scholarly journals An unusual headache: CSF negative APML relapse in the brain

2020 ◽  
Vol 2020 (9) ◽  
Author(s):  
Thomas Quinn ◽  
Manish Jain ◽  
Ming-Te Lee
Keyword(s):  
Diagnostic Delay ◽  
Diagnostic Challenge ◽  
Cerebrospinal Fluid Analysis ◽  
Fluid Analysis ◽  
Diagnostic Difficulties ◽  
The Central Nervous System ◽  
High Degree ◽  
The Brain ◽  
Post Therapy

ABSTRACT Acute Promyelocytic Leukaemia (APML) is a subtype of Acute Myeloid Leukaemia (AML), responsible for around 10% of cases of the disease in adults. Extra medullary disease (EMD) occurs infrequently in APML, but where EMD does occur, the central nervous system is one of the most commonly infiltrated sites. Our case describes a man in his 40s undergoing post-therapy surveillance for APML who presented to follow-up clinic with a headache, which was ultimately found to be caused by a tumour comprised of APML cells. His case presented a diagnostic challenge due to the benign appearances of the lesion on initial computed tomography brain imaging and the non-diagnostic cerebrospinal fluid analysis. The diagnostic difficulties described in our case emphasizes that clinicians working with APML patients must approach new neurological symptoms with a high degree of suspicion to prevent diagnostic delay.

scholarly journals Importance of Follow-Up Cerebrospinal Fluid Analysis in Cryptococcal Meningoencephalitis

2014 ◽  
Vol 2014 ◽  
pp. 1-10 ◽  
Author(s):  
Thomas Skripuletz ◽  
Philipp Schwenkenbecher ◽  
Kaweh Pars ◽  
Matthias Stoll ◽  
Josef Conzen ◽  
...  
Keyword(s):  
Cell Count ◽  
Antifungal Therapy ◽  
Fatal Outcome ◽  
University Hospital ◽  
Cerebrospinal Fluid Analysis ◽  
Cryptococcal Meningoencephalitis ◽  
Fluid Analysis ◽  
Serious Infection ◽  
The Central Nervous System

Cryptococcal meningoencephalitis represents a serious infection of the central nervous system, where reliable prognostic factors during the disease course are needed. Twenty-one patients diagnosed with cryptococcal meningoencephalitis in a German university hospital from 1999 to 2013 were analysed retrospectively. CSF parameters were analysed prior to therapy and during antifungal treatment and were compared between patients who survived or deceased. Fifteen patients clinically improved after antifungal therapy, while six patients died. No differences were observed between the outcome groups for the CSF parameters cell count, lactate, total protein, and CSF-serum albumin quotients (QAlb). Follow-up examinations of serum cryptococcal antigen titer and CSF cell count have shown that these parameters cannot be used to monitor the efficacy of antifungal therapy as well. In contrast, the course of QAlb during therapy was indicative for the outcome as a possible prognostic marker. In patients with clinical improvement QAlb values were falling under therapy, while rising QAlb values were found in patients with fatal outcome indicating a continuing dysfunction of the blood-CSF barrier. In conclusion, our results indicate that, among the various CSF parameters, the course of QAlb presents a promising marker that might be used to monitor the efficacy of antifungal therapy.

Recurrent cerebrovascular accidents caused by intravascular lymphoma in a dog

2018 ◽  
Vol 6 (3) ◽  
pp. e000667
Author(s):  
Lluis Sanchez ◽  
Katrin Beckmann ◽  
Elisabet Dominguez ◽  
Stefano Di Palma ◽  
Anita Shea
Keyword(s):  
Intravascular Lymphoma ◽  
Cerebrospinal Fluid Analysis ◽  
Null Cell ◽  
Auditory Evoked Response ◽  
Fluid Analysis ◽  
The Central Nervous System ◽  
Brainstem Auditory Evoked Response ◽  
Thoracic And Abdominal ◽  
Response Testing ◽  
The Brain

An eight-year-old, neutered male labrador was presented with recent recurrent vestibular episodes. MRI was consistent with multiple lacunar ischaemic infarcts in the thalamus and medulla oblongata. The imaging diagnosis was supported by a markedly elevated D-dimer concentration. Despite a comprehensive diagnostic workup (including fine needle cytology of cutaneous and subcutaneous nodules, complete bloodwork, urinalysis, thoracic and abdominal imaging, cerebrospinal fluid analysis, serial blood pressure measurements, echocardiography, electrocardiography and brainstem auditory evoked response testing), no underlying cause was found. After a partial response to 2  mg/kg clopidogrel once a day and 1  mg/kg prednisolone once a day, the dog acutely deteriorated and repeated MRI of the brain revealed an intra-axial haemorrhagic mass. Euthanasia was elected and postmortem examination revealed the presence of an intravascular null-cell lymphoma, exclusively in the central nervous system. Intravascular lymphoma is rare, difficult to diagnose ante-mortem and reports in veterinary literature are few.

scholarly journals Primary Burkitt Lymphoma of the Fourth Ventricle in an Immunocompetent Young Patient

2014 ◽  
Vol 2014 ◽  
pp. 1-6 ◽  
Author(s):  
Abdulrahman Alabdulsalam ◽  
Syed Z. A. Zaidi ◽  
Imran Tailor ◽  
Yasser Orz ◽  
Sadeq Al-Dandan
Keyword(s):  
Burkitt Lymphoma ◽  
Cranial Nerves ◽  
High Dose ◽  
Rare Entity ◽  
Diagnostic Challenge ◽  
Dose Methotrexate ◽  
The Central Nervous System ◽  
Blue Cell ◽  
The Brain ◽  
4Th Ventricle

Primary Burkitt lymphoma of the central nervous system (CNS) is rare, with only few cases reported in the literature. An 18 year-old immunocompetent male presented with multiple cranial nerves palsies and was found to have a mass predominantly in the 4th ventricle of the brain. Tumor was surgically removed and showed morphological and immunohistochemical features consistent with Burkitt lymphoma. The patient responded very well to anthracycline based chemotherapy with high dose methotrexate (HD MTX) and intrathecal (IT) chemotherapy delivered by Ommaya reservoir. Primary Burkitt lymphoma of the CNS is a rare entity that poses differential diagnostic challenge with other small round blue cell tumors.

scholarly journals Invasive Sino-Orbital Aspergillosis in an Immunocompetent Patient

2019 ◽  
Vol 2 (4) ◽  
pp. 208-211
Author(s):  
OM Okolo ◽  
GM Bot ◽  
IK Onyedibe ◽  
DJ Shilong ◽  
DJ Alfin ◽  
...  
Keyword(s):  
Immunocompetent Patient ◽  
Intracranial Extension ◽  
Cerebrospinal Fluid Analysis ◽  
Fluid Analysis ◽  
Computer Tomography Scan ◽  
History Of ◽  
Antifungal Chemotherapy ◽  
Intracranial Aspergillosis ◽  
The Brain ◽  
Tomography Scan

Invasive aspergillosis that involves intra-orbital and intracranial extension occurs in immunodeficient and immunocompetent patients resulting in significant morbidity and mortality. We report the case of a 38year old farmer who had recurrent fronto-ethmoidal mucocoele and proptosis of the left eye. She presented with a history of hypertension and no other significant findings on examination. Computer tomography scan of the brain showed a left fronto-orbital uniform contrast-enhancing extra-axial lesion with thickened peripheral capsule and an associated left fronto-orbital skull defect. Cerebrospinal fluid analysis did not show any sign of infection. Intra-operative biopsy sample showed cheesy material which on culture grew Aspergillus species that was identified further using molecular methods. Antifungal agents were used to treat the patient. The present case strongly suggests that it is possible to control intracranial aspergillosis with a combination of surgery and antifungal chemotherapy.

scholarly journals Transcranial ultrasound pulse stimulation reduces cortical atrophy in Alzheimer's patients: a follow-up study

2020 ◽  
Author(s):  
Tudor Popescu ◽  
Cyril R Pernet ◽  
Roland Beisteiner
Keyword(s):  
Cortical Thickness ◽  
Brain Morphology ◽  
Cortical Atrophy ◽  
Transcranial Ultrasound ◽  
Therapeutic Concept ◽  
The Brain ◽  
Post Therapy ◽  
Ultrasound Pulse ◽  
Pulse Stimulation

INTRODUCTION: Ultrasound for the brain is a revolutionary therapeutic concept. The first clinical data indicate that 2-4 weeks of therapy with Transcranial Pulse Stimulation improve functional networks and cognitive performance of Alzheimer’s disease (AD) patients for up to 3 months. No data currently exist on possible benefits concerning brain morphology, concerning namely the cortical atrophy characteristic of AD. METHODS: We performed a pre-/post-therapy analysis of cortical thickness in a group of N=17 Alzheimer’s patients. RESULTS: We found a significant correlation between neuropsychological improvement and cortical thickness increase in AD-critical brain areas. DISCUSSION: AD patients who benefit from TPS appear to reduce cortical atrophy within the default mode network in particular.

scholarly journals Invasive Sino-Orbital Aspergillosis in an Immunocompetent Patient

2019 ◽  
Vol 2 (4) ◽  
pp. 208-211
Author(s):  
OM Okolo ◽  
GM Bot ◽  
IK Onyedibe ◽  
DJ Shilong ◽  
DJ Alfin ◽  
...  
Keyword(s):  
Immunocompetent Patient ◽  
Intracranial Extension ◽  
Cerebrospinal Fluid Analysis ◽  
Fluid Analysis ◽  
Computer Tomography Scan ◽  
History Of ◽  
Antifungal Chemotherapy ◽  
Intracranial Aspergillosis ◽  
The Brain ◽  
Tomography Scan

Invasive aspergillosis that involves intra-orbital and intracranial extension occurs in immunodeficient and immunocompetent patients resulting in significant morbidity and mortality. We report the case of a 38year old farmer who had recurrent fronto-ethmoidal mucocoele and proptosis of the left eye. She presented with a history of hypertension and no other significant findings on examination. Computer tomography scan of the brain showed a left fronto-orbital uniform contrast-enhancing extra-axial lesion with thickened peripheral capsule and an associated left fronto-orbital skull defect. Cerebrospinal fluid analysis did not show any sign of infection. Intra-operative biopsy sample showed cheesy material which on culture grew Aspergillus species that was identified further using molecular methods. Antifungal agents were used to treat the patient. The present case strongly suggests that it is possible to control intracranial aspergillosis with a combination of surgery and antifungal chemotherapy.

scholarly journals ENCEPHALOMYELITIS OF MICE

1940 ◽  
Vol 72 (1) ◽  
pp. 49-67 ◽  
Author(s):  
Max Theiler ◽  
Sven Gard
Keyword(s):  
Virulent Strain ◽  
Flaccid Paralysis ◽  
Intracerebral Inoculation ◽  
Cent Concentration ◽  
The Central Nervous System ◽  
The Stability ◽  
High Degree ◽  
Cardinal Symptom ◽  
The Brain ◽  
Intraperitoneal Inoculation

1. The two strains of virus named GD VII and FA, respectively, accidentally discovered during experiments with yellow fever, have been shown to be immunologically related to each other, as well as to the virus of mouse encephalomyelitis. 2. Infection of the central nervous system can be produced with both strains by intracerebral, intranasal, or intraperitoneal inoculations. The cardinal symptom produced by the GD VII strain of virus by all three methods of inoculation is a flaccid paralysis of the limbs. The symptoms produced by the FA strain are referable to lesions of the brain when infection is produced by intracerebral and intranasal inoculation. Following intraperitoneal inoculation of the FA strain of virus, however, a flaccid paralysis is usually produced. 3. By the use of graded collodion membranes the particle size of the virus of mouse encephalomyelitis has been shown to be from 9 to 13 mµ 4. The stability of the virus at different hydrogen ion concentrations has been tested. It has been found that there are two optima of stability, one at about pH 8.0 and the other at pH 3.3. 5. The virus is readily inactivated at 37°C. by 1 per cent hydrogen peroxide. 6. Of organic solvents tested, ether had no action, whereas ethyl alcohol in 20 per cent concentration almost completely inactivated the virus after 45 minutes in the cold. 7. The virus can be precipitated by means of ammonium sulfate. 8. With increasing age mice acquire a relative resistance to the virus. 9. Immunity to a subsequent intracerebral inoculation can be produced by intraperitoneal, as well as intranasal, administrations of relatively large amounts of virus. 10. Mice infected by the intracerebral inoculation of a relatively avirulent virus acquire a high degree of immunity to a subsequent inoculation of a highly virulent strain. 11. The course of infection in mice following intracerebral, intranasal, and intraperitoneal inoculation of the FA strain of virus has been studied.

Brain Biopsy in Tuberculoma: The Risks and Benefits

Neurosurgery ◽  
1991 ◽  
Vol 28 (3) ◽  
pp. 405-409 ◽  
Author(s):  
A. Bouchama ◽  
M. Zuheir Al-Kawi ◽  
I. Kanaan ◽  
R. Coates ◽  
A. Jallu ◽  
...  
Keyword(s):  
Postoperative Mortality ◽  
Brain Biopsy ◽  
Drug Compliance ◽  
Antituberculous Therapy ◽  
Additional Surgery ◽  
The Central Nervous System ◽  
Histological Confirmation ◽  
Lost To Follow Up ◽  
The Brain

Abstract In developing countries, 5 to 8% of the space-occupying lesions of the central nervous system are tuberculomas. Diagnosis can be difficult in the absence of extracranial tuberculosis; computed tomography is suggestive only. To assess the value of brain biopsies in tuberculomas, the records of 15 patients aged 6 to 80 years were reviewed. Histological confirmation was obtained in 15 patients, and acid-fast bacilli were cultured from 12 patients. Intracranial hypertension was the principal sign in 11 patients; other neurological signs were related to the location of the tuberculoma. One patient had evidence of extracranial tuberculosis. Biopsy-related complications consisted of an epidural hematoma in 1 patient and hydrocephalus in another; both required additional surgery. One case of tuberculous meningitis was probably related to surgery and poor drug compliance. There was no postoperative mortality. Thirteen patients (2 were lost to follow-up) were cured after an average of 16 months of antituberculous therapy. It was concluded that the brain biopsy is useful in diagnosing tuberculoma but that there is some associated risk.

scholarly journals An update on meningoencephalomyelitis of unknown aetiology in dogs

2017 ◽  
Vol 64 (2) ◽  
pp. 131
Author(s):  
M. CHARALAMBOUS (Μ. ΧΑΡΑΛΑΜΠΟΥΣ) ◽  
T. DANOURDIS (Τ. ΔΑΝΟΥΡΔΗΣ) ◽  
A. HATZIS (Α. ΧΑΤΖΗΣ) ◽  
Z. S. POLIZOPOULOU (Ζ. ΠΟΛΥΖΟΠΟΥΛΟΥ)
Keyword(s):  
Computed Tomography ◽  
Central Nervous System ◽  
Cerebrospinal Fluid ◽  
Nervous System ◽  
Inflammatory Diseases ◽  
Histopathological Examination ◽  
Unknown Aetiology ◽  
Cerebrospinal Fluid Analysis ◽  
Fluid Analysis ◽  
The Central Nervous System

Inflammatory diseases of the central nervous system are common causes of neurological dysfunction in the dog and can be grouped into two broad categories; those of infectious and those of unknown aetiology. Μeningoencephalomyelitis of unknown aetiology include non-infectious inflammatory central nervous system diseases in which abnormal findings on magnetic resonance imaging and cerebrospinal fluid analysis indicate inflammatory central nervous system disease, but for which histopathological confirmation has not been reached. Meningoencephalomyelitis of unknown aetiology describes a group of non-infectious inflammatory diseases of the central nervous system. These include the granulomatous meningoencephalomyelitis and the necrotising encephalitis, the latter can be further distinguished into two subtypes: necrotising meningoencephalitis and necrotising leucoencephalitis. Steroid-responsive meningitis-arteritis may be also included to this category and, usually, does not present signs of encephalitis or/and myelitis (except in the chronic form) and is easier diagnosed even without histopathological examination. In most cases of meningoencephalomyelitis of unknown aetiology, a presumptive diagnosis can be achieved by the assessment of case presentation, theneurologic signs, cerebrospinal fluid testing, cross-sectional imaging of the central nervous system and appropriate microbiological tests.Definite diagnosis is achieved with histopathological examination. The underlying cause for these diseases is unknown. The clinical signs in meningoencephalomyelitis of unknown aetiology is variable and depends on which area of the central nervous sytem is affected. Meningoencephalomyelitis is acute in onset, progressive in nature and associated with multifocal to diffuse neuroanatomic localization. Extraneural signs are less common and these usually include pyrexia and peripheral neutrophilia. The differential diagnosis for dogs presented for an acute onset of multifocal central nervous system signs includes genetic abnormalities, metabolic disorders, infectious meningoencephalitis, toxin exposure, stroke and neoplasia.The diagnostic approach includes a complete blood count, a comprehensive chemistry panel, urinalysis, survey radiographs of the thorax plus abdominal ultrasound to rule out systematic disease and metastatic neoplasia, computed-tomography or magnetic reso meningitisnance imaging, cerebrospinal fluid analysis and microbiological tests.When neoplasia is suspected, computed-tomography-guided brain biopsy may be required for the differentiation. Meningoencephalomyelitis of unknown aetiology responds more or less to immunosuppressive therapies, but the prognosis should be guarded to poor with the exception of steroid-responsive meningitisarteritis, for which it is good. Treatment protocols are based on prednisolone, but new immunosuppressive agents have now been added in those to control the diseases and they seem to be effective. However, gold standard protocols have yet to be established.

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