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 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.

Intravascular Lymphoma Involving the Central and Peripheral Nervous Systems in a Dog

2003 ◽  
Vol 39 (1) ◽  
pp. 90-96 ◽  
Author(s):  
William W. Bush ◽  
Juliene L. Throop ◽  
Patricia M. McManus ◽  
Amy S. Kapatkin ◽  
Charles H. Vite ◽  
...  
Keyword(s):  
Intravascular Lymphoma ◽  
Cerebrospinal Fluid Analysis ◽  
Nervous Systems ◽  
Fluid Analysis ◽  
Organ Systems ◽  
Mixed Breed ◽  
The Central Nervous System ◽  
Peripheral Nervous Systems ◽  
Tentative Diagnosis ◽  
Histopathological Evidence

A 5-year-old, castrated male mixed-breed dog was presented for paraparesis, ataxia, hyperesthesia, and thrombocytopenia of 5 months’ duration and recurrent seizures during the preceding 2 weeks. Multifocal neurological, ophthalmological, pulmonary, and cardiac diseases were identified. Magnetic resonance imaging and cerebrospinal fluid analysis supported a tentative diagnosis of neoplastic or inflammatory disease. A computed tomography-guided biopsy provided both cytopathological and histopathological evidence of intravascular lymphoma. The disease progressed despite chemotherapy with prednisone, L-asparginase, and vincristine. Postmortem histopathological examinations suggested intravascular lymphoma in the central and peripheral nervous systems as well as in multiple other organ systems. This is the first description of an antemortem diagnosis and treatment of intravascular lymphoma involving the central nervous system of a dog.

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.

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 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.

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.

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