference Intervals ◽  
Patient Data ◽  
Age Dependence ◽  
Data Set

Abstract BACKGROUND Reference intervals are vital for interpretation of laboratory results. Many existing reference intervals for cerebrospinal fluid total protein (CSF-TP) are derived from old literature because of the invasive nature of sampling. The objective of this study was to determine reference intervals for CSF-TP using available patient data. METHODS Twenty years of hospital database information was mined for previously reported CSF-TP results. Associated demographic, laboratory, and clinical diagnosis (International Classification of Diseases 9/10 codes) details were extracted. CSF-TP results included 3 different analytical platforms: the Siemens Vista 1500, Beckman Lx20, and Roche Hitachi 917. From an initial data set of 19591 samples, the following exclusion criteria were applied: incomplete data, white blood cells (WBCs) >5 × 106/L, red blood cells (RBCs) >50 × 106/L, and glucose <2.5 mmol/L. Patient charts were reviewed in detail to exclude 60 different conditions for which increases in CSF-TP would be expected. A total of 6068 samples were included; 63% of the samples were from females. Continuous reference intervals were determined using quantile regression. Age- and sex-partitioned intervals were established using the quantile regression equation and splitting age-groups into 5-year bins. RESULTS CSF-TP showed a marked age dependence, and males had significantly higher CSF-TP than females across all ages. CSF-TP results from the 3 different instruments and manufacturers showed small (approximately 0.04 g/L), but statistically significant, differences. CSF-TP showed weak, but again statistically significant, correlation with WBC and RBC but was independent of serum total protein and creatinine. CONCLUSIONS The age dependence of CSF-TP supports that age-partitioned reference intervals will be more accurate than a single cutoff, particularly in patients with advancing age.

Intracranial Pressure

2019 ◽  
pp. 69-73
Author(s):  
Eelco F. M. Wijdicks ◽  
William D. Freeman
Keyword(s):  
Cerebrospinal Fluid ◽  
Smooth Muscle ◽  
Choroid Plexus ◽  
Blood Cells ◽  
White Blood Cells ◽  
Ependymal Cells ◽  
Cerebral Aqueduct ◽  
Epithelial Surface ◽  
The Brain ◽  
Route Of Delivery

Cerebrospinal fluid (CSF) fills the subarachnoid space, spinal canal, and ventricles of the brain. CSF is enclosed within the brain by the pial layer, ependymal cells lining the ventricles, and the epithelial surface of the choroid plexus, where it is largely produced. Choroid plexus is present throughout the ventricular system with the exception of the frontal and occipital horns of the lateral ventricle and the cerebral aqueduct. The vascular smooth muscle and the epithelium of the choroid plexus receive both sympathetic and parasympathetic input. In an adult, CSF is normally acellular. A normal spinal sample may contain up to 5 white blood cells (WBCs) or red blood cells (RBCs). CSF allows for a route of delivery and removal of nutrients, hormones, and transmitters for the brain.

Opposite changes in predominantly docosahexaenoic acid (DHA) in cerebrospinal fluid and red blood cells from never-medicated first-episode psychotic patients

2008 ◽  
Vol 98 (1-3) ◽  
pp. 295-301 ◽  
Author(s):  
Anvita Kale ◽  
Sadhana Joshi ◽  
Nilesh Naphade ◽  
Swati Sapkale ◽  
M.S.V.K. Raju ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Docosahexaenoic Acid ◽  
Red Blood Cells ◽  
Blood Cells ◽  
First Episode

White Blood Cells and Cerebrospinal Fluid

PEDIATRICS ◽  
1996 ◽  
Vol 97 (6) ◽  
pp. 929-929
Author(s):  
Joseph J. Scarano
Keyword(s):  
Cerebrospinal Fluid ◽  
Standard Deviation ◽  
Absolute Neutrophil Count ◽  
Neutrophil Count ◽  
Blood Cells ◽  
White Blood Cells ◽  
Csf Analysis ◽  
Upper Limit ◽  
Leukocyte Counts

I would like to thank Drs Carraccio, Blotny, and Fisher1 for their recent study on cerebrospinal fluid (CSF) analysis. However, the presented data do not define the CSF absolute neutrophil count (ANC), upper limit of ANC, and standard deviation of ANC for their patients. I would like to review this potentially valuable information. The authors referred to the study by Rodewald et al2 who found nucleated and segmented leukocyte counts to be important CSF indicators.

Cerebrospinal Fluid Shunts Interfere with Host Defenses

Neurosurgery ◽  
1982 ◽  
Vol 10 (1) ◽  
pp. 55-60 ◽  
Author(s):  
Lawrence F. Borges
Keyword(s):  
Cerebrospinal Fluid ◽  
Blood Cells ◽  
White Blood Cells ◽  
In Vitro Study ◽  
Human Neutrophils ◽  
Cerebrospinal Fluid Shunts ◽  
Host Defenses ◽  
Normal Numbers ◽  
Shunt Infections

Abstract Despite advances in neurosurgical therapeutics, cerebrospinal fluid shunt infections have continued to complicate the management of patients with shunted hydrocephalus. Although various factors have been proposed to explain the pathogenesis of these infections, they have remained poorly understood. This in vitro study determined the ability of human neutrophils and monocytes to adhere to two types of shunt catheters and to phagocytose bacteria. These white blood cells failed to adhere in normal numbers to the catheters and failed to ingest fully a bacterial innoculum on the catheters' surfaces. While in contact with the shunt apparatus, the neutrophils also exocytosed myeloperoxidase, a major component of the intracellular microbicidal system. These observations suggest that the shunt apparatus may diminish the effectiveness of the hosts' defenses at the site of implantation.

scholarly journals Higher positive identification of malignant CSF cells using the cytocentrifuge than the Suta chamber

2016 ◽  
Vol 74 (10) ◽  
pp. 816-822 ◽  
Author(s):  
Sérgio Monteiro de Almeida ◽  
Indianara Rotta ◽  
Arnaldo José de Conto ◽  
Dario Antonelli Filho ◽  
Carlos Dabdoub Roda ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Comparative Study ◽  
Retrospective Analysis ◽  
Blood Cells ◽  
Cell Concentration ◽  
White Blood Cells ◽  
Malignant Cells ◽  
Normal Range ◽  
Positive Identification ◽  
Csf Cells

ABSTRACT Objective To define how to best handle cerebrospinal fluid (CSF) specimens to obtain the highest positivity rate for the diagnosis of malignancy, comparing two different methods of cell concentration, sedimentation and cytocentrifugation. Methods A retrospective analysis of 411 CSF reports. Results This is a descriptive comparative study. The positive identification of malignant CSF cells was higher using the centrifuge than that using the Suta chamber (27.8% vs. 19.0%, respectively; p = 0.038). Centrifuge positively identified higher numbers of malignant cells in samples with a normal concentration of white blood cells (WBCs) (< 5 cells/mm3) and with more than 200 cells/mm3, although this was not statistically significant. There was no lymphocyte loss using either method. Conclusions Cytocentrifugation positively identified a greater number of malignant cells in the CSF than cytosedimentation with the Suta chamber. However, there was no difference between the methods when the WBC counts were within the normal range.

scholarly journals Acute bacterial meningitis in HIV, pacients in southern Brazil: Curitiba, Paraná, Brazil

2007 ◽  
Vol 65 (2A) ◽  
pp. 273-278 ◽  
Author(s):  
Sérgio M. de Almeida ◽  
George Savalla ◽  
Betina Mendez A. Gabardo ◽  
Clea Elisa Ribeiro ◽  
Andrea M. Rossoni ◽  
...  
Keyword(s):  
Infectious Disease ◽  
Cerebrospinal Fluid ◽  
Mortality Rate ◽  
Bacterial Meningitis ◽  
High Mortality ◽  
Blood Cells ◽  
White Blood Cells ◽  
Health Department ◽  
Acute Bacterial Meningitis ◽  
Southern Brazil

Acute communitarian bacterial meningitis and AIDS are prevalent infectious disease in Brazil. The objective of this study was to evaluate the frequency of acute communitarian bacterial meningitis in AIDS patients, the clinical and cerebrospinal fluid (CSF) characteristics. It was reviewed the Health Department data from city of Curitiba, Southern Brazil, from 1996 to 2002. During this period, 32 patients with AIDS fulfilled criteria for acute bacterial meningitis, representing 0.84% of the AIDS cases and 1.85% of the cases of bacterial meningitis. S. pneumoniae was the most frequent bacteria isolated. The number of white blood cells and the percentage of neutrophils were higher and CSF glucose was lower in the group with no HIV co-infection (p 0.12; 0.008; 0.04 respectively). Bacteria not so common causing meningitis can occur among HIV infected patients. The high mortality rate among pneumococcus meningitis patients makes pneumococcus vaccination important.

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