Complicated Pneumococcal Meningitis: A Diagnostic and Therapeutic Challenge

Meningitis is an uncommon complication of head trauma. Vasculitis in bacterial meningitis is seen in 9–25% of adults while neurological deficits in bacterial meningitis are seen in about one-third of children. We report a 5-year-old boy, previously healthy who was admitted in March 2019 to Latifa Women’s and Children’s Hospital, Dubai, UAE, with pneumococcal meningitis. One day before presentation, he had a history of fall with head trauma while running at school. Initial brain CT scan was normal. Few hours after admission, the child was noticed to be drowsy with cold extremities and mottled skin. He was shifted to PICU and, ultimately, he required intubation and mechanical ventilation. The child continued spiking high-grade fever with deterioration in the neurologic status. His GCS deteriorated to 4/15 with decerebrations posture. He underwent serial brain imaging which revealed multiple chronic infarcts with hydrocephalic changes due to ongoing cerebral vasculitis. The child was started on steroid therapy on 28 April 2019 after which his condition improved at an incredible pace.

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Child Neurology (Neurocritical Care/Neuro Trauma)

Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques ◽

10.1017/cjn.2015.121 ◽

2015 ◽

Vol 42 (S1) ◽

pp. S24-S24

Author(s):

JA Mailo ◽

J Pugh ◽

FD Jacob

Keyword(s):

Bacterial Meningitis ◽

Facial Nerve ◽

Nerve Palsy ◽

Facial Nerve Palsy ◽

Neurological Deficits ◽

Search Terms ◽

History Of ◽

Streptococcal Meningitis ◽

The Brain ◽

New Onset

Background: Focal neurological deficits occur in approximately 15% of children with bacterial meningitis. However, cranial nerve involvement such as facial-nerve palsy is uncommon in non-tuberculous bacterial meningitis. Methods: Case Report. Review of the literature was conducted on Pubmed for the search terms: facial nerve palsy and meningitis. Results: We present the case of a 4-year old right-handed girl who presented with a new onset unilateral facial nerve palsy preceded by 5-day history of fever and headaches. The patient had meningeal signs and was identified to have Streptococcal Meningitis. MRI of the brain showed a large previously undiagnosed intranasal encephalocele. The facial palsy resolved within 7 days of antibiotic treatment. Conclusions: Our case represents an unusual combination of facial nerve palsy in context of Streptococcal Meningitis secondary to intranasal encephalocele.

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Posttraumatic Intradiploic Leptomeningeal Cyst: A Rare Complication of Head Trauma

Case Reports in Radiology ◽

10.1155/2015/395380 ◽

2015 ◽

Vol 2015 ◽

pp. 1-4

Author(s):

Jernailsingh Bava ◽

Ashank Bansal ◽

Santosh Bhaugaunda Patil ◽

Kiran Ashok Kale ◽

Anagha Rajiv Joshi

Keyword(s):

Differential Diagnosis ◽

Head Trauma ◽

Bone Fracture ◽

Rare Complication ◽

Skull Fracture ◽

Occipital Bone ◽

Leptomeningeal Cyst ◽

History Of ◽

Uncommon Complication

Posttraumatic intradiploic leptomeningeal cyst is an exceedingly uncommon complication of skull fracture in childhood with only about twenty-one cases described in literature till now. We report 2 such cases of intradiploic leptomeningeal cyst of occipital bone in two 17- and 21-year-old males presenting with headache with history of occipital bone fracture in childhood and briefly discuss its pathogenesis and differential diagnosis.

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HEAT STROKE WITH DIARETES INSIPIDUS

The Professional Medical Journal ◽

10.29309/tpmj/2009.16.02.2952 ◽

2009 ◽

Vol 16 (02) ◽

pp. 302-304

Author(s):

MUHAMMAD SHAHID AZIZ

Keyword(s):

Head Trauma ◽

Heat Stroke ◽

Loss Of Consciousness ◽

High Grade ◽

High Grade Fever ◽

Sudden Loss ◽

History Of

A young soldier 20 years of age was brought with 02hour history of sudden loss of consciousness associatedwith high grade fever while working in the field for severalhours in hot and humid weather in month of August.There was no history of head trauma.

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When less is more: a daring conservative approach to postpneumonectomy oesophago-pleural fistula

Interactive CardioVascular and Thoracic Surgery ◽

10.1093/icvts/ivz240 ◽

2019 ◽

Vol 30 (1) ◽

pp. 146-148

Author(s):

Lara Girelli ◽

Elena Prisciandaro ◽

Niccolò Filippi ◽

Lorenzo Spaggiari

Keyword(s):

Clinical Presentation ◽

Clinical Status ◽

High Morbidity ◽

Conservative Approach ◽

Chronic Fistula ◽

Less Is More ◽

Primary Surgery ◽

History Of ◽

Uncommon Complication

Abstract Oesophago-pleural fistula is an uncommon complication after pneumonectomy, usually related to high morbidity and mortality. Due to its rarity and heterogeneous clinical presentation, its diagnosis and management are challenging issues. Here, we report the case of a patient with a history of pneumonectomy for a tracheal tumour, who developed an asymptomatic oesophago-pleural fistula 7 years after primary surgery. In consideration of the patient’s good clinical status and after verifying the preservation of respiratory and digestive functions, a bold conservative approach was adopted. Five-year follow-up computed tomography did not disclose any sign of recurrence of disease and showed a stable, chronic fistula.

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R1352Q CACNA1A Variant in a Patient with Sporadic Hemiplegic Migraine, Ataxia, Seizures and Cerebral Oedema: A Case Report

Case Reports in Neurology ◽

10.1159/000512275 ◽

2021 ◽

pp. 123-130

Author(s):

Anker Stubberud ◽

Emer O’Connor ◽

Erling Tronvik ◽

Henry Houlden ◽

Manjit Matharu

Keyword(s):

Mental Retardation ◽

Case Report ◽

Genetic Testing ◽

Head Trauma ◽

Cerebral Oedema ◽

De Novo ◽

Minor Head Trauma ◽

Hemiplegic Migraine ◽

Wide Range ◽

History Of

Mutations in the CACNA1A gene show a wide range of neurological phenotypes including hemiplegic migraine, ataxia, mental retardation and epilepsy. In some cases, hemiplegic migraine attacks can be triggered by minor head trauma and culminate in encephalopathy and cerebral oedema. A 37-year-old male without a family history of complex migraine experienced hemiplegic migraine attacks from childhood. The attacks were usually triggered by minor head trauma, and on several occasions complicated with encephalopathy and cerebral oedema. Genetic testing of the proband and unaffected parents revealed a de novo heterozygous nucleotide missense mutation in exon 25 of the CACNA1A gene (c.4055G>A, p.R1352Q). The R1352Q CACNA1A variant shares the phenotype with other described CACNA1A mutations and highlights the interesting association of trauma as a precipitant for hemiplegic migraine. Subjects with early-onset sporadic hemiplegic migraine triggered by minor head injury or associated with seizures, ataxia or episodes of encephalopathy should be screened for mutations. These patients should also be advised to avoid activities that may result in head trauma, and anticonvulsants should be considered as prophylactic migraine therapy.

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Depth Electrode Guided Anterior Insulectomy: 2-Dimensional Operative Video

Operative Neurosurgery ◽

10.1093/ons/opab112 ◽

2021 ◽

Author(s):

Mauricio Mandel ◽

Layton Lamsam ◽

Pue Farooque ◽

Dennis Spencer ◽

Eyiyemisi Damisah

Keyword(s):

Right Hemisphere ◽

Preoperative Evaluation ◽

Epileptiform Activity ◽

Neurological Deficits ◽

Depth Electrodes ◽

Depth Electrode ◽

Patient Reported ◽

Frontal Operculum ◽

History Of ◽

Electroencephalogram Eeg

Abstract The insula is well established as an epileptogenic area.1 Insular epilepsy surgery demands precise anatomic knowledge2-4 and tailored removal of the epileptic zone with careful neuromonitoring.5 We present an operative video illustrating an intracranial electroencephalogram (EEG) depth electrode guided anterior insulectomy. We report a 17-yr-old right-handed woman with a 4-yr history of medically refractory epilepsy. The patient reported daily nocturnal ictal vocalization preceded by an indescribable feeling. Preoperative evaluation was suggestive of a right frontal-temporal onset, but the noninvasive results were discordant. She underwent a combined intracranial EEG study with a frontal-parietal grid, with strips and depth electrodes covering the entire right hemisphere. Epileptiform activity was observed in contact 6 of the anterior insula electrode. The patient consented to the procedure and to the publication of her images. A right anterior insulectomy was performed. First, a portion of the frontal operculum was resected and neuronavigation was used for the initial insula localization. However, due to unreliable neuronavigation (ie, brain shift), the medial and anterior borders of the insular resection were guided by the depth electrode reference. The patient was discharged 3 d after surgery with no neurological deficits and remains seizure free. We demonstrate that depth electrode guided insular surgery is a safe and precise technique, leading to an optimal outcome.

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Stroke prediction in patients presenting with isolated dizziness in the emergency department

Scientific Reports ◽

10.1038/s41598-021-85725-1 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

June-sung Kim ◽

Hong Jun Bae ◽

Muyeol Kim ◽

Shin Ahn ◽

Chang Hwan Sohn ◽

...

Keyword(s):

Risk Factors ◽

Emergency Department ◽

Multivariate Analysis ◽

Acute Stroke ◽

Neurological Deficits ◽

Cerebrovascular Injury ◽

Risk Patients ◽

History Of ◽

Independent Risk Factors ◽

Record Review

AbstractDiagnosing stroke in patients experiencing dizziness without neurological deficits is challenging for physicians. The aim of this study was to evaluate the prevalence of acute stroke in patients who presented with isolated dizziness without neurological deficits at the emergency department (ED), and determine the relevant stroke predictors in this population. This was an observational, retrospective record review of consecutive 2215 adult patients presenting with dizziness at the ED between August 2019 and February 2020. Multivariate analysis was performed to identify risk factors for acute stroke. 1239 patients were enrolled and analyzed. Acute stroke was identified in 55 of 1239 patients (4.5%); most cases (96.3%) presented as ischemic stroke with frequent involvement (29.1%) of the cerebellum. In the multivariate analysis, the history of cerebrovascular injury (odds ratio [OR] 3.08 [95% confidence interval {CI} 1.24 to 7.67]) and an age of > 65 years (OR 3.01 [95% CI 1.33 to 6.83]) were the independent risk factors for predicting acute stroke. The combination of these two risks showed a higher specificity (94.26%) than that of each factor alone. High-risk patients, such as those aged over 65 years or with a history of cerebrovascular injury, may require further neuroimaging workup in the ED to rule out stroke.

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Head Trauma in a Community-Based Sample of Victims of Intimate Partner Violence: Prevalence, Mechanisms of Injury and Symptom Presentation

Journal of Interpersonal Violence ◽

10.1177/08862605211016362 ◽

2021 ◽

pp. 088626052110163

Author(s):

Jessica E. Meyer ◽

Varna Jammula ◽

Peter A. Arnett

Keyword(s):

Intimate Partner Violence ◽

Brain Injury ◽

Head Trauma ◽

Partner Violence ◽

Physical Violence ◽

Structured Interview ◽

Intimate Partner ◽

Difficulty Breathing ◽

History Of ◽

Subconcussive Head Trauma

Objective. The present study aimed to explore the prevalence of subconcussive head trauma, traumatic brain injury (TBI), potential hypoxic events, and hypoxic brain injury (HBI) in victims of physical intimate partner violence (IPV). The study also aimed to characterize the injury presentation and mechanisms of injury in this population. Method. A group of 47 female participants with a history of at least one relationship that included physical violence completed a structured interview assessing for subconcussive hits, TBI, and HBI. Participants ranged in age from 19 to 55, and had an average of 15.3 years of education. Forty-four participants completed the structured interview in person and three participants completed the interview over the phone. Results. The majority of participants reported sustaining at least one impact to the head and approximately half of the participants sustained at least one impact that resulted in a mild TBI. Approximately half of the participants experienced at least one incident of having difficulty breathing due to a violent act from their partner, and approximately one-third of participants reported symptoms consistent with mild HBI. The most common mechanisms of injury were being hit with a closed fist and being strangled. Conclusions. The high levels of head trauma observed in this study highlight the need for clinical and community providers to screen victims of physical IPV for head trauma. The unique characteristics of this population (female sex, high frequency of injuries, and presence of HBIs) indicate that research evaluating the cognitive effects of injuries in this population is needed.

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The formyl peptide receptor agonist Ac2-26 alleviates neuroinflammation in a mouse model of pneumococcal meningitis

Journal of Neuroinflammation ◽

10.1186/s12974-020-02006-w ◽

2020 ◽

Vol 17 (1) ◽

Author(s):

Marvin Rüger ◽

Eugenia Kipp ◽

Nadine Schubert ◽

Nicole Schröder ◽

Thomas Pufe ◽

...

Keyword(s):

Streptococcus Pneumoniae ◽

Bacterial Meningitis ◽

Mouse Model ◽

Post Infection ◽

Pneumococcal Meningitis ◽

Hippocampal Formation ◽

Formyl Peptide Receptor ◽

Formyl Peptide ◽

Anti Inflammatory ◽

Deficient Mice

Abstract Background Bacterial meningitis is still a cause of severe neurological disability. The brain is protected from penetrating pathogens by the blood-brain barrier and the innate immune system. The invading pathogens are recognized by pattern recognition receptors including the G-protein-coupled formyl peptide receptors (FPRs), which are expressed by immune cells of the central nervous system. FPRs show a broad spectrum of ligands, including pro- and anti-inflammatory ones. Here, we investigated the effects of the annexin A1 mimetic peptide Ac2-26 in a mouse model of pneumococcal meningitis. Methods Wildtype (WT) and Fpr1- and Fpr2-deficient mice were intrathecally infected with Streptococcus pneumoniae D39 (type 2). Subsequently, the different mice groups were treated by intraperitoneal injections of Ac2-26 (1 mg/kg body weight) 2, 8, and 24 h post-infection. The extent of inflammation was analyzed in various brain regions by means of immunohistochemistry and real-time reverse transcription polymerase chain reaction (RT-PCR) 30 h post-infection. Results Ac2-26-treated WT mice showed less severe neutrophil infiltration, paralleled by a reduced induction of pro-inflammatory glial cell responses in the hippocampal formation and cortex. While meningitis was ameliorated in Ac2-26-treated Fpr1-deficient mice, this protective effect was not observed in Fpr2-deficient mice. Irrespective of Ac2-26 treatment, inflammation was more severe in Fpr2-deficient compared to Fpr1-deficient mice. Conclusions In summary, this study demonstrates anti-inflammatory properties of Ac2-26 in a model of bacterial meningitis, which are mediated via FPR2, but not FPR1. Ac2-26 and other FPR2 modulators might be promising targets for the development of novel therapies for Streptococcus pneumoniae-induced meningitis.

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Melioidosis: A Rare Cause of Liver Abscess

Case Reports in Hepatology ◽

10.1155/2016/5910375 ◽

2016 ◽

Vol 2016 ◽

pp. 1-3 ◽

Cited By ~ 2

Author(s):

Peter Franz M. San Martin ◽

Catherine S. C. Teh ◽

Ma. Amornetta J. Casupang

Keyword(s):

Liver Abscess ◽

Burkholderia Pseudomallei ◽

Abdominal Ultrasound ◽

Open Drainage ◽

High Grade Fever ◽

Rare Presentation ◽

Culture Studies ◽

Moderate Growth ◽

Male Farmer ◽

History Of

Case Presentation. This is a case of a 44-year-old male, farmer, known to be diabetic, presenting with two-week history of vague abdominal pain associated with high grade fever. Abdominal CT scan showed localized liver abscess at segment 8 measuring 7.5 × 6.8 × 6.1 cm. Patient subsequently underwent laparoscopic ultrasound guided pigtail insertion for drainage of abscess. Culture studies showed moderate growth ofBurkholderia pseudomalleiin which the patient completed seven days of IV Meropenem. On follow-up after 12 weeks of oral Sulfamethoxazole/Trimethoprim, taken twice a day, the patient remained asymptomatic with no residual findings based on the abdominal ultrasound.Discussion. Diagnosis of melioidosis, a known “great masquerader,” relies heavily on culture studies. Consensus with regard to the management of liver abscess caused byBurkholderia pseudomalleihas not yet been established due to the rarity of cases. Surgical intervention through either a percutaneous or open drainage has shown good outcomes compared to IV antibiotics alone. In Philippines, the possibility of underreporting is highly plausible. This write-up serves not only to report a rare presentation of melioidosis but also to add to the number of cases reported in the country, possibly indicative of disease emergence.

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