scholarly journals Gummatous neurosyphilis in an elderly patient in the Australian outback: a case report

2021 ◽  
Vol 15 (1) ◽  
Author(s):  
Nilesh Anand Devanand ◽  
Krishnaswamy Sundararajan
Keyword(s):  
Cerebrospinal Fluid ◽  
Clinical Symptoms ◽  
Venereal Disease ◽  
Treponema Pallidum ◽  
The Elderly ◽  
Cognitive Improvement ◽  
Tabes Dorsalis ◽  
Cerebrospinal Fluid Examination ◽  
High Index Of Suspicion ◽  
Bilateral Deafness

Abstract Introduction Neurosyphilis is an infection caused by the spirochete Treponema pallidum, which causes infiltration and thickening of brain meninges. Despite being an Old World disease, the rates of infection continue to rise. This clinical challenge involves early and accurate diagnosis, as neurosyphilis masquerades with various clinical symptoms and is often missed during initial presentation to the hospital. A comprehensive history and clinical examination are essential to detect suspicious cases early for further cerebrospinal fluid examination and neuroimaging. Patients treated with benzylpenicillin for a specific duration often show promising clinical and cognitive improvement, thus emphasizing the need for constant vigilance in our day-to-day practice. Case presentation A 77-year-old Caucasian gentleman presented to our hospital repeatedly with multiple episodes of presyncope and cognitive impairment. He also demonstrated bilateral deafness, tabes dorsalis, and left sixth cranial nerve palsy. His cerebrospinal fluid examination showed a nonreactive venereal disease research laboratory test, and magnetic resonance imaging of the brain revealed a gumma. Conclusion The diagnosis of neurosyphilis in the elderly requires a combination of clinical vigilance and a high index of suspicion, along with multimodal investigations, including cerebrospinal fluid examination and brain imaging.

scholarly journals Cerebrospinal fluid examination may be useful in diagnosing neurosyphilis in asymptomatic HIV+ patients with syphilis

2016 ◽  
Vol 74 (2) ◽  
pp. 128-132 ◽  
Author(s):  
Ronald Salamano ◽  
Raquel Ballesté ◽  
Abayubá Perna ◽  
Natalia Rodriguez ◽  
Diego Lombardo ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Venereal Disease ◽  
Treponema Pallidum ◽  
Hiv Patients ◽  
Hemagglutination Assay ◽  
Protein Levels ◽  
Disease Research ◽  
Csf Analysis ◽  
High Degree ◽  
Asymptomatic Hiv

ABSTRACT Lumbar puncture in neurologically asymptomatic HIV+ patients is still under debate. There are different criteria for detecting neurosyphilis through cerebrospinal fluid (CSF), especially in cases that are negative through the Venereal Disease Research Laboratory (VDRL), regarding cellularity and protein content. However, a diagnosis of neurosyphilis can still exist despite negative VDRL. Treponema pallidum hemagglutination assay (TPHA) titers and application of the TPHA index in albumin and IgG improve the sensitivity, with a high degree of specificity. Thirty-two patients were selected for this study. VDRL was positive in five of them. The number of diagnoses reached 14 when the other techniques were added. It was not determined whether cellularity and increased protein levels were auxiliary tools in the diagnosis. According to our investigation, CSF analysis using the abovementioned techniques may be useful in diagnosing neurosyphilis in these patients.

scholarly journals A comparison of nontreponemal tests in cerebrospinal fluid for neurosyphilis diagnosis: equivalent detection of specific antibodies

2019 ◽  
Vol 77 (2) ◽  
pp. 91-95
Author(s):  
Isadora Versiani ◽  
Mauro Jorge Cabral-Castro ◽  
Marzia Puccioni-Sohler
Keyword(s):  
Cerebrospinal Fluid ◽  
Venereal Disease ◽  
Intraclass Correlation ◽  
Treponema Pallidum ◽  
Rapid Plasma Reagin ◽  
Transmitted Infection ◽  
Sexually Transmitted ◽  
Disease Research ◽  
The Central Nervous System ◽  
Absolute Agreement

ABSTRACT Syphilis is a re-emerging sexually-transmitted infection, caused by the spirochete Treponema pallidum, that may penetrate early into the central nervous system. The venereal disease research laboratory test (VDRL) on the cerebrospinal fluid (CSF) is the most widely used for neurosyphilis diagnosis. We evaluated the performance of two other nontreponemal tests (rapid plasma reagin [RPR] and unheated serum reagin [USR] tests) in comparison with the VDRL in CSF. Methods: We analyzed CSF samples from 120 individuals based on VDRL reactivity in the CSF and the clinical picture of neurosyphilis. Results: High inter-rater reliability was found among all three tests, with equivalent sensitivity and specificity. Intraclass correlation coefficient for absolute agreement was 1 for VDRL versus USR, 0.99 for VDRL versus RPR, and 0.99 for RPR versus USR. Conclusions: Rapid plasma reagin and unheated serum reagin tests were identified as excellent alternatives for neurosyphilis diagnosis.

Chapter 10: Diagnosis

2019 ◽  
Author(s):  
Gerhard Dobler
Keyword(s):  
Cerebrospinal Fluid ◽  
Viral Encephalitis ◽  
Clinical Symptoms ◽  
Serological Tests ◽  
Specific Antibodies ◽  
Cross Reactions ◽  
Neuro Imaging ◽  
Tbev Infection

• TBE appears with non-characteristic clinical symptoms, which cannot be distinguished from oth-er forms of viral encephalitis or other diseases. • Cerebrospinal fluid and neuro-imaging may give some evidence of TBE, but ultimately cannot confirm the diagnosis. • Thus, proving the diagnosis “TBE” necessarily requires confirmation of TBEV-infection by detec-tion of the virus or by demonstration of specific antibodies from serum and/or cerebrospinal fluid. • During the phase of clinic symptoms from the CNS, the TBEV can only rarely be detected in the cerebrospinal fluid of patients. • Most routinely used serological tests for diagnosing TBE (ELISA, HI, IFA) show cross reactions resulting from either Infection with other flaviviruses or with other flavivirus vaccines.

Chapter 10: Diagnosis

2020 ◽  
Keyword(s):  
Cerebrospinal Fluid ◽  
Viral Encephalitis ◽  
Clinical Symptoms ◽  
Serological Tests ◽  
Specific Antibodies ◽  
Cross Reactions ◽  
Neuro Imaging ◽  
Tbev Infection

TBE appears with non-characteristic clinical symptoms, which cannot be distinguished from other forms of viral encephalitis or other diseases. Cerebrospinal fluid and neuro-imaging may give some evidence of TBE, but ultimately cannot confirm the diagnosis. Thus, proving the diagnosis “TBE” necessarily requires confirmation of TBEV-infection by detection of the virus or by demonstration of specific antibodies from serum and/or cerebrospinal fluid. During the phase of clinic symptoms from the CNS, the TBEV can only rarely be detected in the cerebrospinal fluid of patients. Most routinely used serological tests for diagnosing TBE (ELISA, HI, IFA) show cross reactions resulting from either infection with other flaviviruses or with other flavivirus vaccines.

CASE REPORT: RARE FORM OF HIRSCHPRUNG’S DISEASE

2020 ◽  
Vol 30 (5) ◽  
pp. 82-84
Author(s):  
Ilja Skalskis
Keyword(s):  
Down Syndrome ◽  
Case Report ◽  
Clinical Symptoms ◽  
Hirschsprung Disease ◽  
Distal Colon ◽  
Total Colonic Aganglionosis ◽  
Sphincter Function ◽  
Anal Sphincter Function ◽  
History Of ◽  
High Index Of Suspicion

Hirschsprung disease (HD) is a developmental disorder characterized by the absence of ganglia in the distal colon, resulting in a functional obstruction. Incidence of total colonic aganglionosis (TCA) is 1 in 500 000 and it accounts for 5-10% of all cases of HD. HD should be suspected in patients with typical clinical symptoms and a high index of suspicion is appropriate for infants with a predisposing condition such as Down Syndrome (DS), or for those with a family history of HD. The treatment of choice for HD is surgical, such as Swenson, Soave, and Duhamel procedures. The goals are to resect the affected segment of the colon, bring the normal ganglionic bowel down close to the anus, and preserve internal anal sphincter function. We present a clinical case report of TCA in a child with Down syndrome (DS) and review of literature.

Diagnosis of neuroschistosomiasis by antibody specificity index and semi-quantitative real-time PCR from cerebrospinal fluid and serum

2014 ◽  
Vol 63 (2) ◽  
pp. 309-312 ◽  
Author(s):  
Georg Härter ◽  
Hagen Frickmann ◽  
Sebastian Zenk ◽  
Dominic Wichmann ◽  
Bettina Ammann ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Real Time ◽  
Real Time Pcr ◽  
Clinical Symptoms ◽  
Diagnostic Procedures ◽  
Lower Limbs ◽  
Antibody Specificity ◽  
Quantitative Real Time Pcr ◽  
Specific Antibodies ◽  
Routine Diagnosis

We describe the case of a 16-year-old German male expatriate from Ghana who presented with obstipation, dysuria, dysaesthesia of the gluteal region and the lower limbs, bilateral plantar hypaesthesia and paraesthesia without pareses. A serum–cerebrospinal fluid (CSF) Schistosoma spp. specific antibody specificity index of 3.1 was considered highly suggestive of intrathecal synthesis of anti-Schistosoma spp. specific antibodies, although standardization of this procedure has not previously been described. Diagnosis was confirmed by detection of Schistosoma DNA in CSF by semi-quantitative real-time PCR at 100-fold concentration compared with serum. Accordingly the two diagnostic procedures, which have not previously been applied for routine diagnosis, appear to be useful for the diagnosis of neuroschistosomiasis. Clinical symptoms resolved following anthelmintic and anti-inflammatory therapy.

scholarly journals Complications of Extended Endoscopic Endonasal Surgery in Elderly Patients

2018 ◽  
Vol 79 (S 03) ◽  
pp. S287-S288 ◽  
Author(s):  
Tyler Kenning ◽  
Carlos Pinheiro-Neto
Keyword(s):  
Cerebrospinal Fluid ◽  
Elderly Population ◽  
Operative Time ◽  
The Elderly ◽  
High Flow ◽  
Endoscopic Endonasal ◽  
Surgical Interventions ◽  
Perioperative Morbidity ◽  
Increased Risk ◽  
Cerebrospinal Fluid Leaks

AbstractExtended endoscopic endonasal procedures are not unique among surgical interventions in carrying increased risk in the elderly population. There are, however, components of the procedure, namely high-flow cerebrospinal fluid leaks, that do result in the potential for increased perioperative morbidity for these patients. We present the case of a 77-year-old male with a large invasive pituitary macroadenoma resected through a transplanum-transtuberculum-transsellar endonasal approach. A gross total resection was obtained with resolution of the patient's preoperative ophthalmologic deficits. One month postoperatively, the patient developed progressive lethargy and cranial imaging demonstrated a left convexity subacute subdural hematoma. This was evacuated through a twist drill craniostomy. Despite measures to limit the operative time of the initial endonasal procedure as well as the absence of a postoperative cerebrospinal fluid fistula, the patient still developed this complication. Along with more typical potential causes of postoperative decline following extended endonasal procedures, problems from high-flow intraoperative cerebrospinal fluid leaks alone can result in morbidity in the elderly population. This should be acknowledged preoperatively and a high suspicion should exist for the presence of intracranial hemorrhage in these patients with any postoperative deficits. Additional intraoperative measures can be utilized to minimize such risks.The link to the video can be found at: https://youtu.be/EkLmt2T8_UE.

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