Haemorrhagic encephalitis in the garb of scrub typhus

2020 ◽  
Vol 13 (8) ◽  
pp. e235790
Author(s):  
Saurabh Gaba ◽  
Swati Garg ◽  
Monica Gupta ◽  
Rekha Gupta
Keyword(s):  
Scrub Typhus ◽  
Brain Mri ◽  
Midline Shift ◽  
Recovery Sequence ◽  
Cerebrospinal Fluid Analysis ◽  
Hyperintense Lesion ◽  
Fluid Analysis ◽  
Elevated Protein ◽  
Normal Glucose ◽  
The Brain

A 19-year-old girl presented with fever, headache, vomiting and drowsiness. She had grade 1 papilloedema and neck rigidity but no focal deficits or seizures. Cerebrospinal fluid analysis revealed lymphocytic pleocytosis, slightly elevated protein and normal glucose. MRI of the brain showed a hyperintense lesion in left ganglio-capsular region on the fluid attenuation inversion recovery sequence with perilesional oedema and mild midline shift. Haemorrhage was seen in the region on susceptibility weighted imaging . The patient was thoroughly investigated for known causes of meningoencephalitis, but the diagnosis of scrub typhus was delayed till the 10th day of illness. She was treated with doxycycline for 2 weeks and had marked improvement, both clinically and radiologically. Literature review has revealed that although meningoencephalitis in scrub typhus is not uncommon, such atypical lesions on brain MRI are a rarity. Serial imaging was performed to document the disease progression and resolution on treatment.

scholarly journals New-Onset Seizure With Possible Limbic Encephalitis in a Patient With COVID-19 Infection: A Case Report and Review

2021 ◽  
Vol 9 ◽  
pp. 232470962098630
Author(s):  
Riwaj Bhagat ◽  
Barbara Kwiecinska ◽  
Nolan Smith ◽  
Matthew Peters ◽  
Christopher Shafer ◽  
...  
Keyword(s):  
Brain Magnetic Resonance Imaging ◽  
Nasopharyngeal Swab ◽  
Onset Seizure ◽  
Cerebrospinal Fluid Analysis ◽  
Fluid Analysis ◽  
Global Pandemic ◽  
Elevated Protein ◽  
T2 Hyperintensity ◽  
Elevated Protein Level ◽  
New Onset

With the outbreak of COVID-19 (coronavirus disease 2019) as a global pandemic, various of its neurological manifestations have been reported. We report a case of a 54-year-old male with new-onset seizure who tested positive for severe acute respiratory syndrome coronavirus 2 from a nasopharyngeal swab sample. Investigative findings, which included contrast-enhancing right posterior temporal lobe T2-hyperintensity on brain magnetic resonance imaging, right-sided lateralized periodic discharges on the electroencephalogram, and elevated protein level on cerebrospinal fluid analysis, supported the diagnosis of possible encephalitis from COVID-19 infection. The findings in this case are placed in the context of the existing literature.

Haemiballism/haemichorea: an atypical presentation of ischaemic stroke

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.

scholarly journals Diagnosing Ring-Enhancing Lesions in the Brain of a Patient With AIDS Without Brain Biopsy: A Case of Central Nervous System Histoplasmoma

2017 ◽  
Vol 8 (2) ◽  
pp. 86-91 ◽  
Author(s):  
Rachel Beekman ◽  
Jessica M. Hu ◽  
Steven I. Aronin ◽  
Maricar F. Malinis
Keyword(s):  
Central Nervous System ◽  
Cerebrospinal Fluid ◽  
Nervous System ◽  
Histoplasma Capsulatum ◽  
Brain Mri ◽  
Central Nervous System Involvement ◽  
Brain Biopsy ◽  
Empiric Therapy ◽  
Fluid Analysis ◽  
The Brain

We report a case of a Puerto Rican male with advanced AIDS who presented with multiple falls and pancytopenia. Magnetic resonance imaging (MRI) of the brain, as initial workup, revealed 2 ring-enhancing brain lesions. Initial cerebrospinal fluid analysis revealed minimal cells, mildly elevated protein, and no organism seen on gram stain. Due to prohibitive thrombocytopenia, brain biopsy was deferred. He had neither clinical nor radiographic improvement despite empiric therapy for both toxoplasmosis and bacterial abscesses. Indicated by pancytopenia, bone marrow (BM) aspiration was performed. Culture of BM aspirate grew Histoplasma capsulatum. Urine histoplasma antigen was markedly elevated. He was treated with liposomal amphotericin B (LamB) for progressive disseminated histoplasmosis with probable central nervous system involvement. Cerebrospinal fluid histoplasma antigen obtained after 2 months of LamB was detected. After prolonged course of LamB, he took itraconazole. Brain MRI at 7-month follow-up revealed significant improvement from baseline study.

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 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 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 Neurosyphilis Presenting As Status Epilepticus, Successively Hemiparesis And Aphasia

2021 ◽  
Author(s):  
Yunwen Qi ◽  
Zongze Jiang ◽  
Xiong Zhang ◽  
Daixin Xie ◽  
Zhiyou Cai
Keyword(s):  
Status Epilepticus ◽  
Brain Mri ◽  
Case Presentation ◽  
Fluid Analysis ◽  
Penicillin Therapy ◽  
History Of ◽  
No Gold Standard ◽  
Todd’S Paresis ◽  
The Brain ◽  
Better Than

Abstract Background: Neurosyphilis can occur anytime and present with a myriad of symptoms. Lissauer form of General Paresis Insane (GPI) is rare. We can learn more about this form of GPI through this case report.Case Presentation: The patient presented as status epilepticus, successively as hemiparesis and aphasia, which may be considered as the Todd's paresis or stroke. By performing the reactive serum rapid plasma reagent test and cerebrospinal fluid analysis, as well as the brain MRI results, we made the diagnosis as Lissauer form of GPI. The patient was started on intravenous penicillin for a total of 14 days. After that, the patient appeared with marked clinical improvement. Cognitive ability was better than before. Conclusions: GPI typically has a progressive course and normally presents 10 to 30 years after the initial infection. The manifestations of this patient and his suspicious history of Transient Ischemic Attacks (TIA) may mislead to the diagnosis of Todd's paresis or stroke. The prevalence of syphilis is rising again in recent years. To date, there is no gold standard for the diagnosis of neurosyphilis. Early diagnosis is of great importance as effective penicillin therapy is available.

scholarly journals Special aspects of the course and diagnosis of neurosyphilis on the example of a clinical case

2021 ◽  
Keyword(s):  
Cerebrospinal Fluid ◽  
Clinical Case ◽  
Structural Changes ◽  
Treponema Pallidum ◽  
State Institution ◽  
Neurological Status ◽  
Diagnostic Methods ◽  
Cerebrospinal Fluid Analysis ◽  
Fluid Analysis ◽  
The Brain

Neurosyphilis is an infectious disease caused by Treponema pallidum and characterized by damage of the central nervous system. This disease may be asymptomatic or have an atypical clinical course, which leads to late diagnosis. The most informative diagnostic methods for this disease are specific serological reactions to syphilis, MRI of the brain and cerebrospinal fluid analysis. Aim. To show the features of the course, treatment and diagnosis of neurosyphilis using the example of a clinical case. Materials and methods. Patient S., born in 1963, complained about significant memory impairment, difficulties with orientation in time and space, mood swings, verbosity and exaggeration, and was hospitalized at the State Institution “Institute of Neurology, Psychiatry and Narcology of the National Academy of Medical Sciences of Ukraine”. Neurological status: eye slits and pupils were uniform. The movements of the eyeballs were painless. Insufficiency of the act of convergence was found. Corneal reactions were reduced. The patient felt pain after the palpation of supra- and infraorbital points. There was an asymmetry in the facial innervation. The tongue was on the midline, swollen, with tooth imprints. There were no pathological signs, sensitive violations. Shaking movements were noticed during the Romberg test. During the examination of the cognitive function using the Mini-Mental State Examination (MMSE) scale, the patient scored 21 points, which corresponds to mild dementia. Results. 1. According to the results of MRI examination of the brain, there was an MR-picture of areas of cystic-gliosis transformation of the poles of the temporal lobes and structural changes of the hippocampal gyrus (most likely, caused by the chronic inflammatory process); vascular foci of the brain as manifestations of dyscirculatory changes, moderate external hydrocephalus. 2. A serological examination for the presence of the antigen of the Treponema pallidum pathogen was performed, the result was positive. 3. Cerebrospinal fluid analysis revealed the following results. Cytosis was 1x106/l, protein was 0.21 g/l, glucose 3.4 mmol/l, Pandy test positivity. Based on the obtained data, the patient was diagnosed with neurosyphilis. The patient underwent etiopathogenetic treatment with benzylpenicillin sodium. After treatment the patient's condition gradually improved. Conclusions. Specific serological reactions to syphilis, MRI of the brain and cerebrospinal fluid analysis are mandatory tests for the diagnosis of neurosyphilis. Early detection of Treponema pallidum and rational therapy can prevent the development of severe consequences and improve the patient's condition. Syphilis is a multidisciplinary problem today and needs the attention of general practitioners, dermatologists and neurologists.

scholarly journals Findings to Leptomeningeal Metastases in Lung Cancer: A Case Report

2019 ◽  
Vol 05 (01) ◽  
pp. 34-35
Author(s):  
Thiago Rodrigo de Noronha ◽  
Ricardo Ambrósio Fock
Keyword(s):  
Lung Cancer ◽  
Lung Tumor ◽  
Malignant Tumors ◽  
Primary Brain Tumor ◽  
Leptomeningeal Metastases ◽  
Hematologic Neoplasms ◽  
Cerebrospinal Fluid Analysis ◽  
Fluid Analysis ◽  
Cancer Breast ◽  
The Brain

Abstract Leptomeningeal metastases (LM) is defined as diffuse or focal infiltration of malignant cells into the meninges that bathe the brain and spinal subarachnoid. All malignant tumors may cause LM; however, there are several tumor entities that are more frequently associated with leptomeningeal spread than others such as lung cancer, breast carcinoma, melanoma, and hematologic neoplasms as well as primary brain tumor. Here, we present a case of LM from a 53-year-old woman with lung tumor and show the importance of cerebrospinal fluid analysis in the diagnosis of LM.

scholarly journals Guillain-Barre syndrome following the first dose of the chimpanzee adenovirus-vectored COVID-19 vaccine, ChAdOx1

2021 ◽  
Vol 14 (4) ◽  
pp. e242956
Author(s):  
Shreena Umit Patel ◽  
Ruhaid Khurram ◽  
Anjali Lakhani ◽  
Bernadine Quirk
Keyword(s):  
Interesting Case ◽  
Guillain Barre Syndrome ◽  
Prevention Strategies ◽  
Cerebrospinal Fluid Analysis ◽  
Fluid Analysis ◽  
Main Emphasis ◽  
Guillain Barré Syndrome ◽  
Guillain Barré ◽  
Whole Spine ◽  
The Brain

Prevention strategies for COVID-19 transmission are at the forefront of healthcare paradigms worldwide, the main emphasis of which is vaccination. We present an interesting case of a 37-year-old man who, 3 weeks following his first dose of the chimpanzee adenovirus-vectored COVID-19 vaccine, ChAdOx1, presented to hospital with a rapidly progressive ascending muscle weakness and back pain in the absence of any other triggers. He also had a negative COVID-19 swab during admission. A diagnosis of Guillain-Barre syndrome was confirmed by correlating the clinical features with cerebrospinal fluid analysis, nerve conduction studies and MRI of the brain and whole spine. The patient received treatment with 5 days of intravenous immunoglobulin and did not require any respiratory support. He was also regularly reviewed by a multidisciplinary team consisting of neurologists, speech and language therapists, and physiotherapists and is on the course to a recovery.

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