Ocular Manifestations of Meningitis in Children

Introduction: Meningitis is the most common central nervous system disease affecting children leading to focal neurological deficits and various oculovisual anomalies including blindness in children. The objective of this study was to evaluate the oculovisual anomalies occurring in Nepalese children suffering from different types of bacterial meningitis. Materials and Methods: A Prospective, study was undertaken for 18 months at B.P.Koirala Lion’s Center for ophthalmic studies, TU Teaching Hospital to study the children suffering from bacterial meningitis admitted at Kanti Children’s Hospital for ocular involvement. A through history, anterior and posterior segment ocular examination and investigations like blood, CSF and CT scan were done. Results: A total of 182 cases of bacterial meningitis were screened. Tubercular meningitis cases were 40 (21.97%) and Pyogenic were 142 (78.02%). Oculovisual anomalies were seen in 70 (38.46%) cases. The ocular abnormalities included pupillary changes (34.28%), Cranial Nerve Palsy (22.86%), Fundus changes (35.72%), Cortical Blindness (4.28%), Panophthalmitis and Proptosis (1.43%). Third nerve involvement was seen in 17.14% cases, sixth nerve in 4.29% cases, Papilledema in 11.43 % and Optic atrophy in 22.86 %. Risk factors included late presentation; hydrocephalous and increased CSF cell count and protein level. Conclusion: Oculovisual anomalies formed an important group of clinical manifestations of bacterial meningitis. Incidence of oculovisual anomalies was more frequently seen in Tubercular meningitis (55%).Children with early presentation and intervention had better prognosis. Hence, timely intervention and health education is important. J. Nepal Paediatr. Soc. 32(2) 2012 136-141 doi: http://dx.doi.org/10.3126/jnps.v32i2.5534

Download Full-text

1632. Comparing the epidemiology and clinical characteristics of childhood tuberculosis through active and passive case finding

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.1812 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S807-S808

Author(s):

Saki Ikeda ◽

Andrea T Cruz ◽

Jeffrey R Starke

Keyword(s):

Clinical Manifestations ◽

Central Nervous System Disease ◽

Data Safety Monitoring Board ◽

Case Finding ◽

Childhood Tuberculosis ◽

Contact Tracing ◽

System Disease ◽

Radiologic Findings ◽

Mediastinal Adenopathy ◽

Epidemiological Characteristics

Abstract Background Childhood tuberculosis can be found via passive case finding (PCF), diagnosing a symptomatic child, and active case finding (ACF), discovering a child through contact tracing. Most high prevalence areas perform PCF, but as ACF is introduced, the clinical and radiologic findings may differ. We compare clinical, radiographic, microbiologic and epidemiological characteristics of children diagnosed through PCF and ACF. Methods A retrospective cohort study of all patients diagnosed with TB from 01/01/2012-12/31/2019 at Texas Children’s Hospital. ACF is TB in a child who had not previously sought care before identified via contact tracing, immigration screening, or screening for incarceration. Severity of disease was based on location of illness, imaging and bacteriology/histopathology. Associations between PCF/ACF and demographics, disease severity, and microbiology were analyzed. Results Of 178 patients, 80 (45%) were diagnosed via ACF. ACF patients were more likely to be US-born (OR: 2.29, [95% Confidence interval (CI): 1.12-4.67]) and younger (mean 6.18 vs 8.84 years, p= 0.016). Only 2.5% of ACF patients had extrapulmonary disease, compared to 45% of the PCF group (p< 0.0001). All 14 severe extrathoracic cases were in the PCF group (10 central nervous system disease, 3 ocular disease, 1 spondylitis). Fewer patients in the ACF group had severe intrathoracic findings (11% vs 39%, p< 0.001): miliary disease (0% vs 10%, p=0.006), cavity (1% vs 9%, p=0.04), and multilobar involvement (7.5% vs 22.4%, p=0.006). ACF patients had more hilar/mediastinal adenopathy (OR: 2.51, [CI: 1.34-3.72], p=0.004). ACF patients were less often cultured (38% vs 89%, p< 0.0001) and had less microbiological confirmation by cultures or PCR (21% vs 52%, p=< 0.0001). Conclusion Patients in the ACF group were younger, had less severe clinical manifestations, and had almost no extrathoracic disease. Clinicians need to be aware that the common clinical and radiographic presentations in children differ between PCF and ACF. Disclosures Jeffrey R. Starke, MD, Otsuka Pharmaceuticals (Other Financial or Material Support, Member, Data Safety Monitoring Board)

Download Full-text

Idiopathic Superficial Siderosis of the Central Nervous System

10.21203/rs.3.rs-132626/v2 ◽

2021 ◽

Author(s):

Shakila Meshkat ◽

Parnia Ebrahimi ◽

Abbas Tafakhori ◽

Aidin Taghiloo ◽

Sajad Shafiee ◽

...

Keyword(s):

Central Nervous System ◽

Nervous System ◽

Hearing Loss ◽

Sleep Disturbances ◽

Brain Mri ◽

Spastic Paraparesis ◽

Central Nervous System Disease ◽

Neurological Deficits ◽

Superficial Siderosis ◽

System Disease

Abstract Background: Regardless of the cause of the superficial siderosis (SS) disease, which is bleeding, the source of bleeding cannot be found in some cases.Case presentation: In this article, we report two cases with idiopathic SS. Case 1 presented with bilateral hearing loss, cognitive impairment, sleep disturbances, and tremors. Case 2 presented with sensory neural hearing loss, ataxia, and spastic paraparesis. In both cases, brain MRI indicated evidence of SS. CT myelogram and SPECT with labeled RBC couldn't help finding the source of occult bleeding.Conclusion: SS is a rare central nervous system disease caused by the deposition of hemosiderin in the brain and spinal cord, which results in the progression of neurological deficits. The cause of this hemorrhage is often subarachnoid haemorrhage, intradural surgery, carcinoma, arteriovenous malformation, nerve root avulsion, and dural abnormality. The condition progresses slowly and, by the time diagnosis is confirmed, the damage is often irreversible. In our cases, brain MRI clarified the definitive diagnosis, but we could not find the source of bleeding. SS should be considered in cases with ataxia and hearing loss, even if no source of bleeding is found.

Download Full-text

Whipple’s disease

Oxford Textbook of Medicine ◽

10.1093/med/9780198746690.003.0303 ◽

2020 ◽

pp. 2909-2911

Author(s):

Florence Fenollar ◽

Didier Raoult

Keyword(s):

Clinical Manifestations ◽

Central Nervous System Disease ◽

Prolonged Treatment ◽

Term Therapy ◽

Whipple’S Disease ◽

Whipple's Disease ◽

System Disease ◽

Systemic Manifestations ◽

Long Term Therapy

Whipple’s disease is an uncommon infection caused by the actinomycete Tropheryma whipplei, most commonly diagnosed when overt small intestinal disease leads to malabsorption, but with protean other clinical manifestations (e.g. systemic, neurological, or cardiological). Diagnosis usually depends upon demonstration of classical histological features in the small intestine, and positive identification of T. whipplei DNA by polymerase chain reaction. Treatment is with antibiotics, initially doxycycline and hydroxychloroquine followed by long-term therapy with doxycycline. Clinical improvement occurs within a few weeks, but prolonged treatment for at least a year is recommended. Relapse can occur, even after many years, especially when progressive central nervous system disease occurs in the absence of other systemic manifestations.

Download Full-text

HIV-vacuolar myelopathy: an unusual early presentation in HIV

International Journal of STD & AIDS ◽

10.1177/0956462420933786 ◽

2020 ◽

pp. 095646242093378

Author(s):

Jacob Leffert ◽

Rangarajan Purushothaman ◽

George Koshy Vilanilam ◽

Marc Stanley ◽

Atul Kothari

Keyword(s):

Human Immunodeficiency Virus ◽

Hiv Infection ◽

Rare Case ◽

Late Presentation ◽

Neurological Deficits ◽

Newly Diagnosed ◽

Early Presentation ◽

Immunodeficiency Virus ◽

Vacuolar Myelopathy ◽

High Index Of Suspicion

Human immunodeficiency virus (HIV)-vacuolar myelopathy is a late presentation of HIV infection and rarely the presenting symptom. Treatment of HIV-vacuolar myelopathy involves anti-retroviral therapy, but neurological deficits are devastating if diagnosis is delayed. We present a rare case of a patient who presented with HIV-vacuolar myelopathy as the initial presentation in a case of newly diagnosed HIV. The case emphasizes the importance of a high index of suspicion and diagnosis for better outcomes in HIV-vacuolar myelopathy.

Download Full-text

Idiopathic Superficial siderosis of the central nervous system

10.21203/rs.3.rs-132626/v1 ◽

2020 ◽

Author(s):

Shakila Meshkat ◽

Parnia Ebrahimi ◽

Abbas Tafakhori ◽

Aidin Taghiloo ◽

Sajad Shafiee ◽

...

Keyword(s):

Central Nervous System ◽

Nervous System ◽

Hearing Loss ◽

Sleep Disturbances ◽

Brain Mri ◽

Spastic Paraparesis ◽

Central Nervous System Disease ◽

Neurological Deficits ◽

Superficial Siderosis ◽

System Disease

Abstract Background: Regardless of the cause of the superficial sidrosis (SS) disease, which is bleeding, the source of bleeding cannot be found in some cases. Case presentation: In this article, we report two cases with idiopathic SS. Case 1 presented with bilateral hearing loss, cognitive impairment, sleep disturbances and tremors. Case 2 presented with sensory neural hearing loss, ataxia, and spastic paraparesis. Brain MRI indicated evidence of SS. CT myelogram and SPECT/CT with labeled RBC couldn't help finding the source of occult bleeding. Conclusion: Superficial sisdorsis (SS) is a rare central nervous system disease caused by deposition of hemosiderin in brain and spinal cord which results in progression of neurological deficits. The cause of this hemorrhage is often subarachnoid haemorrhage, intradural surgery, carcinoma, arteriovenous malformation, nerve root avulsion, and dural abnormality. The condition progresses slowly and, by the time diagnosis is confirmed, the damage is often irreversible. In our cases, brain MRI clarified the definitive diagnosis but we could not find the source of bleeding. SS should be considered in cases with ataxia and hearing loss even if no source of bleeding is found.

Download Full-text

Abstract #815: Massive Polyuria Due to Ewing’s Sarcoma-Associated Central Nervous System Disease

Endocrine Practice ◽

10.1016/s1530-891x(20)43662-6 ◽

2005 ◽

Vol 11 ◽

pp. 56

Author(s):

Farah Dawood-Farah ◽

Maryann Mugo ◽

Stephen A. Brietzke

Keyword(s):

Central Nervous System ◽

Nervous System ◽

Ewing’S Sarcoma ◽

Ewing's Sarcoma ◽

Central Nervous System Disease ◽

Nervous System Disease ◽

System Disease

Download Full-text

Vergleich von MRT- und SPECT-Befunden bei Patienten mit zerebraler Mikroangiopathie

Nuklearmedizin ◽

10.1055/s-0038-1629569 ◽

1991 ◽

Vol 30 (05) ◽

pp. 161-169 ◽

Cited By ~ 6

Author(s):

C. Weiller ◽

R. Weigmann ◽

H.-J. Kaiser ◽

U. Büll ◽

R. Schneider ◽

...

Keyword(s):

White Matter Lesions ◽

Central Nervous System Disease ◽

Deep White Matter ◽

Cranial Ct ◽

System Disease ◽

Ct Findings ◽

Hmpao Spect ◽

Significant Difference ◽

Cerebral Microangiopathy ◽

99Mtc Hmpao

Lacunar infarctions and periventricular hypodensity are assumed to be typical CT patterns of cerebral microangiopathy (MA). In 17 patients with such findings and in 6 controls without any signs of central nervous system disease cranial CT, MRT and 99mTc-HMPAO-SPECT were employed. In 7 patients with CT findings of minor MA demonstrated in comparison to controls no significant difference. In 10 cases with CT findings of pronounced MA periventricular rCBF was significantly reduced compared to controls. rCBF of temporal and parietal cortex were not diminished compared to controls. In 14 patients studied with MRT deep white matter lesions were found which appeared solitary, multiple or confluent. Employing 99mTc-HMPAO-SPECT, cerebral MA revealed rCBF reduction in periventricular brain tissue by cerebellar standardization.

Download Full-text