Optic neuritis caused by the re-emerging great masquerader

A 49-year-old Caucasian woman presented with subacute headache and right eye pain associated with scotoma, blurred vision and photophobia. MRI was suggestive of optic neuritis of the right optic nerve and she was treated with steroids. Due to persistent symptoms, a lumbar puncture was performed and cerebrospinal fluid analysis was positive for venereal disease research laboratory and rapid plasma reagin titres. On further history, she recalled experiencing an illness associated with diffuse rash, likely secondary syphilis, 1–2 months prior. She tested negative for HIV. She was treated with intravenous penicillin for 2 weeks following which she experienced improvement in symptoms.

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Psychosis or Simply a New Manifestation of Neurosyphilis?

Journal of International Medical Research ◽

10.1177/147323000603400314 ◽

2006 ◽

Vol 34 (3) ◽

pp. 335-337 ◽

Cited By ~ 6

Author(s):

E Kararizou ◽

C Mitsonis ◽

N Dimopoulos ◽

K Gkiatas ◽

I Markou ◽

...

Keyword(s):

Cerebrospinal Fluid ◽

Differential Diagnosis ◽

Venereal Disease ◽

Penicillin G ◽

Rapid Plasma Reagin ◽

Cerebrospinal Fluid Analysis ◽

Disease Research ◽

Fluid Analysis ◽

Antibody Absorption ◽

Persistent Headache

The widespread use of antibiotics in recent years has caused a significant reduction in the incidence of neurosyphilis and changes in its clinical features. We present a case that initially presented as persistent headache and untreatable psychosis. Neurosyphilis was diagnosed during the clinical evaluation. Blood serum analyses for syphilis were positive for rapid plasma reagin titres, the Venereal Disease Research Laboratories test and fluorescent treponemal antibody absorption. A lumbar puncture was performed and cerebrospinal fluid analysis resulted in the diagnosis of neurosyphilis. The patient completed a 2-week course of treatment with aqueous crystalline penicillin G and his symptoms subsequently improved. We suggest that neurosyphilis should always be included in the differential diagnosis of untreatable psychosis.

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Haemiballism/haemichorea: an atypical presentation of ischaemic stroke

BMJ Case Reports ◽

10.1136/bcr-2020-240439 ◽

2021 ◽

Vol 14 (6) ◽

pp. e240439

Author(s):

Raman Nohria ◽

Stacey Bennett ◽

Yasmin Ali O'Keefe

Keyword(s):

Brain Mri ◽

Acute Onset ◽

Cerebral Peduncle ◽

Atypical Presentation ◽

Cerebrospinal Fluid Analysis ◽

Medication Therapy ◽

Fluid Analysis ◽

Ct Head ◽

The Right ◽

Distressing Condition

A 76-year-old man was admitted to the hospital with acute onset of involuntary movements of the left side of his body. His neurological examination revealed he was oriented only to himself, and aforementioned movements of his left arm and leg. CT head demonstrated old infarcts in his right aspect of his pons and basal ganglia. Cerebrospinal fluid analysis was unremarkable. He initially had a normal blood glucose with an elevated anion gap and elevated creatine kinase. Brain MRI showed a small lacunar-type ischaemic infarct within the anteromedial aspect of the right cerebral peduncle, which localised to his haemiballism. To prevent worsening rhabdomyolysis associated with his haemiballism, the primary team initiated both tetrabenazine and diazepam. His movements improved after 1 week of medication therapy. This report discusses a thorough workup for this movement disorder and when to intervene for this distressing condition.

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A case of late-onset sporadic hemiplegic migraine

Journal of International Medical Research ◽

10.1177/0300060519873468 ◽

2019 ◽

Vol 47 (10) ◽

pp. 5278-5280

Author(s):

Xiu-Yan Yang ◽

Hua-Ping Du ◽

Yuan Xu

Keyword(s):

Migraine Headache ◽

Late Onset ◽

Hemiplegic Migraine ◽

Rare Form ◽

Cerebrospinal Fluid Analysis ◽

Blurred Vision ◽

Motor Weakness ◽

Recurrent Headache ◽

Fluid Analysis ◽

Inflammatory Drugs

Sporadic hemiplegic migraine is a rare form of migraine headache with aura. We herein report a case of visual impairment, dizziness, and motor weakness in a patient who had experienced recurrent headache attacks with aura including flickering spots and blurred vision for 20 years, Electroencephalography, cerebrospinal fluid analysis, and brain imaging findings were normal. The patient gradually recovered after treatment with nonsteroidal anti-inflammatory drugs and flunarizine.

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Isolated third cranial nerve palsy as the first presentation of multiple myeloma

BMJ Case Reports ◽

10.1136/bcr-2020-239917 ◽

2021 ◽

Vol 14 (3) ◽

pp. e239917

Author(s):

Tejasvini Vaid ◽

Rishi Dhawan ◽

Mukul Aggarwal ◽

Seema Tyagi

Keyword(s):

Multiple Myeloma ◽

Cranial Nerve ◽

Cranial Nerve Palsy ◽

Nerve Palsy ◽

Cns Involvement ◽

Cerebrospinal Fluid Analysis ◽

Fluid Analysis ◽

Third Cranial Nerve Palsy ◽

The Right ◽

Rare Diagnosis

A 50-year-old woman presented with a right-sided isolated third cranial nerve palsy. MRI brain showed a mass lesion arising from the right clivus with extension into the cavernous sinus. Blood investigations and bone marrow biopsy were suggestive of multiple myeloma with hypercalcaemia and renal dysfunction. It was unclear at first if the intracranial lesion was due to myelomatous involvement or a separate disease entirely. The patient declined consent for a biopsy and cerebrospinal fluid analysis was inconclusive. She was treated with bortezomib based chemotherapy and the palsy resolved by day 6, which helped clinch the rare diagnosis of central nervous system (CNS) involvement by multiple myeloma. Most patients with CNS myeloma have a dismal survival of under 6 months but she is on therapy for relapse 26 months after diagnosis. While placed under the umbrella of CNS myeloma, patients with osteodural myeloma have better outcomes, perhaps due to their distinct aetiopathogenesis.

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Bilateral Optic Neuritis Associated with the Use of Infliximab

Case Reports in Ophthalmological Medicine ◽

10.1155/2011/232986 ◽

2011 ◽

Vol 2011 ◽

pp. 1-2 ◽

Cited By ~ 2

Author(s):

Jan O. Aasly

Keyword(s):

Optic Neuritis ◽

Inflammatory Diseases ◽

Visual Fields ◽

Tnf Alpha ◽

First Year ◽

Blurred Vision ◽

Tnf Antagonists ◽

History Of ◽

The Right ◽

Necrosis Factor

A 40 year old man was admitted with a 2 weeks history of headache, blurred vision and bilateral optic neuritis. During the 6 months period prior to admission he had treated with infliximab infusions for prsoriasis arthritis. He had 0.2 vision in right eye and 0.5 in left Fundoscopy showed moderate disc swelling more on the right than on the left side and right-sided splinter heamorrhages at the disc margin. The intracranial pressure was normal. He was treated with oral methylprednisolone, 100 mg daily for 1 week. His vision improved gradually and when seen 10 weeks later his visual acuity was 1.0 in both eyes and he had normal visual fields. Optic neuritis is a rare but well recognized serious adverse effect of treatments with tumor necrosis factor (TNF) antagonists. This case report illustrates a rare but typical side effect of a TNF alpha inhibitors used for treating a number of inflammatory diseases. These reactions usually appear during first year of treatments and never after the first one or two infusions. Both genders and all ages are affected. In some patients the visual defects are irreversible.

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Punctate Inner Choroidopathy

Case Reports in Ophthalmological Medicine ◽

10.1155/2015/371817 ◽

2015 ◽

Vol 2015 ◽

pp. 1-4

Author(s):

Mariana Sá-Cardoso ◽

Arnaldo Dias-Santos ◽

Natália Nogueira ◽

Heloísa Nascimento ◽

Rubens Belfort-Mattos

Keyword(s):

Pigment Epithelium ◽

Retinal Pigment ◽

Systemic Disease ◽

Posterior Pole ◽

Caucasian Woman ◽

Blurred Vision ◽

Imaging Evaluation ◽

Punctate Inner Choroidopathy ◽

Clinically Significant ◽

The Right

Purpose. To report a case of bilateral punctate inner choroidopathy (PIC).Case Report. A 26-year-old Caucasian woman presented with bilateral blurred vision with one year of evolution. There was no relevant systemic disease or family history. Best-corrected visual acuity in the right eye was 20/30 and in the left eye was 20/20; there was no clinically significant refractive error. Fundoscopy evidenced multiple, small, round, yellow-white lesions limited to the posterior pole of both eyes, with greater macular involvement in the RE. There were no signs of inflammation in the anterior chamber or vitreous cavity. Fluorescein angiography revealed the presence of multiple hyperfluorescent lesions more evident in the later stages of the angiogram in both eyes. On indocyanine green angiography, these lesions appeared hypofluorescent in both early and late phases. Optical coherence tomography showed the presence of focal elevations of the retinal pigment epithelium with underlying hyporeflective space, bilaterally. Laboratory and imaging evaluation for evidence of autoimmune and infectious diseases were negative.Conclusion. The PIC is a relatively uncommon condition. In this report, an attempt has been made to describe a classic clinic presentation of this disease in a young and female patient.

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Late neurosyphilis and VZV meningoencephalitis coinfection

BMJ Case Reports ◽

10.1136/bcr-2020-240412 ◽

2021 ◽

Vol 14 (6) ◽

pp. e240412

Author(s):

Kristin Carr ◽

Onyema Ogbuagu

Keyword(s):

Cerebrovascular Accident ◽

Venereal Disease ◽

Venereal Disease Research Laboratory ◽

Central Nervous System Infections ◽

Cerebrospinal Fluid Analysis ◽

Varicella Zoster ◽

Mri Brain ◽

Disease Research ◽

Fluid Analysis ◽

Neurological Infections

The incidence of syphilis has increasing recently, largely attributable to improved screening that may result in the diagnosis of chronic untreated infections. These patients can develop severe or subtle neurologic symptoms that can be missed and, therefore, detected accidentally while a patient is evaluated for other mimicking neurological infections. A 58-year-old man with diabetes presented with 2 days of aphasia, headache, chills and confusion. He had an MRI brain with evidence of a prior cerebrovascular accident. Subsequently, he developed a fever and thoracic dermatomal rash consistent with herpes zoster. A lumbar puncture was performed, and cerebrospinal fluid analysis revealed a lymphocytic pleocytosis, a reactive Venereal Disease Research Laboratory test and positive varicella-zoster virus (VZV) PCR. He was suspected to have both late neurosyphilis and acute meningoencephalitis from VZV. This paper will discuss how to approach the diagnosis of late neurosyphilis and possible associations with herpesvirus central nervous system infections.

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IBUPROFEN-INDUCED ASEPTIC MENINGITIS: A CASE REPORT

Revista Paulista de Pediatria ◽

10.1590/1984-0462/;2019;37;3;00016 ◽

2019 ◽

Vol 37 (3) ◽

pp. 382-385 ◽

Cited By ~ 3

Author(s):

Sofia Alexandra Pereira Pires ◽

Ana Pereira Lemos ◽

Ester Preciosa Maio Nunes Pereira ◽

Paulo Alexandre da Silva Vilar Maia ◽

João Patrício de Sousa e Alvim Bismarck do Agro

Keyword(s):

Aseptic Meningitis ◽

Early Recognition ◽

Conjunctival Hyperemia ◽

Cerebrospinal Fluid Analysis ◽

Drug Induced ◽

Blurred Vision ◽

Neck Stiffness ◽

Fluid Analysis ◽

Causative Agents ◽

Inflammatory Drugs

ABSTRACT Objective: To report a case of a male adolescent with the diagnosis of ibuprofen-induced meningitis. We discuss themain causes of drug-induced aseptic meningitis (DIAM) and highlight the importance of early recognition of DIAM, sothat the offending drug can be withdrawn, and recurrences prevented. Only few DIAM cases have been reported in pediatric age. Case description: A healthy 15-year-old boy presented to the emergency department with headache, nausea, dizziness, fever, conjunctival hyperemia and blurred vision 30 minutes after ibuprofen-intake. During his stay, he developed emesis and neck stiffness. Cerebrospinal ﬂuid analysis excluded infectious causes, and DIAM was considered. He totally recovered after drug withdrawal. Comments: DIAM is a rare entity, that should be considered in the differential diagnosis of an aseptic meningitis. The major causative agents are nonsteroidal anti-inflammatory drugs, particularly ibuprofen. Suspicion is made by the chronologic link between drug intake and the beginning of symptoms, but infectious causes should always be ruled out.

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Intravascular Malignant T-cell Lymphoma (Malignant Angioendotheliomatosis) in a Cat

Veterinary Pathology ◽

10.1177/030098589703400314 ◽

1997 ◽

Vol 34 (3) ◽

pp. 247-250 ◽

Cited By ~ 24

Author(s):

J.-M. Lapointe ◽

R. J. Higgins ◽

G. D. Kortz ◽

C. S. Bailey ◽

P. F. Moore

Keyword(s):

Arterial Wall ◽

Cell Lymphoma ◽

Vascular Wall ◽

Cerebrospinal Fluid Analysis ◽

Parietal Lobes ◽

Fluid Analysis ◽

History Of ◽

Complete Thrombosis ◽

The Right ◽

Wall Invasion

A 7-year-old spayed female Siamese cat was presented with a 7-day history of ataxia, circling to the right, and involuntary micturition and defecation. Cerebrospinal fluid analysis showed increased protein content and relative eosinophilia. At necropsy, there was flattening of the cerebral cortical gyri of the right frontal and parietal lobes, and both kidneys had multiple wedge-shaped cortical indentations. Histologically, the cerebral cortex contained several extensive malacic foci, and the kidneys had multifocal parenchymal degeneration and atrophy. There was multifocal partial to complete thrombosis of renal interlobar arteries and of the right middle cerebral artery and meningeal branches; these thrombi contained large anaplastic round cells, which often invaded the arterial wall. Many smaller vessels within the kidneys and brain were occluded with clusters of similar cells, without thrombosis or vascular wall invasion. The neoplastic round cells had immunohistochemical staining properties of T lymphocytes.

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Recurrence of Primary Breast Lymphoma Presenting as Bilateral Vitreoretinal Lymphoma

Ocular Oncology and Pathology ◽

10.1159/000515560 ◽

2021 ◽

pp. 1-5

Author(s):

Karishma Habbu ◽

Roshan George ◽

Miguel Materin

Keyword(s):

Brain Mri ◽

B Cell Lymphoma ◽

Intrathecal Chemotherapy ◽

Primary Breast Lymphoma ◽

Blurred Vision ◽

Breast Lymphoma ◽

Central Nervous System Penetration ◽

Vitreoretinal Lymphoma ◽

The Right ◽

Vitreous Biopsy

Purpose: This report describes a case of relapsed primary breast lymphoma (PBL) presenting as vitreoretinal lymphoma (VRL). Methods: We describe the clinical and hematopathologic findings in a patient with relapsed PBL involving the vitreous of both eyes. Results: A 59-year-old woman was treated for PBL with systemic and intrathecal chemotherapy 5 years prior to presentation. Three years later, she presented to an outside clinic with blurred vision in both eyes and bilateral vitritis. She was referred to our clinic with concern for ocular lymphoma. On presentation, the patient’s best-corrected visual acuity was 20/40 in the right eye and 20/25 in the left eye with 3+ vitreous cells in the right eye and 2+ vitreous cells in the left eye. Vitreous biopsy of the right eye revealed CD5-negative/CD10-negative B-cell lymphoma cells on flow cytometry. She had no evidence of disease on brain MRI, lumbar puncture, bone marrow biopsy, or full-body CT scans. She was treated with a regimen of rituximab, methotrexate, procarbazine, and vincristine for central nervous system penetration as well as multiple intraocular injections of methotrexate and rituximab with improvement in vision and ocular inflammation bilaterally. Conclusion: Relapsed PBL can present as bilateral VRL.

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