scholarly journals CompartmentalizedHistoplasma capsulatumInfection of the Central Nervous System

2015 ◽  
Vol 2015 ◽  
pp. 1-3 ◽  
Author(s):  
Albert J. Eid ◽  
John D. Leever ◽  
Kathrin Husmann
Keyword(s):  
Histoplasma Capsulatum ◽  
Brain Mri ◽  
Cerebrospinal Fluid Analysis ◽  
Case Presentation ◽  
Fluid Analysis ◽  
Disseminated Histoplasmosis ◽  
Progressive Neurological Deficit ◽  
The Central Nervous System ◽  
Progressive Weakness ◽  
Immunocompetent Patients

Background. Histoplasmosis is a common fungal infection in the southeastern, mid-Atlantic, and central states; however, its presentation can be atypical.Case Presentation. We report a case ofHistoplasma capsulatuminfection presenting as slowly progressive weakness in the lower extremities, followed by the development of numbness below the midthoracic area, urinary incontinence, and slurred speech. Brain MRI showed leptomeningeal enhancement, predominantly linear, involving the basal cisterns, the brainstem, and spinal cord. Cerebrospinal fluid analysis showed lymphocytic pleocytosis.Discussion. CNS histoplasmosis is usually seen in patients with disseminated histoplasmosis. Isolated CNS histoplasmosis is rarely seen, especially in immunocompetent patients.Conclusions. Histoplasmosis should be considered in the differential diagnosis of patients experiencing slowly progressive neurological deficit.

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 Rasmussen’s Encephalitis: A Report of a Tunisian Pediatric Case and Literature Review

2020 ◽  
Vol 2020 ◽  
pp. 1-5
Author(s):  
Hedia Klaa ◽  
Thouraya Ben Younes ◽  
Hanene Benrhouma ◽  
Sonia Nagi ◽  
Aida Rouissi ◽  
...  
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Brain Imaging ◽  
Brain Mri ◽  
Rasmussen Encephalitis ◽  
Pediatric Case ◽  
Rasmussen’S Encephalitis ◽  
Progressive Neurological Deficit ◽  
The Central Nervous System

Rasmussen’s encephalitis (RE) is a rare progressive inflammatory disease of the central nervous system. It is characterized by unilateral hemispheric atrophy, pharmacoresistant focal seizures, and progressive neurological deficit. The exact etiopathogenesis still remains unknown. Brain imaging plays an important role in diagnosis and follow-up. Fluctuation of lesions in brain imaging was reported in few cases. Herein, we report an additional pediatric case of Rasmussen encephalitis with fluctuating changes in brain MRI.

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 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 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 Disseminated Histoplasmosis with Miliary Histoplasmosis, Neurohistoplasmosis, and Histoplasma capsulatum Bacteremia in Probable Neurosarcoidosis

2018 ◽  
Vol 2018 ◽  
pp. 1-3 ◽  
Author(s):  
Peter V. Bui
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Histoplasma Capsulatum ◽  
Fungal Infections ◽  
Immunosuppressive Agents ◽  
Barrier Dysfunction ◽  
Diagnostic Uncertainty ◽  
Disseminated Histoplasmosis ◽  
History Of ◽  
The Central Nervous System

Introduction. Neurosarcoidosis, either isolated or as part of systemic sarcoidosis, is an uncommon entity and has diagnostic uncertainty. Treatment for neurosarcoidosis can increase the risk of infections, including fungal infections such as disseminated histoplasmosis. Neurosarcoidosis may further predispose patients to infections of the central nervous system. Case Presentation. A 54-year-old male with a history of probable neurosarcoidosis on methotrexate and infliximab presented with encephalopathy, hypoxia, and reported fevers. The patient was found to have disseminated histoplasmosis involving the lungs (miliary histoplasmosis), central nervous system (neurohistoplasmosis), and bloodstream. The Histoplasma capsulatum infection was treated with amphotericin and then voriconazole. Discussion. Patients with neurosarcoidosis are suspected to have blood-brain barrier dysfunction. Lumbar puncture should be considered as part of initial investigative studies for infection. Empiric antimicrobial therapy for a patient with neurosarcoidosis on immunosuppressive agents may need to include antifungal agents.

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 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.

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