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 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 Comparative analysis between the profile of cerebrospinal liquid (CSF) and clinical evolution in patients with bacterial meningitis

2021 ◽  
Author(s):  
Clara Kimie Miyahira ◽  
Vania Maria Sabadoto Brienze
Keyword(s):  
Central Nervous System ◽  
Cerebrospinal Fluid ◽  
Bacterial Meningitis ◽  
Medical Records ◽  
Signs And Symptoms ◽  
Cerebrospinal Fluid Analysis ◽  
Fluid Analysis ◽  
Serious Infection ◽  
Cerebrospinal Fluid Examination ◽  
The Central Nervous System

Background: Bacterial meningitis is a serious infection that occurs in the Central Nervous System, which presents important morbidity and mortality, mainly in children. The main bacterial agents causing meningitis in the community are Haemophilus influenzae, Neisseria meningitidis and Streptococcus pneumoniae. Specific signs and symptoms suggest meningitis and cerebrospinal fluid analysis is the main exam leading to diagnosis. Objectives: To analyze the behavior of cerebrospinal fluid during the evolution of the patient with bacterial meningitis. Methods: A retrospective study revised the medical records of patients with bacterial meningitis confirmed by cerebrospinal fluid examination in the Base Hospital of São José do Rio Preto from January 1996 to December 2002. Results: in the 63 Patients, there were 18 cases (28.6%) of S. pneumoniae, 20 cases (31.7%) of H. influenzae, 12 cases (19%) of N.meningitides B and 13 (20.6%) cases of N. meningitidis C. In the 18 patients with pneumococcus, 10 (55.6%) were discharged and 8 (44.4%) died. In the 20 patients with HIB, only 3 (15%) died, there was no death patients with meningococcus B and C. Conclusion: There was no difference statistics in the cerebrospinal fluid of the patients who were discharged and those who died.

scholarly journals Meningitis gone viral: Description of the German Echo Wave 2013

2019 ◽  
Author(s):  
Jonas Graf ◽  
Christian Hartmann ◽  
Helmar C Lehmann ◽  
Carolin Otto ◽  
Ortwin Adams ◽  
...  
Keyword(s):  
Aseptic Meningitis ◽  
University Hospital ◽  
Cerebrospinal Fluid Analysis ◽  
Enteroviral Infection ◽  
Varicella Zoster ◽  
Fluid Analysis ◽  
Significant Burden ◽  
Simplex Virus ◽  
Herpes Simplex Virus 2 ◽  
The University

Abstract BACKGROUND: Aseptic meningitis epidemics may pose various health care challenges. OBJECTIVE: We describe the German enterovirus meningitis epidemics in the university hospital centers of Düsseldorf, Cologne and Berlin between January 1st and December 31st, 2013. RESULTS: A total of 72 enterovirus (EV-positive) meningitis cases were detected in our multicenter cohort, corresponding to 2.1% of all EV-positive cases which were voluntarily reported within the National Enterovirussurveillance (based on investigation of patients with suspected aseptic meningitis/encephalitis and acute flaccid paralysis) by physicians within this period of time. Among these 72 patients, 38 (52.8%) were echovirus-positive (18 pediatric and 20 adult cases, median age 18.5 years). At the same time, 45 aseptic meningitis cases in our cohort were excluded to be due to enteroviral infection (EV-negative). Three EV-negative patients were tested positive for varicella zoster virus (VZV) and one EV-negative patient for herpes simplex virus 2. Hospitalization was significantly longer in EV-negative cases. Cerebrospinal fluid analysis did not reveal significant differences between the two groups. After discharge, EV-meningitis resulted in significant burden of sick leave in our pediatric cohort as parents had to care for the children at home. CONCLUSION: Voluntary disease-specific surveillance, such as provided by the National Enterovirussurveillance in our study may be a valuable tool for epidemiological research.

scholarly journals Cerebrospinal fluid analysis in 108 patients with progressive multifocal leukoencephalopathy

2020 ◽  
Author(s):  
Nora Möhn ◽  
Luo Yi ◽  
Thomas Skripuletz ◽  
Philipp Schwenkenbecher ◽  
Anne Ladwig ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Cerebrospinal Fluid ◽  
Progressive Multifocal Leukoencephalopathy ◽  
Cell Count ◽  
Normal Pressure ◽  
Control Group ◽  
Fluid Analysis ◽  
Immunodeficiency Virus ◽  
The Central Nervous System ◽  
Insight Into

Abstract Background: Progressive multifocal leukoencephalopathy (PML) is caused by an opportunistic infection with JC polyoma virus (JCPyV) and mainly affects immunocompromised patients. It leads to pronounced demyelination of the central nervous system (CNS) resulting in severe disability or even death. Detection of JCPyV DNA in the cerebrospinal fluid (CSF) is usually accepted as proof for the diagnosis of PML. Routine CSF parameters, like CSF cell count, protein concentration, Qalbumin, or intrathecal immunoglobulin synthesis are mostly considered normal. However, this has not been investigated systematically. Methods: We analyzed routine CSF parameters in a cohort of 108 PML patients that were treated at four different neurological centers in Germany. The patients exhibited different underlying conditions with natalizumab-treated multiple sclerosis (n=54) and human immunodeficiency virus (HIV)-infection (n=25) being the most frequent. The data were collected at the respective centers in accordance with local requirements and then jointly analyzed. The total PML cohort was compared with a control group of patients with normal pressure hydrocephalus (NPH) and idiopathic intracranial hypertension (IIH). Multiple sclerosis and HIV patients were additionally compared with their own non-PML control groups. Results: The PML group showed an elevated cell count (p<0.001) compared to the control group, however, this effect was mainly driven by HIV-PML patients. This subgroup also demonstrated a significantly higher proportion of patients with a disturbed blood-CSF-barrier function. Conclusions: This comprehensive, retrospective study on CSF diagnostic analysis in PML patients provides insight into the CSF of those patients. It demonstrates that CSF composition in PML patients may be specific for the underlying condition that predisposes for the development of PML and thus data have to be interpreted in this context.

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.

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 Predicting conversion to multiple sclerosis in patients with radiologically isolated syndrome: a retrospective study

2021 ◽  
Vol 14 ◽  
pp. 175628642110306
Author(s):  
Panagiotis Chaloulos-Iakovidis ◽  
Franca Wagner ◽  
Lea Weber ◽  
Lara Diem ◽  
Andrew Chan ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Cell Count ◽  
Immune Cell ◽  
Univariate Analysis ◽  
Prediction Score ◽  
University Hospital ◽  
Cerebellar Hemisphere ◽  
Albumin Concentration ◽  
Radiologically Isolated Syndrome

Aims: To retrospectively analyse the Bernese radiologically isolated syndrome (RIS) cohort with the goal of developing a prediction score for conversion to multiple sclerosis (MS). Methods: A total of 31 patients with RIS were identified by screening medical records of neurological patients seen at the University Hospital of Bern between 2004 and 2017 for the diagnoses ‘radiologically isolated syndrome’ and ‘RIS’ adhering to 2009 Okuda recommendations. We analysed clinical, paraclinical and magnetic resonance imaging data during a maximum follow-up period of 3 years and identified significant predictors of conversion to MS. Results: Data were available for 31 patients meeting 2009 Okuda RIS criteria. During the 3 years of follow up, 5/31 RIS patients converted to relapsing-remitting (RR) MS. In our univariate analysis, gadolinium (Gd) enhancement, brainstem and cerebellar hemisphere lesions, immune cell count and albumin concentration in cerebrospinal fluid (CSF), and anti-nuclear antibody (ANA) positivity in serum were identified as significant predictors of conversion to MS. Integrating these factors into our ‘RIS–MS prediction score’ enabled us to calculate a cut-off for prediction of conversion to MS within 3 years with high specificity [1.0, 95% confidence interval (CI) 0.84–1.00) and acceptable sensitivity (0.6, 95% CI 0.17–0.93)]. Conclusion: Our RIS–MS prediction score, if validated in an independent cohort, integrating radiological (Gd enhancement, brainstem and cerebellar hemisphere lesions) and paraclinical factors (ANA in serum, cell count and albumin in CSF) could be a useful prognostic tool for early recognition of RIS patients with a high risk of clinical progression to MS.

scholarly journals Cerebrospinal fluid analysis in 108 patients with progressive multifocal leukoencephalopathy

2020 ◽  
Vol 17 (1) ◽  
Author(s):  
Nora Möhn ◽  
Yi Luo ◽  
Thomas Skripuletz ◽  
Philipp Schwenkenbecher ◽  
Anne Ladwig ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Cerebrospinal Fluid ◽  
Progressive Multifocal Leukoencephalopathy ◽  
Cell Count ◽  
Normal Pressure ◽  
Control Group ◽  
Fluid Analysis ◽  
Immunodeficiency Virus ◽  
The Central Nervous System ◽  
Insight Into

Abstract Background Progressive multifocal leukoencephalopathy (PML) is caused by an opportunistic infection with JC polyoma virus (JCPyV) and mainly affects immunocompromised patients. It leads to pronounced demyelination of the central nervous system (CNS) resulting in severe disability or even death. Detection of JCPyV DNA in the cerebrospinal fluid (CSF) is usually accepted as proof for the diagnosis of PML. Routine CSF parameters, like CSF cell count, protein concentration, Qalbumin, or intrathecal immunoglobulin synthesis are mostly considered normal. However, this has not been investigated systematically. Methods We analyzed routine CSF parameters in a cohort of 108 PML patients that were treated at four different neurological centers in Germany. The patients exhibited different underlying conditions with natalizumab-treated multiple sclerosis (n = 54) and human immunodeficiency virus (HIV)-infection (n = 25) being the most frequent. The data were collected at the respective centers in accordance with local requirements and then jointly analyzed. The total PML cohort was compared with a control group of patients with normal pressure hydrocephalus (NPH) and idiopathic intracranial hypertension (IIH). Multiple sclerosis and HIV patients were additionally compared with their own non-PML control groups. Results The PML group showed an elevated cell count (p < 0.001) compared to the control group, however, this effect was mainly driven by HIV-PML patients. This subgroup also demonstrated a significantly higher proportion of patients with a disturbed blood-CSF-barrier function. Conclusions This comprehensive, retrospective study on CSF diagnostic analysis in PML patients provides insight into the CSF of those patients. It demonstrates that CSF composition in PML patients may be specific for the underlying condition that predisposes for the development of PML and thus data have to be interpreted in this context.

scholarly journals Clinical, clinicopathological and diagnostic imaging findings in 14 dogs with suspected fibrocartilaginous embolic myelopathy

2017 ◽  
Vol 63 (3) ◽  
pp. 193
Author(s):  
Z. S. POLIZOPOULOU (Ζ.Σ. ΠΟΛΥΖΟΠΟΥΛΟΥ) ◽  
D. KARNEZI (Δ. ΚΑΡΝΕΖΗ) ◽  
G. KARNEZI (ΚΑΡΝΕΖΗ Γ.)
Keyword(s):  
Spinal Cord ◽  
Diagnostic Imaging ◽  
Clinical Signs ◽  
Spinal Column ◽  
Neurological Dysfunction ◽  
Cerebrospinal Fluid Analysis ◽  
Imaging Evaluation ◽  
Lesion Location ◽  
Fluid Analysis

Fibrocartilaginous embolic myelopathy was diagnosed in 14 dogs with acute neurological dysfunction, based on history, findings of clinical examination, diagnostic imaging evaluation, follow-up and outcome. The dogs were presented with signs of variable involvement of the spinal cord, which were lateralized in 4 cases. The initial clinicopathological evaluation was unremarkable, while cerebrospinal fluid analysis was abnormal in one dog. Diagnostic imaging investigation (plain radiographs of the spinal column and myelography) did not reveal any abnormalities in the vertebrae and adjacent tissues or compression of the spinal cord, with the exception of one case, where there was evidence of focal intramedullary oedema corresponding to the lesion location. Seven dogs improved significantly with supportive treatment; complete remission of clinical signs was evident in two. Moderate improvement was seen in three animals and minimal or no improvement in four dogs, which were euthanised due to persisting neurological incapacitation.

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