scholarly journals Bacterial meningitis as a first presentation of pituitary macroprolactinoma

2014 ◽  
Vol 2014 ◽  
Author(s):  
Niki Margari ◽  
Simon Page
Keyword(s):  
Bacterial Meningitis ◽  
Dopamine Agonist ◽  
Pneumococcal Meningitis ◽  
Final Diagnosis ◽  
Favourable Outcome ◽  
List Type ◽  
Close Monitoring ◽  
Tissue Mass ◽  
Csf Leakage ◽  
The Brain

Summary A 56-year-old man was brought to the Emergency Department after being found collapsed at his office with a reduced level of consciousness. From clinical examination and initial investigations, he was diagnosed as having bacterial meningitis and was promptly commenced on empirical i.v. antibiotics. Computed tomography of the brain revealed a parenchymal mass at the base of the skull and subsequent magnetic resonance imaging of the head 4 days later confirmed a large soft tissue mass, which extended through to the cavernous sinus. Examination of the cerebrospinal fluid (CSF) following lumbar puncture confirmed pneumococcal meningitis and antibiotics were continued for 2 weeks in total. During the admission, hormone profiling revealed a grossly elevated prolactin. When coupled with the initial results of the brain imaging, this result helped to confirm a macroprolactinoma that was invading the postnasal space. A final diagnosis of pneumococcal meningitis secondary to invading prolactinoma was made. The patient was started on cabergoline and was followed up in the outpatient clinic upon discharge. He made a full recovery from the meningitis. Over the next few months, prolactin levels returned to be normal and the prolactinoma shrank significantly in size. The patient remains on cabergoline that will most likely be continued indefinitely. Learning points Bacterial meningitis is a rare first presentation of pituitary macroprolactinoma. Patients with invasive macroprolactinoma do not always present with CSF leakage. Prompt treatment with antibiotics and a dopamine agonist is of great importance for a favourable outcome. Close monitoring of the patient for signs of raised intracranial pressure is essential in the management of macroprolactinoma. Note the risk of CSF leakage after initiation of dopamine agonist therapy irrespective of concomitant meningitis in macroprolactinoma.

scholarly journals Triptans Reduce the Inflammatory Response in Bacterial Meningitis

2002 ◽  
Vol 22 (8) ◽  
pp. 988-996 ◽  
Author(s):  
Olaf Hoffmann ◽  
Nikolas Keilwerth ◽  
Margarethe Bastholm Bille ◽  
Uwe Reuter ◽  
Klemens Angstwurm ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Bacterial Meningitis ◽  
Pneumococcal Meningitis ◽  
Clinical Score ◽  
Nerve Fibers ◽  
Adjunctive Treatment ◽  
Calcitonin Gene ◽  
The Brain ◽  
Meningeal Nociception ◽  
Brain Water

Severe headache and meningism provide clear evidence for the activation of trigeminal neurotransmission in meningitis. The authors assessed the antiinflammatory potential of 5HT1B/D/F receptor agonists (triptans), which inhibit the release of proinflammatory neuropeptides from perivascular nerve fibers. In a 6-hour rat model of pneumococcal meningitis, zolmitriptan and naratriptan reduced the influx of leukocytes into the cerebrospinal fluid, and attenuated the increase of regional cerebral blood flow. Elevated intracranial pressure as well as the brain water content at 6 hours was reduced by triptans. These effects were partially reversed by a specific 5HT1D as well as by a specific 5HT1B receptor antagonist. Meningitis caused a depletion of calcitonin gene-related peptide (CGRP) and substance P from meningeal nerve fibers, which was prevented by zolmitriptan and naratriptan. In line with these findings, patients with bacterial meningitis had significantly elevated CGRP levels in the cerebrospinal fluid. In a mouse model of pneumococcal meningitis, survival and clinical score at 24 hours were significantly improved by triptan treatment. The findings suggest that, besides mediating meningeal nociception, meningeal nerve fibers contribute to the inflammatory cascade in the early phase of bacterial meningitis. Adjunctive treatment with triptans may open a new therapeutic approach in the acute phase of bacterial meningitis.

scholarly journals Musculoskeletal Soft-Tissue Sarcoma: Quality Assessment of Initial MRI Reports Shows Frequent Deviation from ESSR Guidelines

Diagnostics ◽  
2021 ◽  
Vol 11 (4) ◽  
pp. 695
Author(s):  
Sebastian Weiss ◽  
Alexander Korthaus ◽  
Nora Baumann ◽  
Jin Yamamura ◽  
Alexander S. Spiro ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Soft Tissue Sarcomas ◽  
Quality Criteria ◽  
Final Diagnosis ◽  
Tissue Mass ◽  
Musculoskeletal Radiology ◽  
Radiology Reports ◽  
Patients At Risk ◽  
Magnetic Resonance Imaging Mri ◽  
The Masses

Soft-tissue sarcomas (STS) are a rare subtype of soft-tissue mass and are frequently misinterpreted as benign lesions. Magnetic resonance imaging (MRI) is the primary recommended type of diagnostics. To assess the quality of primary radiology reports, we investigated whether recommended MRI report elements were included in compliance with European Society of Musculoskeletal Radiology (ESSR) guidelines. A total of 1107 patients were evaluated retrospectively, and 126 radiological reports on patients with malignant STS were assessed for ESSR quality criteria. One or more required sequences or planes were missing in 67% of the reports. In all 126 cases, the report recognized the mass as anomalous (100%). Sixty-eight percent of the reports mentioned signs of malignancy. The majority of reports (n = 109, 87%) articulated a suspected diagnosis, 32 of which showed a mismatch with the final diagnosis (25%). Thirty-two percent of the reports had a misinterpretation of the masses as benign. Benign misinterpretations were more common in masses smaller than 5 cm (65% vs. 27%). Thirty percent of the reports suggested tissue biopsy and 6% recommended referral to a sarcoma center. MRI reports showed frequent deviations from ESSR guidelines, and protocol guidelines were not routinely met. Deviations from standard protocol and reporting guidelines could put patients at risk for inadequate therapy.

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

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.

scholarly journals Inhibition of Leukocyte Entry into the Brain by the Selectin Blocker Fucoidin Decreases Interleukin-1 (IL-1) Levels but Increases IL-8 Levels in Cerebrospinal Fluid during Experimental Pneumococcal Meningitis in Rabbits

2000 ◽  
Vol 68 (6) ◽  
pp. 3153-3157 ◽  
Author(s):  
Christian Østergaard ◽  
Runa Vavia Yieng-Kow ◽  
Thomas Benfield ◽  
Niels Frimodt-Møller ◽  
Frank Espersen ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Pneumococcal Meningitis ◽  
Interleukin 1 ◽  
Treated Group ◽  
Control Group ◽  
Necrosis Factor Alpha ◽  
Tnf Α ◽  
Significant Difference ◽  
The Brain ◽  
Experimental Pneumococcal Meningitis

ABSTRACT The polysaccharide fucoidin is a selectin blocker that inhibits leukocyte recruitment into the cerebrospinal fluid (CSF) during experimental pneumococcal meningitis. In the present study, the effect of fucoidin treatment on the release of the proinflammatory cytokines tumor necrosis factor alpha (TNF-α), interleukin-1 (IL-1), and IL-8 into the CSF was investigated. Rabbits (n = 7) were treated intravenously with 10 mg of fucoidin/kg of body weight every second hour starting 4 h after intracisternal inoculation of ∼106 CFU of Streptococcus pneumoniae type 3 (untreated control group, n = 7). CSF samples were obtained every second hour during a 16-h study period. Treatment with fucoidin caused a consistent and significant decrease in CSF IL-1 levels (in picograms per milliliter) between 12 and 16 h (0 versus 170, 0 versus 526, and 60 versus 1,467, respectively;P < 0.02). A less consistent decrease in CSF TNF-α levels was observed in the fucoidin-treated group, but with no significant difference between the two groups (P > 0.05). In contrast, there was no attenuation in CSF IL-8 levels. Indeed, there was a significant increase in CSF IL-8 levels (in picograms per milliliter) in the fucoidin-treated group at 10 and 12 h (921 versus 574 and 1,397 versus 569, respectively;P < 0.09). In conclusion, our results suggest that blood-derived leukocytes mainly are responsible for the release of IL-1 and to some degree TNF-α into the CSF during pneumococcal meningitis, whereas IL-8 may be produced by local cells within the brain.

Lumbar Puncture in Pediatric Bacterial Meningitis: Defining the Time Interval for Recovery of Cerebrospinal Fluid Pathogens After Parenteral Antibiotic Pretreatment

PEDIATRICS ◽  
2001 ◽  
Vol 108 (5) ◽  
pp. 1169-1174 ◽  
Author(s):  
John T. Kanegaye ◽  
Peyman Soliemanzadeh ◽  
John S. Bradley
Keyword(s):  
Cerebrospinal Fluid ◽  
Bacterial Meningitis ◽  
Laboratory Data ◽  
Final Diagnosis ◽  
Prolonged Treatment ◽  
Time Interval ◽  
Antibiotic Administration ◽  
Parenteral Antibiotic ◽  
Culture Material ◽  
Before And After

Objective. Despite the lack of evidence defining a time interval during which cerebrospinal fluid (CSF) culture yield will not be affected by previous antibiotic therapy, recent publications cite a “minimum window” of 2 to 3 hours for recovery of bacterial pathogens after parenteral antibiotic administration. We conducted a retrospective review of children with bacterial meningitis to describe the rate at which parenteral antibiotic pretreatment sterilizes CSF cultures. Methods. The medical records of pediatric patients who were discharged from a tertiary children's hospital during a 5-year period with the final diagnosis of bacterial meningitis or suspected bacterial meningitis were reviewed. The decay in yield of CSF cultures over time was evaluated in patients with lumbar punctures (LP) delayed until after initiation of parenteral antibiotics and in patients with serial LPs before and after initiation of parenteral antibiotics. Results. The pathogens that infected the 128 study patients were Streptococcus pneumoniae (49),Neisseria meningitidis (37), group BStreptococcus (21), Haemophilus influenzae (8), other organisms (11), and undetermined (3). Thirty-nine patients (30%) had first LPs after initiation of parenteral antibiotics, and 55 (43%) had serial LPs before and after initiation of parenteral antibiotics. After ≥50 mg/kg of a third-generation cephalosporin, 3 of 9 LPs in meningococcal meningitis were sterile within 1 hour, occurring as early as 15 minutes, and all were sterile by 2 hours. With pneumococcal disease, the first negative CSF culture occurred at 4.3 hours, with 5 of 7 cultures negative from 4 to 10 hours after initiation of parenteral antibiotics. Reduced susceptibility to β-lactam antibiotics occurred in 11 of 46 pneumococcal isolates. Group B streptococcal cultures were positive through the first 8 hours after parenteral antibiotics. Blood cultures were positive in 74% of cases without pretreatment and in 57% to 68% of cases with negative CSF cultures. Conclusions. The temptation to initiate antimicrobial therapy may override the principle of obtaining adequate pretreatment culture material. The present study demonstrates that CSF sterilization may occur more rapidly after initiation of parenteral antibiotics than previously suggested, with complete sterilization of meningococcus within 2 hours and the beginning of sterilization of pneumococcus by 4 hours into therapy. Lack of adequate culture material may result in inability to tailor therapy to antimicrobial susceptibility or in unnecessarily prolonged treatment if the clinical presentation and laboratory data cannot exclude the possibility of bacterial meningitis.

scholarly journals Intrauterine death following intraamniotic triiodothyronine and thyroxine therapy for fetal goitrous hypothyroidism associated with polyhydramnios and caused by a thyroglobulin mutation

2017 ◽  
Vol 2017 ◽  
Author(s):  
Pradeep Vasudevan ◽  
Corrina Powell ◽  
Adeline K Nicholas ◽  
Ian Scudamore ◽  
James Greening ◽  
...  
Keyword(s):  
Prenatal Diagnosis ◽  
Hormone Replacement ◽  
Favourable Outcome ◽  
Compound Heterozygous ◽  
Intrauterine Death ◽  
List Type ◽  
Loss Of Function ◽  
Respiratory Compromise ◽  
Mechanical Complications ◽  
Elective Delivery

Summary In the absence of maternal thyroid disease or iodine deficiency, fetal goitre is rare and usually attributable to dyshormonogenesis, for which genetic ascertainment is not always undertaken in the UK. Mechanical complications include tracheal and oesophageal compression with resultant polyhydramnios, malpresentation at delivery and neonatal respiratory distress. We report an Indian kindred in which the proband (first-born son) had congenital hypothyroidism (CH) without obvious neonatal goitre. His mother’s second pregnancy was complicated by fetal hypothyroid goitre and polyhydramnios, prompting amniotic fluid drainage and intraamniotic therapy (with liothyronine, T3 and levothyroxine, T4). Sadly, intrauterine death occurred at 31 weeks. Genetic studies in the proband demonstrated compound heterozygous novel (c.5178delT, p.A1727Hfs*26) and previously described (c.7123G > A, p.G2375R) thyroglobulin (TG) mutations which are the likely cause of fetal goitre in the deceased sibling. TG mutations rarely cause fetal goitre, and management remains controversial due to the potential complications of intrauterine therapy however an amelioration in goitre size may be achieved with intraamniotic T4, and intraamniotic T3/T4 combination has achieved a favourable outcome in one case. A conservative approach, with surveillance, elective delivery and commencement of levothyroxine neonatally may also be justified, although intubation may be required post delivery for respiratory obstruction. Our observations highlight the lethality which may be associated with fetal goitre. Additionally, although this complication may recur in successive pregnancies, our case highlights the possibility of discordance for fetal goitre in siblings harbouring the same dyshormonogenesis-associated genetic mutations. Genetic ascertainment may facilitate prenatal diagnosis and assist management in familial cases. Learning points: CH due to biallelic, loss-of-function TG mutations is well-described and readily treatable in childhood however mechanical complications from associated fetal goitre may include polyhydramnios, neonatal respiratory compromise and neck hyperextension with dystocia complicating delivery. CH due to TG mutations may manifest with variable phenotypes, even within the same kindred. Treatment options for hypothyroid dyshormogenic fetal goitre in a euthyroid mother include intraamniotic thyroid hormone replacement in cases with polyhydramnios or significant tracheal obstruction. Alternatively, cases may be managed conservatively with radiological surveillance, elective delivery and neonatal levothyroxine treatment, although intubation and ventilation may be required to support neonatal respiratory compromise. Genetic ascertainment in such kindreds may enable prenatal diagnosis and anticipatory planning for antenatal management of further affected offspring.

Evaluation of Fibrin Sealants for Central Nervous System Sealing in the Mongrel Dog Durotomy Model

Neurosurgery ◽  
2011 ◽  
Vol 69 (4) ◽  
pp. 921-929 ◽  
Author(s):  
Richard W Hutchinson ◽  
Vince Mendenhall ◽  
Randolph M Abutin ◽  
Tim Muench ◽  
James Hart
Keyword(s):  
Fibrin Sealant ◽  
Tissue Response ◽  
Neurosurgical Procedures ◽  
Fibrin Sealants ◽  
Csf Leakage ◽  
Mongrel Dog ◽  
Tissue Changes ◽  
Foamy Macrophages ◽  
The Brain

Abstract BACKGROUND: Watertight repair of the dura is imperative after neurosurgical procedures involving the brain or spinal cord because inadequately treated leakage of cerebrospinal fluid (CSF) from punctured dura can have serious consequences such as meningitis, arachnoiditis, or epidural abscess. OBJECTIVE: To assess the efficacy of Evicel Fibrin Sealant (Human) to prevent CSF leakage using a 2.0-cm durotomy mongrel dog repair model and to compare the tissue response with Tisseel (a fibrin sealant) and Duraseal (a synthetic polyethylene glycol [PEG] hydrogel sealant). METHODS: The canine durotomy repair model was used. This well-characterized model assesses the ability of sealants to achieve intraoperative watertight seals of the dura mater, as well as long-term safety and efficacy. This study included 27 mongrel dogs and had a 28-day duration. RESULTS: The 3 sealants were 100% effective in preventing CSF leakage intraoperatively at 15 mm Hg. The 2 fibrin sealants were 100% effective in postoperative sealing; the PEG hydrogel was not. Microscopically, the tissue changes induced by Evicel at the durotomy site were similar in nature except for foamy macrophages seen only with the PEG hydrogel. The extent and severity of adhesions at 28 days were less with the fibrin sealants than with the PEG hydrogel. CONCLUSION: Evicel, a fibrin sealant, was safe and effective in achieving and maintaining a watertight seal of the dura. The performance of the fibrin sealants was similar to that of the synthetic PEG hydrogel sealant with the exception of a Duraseal seal, which leaked.

scholarly journals Giant jejunal gasto-intestinal stromal tumor: A rare cause of abdominal mass in an elderly female

2021 ◽  
Vol 1 (2) ◽  
pp. 65-67
Author(s):  
AC Diallo ◽  
A Ndong ◽  
I Niang ◽  
MB Ba ◽  
JA Thiam ◽  
...  
Keyword(s):  
Abdominal Mass ◽  
Pelvic Mass ◽  
Final Diagnosis ◽  
Progressive Increase ◽  
Stromal Tumor ◽  
Biological Assessment ◽  
Pathological Examination ◽  
Tissue Mass ◽  
Surgical Specimen ◽  
One Year

OBJECTIVE: We report the case of a patient presenting an abdominal mass whose final diagnosis is a gastrointestinal stromal tumor (GIST). CLINICAL OBSERVATION: It was a 61-year-old patient with no pathological history received for a progressive increase in the volume of the abdomen evolving for one year and painless. On examination, the patient was in good general condition, with normal patterns. There was an abdomino-pelvic mass of about 20 cm long axis, mobile. The rest of the exam was unremarkable. The biological assessment was normal. Abdominopelvic computed tomography revealed a tissue mass with necrosis. During the surgical exploration, a mass developed on the mesenteric border 45 cm from the Treitz angle was noted. It is not associated with ascites or peritoneal carcinoma. Bowel resection removing the mass was performed followed by end-to-end anastomosis. Pathological examination of the surgical specimen diagnosed GIST. The postoperative course at three months was excellent both clinically and radiologically. CONCLUSION: The case that we report underlines the possible jejunal localization of GIST and the clinical presentation may be usual. It also shows the difficulty of obtaining a preoperative diagnosis and the central role of surgery in management.

scholarly journals A case of pneumococcal meningitis in infant resulting in unmanageable brain edema with dislocation of the brain stem

2017 ◽  
pp. 193-197
Author(s):  
E. V. Melekhina ◽  
E. N. Velikanova ◽  
V. I. Barykin ◽  
I. S. Korolyova ◽  
A. V. Gorelov
Keyword(s):  
Brain Stem ◽  
Brain Edema ◽  
Pneumococcal Meningitis ◽  
The Brain
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