Aseptic meningitis and hydrocephalus secondary to neurosarcoidosis

A 53-year-old woman presented to hospital with gait instability, urinary incontinence and confusion. She had a 4-month history of headache, blurred vision, personality change and memory problems. Magnetic Resonance Imaging of the brain after contrast application showed tectal plate and occipital enhancement, as well as a known hydrocephalus. Cerebrospinal fluid showed aseptic meningitis with no evidence of clonal expansion. After further imaging that showed generalised lymphadenopathy and subsequent tissue biopsy that showed granulomatous lymphadenitis, she was diagnosed with neurosarcoidosis. She was treated with steroids which resulted in immediate cognitive and motor improvements as well as resolution of her urinary incontinence. We discuss the features of this case that pointed towards neoplastic, infective and other autoimmune aetiologies. We describe how they were excluded and provide the rationale for our treatment. This case demonstrates an important sequela sarcoidosis, and we conclude by recommending a multidisciplinary approach towards its diagnosis and management.

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Familial Retinal Arteriolar Tortuosity with Acute Hippocampal Infarction

Case Reports in Ophthalmology ◽

10.1159/000456069 ◽

2017 ◽

Vol 8 (1) ◽

pp. 185-189 ◽

Cited By ~ 1

Author(s):

Tae Hee Kim ◽

Sonia Lee ◽

Su Jin Lim

Keyword(s):

Past History ◽

Brain Magnetic Resonance Imaging ◽

Transient Global Amnesia ◽

Subcortical White Matter ◽

Blurred Vision ◽

Retinal Arterioles ◽

History Of ◽

Global Amnesia ◽

The Brain ◽

Retinal Arteriolar

Purpose: To report a case of familial retinal arteriolar tortuosity with acute hippocampal infarction. Method: Single-patient case report. Results: A 50-year-old woman presented with blurred vision and was found to have cataract, retinal hemorrhages, and tortuous retinal arterioles in both eyes. Similar findings of tortuous retinal arterioles were observed in her daughter and son. In her past history of 6 years prior to the visit, she had been diagnosed with transient global amnesia after brain magnetic resonance imaging, which showed hippocampal infarction and multiple chronic ischemic lesions in the periventricular and subcortical white matter. Conclusion: Familial retinal arteriolar tortuosity is known to affect the retinal vessels only. To our knowledge, this is the first report of ischemic injury to the brain in a patient with familial retinal arteriolar tortuosity.

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January 2022 Critical Care Case of the Month: Ataque Isquémico Transitorio in Spanish

Southwest Journal of Pulmonary and Critical Care ◽

10.13175/swjpcc051-21 ◽

2022 ◽

Vol 24 (1) ◽

pp. 1-5

Author(s):

Mohammad Mahmoud ◽

◽

Bo Gu ◽

Benito Armenta ◽

Nikita Samra

Keyword(s):

Family History ◽

Social History ◽

Illicit Drugs ◽

Medical Service ◽

Blurred Vision ◽

Old Spanish ◽

History Of ◽

Ct Head ◽

Contrast Ct ◽

The Brain

No abstract available. Article truncated after 150 words. History of Present Illness: The patient is a previously healthy 61-year-old Spanish-speaking woman who was unable to speak after awakening. Per Emergency Medical Service she was found to be aphasic upon their arrival. While in the Emergency Room the patient was able to speak, alert and oriented x4, with all her symptoms spontaneously resolved. The patient denied fever, chills, blurred vision, headache or any history of migraines, TIA, or stroke. The patient had a similar event about two weeks earlier which also spontaneously resolved. During that time, the patient had a non-contrast CT head and an MRI of the brain, both of which were unremarkable. Her home medications include aspirin 81 mg and atorvastatin 40 mg daily. Past Medical History, Family History and Social History: The patient denies tobacco use or use of illicit drugs. She reports that she will occasionally drink alcohol. There is no family history of strokes. …

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Bilateral optic perineuritis associated with p-ANCA vasculitis

Malaysian Journal of Ophthalmology ◽

10.35119/myjo.v1i2.21 ◽

2019 ◽

Vol 1 (2) ◽

pp. 139-144

Author(s):

Ivan Cheng En Yoo ◽

Yong Meng Hsien ◽

Mushawiahti Binti Mustapha ◽

Jemaima Che Hamzah

Keyword(s):

Previous History ◽

Ocular Involvement ◽

Intravenous Methylprednisolone ◽

Blurred Vision ◽

Anca Vasculitis ◽

Severe Visual Loss ◽

History Of ◽

Magnetic Resonance Imaging Mri ◽

Optic Discs ◽

The Brain

A 69-year-old Chinese woman with underlying perinuclear anti-neutrophil cytoplasmic antibody associated with vasculitis (p-ANCA vasculitis) with no previous history of ocular involvement experienced one week of blurred vision in both eyes associated with pain. Ophthalmological evaluation demonstrated severe visual loss in both eyes, with pale optic discs but without other signs of ocular vasculitis. Magnetic resonance imaging (MRI) of the brain and orbit revealed bilateral enhancement of the optic nerve sheath with classical tram-track and doughnut signs. Intravenous methylprednisolone was given for five days and marked improvement of vision was seen. In patients with p-ANCA vasculitis, bilateral optic perineuritis (OPN) is uncommon but can be one of the treatable causes to be considered, with good response to prompt steroid treatment.

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Cladophialophora bantianaCerebral Phaeohyphomycosis Complicated by Pulmonary Nocardiosis: A Tale of Two Infections

Case Reports in Infectious Diseases ◽

10.1155/2019/4352040 ◽

2019 ◽

Vol 2019 ◽

pp. 1-6

Author(s):

Muhammad Farhan Khaliq ◽

Rayan E. Ihle ◽

Christopher P. Schirtzinger

Keyword(s):

Multidisciplinary Approach ◽

Brain Mri ◽

Brain Biopsy ◽

Term Treatment ◽

Chest Ct ◽

Long Term Treatment ◽

History Of ◽

The Brain ◽

Neurosurgical Intervention

Cladophialophora bantiana, a melanized neurotropic fungus, is the most commonly reported agent of cerebral phaeohyphomycosis. We present a case of cerebral phaeohyphomycosis due toC. bantianawith a concomitantNocardiainfection in the lung. The patient was a 64-year-old male who presented with one-week history of productive cough, confusion, and staggering gait. Brain MRI showed multiple enhancing masses, and chest CT demonstrated multifocal consolidation. To confirm diagnosis, brain biopsy was performed that showedCladophialophora bantiana. Bronchoscopic lung biopsy confirmed infection withNocardia araoensis. The patient was treated with trimethoprim-sulfamethoxazole, meropenem, voriconazole, and liposomal amphotericin in addition to partial resection of the brain mass. After several weeks in the hospital and deteriorating status with poor prognosis, medical care was withdrawn.Cladophialophora bantianainfection is rare and requires multidisciplinary approach for accurate diagnostic confirmation. Aggressive and long-term treatment with voriconazole along with early neurosurgical intervention may offer an improved chance of survival in these patients.

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Left suboccipital supracerebellar transtentorial approach for resection of tectal cavernous malformation

Neurosurgical Focus: Video ◽

10.3171/2019.10.focusvid.19394 ◽

2019 ◽

Vol 1 (2) ◽

pp. V19

Author(s):

Hussam Abou-Al-Shaar ◽

Timothy G. White ◽

Ivo Peto ◽

Amir R. Dehdashti

Keyword(s):

Nerve Palsy ◽

Oculomotor Nerve ◽

Oculomotor Nerve Palsy ◽

Entry Zone ◽

Third Nerve Palsy ◽

History Of ◽

Tectal Plate ◽

The Right ◽

Transtentorial Approach ◽

Third Nerve

A 64-year-old man with a midbrain cavernoma and prior bleeding presented with a 1-week history of diplopia, partial left oculomotor nerve palsy, and worsening dysmetria and right-sided weakness. MRI revealed a hemorrhagic left tectal plate and midbrain cavernoma. A left suboccipital supracerebellar transtentorial approach in the sitting position was performed for resection of his lesion utilizing the lateral mesencephalic sulcus safe entry zone. Postoperatively, he developed a partial right oculomotor nerve palsy; imaging depicted complete resection of the cavernoma. He recovered from the right third nerve palsy, weakness, and dysmetria, with significant improvement of his partial left third nerve palsy.The video can be found here: https://youtu.be/ofj8zFWNUGU.

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L2HGDH Missense Variant in a Cat with L-2-Hydroxyglutaric Aciduria

Genes ◽

10.3390/genes12050682 ◽

2021 ◽

Vol 12 (5) ◽

pp. 682

Author(s):

Matthias Christen ◽

Nils Janzen ◽

Anne Fraser ◽

Adrian C. Sewell ◽

Vidhya Jagannathan ◽

...

Keyword(s):

Current Knowledge ◽

Genetic Defect ◽

Clinical Signs ◽

Missense Variant ◽

Microcytic Anemia ◽

Abnormal Behavior ◽

Functional Candidate Gene ◽

History Of ◽

The Brain ◽

Hydroxyglutaric Acid

A 7-month-old, spayed female, domestic longhair cat with L-2-hydroxyglutaric aciduria (L-2-HGA) was investigated. The aim of this study was to investigate the clinical signs, metabolic changes and underlying genetic defect. The owner of the cat reported a 4-month history of multiple paroxysmal seizure-like episodes, characterized by running around the house, often in circles, with abnormal behavior, bumping into obstacles, salivating and often urinating. The episodes were followed by a period of disorientation and inappetence. Neurological examination revealed an absent bilateral menace response. Routine blood work revealed mild microcytic anemia but biochemistry, ammonia, lactate and pre- and post-prandial bile acids were unremarkable. MRI of the brain identified multifocal, bilaterally symmetrical and T2-weighted hyperintensities within the prosencephalon, mesencephalon and metencephalon, primarily affecting the grey matter. Urinary organic acids identified highly increased levels of L-2-hydroxyglutaric acid. The cat was treated with the anticonvulsants levetiracetam and phenobarbitone and has been seizure-free for 16 months. We sequenced the genome of the affected cat and compared the data to 48 control genomes. L2HGDH, coding for L-2-hydroxyglutarate dehydrogenase, was investigated as the top functional candidate gene. This search revealed a single private protein-changing variant in the affected cat. The identified homozygous variant, XM_023255678.1:c.1301A>G, is predicted to result in an amino acid change in the L2HGDH protein, XP_023111446.1:p.His434Arg. The available clinical and biochemical data together with current knowledge about L2HGDH variants and their functional impact in humans and dogs allow us to classify the p.His434Arg variant as a causative variant for the observed neurological signs in this cat.

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Cancer immunotherapy in special challenging populations: recommendations of the Advisory Committee of Spanish Melanoma Group (GEM)

Journal for ImmunoTherapy of Cancer ◽

10.1136/jitc-2020-001664 ◽

2021 ◽

Vol 9 (3) ◽

pp. e001664

Author(s):

Maria Gonzalez-Cao ◽

Teresa Puertolas ◽

Mar Riveiro ◽

Eva Muñoz-Couselo ◽

Carolina Ortiz ◽

...

Keyword(s):

Cancer Immunotherapy ◽

Multidisciplinary Approach ◽

Checkpoint Inhibitors ◽

Solid Organ Transplantation ◽

Latent Tuberculosis ◽

Solid Organ ◽

Chronic Infections ◽

Immunosuppressed Patients ◽

History Of ◽

Evidence Based Guidelines

Cancer immunotherapy based on the use of antibodies targeting the so-called checkpoint inhibitors, such as programmed cell death-1 receptor, its ligand, or CTLA-4, has shown durable clinical benefit and survival improvement in melanoma and other tumors. However, there are some special situations that could be a challenge for clinical management. Persons with chronic infections, such as HIV-1 or viral hepatitis, latent tuberculosis, or a history of solid organ transplantation, could be candidates for cancer immunotherapy, but their management requires a multidisciplinary approach. The Spanish Melanoma Group (GEM) panel in collaboration with experts in virology and immunology from different centers in Spain reviewed the literature and developed evidence-based guidelines for cancer immunotherapy management in patients with chronic infections and immunosuppression. These are the first clinical guidelines for cancer immunotherapy treatment in special challenging populations. Cancer immunotherapy in chronically infected or immunosuppressed patients is feasible but needs a multidisciplinary approach in order to decrease the risk of complications related to the coexistent comorbidities.

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Ibuprofen-Induced Aseptic Meningitis in a Male Adolescent with Intracranial Hypertension and Visual Impairment: A Case Report

Case Reports in Neurology ◽

10.1159/000514091 ◽

2021 ◽

Vol 13 (1) ◽

pp. 233-238

Author(s):

Seyed Mohammad Mousavi Mirzaei ◽

Zahra Ahmadi

Keyword(s):

Visual Impairment ◽

Intracranial Hypertension ◽

Aseptic Meningitis ◽

Rare Complication ◽

Clinical Signs ◽

Male Adolescent ◽

Drug Induced ◽

Blurred Vision ◽

Inflammatory Drugs

Drug-induced aseptic meningitis (DIAM) is a rare complication of certain drugs, most commonly reported with ibuprofen use. The present study reports on a male adolescent with intracranial hypertension and visual impairment accompanied by DIAM. We present a 16-year-old male patient who after ibuprofen consumption displayed headache, fever, photophobia, and blurred vision following heavy exercises. Examination of cerebrospinal fluid showed a mononuclear pleocytosis and an increase in protein concentration. Other examinations had normal results. The development of common clinical signs following ibuprofen use reflected DIAM. The patient’s vision was found to improve with supportive care and stopping of the drug during follow-up. Given the widespread use of nonsteroidal anti-inflammatory drugs and the fact that these drugs are the most common cause of DIAM, the probability of occurrence of this event should be always kept in mind, and screening for autoimmune diseases in these patients is of great importance.

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Molecular evolutionary analysis of human primary microcephaly genes

BMC Ecology and Evolution ◽

10.1186/s12862-021-01801-0 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Nashaiman Pervaiz ◽

Hongen Kang ◽

Yiming Bao ◽

Amir Ali Abbasi

Keyword(s):

Evolutionary History ◽

Genetic Basis ◽

Brain Size ◽

Primate Species ◽

Evolutionary Analysis ◽

Australopithecus Afarensis ◽

Primary Microcephaly ◽

Modern Humans ◽

History Of ◽

The Brain

Abstract Background There has been a rapid increase in the brain size relative to body size during mammalian evolutionary history. In particular, the enlarged and globular brain is the most distinctive anatomical feature of modern humans that set us apart from other extinct and extant primate species. Genetic basis of large brain size in modern humans has largely remained enigmatic. Genes associated with the pathological reduction of brain size (primary microcephaly-MCPH) have the characteristics and functions to be considered ideal candidates to unravel the genetic basis of evolutionary enlargement of human brain size. For instance, the brain size of microcephaly patients is similar to the brain size of Pan troglodyte and the very early hominids like the Sahelanthropus tchadensis and Australopithecus afarensis. Results The present study investigates the molecular evolutionary history of subset of autosomal recessive primary microcephaly (MCPH) genes; CEP135, ZNF335, PHC1, SASS6, CDK6, MFSD2A, CIT, and KIF14 across 48 mammalian species. Codon based substitutions site analysis indicated that ZNF335, SASS6, CIT, and KIF14 have experienced positive selection in eutherian evolutionary history. Estimation of divergent selection pressure revealed that almost all of the MCPH genes analyzed in the present study have maintained their functions throughout the history of placental mammals. Contrary to our expectations, human-specific adoptive evolution was not detected for any of the MCPH genes analyzed in the present study. Conclusion Based on these data it can be inferred that protein-coding sequence of MCPH genes might not be the sole determinant of increase in relative brain size during primate evolutionary history.

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Dysphagia in a Young Man

Case Reports in Neurology ◽

10.1159/000507242 ◽

2020 ◽

Vol 12 (3) ◽

pp. 410-415

Author(s):

Jing-Hwa Wey ◽

Jin-Er Lee ◽

Kwang-Hwa Chang ◽

Yen-Nung Lin ◽

Wen-Kuei Chung

Keyword(s):

Aseptic Meningitis ◽

Multidisciplinary Approach ◽

Body Weight Gain ◽

Oropharyngeal Dysphagia ◽

Acute Onset ◽

Team Work ◽

Optimal Outcome ◽

Significant Weight Loss ◽

Videofluoroscopic Swallowing Study ◽

Laryngeal Muscles

This case report presents oropharyngeal dysphagia due to oromandibular and cervical dystonia, a rare consequence of aseptic meningitis. A 19-year-old male who was diagnosed with aseptic meningitis visited the rehabilitation outpatient clinic for a sense of foreign body in his throat and odynophagia. Repetitive involuntary movements of his facial, tongue, and laryngeal muscles accompanied by lateroanterior torticollis were observed. Videofluoroscopic swallowing study showed inefficient bolus formation due to repetitive rolling of his tongue and vallecular stasis without penetration or aspiration. Dysphagia and odynophagia had brought the patient significant weight loss and frustration. We provided swallowing training to improve the efficiency and safety of swallowing. The patient’s symptoms improved gradually along with body weight gain and emotional stability. Acute-onset oropharyngeal dysphagia is devastating for young adults. A multidisciplinary approach is mandatory for optimal outcome. We share our experience as a team work and emphasize the rehabilitation aspect.

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