scholarly journals Intramedullary abscess associated with acute bacterial meningitis: a case report and review of the literature

2020 ◽  
Vol 10 (3) ◽  
pp. 120-123
Author(s):  
Marouane Hammoud ◽  
Fayçal Lakhdar ◽  
Mohammed Benzagmout ◽  
Khalid Chakour, ◽  
Mohammed El Faiz Chaou
Keyword(s):  
Spinal Cord ◽  
Bacterial Meningitis ◽  
Antibiotic Therapy ◽  
Contralateral Side ◽  
Acute Bacterial Meningitis ◽  
Intramedullary Spinal Cord ◽  
Intramedullary Abscess ◽  
Threatening Condition ◽  
Life Threatening ◽  
The Central Nervous System

Intramedullary spinal cord abscess (ISCA) is a rare infection of the central nervous system. Untreated, it may result in significant morbidity and mortality. We describe the case of a 34-year-old man, who initially was admitted for bacterial meningitis. 3 days after initiation of antibiotic therapy, a gradually and progressive weakness appeared on the left side of his body with numbness on the contralateral side. MRI of the spine demonstrated an ISCA at level of C4. A myelotomy and surgical drainage was performed. Postoperatively, the patient had improved significantly his neurological deficit. ISCA is still a life-threatening condition, we point out that the diagnosis should be highly suspected, if a cystic spinal cord lesion is surrounded by significant medullar edema associated with fast onset of symptoms, especially in a context of sepsis or acuate meningitis. Prompt surgical evacuation followed by adequate antibiotic therapy, are the mainstays of treatment.

Meningitis in service-age personnel

2015 ◽  
Vol 101 (1) ◽  
pp. 63-68
Author(s):  
R Miller ◽  
K Houlberg
Keyword(s):  
Bacterial Meningitis ◽  
Case Fatality ◽  
Acute Bacterial Meningitis ◽  
Operational Environment ◽  
Bacterial Strains ◽  
Threatening Condition ◽  
Life Threatening ◽  
Classical Triad ◽  
The Uk ◽  
Medical Advances

AbstractThe incidence of meningitis is declining in the UK population largely due to increased availability of vaccinations against the most common bacterial strains. Acute bacterial meningitis, however, is a life-threatening condition and distinguishing it from more benign causes of headache and fever is difficult in an operational environment due to limited access to diagnostic tests. Despite medical advances, the case fatality rate in the United Kingdom in adults with invasive meningococcal disease is 10.5%. Acute bacterial meningitis presents with the classical triad of fever, neck pain and altered mental state in less than half of adults, and in the initial course of the disease it frequently mimics common viral illnesses. The aim of this article is to discuss the recognition and management of meningitis with special emphasis on the deployed military environment.

INTRAMEDULLARY ABSCESS OF THE SPINAL CORD

2002 ◽  
Vol 06 (02) ◽  
pp. 127-130
Author(s):  
Osman Acar ◽  
Önder Güney ◽  
Yalçin Kocaoğullar
Keyword(s):  
Spinal Cord ◽  
Antibiotic Therapy ◽  
Rare Case ◽  
Surgical Drainage ◽  
Intramedullary Spinal Cord ◽  
Intramedullary Abscess ◽  
Intramedullary Spinal Cord Abscess

We report a rare case of intramedullary spinal cord abscess. The patient was operated on by surgical drainage and appropriate antibiotic therapy. Improvement was seen postoperatively. Significant changes in the presentation, management, and outcome in these more recent cases are emphasized.

scholarly journals Genomic Landscape of Intramedullary Spinal Cord Tumors Suggests Distinct Genetic Origins Compared to Intracranial Histopathologic Counterparts

Neurosurgery ◽  
2019 ◽  
Vol 66 (Supplement_1) ◽  
Author(s):  
Tej D Azad ◽  
Ming Zhang ◽  
Rajiv Iyer ◽  
Qing Wang ◽  
Tomas Garzon-Muvdi ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Whole Genome Sequencing ◽  
Genome Sequencing ◽  
Treatment Options ◽  
Driver Mutations ◽  
Whole Genome ◽  
Spinal Cord Tumors ◽  
Intramedullary Spinal Cord ◽  
Molecular Features ◽  
The Central Nervous System

Abstract INTRODUCTION Intramedullary spinal cord tumors (IMSCTs) are a rare, heterogeneous group of neoplasms with limited treatment options and high rates of morbidity and mortality. Next-generation sequencing has revealed opportunities for targeted therapies of the intracranial counterparts of IMSCT, but little is known about the molecular features of IMSCT. METHODS To better understand the genetic basis of these tumors we performed whole exome sequencing on fifty-one IMSCT and matched germline DNA, including 29 ependymomas, 16 astrocytomas, 4 gangliogliomas,1hemangioblastoma, and 1 oligodendroglioma. Whole-genome sequencing was further performed on 12 IMSCT to discover possible structural variants. RESULTS Though recurrent somatic mutations in IMSCTs were rare, we identified NF2 mutations in 15.7% of tumors (ependymoma, N = 7; astrocytoma, N = 1), RP1 mutations in 5.9% of tumors (ependymoma, N = 3), and ESX1 mutations in 5.9% of tumors (ependymoma, N = 3). We further identified copy number amplifications in CTU1 in 25% of myxopapillary ependymomas. Given the paucity of somatic driver mutations, we further performed whole-genome sequencing of 12 tumors (ependymoma, N = 9; astrocytoma, N = 3). Overall, we observed that IMSCTs with intracranial histologic counterparts did not harbor the canonical mutations associated with their intracranial counterparts (eg glioblastoma). CONCLUSION Our findings suggest that the origin of IMSCTs may be distinct from tumors arising within other compartments of the central nervous system and provides a framework to begin more biologically based therapeutic strategies.

scholarly journals Effect of Antibiotic Pretreatment on Cerebrospinal Fluid Profiles of Children with Acute Bacterial Meningitis

2013 ◽  
Vol 2 (2) ◽  
pp. 135-139 ◽  
Author(s):  
S Adhikari ◽  
E Gauchan ◽  
G BK ◽  
KS Rao
Keyword(s):  
Cerebrospinal Fluid ◽  
Bacterial Meningitis ◽  
Antibiotic Therapy ◽  
Lumbar Puncture ◽  
Laboratory Finding ◽  
Clinical Findings ◽  
Acute Bacterial Meningitis ◽  
Antibiotic Administration ◽  
Intravenous Antibiotic ◽  
Considerable Difficulty

Background: Analysis of cerebrospinal fluid is gold standard for diagnosis of meningitis. There is considerable difficulty in interpreting laboratory finding after prior antibiotic therapy. This study was conducted to evaluate the effect of intravenous antibiotic administration before lumbar puncture on cerebrospinal fluid profiles in children with bacterial meningitis. Methods: A hospital based retrospective study carried out using the data retrieved from the medical record department of Manipal Teaching Hospital Pokhara, Nepal; from 1st July 2006 to 31st July 2011. Clinical findings and relevant investigations were entered in a predesigned proforma. Patients were divided in two different groups as bacterial meningitis with and without prior intravenous antibiotic therapy. Various laboratory parameters including CSF were compared between these two groups using the statistical software, SPSS version 18.0. Results: A total of 114 children were included in this study among which 49(43%) children had received intravenous antibiotics before lumbar puncture. Mean CSF WBC count was(267.6± 211 vs. 208.1±125.3.3) and protein level (114.1±65.9 vs. 98.3±37.7mg/dl) in untreated vs. pretreated groups respectively. Neutrophil percentage was decreased (57.1±28.1vs.72.9±18.9) with higher CSF sugar level (43.3±11.8 vs. 51.2±13.2) after prior antibiotics therapy (p<0.001). Conclusion: Antibiotic pretreatment was associated with higher cerebrospinal fluid glucose levels with decreased neutrophils and increased lymphocytes. Pretreatment did not modify total cerebrospinal fluid white blood cell count and cerebrospinal fluid protein levels. Nepal Journal of Medical Sciences | Volume 02 | Number 02 | July-December 2013 | Page 135-139 DOI: http://dx.doi.org/10.3126/njms.v2i2.8963

Intramedullary Spinal Cord Abscess

Neurosurgery ◽  
1990 ◽  
Vol 26 (1) ◽  
pp. 145-146 ◽  
Author(s):  
Barbara S. Koppel ◽  
Michael Daras ◽  
Kent R. Duffy
Keyword(s):  
Spinal Cord ◽  
Intravenous Drug User ◽  
Intravenous Drug ◽  
Drug Abusers ◽  
Pseudomonas Cepacia ◽  
Intramedullary Spinal Cord ◽  
Intramedullary Abscess ◽  
History Of ◽  
Intramedullary Spinal Cord Abscess ◽  
High Index Of Suspicion

Abstract Viral myelitis and bacterial epidural infections are common in intravenous drug abusers, but primary infections of the spinal cord are extremely rare. We report a 50-year-old active intravenous drug user who developed tetraplegia from an intramedullary abscess caused by Pseudomonas cepacia. Despite neurosurgical drainage and appropriate antibiotic therapy, no improvement was seen. Earlier intervention and a high index of suspicion is required in patients with a history of intravenous drug abuse and spinal cord symptoms. (Neurosurgery 26:145-146, 1990)

Management of meningitis and encephalitis in the critically ill

2016 ◽  
Author(s):  
Simon Nadel ◽  
Johnny Canlas
Keyword(s):  
Bacterial Meningitis ◽  
Care Setting ◽  
Antimicrobial Agents ◽  
Acute Bacterial Meningitis ◽  
Supportive Treatment ◽  
Intensive Care Setting ◽  
Vaccine Research ◽  
Common Causes ◽  
Life Threatening ◽  
The Common

Management of CNS infections requires specific antimicrobial agents, as well as specific supportive treatment targeted at reducing raised intracranial pressure and other life-threatening complications. It is important that the need for management in an intensive care setting is considered early in the illness. Antibiotic resistance amongst the most common organisms causing bacterial meningitis is becoming more common and antibiotic therapy should be adjusted accordingly. Anti-inflammatory treatment such as steroids should be started as soon as possible in patients with proven acute bacterial meningitis. Optimally, this should be before or with the first dose of antibiotics. Vaccine research is progressing so that effective vaccines should be available in the future against all the common causes of bacterial meningitis and encephalitis, including Neisseria meningitidis serogroup b.

scholarly journals Serotonin Syndrome in the Setting of Lamotrigine, Aripiprazole, and Cocaine Use

2015 ◽  
Vol 2015 ◽  
pp. 1-3 ◽  
Author(s):  
Anupam Kotwal ◽  
Sarah L. Cutrona
Keyword(s):  
Cocaine Abuse ◽  
Serotonin Syndrome ◽  
Pharmacodynamic Interactions ◽  
Serotonergic Activity ◽  
Threatening Condition ◽  
Neuromuscular Abnormalities ◽  
Life Threatening ◽  
The Central Nervous System ◽  
Autonomic Hyperactivity ◽  
Toxicity Criteria

Serotonin syndrome is a potentially life-threatening condition associated with increased serotonergic activity in the central nervous system. It is classically associated with the simultaneous administration of two serotonergic agents, but it can occur after initiation of a single serotonergic drug or increasing the dose of a serotonergic drug in individuals who are particularly sensitive to serotonin. We describe a case of serotonin syndrome that occurred after ingestion of higher than prescribed doses of lamotrigine and aripiprazole, in addition to cocaine abuse. The diagnosis was established based on Hunter toxicity criteria and severity was classified as mild. The features of this syndrome resolved shortly after discontinuation of the offending agents. Serotonin syndrome is characterized by mental status changes, autonomic hyperactivity, and neuromuscular abnormalities along a spectrum ranging from mild to severe. Serotonin syndrome in our patient was most likely caused by the pharmacokinetic and pharmacodynamic interactions between lamotrigine, aripiprazole, and cocaine leading to increased CNS serotonergic activity.

Nonenhancing tumors of the spinal cord

2007 ◽  
Vol 7 (4) ◽  
pp. 403-407 ◽  
Author(s):  
J. Bradley White ◽  
Gary M. Miller ◽  
Kennith F. Layton ◽  
William E. Krauss
Keyword(s):  
Spinal Cord ◽  
Common Finding ◽  
Subtotal Resection ◽  
Low Grade ◽  
Spinal Cord Tumors ◽  
Intramedullary Tumors ◽  
Intramedullary Spinal Cord ◽  
Tumor Invasiveness ◽  
The Central Nervous System ◽  
Tumor Types

Object Enhancement of pathological entities in the central nervous system is a common finding when the blood–brain barrier has been compromised. In the brain, the presence or absence of gadolinium enhancement is often an indicator of tumor invasiveness and/or grade. In the spinal cord, however, contrast enhancement has been shown in all tumor types, regardless of grade. In this study the authors explore the incidence of nonenhancing tumors of the spinal cord and the clinical course of patients with these lesions. Methods A retrospective analysis was conducted in which investigators examined the patterns of enhancement of histologically proven intramedullary spinal cord tumors that had been evaluated at the Mayo Clinic between 1998 and 2002. The tumors that did not enhance were the subject of this report. Results A total of 130 patients with intramedullary tumors were evaluated. Of those, 11 patients (9%) had tumors that did not enhance. Histologically, a majority of tumors were astrocytomas (eight low-grade and two high-grade lesions); one tumor was a subependymoma. Morphologically, most of the tumors were diffuse and none had associated cysts. Tumors spanned from two to seven levels and were located throughout the spinal cord (four cervical, three cervicothoracic, one thoracic, and three thoracolumbar). Biopsy procedures were performed in eight patients, subtotal resection was performed in two, and gross-total resection in one. After a mean follow-up period of 19 months, tumors remained stable in eight patients but progressed in three, two of whom died. Conclusions A number of intramedullary spinal cord tumors will not enhance after addition of contrast agents. The absence of enhancement does not imply the absence of tumor.

scholarly journals Intramedullary Spinal Cord Abscess Treated With Antibiotic Therapy

2009 ◽  
Vol 49 (6) ◽  
pp. 262-268 ◽  
Author(s):  
Noriaki KURITA ◽  
Yasuhisa SAKURAI ◽  
Makoto TANIGUCHI ◽  
Toru TERAO ◽  
Hiroshi TAKAHASHI ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Antibiotic Therapy ◽  
Intramedullary Spinal Cord ◽  
Intramedullary Spinal Cord Abscess

Intramedullary spinal cord metastasis

1985 ◽  
Vol 62 (2) ◽  
pp. 227-233 ◽  
Author(s):  
Donal A. Costigan ◽  
Marc D. Winkelman
Keyword(s):  
Spinal Cord ◽  
Metastatic Tumor ◽  
Leptomeningeal Carcinomatosis ◽  
The Other ◽  
Autopsy Study ◽  
Intramedullary Spinal Cord ◽  
Content Type ◽  
The Central Nervous System ◽  
Spinal Cord Metastasis ◽  
Intramedullary Spinal Cord Metastasis

✓ A retrospective autopsy study of 627 patients with systemic cancer disclosed 153 patients with metastasis to the central nervous system (CNS) and 13 patients with intramedullary spinal cord metastasis (ISM). Thus, the frequency of ISM was 8.5% of cases of metastasis to the CNS and 2.1% of all cases of cancer. Bronchogenic carcinoma accounted for 11 cases of ISM, and breast carcinoma and melanoma for the other two. There were two distinct patterns of spinal cord involvement, indicating spread of tumor to the cord by two different routes. In nine of the 13 ISM patients a metastasis was found deep within the spinal cord, unassociated with leptomeningeal carcinomatosis; this most likely resulted from hematogenous spread of tumor from a pulmonary source. In the other four patients there was focal or multifocal direct extension of leptomeningeal metastatic tumor across the pia into the parenchyma of the cord. Only four of the 13 patients had a clinical myelopathy; in three of these four this was the presenting feature of an occult lung cancer.

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