scholarly journals Gram stain to the rescue: a case report of cerebral phaeohyphomycosis by Cladophialophora bantiana in an immunocompetent 24-year-old

2022 ◽  
Vol 22 (1) ◽  
Author(s):  
Perceus Mody ◽  
Paul Wada ◽  
Karen C. Bloch ◽  
Michail S. Lionakis ◽  
Katie D. White ◽  
...  
Keyword(s):  
Antifungal Therapy ◽  
Brain Mri ◽  
Surgical Excision ◽  
Delayed Presentation ◽  
Case Presentation ◽  
Stereotactic Aspiration ◽  
Disease States ◽  
Brain Abscesses ◽  
Appropriate Therapy ◽  
The Brain

Abstract Background Fungal brain abscesses in immunocompetent patients are exceedingly rare. Cladophialophora bantiana is the most common cause of cerebral phaeohyphomycosis, a dematiaceous mold. Radiological presentation can mimic other disease states, with diagnosis through surgical aspiration and growth of melanized fungi in culture. Exposure is often unknown, with delayed presentation and diagnosis. Case presentation We present a case of cerebral phaeohyphomycosis in a 24-year-old with no underlying conditions or risk factors for disease. He developed upper respiratory symptoms, fevers, and headaches over the course of 2 months. On admission, he underwent brain MRI which demonstrated three parietotemporal rim-enhancing lesions. Stereotactic aspiration revealed a dematiaceous mold on staining and the patient was treated with liposomal amphotericin B, 5-flucytosine, and posaconazole prior to culture confirmation. He ultimately required surgical excision of the brain abscesses and prolonged course of antifungal therapy, with clinical improvement. Conclusions Culture remains the gold standard for diagnosis of infection. Distinct microbiologic findings can aid in identification and guide antimicrobial therapy. While little guidance exists on treatment, patients have had favorable outcomes with surgery and combination antifungal therapy. In improving awareness, clinicians may accurately diagnose disease and initiate appropriate therapy in a more timely manner.

scholarly journals Tuberculous brain abscess in a patient with AIDS: case report and literature review

2003 ◽  
Vol 45 (2) ◽  
pp. 111-114 ◽  
Author(s):  
José E. Vidal ◽  
Sérgio Cimerman ◽  
Paula R. Marques da Silva ◽  
Jaques Sztajnbok ◽  
João F.G.S. Coelho ◽  
...  
Keyword(s):  
Brain Abscess ◽  
Surgical Excision ◽  
Toxoplasmic Encephalitis ◽  
Surgical Approaches ◽  
Aids Patients ◽  
Stereotactic Aspiration ◽  
Antituberculous Treatment ◽  
Brain Abscesses ◽  
Tuberculous Brain Abscess ◽  
Tomography Scan

Tuberculous brain abscesses in AIDS patients are considered rare with only eight cases reported in the literature. We describe the case of a 34-year-old woman with AIDS and previous toxoplasmic encephalitis who was admitted due to headache and seizures. A brain computed tomography scan disclosed a frontal hypodense lesion with a contrast ring enhancement. Brain abscess was suspected and she underwent a lesion puncture through a trepanation. The material extracted was purulent and the acid-fast smear was markedly positive. Timely medical and surgical approaches allowed a good outcome. Tuberculous abscesses should be considered in the differential diagnosis of focal brain lesions in AIDS patients. Surgical excision or stereotactic aspiration, and antituberculous treatment are the mainstay in the management of these uncommon lesions.

Brain Abscess

2016 ◽  
Author(s):  
Sneha A. Chinai
Keyword(s):  
Brain Abscess ◽  
Signs And Symptoms ◽  
Surgical Excision ◽  
Needle Aspiration ◽  
Source Of Infection ◽  
Empiric Antibiotic ◽  
Life Threatening ◽  
Brain Abscesses ◽  
The Brain ◽  
Repeat Imaging

A brain abscess is a life-threatening infection within the brain that originates as cerebritis and evolves into an encapsulated collection of purulent material. Epidemiologically, brain abscesses are seen more frequently in immunocompromised patients. The signs and symptoms of a brain abscess are influenced by the location and size of the infection, the causative pathogen, and the patient’s immune status and medical comorbidities. This diagnosis requires neurosurgical consultation for management and inpatient admission. The majority of patients undergo either needle aspiration or surgical excision. This is critical for obtaining a specimen for culture in order to direct accurate and specific antimicrobial therapy. Needle aspiration is more commonly utilized and has a lower mortality rate than surgical excision. Repeat imaging is required for any change in mental status. Empiric antibiotic selections are guided by the most likely source of infection and are adjusted for renal function.

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.

Cerebral Abscess Caused by Listeria monocytogenes: Case Report and Literature Review

2021 ◽  
Author(s):  
Debora Cipriani ◽  
Michael Trippel ◽  
Klaus-Jürgen Buttler ◽  
Eva Rohr ◽  
Dirk Wagner ◽  
...  
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Listeria Monocytogenes ◽  
Review Of The Literature ◽  
Case Presentation ◽  
Stereotactic Aspiration ◽  
Invasive Diseases ◽  
Immunosuppressed Patients ◽  
The Central Nervous System ◽  
Brain Abscesses

Abstract Background Listeria monocytogenes is an opportunistic gram-positive, facultative intracellular bacterium that causes invasive diseases mostly in pregnant women and immunosuppressed patients. Despite the predilection toward the central nervous system (CNS), it usually causes meningitis and meningoencephalitis, whereas brain abscesses are very uncommon. Case presentation We describe the case of a 69-year-old homeless patient with a brain abscess due to L. monocytogenes who was successfully treated surgically by a guided stereotactic aspiration and antibiotic therapy with ampicillin and gentamicin. Our patient was discharged after 4 weeks of therapy without neurologic deficits. Additionally, we provide a review of the literature of brain abscesses caused by L. monocytogenes. Conclusions This case highlights the need to drain cerebral abscesses and culture pus to correctly treat patients with antibiotics, especially given the high mortality rate of this infectious entity.

scholarly journals Glioblastoma Presenting Only as Cortical "Ribbon Sign" in the Early Stage: A Case Report and Literature Review

2020 ◽  
Author(s):  
Ji-ping Zhao ◽  
Chun-xiao Cui ◽  
Hao-zhi Lin ◽  
Chong-feng Duan ◽  
Lei Niu ◽  
...  
Keyword(s):  
Memory Impairment ◽  
Early Stage ◽  
Brain Mri ◽  
Lesion Area ◽  
Who Grade ◽  
Case Presentation ◽  
The Brain ◽  
Reaction Speed ◽  
Irregular Mass ◽  
Primary Malignant Brain Tumor

Abstract Background: Glioblastoma (GB) is the most common primary malignant brain tumor and occurs predominantly in the white matter of the brain. MRI often shows an irregular mass with uneven internal signals, necrosis, surrounding edema and a space-occupying effect. The malignant degree of GB is high, and it often relapses after surgery. Case presentation: A 66-year-old male patient was admitted to our hospital due to sudden left superior strabismus and convulsions . During the patient’s first hospitalization, MRI showed only an abnormal cortical signal, and the diagnosis was viral encephalitis.After the treatment of antiepileptic, antiviral and relieving brain edema, the patient was discharged. Seven months later, he was admitted to the hospital again because of memory impairment and slow reaction speed. MRI showed that there was an obvious mass in the original lesion area, and this was diagnosed as glioblastoma. Postoperative pathology confirmed glioblastoma (WHO) grade IV. Conclusions: The clinical diagnosis, treatment and imaging manifestations of this case of GB are reported as follows to improve understanding of this type of GB, which only has cortical abnormal signals in the early stage, to reduce misdiagnosis.

scholarly journals Nocardia farcinica Brain Abscess in a Multiple Myeloma Patient Treated with Proteasome Inhibitor: A Case Report and Review of the Literature

2021 ◽  
Vol 11 (9) ◽  
pp. 1204
Author(s):  
Nengwen Xu ◽  
Linjie Li ◽  
Wen Lei ◽  
Wenbin Qian
Keyword(s):  
Multiple Myeloma ◽  
Brain Abscess ◽  
Proteasome Inhibitor ◽  
Brain Mri ◽  
Myeloma Patient ◽  
Multiple Myeloma Patient ◽  
Nocardia Farcinica ◽  
Intracranial Lesions ◽  
Brain Abscesses ◽  
The Brain

Nocardia brain abscess is relatively rare, accounting for about 1–2% of all brain abscesses, and its mortality rate is three times higher than of other types of bacterial brain abscesses; thus, early diagnosis and treatment are essential. Nocardia brain abscess generally occurs in immunodeficient patients. We report a case of Nocardia farcinica brain abscess in a multiple myeloma patient treated with proteasome inhibitor (bortezomib and ixazomib), cyclophosphamide, and corticosteroid. The patient was treated with ceftriaxone and trimethoprim-sulfamethoxazole, together with drainage of the brain abscess. Regular brain MRI follow-ups showed that intracranial lesions were gradually absorbed and improved.

scholarly journals Content-Based Estimation of Brain MRI Tilt in Three Orthogonal Directions

2021 ◽  
Author(s):  
Pooja Prabhu ◽  
A. K. Karunakar ◽  
Sanjib Sinha ◽  
N. Mariyappa ◽  
G. K. Bhargava ◽  
...  
Keyword(s):  
Large Scale ◽  
Brain Mri ◽  
Similarity Measures ◽  
Principal Component ◽  
Brain Anatomy ◽  
Morphological Operations ◽  
Mr Images ◽  
Tilt Correction ◽  
Brain Mr Images ◽  
The Brain

AbstractIn a general scenario, the brain images acquired from magnetic resonance imaging (MRI) may experience tilt, distorting brain MR images. The tilt experienced by the brain MR images may result in misalignment during image registration for medical applications. Manually correcting (or estimating) the tilt on a large scale is time-consuming, expensive, and needs brain anatomy expertise. Thus, there is a need for an automatic way of performing tilt correction in three orthogonal directions (X, Y, Z). The proposed work aims to correct the tilt automatically by measuring the pitch angle, yaw angle, and roll angle in X-axis, Z-axis, and Y-axis, respectively. For correction of the tilt around the Z-axis (pointing to the superior direction), image processing techniques, principal component analysis, and similarity measures are used. Also, for correction of the tilt around the X-axis (pointing to the right direction), morphological operations, and tilt correction around the Y-axis (pointing to the anterior direction), orthogonal regression is used. The proposed approach was applied to adjust the tilt observed in the T1- and T2-weighted MR images. The simulation study with the proposed algorithm yielded an error of 0.40 ± 0.09°, and it outperformed the other existing studies. The tilt angle (in degrees) obtained is ranged from 6.2 ± 3.94, 2.35 ± 2.61, and 5 ± 4.36 in X-, Z-, and Y-directions, respectively, by using the proposed algorithm. The proposed work corrects the tilt more accurately and robustly when compared with existing studies.

scholarly journals Innumerable cerebral microbleeds in hepatitis B virus-related decompensated liver cirrhosis: a case report

BMC Neurology ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Chi Hyuk Oh ◽  
Jin San Lee
Keyword(s):  
Liver Cirrhosis ◽  
Hepatic Encephalopathy ◽  
Hepatitis B Virus ◽  
Hepatitis B ◽  
Brain Mri ◽  
Cerebral Microbleeds ◽  
Amyloid Angiopathy ◽  
Decompensated Liver Cirrhosis ◽  
B Virus ◽  
The Brain

Abstract Background Cerebral microbleeds (CMBs) are small, rounded, dark-signal lesions on brain MRI that represent cerebral hemosiderin deposits resulting from prior microhemorrhages and are neuroimaging biomarkers of cerebral amyloid angiopathy (CAA). Here, we report a case of innumerable CMBs in a patient with hepatic encephalopathy underlying decompensated liver cirrhosis. Case presentation An 83-year-old woman diagnosed with hepatitis B virus-related liver cirrhosis 40 years before was referred to our neurology clinic for progressive disorientation of time and place, personality changes, and confusion with somnolence over 2 weeks. Based on the laboratory, neuroimaging, and electrophysiological findings, we diagnosed the patient with hepatic encephalopathy, and her symptoms recovered within 12 h after proper medical management. Brain MRI showed innumerable CMBs in the bilateral frontal, parietal, temporal, and occipital lobes. Since the distribution of CMBs in the patient was mainly corticosubcortical and predominantly in the posterior cortical regions, and the apolipoprotein E genotype was ε4/ε4, we speculated that CAA and hepatic encephalopathy coexisted in this patient. Conclusions We suggest that severe liver dysfunction associated with long-term decompensated liver cirrhosis may be related to an increased number of CMBs in the brain. Our findings indicate that decompensated liver cirrhosis may be a risk factor for the development of CMBs and corroborate a link between the liver and the brain.

scholarly journals The pathophysiology of “happy” hypoglycemia

2021 ◽  
Vol 14 (1) ◽  
Author(s):  
Thomas Loeb ◽  
Anna Ozguler ◽  
Geraldine Baer ◽  
Michel Baer
Keyword(s):  
Critical Care ◽  
Hemorrhagic Shock ◽  
Lactate Production ◽  
Severe Hypoglycemia ◽  
Altered Mental Status ◽  
Case Presentation ◽  
Energy Substrate ◽  
Tissue Hypoperfusion ◽  
The Brain ◽  
Critical Care Patients

Abstract Background Hypoglycemia usually includes various neurological symptoms, which are the consequence of neuroglycopenia. When it is severe, it is associated with altered mental status, even coma. Case presentation We report the case of a patient with severe hypoglycemia, completely asymptomatic, due to the increase of lactate production in response to tissue hypoperfusion following a hemorrhagic shock. This illustrates that lactate can substitute glucose as an energy substrate for the brain. It is also a reminder that this metabolite, despite its bad reputation maintained by its role as a marker of severity in critical care patients, has a fundamental role in our metabolism. Conclusions Following the example of the “happy hypoxemia” recently reported in the literature describing asymptomatic hypoxemia in COVID-19 patients, we describe a case of “happy hypoglycemia.”

scholarly journals Pure Motor Stroke Secondary to Cerebral Infarction of Recurrent Artery of Heubner after Mild Head Trauma: A Case Report

2016 ◽  
Vol 4 (1) ◽  
pp. 139-141
Author(s):  
Ali Yilmaz ◽  
Zahir Kizilay ◽  
Ayca Ozkul ◽  
Bayram Çirak
Keyword(s):  
Ischemic Stroke ◽  
Head Trauma ◽  
Distal Part ◽  
Brain Mri ◽  
Artery Occlusion ◽  
Acute Ischemia ◽  
Post Traumatic ◽  
The Brain ◽  
Perforating Arteries ◽  
Pure Motor

BACKGROUND: The recurrent Heubner's artery is the distal part of the medial striate artery. Occlusion of the recurrent artery of Heubner, classically contralateral hemiparesis with fasciobrachiocrural predominance, is attributed to the occlusion of the recurrent artery of Heubner and is widely known as a stroke syndrome in adults. However, isolated occlusion of the deep perforating arteries following mild head trauma also occurs extremely rarely in childhood.CASE REPORT: Here we report the case of an 11-year-old boy with pure motor stroke. The brain MRI showed an acute ischemia in the recurrent artery of Heubner supply area following mild head trauma. His fasciobrachial hemiparesis and dysarthria were thought to be secondary to the stretching of deep perforating arteries leading to occlusion of the recurrent artery of Heubner.CONCLUSION: Post-traumatic pure motor ischemic stroke can be secondary to stretching of the deep perforating arteries especially in childhood.

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