The diagnostic utility of brain biopsy procedures in patients with rapidly deteriorating neurological conditions or dementia

2007 ◽  
Vol 106 (1) ◽  
pp. 72-75 ◽  
Author(s):  
S. Andrew Josephson ◽  
Alexander M. Papanastassiou ◽  
Mitchel S. Berger ◽  
Nicholas M. Barbaro ◽  
Michael W. McDermott ◽  
...  
Keyword(s):  
Clinical Symptoms ◽  
Tertiary Care ◽  
Laboratory Data ◽  
Brain Biopsy ◽  
B Cell Lymphoma ◽  
Clinical Syndrome ◽  
Biopsy Specimens ◽  
Jakob Disease ◽  
Tertiary Care Institution ◽  
Neurological Conditions

Object Obtaining brain biopsy specimens is often the diagnostic test of last resort for patients with unexplained neurological conditions, particularly those with a rapidly deteriorating neurological course. The goals of this analysis were to determine the diagnostic sensitivity of brain biopsy specimens in these types of patients and retrospectively identify features of these disorders that may have enabled an earlier diagnosis, which may prevent the need for diagnostic brain biopsy procedures in the future. Methods The authors reviewed the case records of all brain biopsy procedures that had been performed at a single tertiary care institution between January 1993 and April 2002 in 171 patients. Patients with HIV or nonlymphomatous brain tumors were excluded from this analysis because the utility of brain biopsy specimens for these conditions has been determined from previous studies. A subgroup analysis of this cohort was performed in the 64 patients who had comprehensive medical records and a clinical syndrome involving a progressively deteriorating neurological condition of less than 1 year in duration. The overall sensitivity of brain biopsy procedures for diagnostic purposes in the cohort was 65% (111 of 171 patients). The two most common diagnoses in the subgroup with rapidly deteriorating neurological conditions were primary central nervous system (CNS) B-cell lymphoma in 20.3% (13 patients) and Creutzfeldt–Jakob disease in 15.6% (10 patients), followed by viral encephalitis in 14.1% (nine patients) and CNS vasculitis in 9.4% (six patients). Clinical symptoms and laboratory data were compared among the diagnostic groups. Conclusions These results will help guide the evaluation of patients with neurological conditions that are difficult to diagnose and will provide a foundation for further prospective studies.

Investigation of a Possible Iatrogenic Case of Creutzfeldt-Jakob Disease After a Neurosurgical Procedure

2006 ◽  
Vol 27 (12) ◽  
pp. 1352-1357 ◽  
Author(s):  
Natalie Keeler ◽  
Lawrence B. Schonberger ◽  
Ermias D. Belay ◽  
Lynne Sehulster ◽  
George Turabelidze ◽  
...  
Keyword(s):  
African American Woman ◽  
Tertiary Care ◽  
American Woman ◽  
Brain Biopsy ◽  
Vital Statistics ◽  
Neurosurgical Procedures ◽  
Care Hospital ◽  
Case Patient ◽  
Neurosurgical Patients ◽  
Jakob Disease

Objective. To investigate a case of Creutzfeldt-Jakob disease (CJD) possibly acquired from contaminated neurosurgical instruments. Design. Retrospective review of medical records, hospital databases, service log books, and state vital statistics. Setting. A tertiary care hospital (hospital A) in Missouri. Patients. The case patient was a 38-year-old African American woman with a 9-month history of progressive memory loss, visual disturbances, and dementia. She underwent neurosurgery in November 1996. CJD was confirmed in April 2004 by immunodiagnostic testing of brain biopsy samples. All patients who underwent neurosurgery at the same hospital within 6 months before or after the case patient's procedure were identified and investigated for preoperative or postoperative evidence of CJD. Results. We reviewed data on 268 neurosurgical procedures, 84 pathology log entries, and 60 death certificates for neurosurgical patients at hospital A and identified 2 suspected cases of CJD. Clinical features and definitive prion testing of stored brain biopsy samples excluded a diagnosis of CJD. Standard operating room procedures were in place, but specific protocols for handling instruments potentially contaminated with prions were not used. Conclusions. Neurosurgical instruments were not implicated as the source exposure for CJD in the case patient. The 2 patients with suspected CJD were identified from different data sources, suggesting good internal consistency in data collection. The key elements of this investigation are suggested for use in future investigations into potential cases of iatrogenic CJD.

scholarly journals Prionic diseases

2013 ◽  
Vol 71 (9B) ◽  
pp. 731-737 ◽  
Author(s):  
Abelardo Q-C Araujo
Keyword(s):  
Prion Protein ◽  
Clinical Symptoms ◽  
Prion Diseases ◽  
Brain Biopsy ◽  
Gene Encoding ◽  
Genetic Studies ◽  
Familial Predisposition ◽  
Jakob Disease ◽  
In Vivo Diagnosis

Prion diseases are neurodegenerative illnesses due to the accumulation of small infectious pathogens containing protein but apparently lacking nucleic acid, which have long incubation periods and progress inexorably once clinical symptoms appear. Prions are uniquely resistant to a number of normal decontaminating procedures. The prionopathies [Kuru, Creutzfeldt-Jakob disease (CJD) and its variants, Gerstmann-Sträussler-Scheinker (GSS) syndrome and fatal familial insomnia (FFI)] result from accumulation of abnormal isoforms of the prion protein in the brains of normal animals on both neuronal and non-neuronal cells. The accumulation of this protein or fragments of it in neurons leads to apoptosis and cell death. There is a strong link between mutations in the gene encoding the normal prion protein in humans (PRNP) - located on the short arm of chromosome 20 – and forms of prion disease with a familial predisposition (familial CJD, GSS, FFI). Clinically a prionopathy should be suspected in any case of a fast progressing dementia with ataxia, myoclonus, or in individuals with pathological insomnia associated with dysautonomia. Magnetic resonance imaging, identification of the 14-3-3 protein in the cerebrospinal fluid, tonsil biopsy and genetic studies have been used for in vivo diagnosis circumventing the need of brain biopsy. Histopathology, however, remains the only conclusive method to reach a confident diagnosis. Unfortunately, despite numerous treatment efforts, prionopathies remain short-lasting and fatal diseases.

Relationship between bacterial colonization of external cerebrospinal fluid drains and secondary meningitis: a retrospective analysis of an 8-year period

2010 ◽  
Vol 113 (6) ◽  
pp. 1309-1313 ◽  
Author(s):  
David J. Hetem ◽  
Peter A. Woerdeman ◽  
Marc J. M. Bonten ◽  
Miquel B. Ekkelenkamp
Keyword(s):  
Clinical Symptoms ◽  
Bacterial Colonization ◽  
Tertiary Care ◽  
Laboratory Data ◽  
Significant Risk ◽  
Prophylactic Antibiotic ◽  
Positive Culture ◽  
Care Hospital ◽  
Drain Removal ◽  
Microbiological Laboratory

Object A frequent complication of CSF drains is secondary meningitis. This study was designed to assess the predictive value of a positive culture from a CSF drain tip for the development of secondary meningitis. Methods The authors conducted a retrospective study of an 8-year period in which patients were treated in a tertiary care hospital in The Netherlands. Patients with positive cultures from CSF drain tips were identified from the microbiology database. Patient charts were reviewed to retrieve demographic, clinical, and laboratory data. Statistical analysis was performed using multivariate logistic regression to determine significant risk factors for the development of secondary meningitis. Results A total of 139 patients with positive CSF-drain cultures were included; 72 patients (52%) suffered secondary meningitis at the time of CSF drain removal, or developed it consecutively. Development of secondary meningitis was associated with use of ventricular drains (OR 3.4 vs lumbar drains; 95% CI 1.7–6.8), with age less than 18 years (OR 4.7; 95% CI 1.3–17.3), and with colonization with Staphylococcus aureus (OR 3.1 vs other microorganisms; CI 1.2–8.5). Thirty-two patients (44% of total secondary meningitis) were diagnosed with secondary meningitis 24 hours or more after CSF drain removal; in 13 patients (18%) the diagnosis was made after 48 hours or more. Conclusions Positive CSF-drain cultures are strongly associated with development of secondary meningitis. A positive CSF-drain culture may precede clinical symptoms and should therefore be communicated to the treating physician by the microbiological laboratory as soon as possible, and prophylactic antibiotic therapy should be considered.

scholarly journals Incidence of Carcinoma Prostate in Transurethral Resection Specimen in a Teaching Hospital of Nepal

2016 ◽  
Vol 4 (2) ◽  
pp. 77
Author(s):  
Neeraj Thapa ◽  
Sachin Shris ◽  
Nabin Pokharel ◽  
Yashwant Gajanan Tambay ◽  
Yeshwant Ramakrishan Kher ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Gleason Score ◽  
Clinical Symptoms ◽  
Tertiary Care ◽  
Histopathological Analysis ◽  
Carcinoma Prostate ◽  
High Prevalence ◽  
Resection Specimen ◽  
Tertiary Care Institution ◽  
Poorly Differentiated

Introduction: As suggested through several autopsy studies there is a high prevalence of latent prostate  cancer in the population. A much smaller proportion of prostate  cancer is detected because of clinical symptoms. This study was done to identify the rates of incidentally detected prostate cancer in patients undergoing surgical management of Benign Prostatic Hyperplasia (BPH) in our centre.   Methods: A retrospective review was done on all transurethral resections of the prostate (TURP)  cases from May 2014 to May 2015 at a single tertiary care institution. One hundred and three men, aged 40 to 88 year, underwent TURP and their specimens were sent for the  histopathological analysis.   Results: Five (4.85%) patients were diagnosed with the prostate  cancer. All the five patients had Gleason score of seven or more. Two patients had moderately differentiated adenocarcinoma  with Gleason score of seven. Three patients had poorly differentiated adenocarcinoma with Gleason score of eight or above. The Prostate cancer was seen only  in the age group above 65 years but it was not statistically significant.   Conclusion: Our series demonstrated that 4.85% of patients had latent prostate  cancer. It occurs mainly in men above 65 years of age though this was not statistically significant.

Expression of B-cell–attracting chemokine 1 (CXCL13) by malignant lymphocytes and vascular endothelium in primary central nervous system lymphoma

Blood ◽  
2003 ◽  
Vol 101 (3) ◽  
pp. 815-821 ◽  
Author(s):  
Justine R. Smith ◽  
Rita M. Braziel ◽  
Samantha Paoletti ◽  
Martin Lipp ◽  
Mariagrazia Uguccioni ◽  
...  
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
B Cell ◽  
Vascular Endothelium ◽  
Tumor Development ◽  
Cell Movement ◽  
Central Nervous System Lymphoma ◽  
Brain Biopsy ◽  
B Cell Lymphoma ◽  
Biopsy Specimens

Abstract Primary central nervous system lymphoma (PCNSL) is a rare but often rapidly fatal form of non-Hodgkin B-cell lymphoma that arises within the central nervous system (CNS) and has a low propensity to metastasize. We performed immunohistochemistry on formalin-fixed, paraffin-embedded brain biopsy specimens from 24 patients with PCNSL to investigate the expression of B cell–attracting chemokine 1 (BCA-1, CXCL13), a lymphoid chemokine involved in B-cell compartmental homing within secondary lymphoid organs and recently implicated in the pathogenesis of inflammatory and malignant lymphocyte-mediated diseases. Whereas BCA-1 was not detected in normal human brain, all 24 brain biopsy specimens containing PCNSL were positive for BCA-1. Double immunostaining on selected specimens localized BCA-1 to malignant B lymphocytes and vascular endothelium. In contrast, 2 chemokines implicated particularly in T-cell movement, secondary lymphoid tissue chemokine (SLC, CCL21) and Epstein-Barr virus–induced molecule 1 ligand chemokine (ELC, CCL19), were expressed only by occasional stromal cells in 2 and 4 of the 24 specimens, respectively. Tumor cells stained positively for CXCR5, the primary receptor for BCA-1. In situ hybridization verified the expression of BCA-1 mRNA by malignant B cells, but not vascular endothelium, within the tumor mass, suggesting that vascular endothelial BCA-1 expression may be consequent to transcytosis. In PCNSL, expression of BCA-1 by malignant lymphocytes and vascular endothelium may influence tumor development and localization to CNS.

Brain biopsy in patients with suspected Creutzfeldt–Jakob disease

2008 ◽  
Vol 109 (4) ◽  
pp. 735-741 ◽  
Author(s):  
Uta Heinemann ◽  
Anna Krasnianski ◽  
Bettina Meissner ◽  
Kai Kallenberg ◽  
Hans A. Kretzschmar ◽  
...  
Keyword(s):  
Mr Imaging ◽  
Clinical Symptoms ◽  
Neurodegenerative Disorder ◽  
Brain Biopsy ◽  
The Other ◽  
Clinical Approach ◽  
Csf Analysis ◽  
Imaging Results ◽  
Jakob Disease ◽  
Probable Diagnosis

Object Creutzfeldt–Jakob disease (CJD) is a rare neurodegenerative disorder with diagnostic criteria defined as a combination of clinical symptoms, electroencephalography findings, cerebrospinal fluid (CSF) analysis, and MR imaging results. Special subtypes are known to present with an atypical course and test findings that can complicate the clinical diagnosis. In such patients a brain biopsy can support the clinical approach. Methods The authors studied the records on 26 brain biopsies conducted in patients with suspected CJD who had been referred to the CJD Surveillance Unit in Germany between 1993 and 2005. Results Of the 26 included patients, 11 suffered from neuropathologically confirmed CJD, which in 5 cases had been deemed clinically “probable” and in 2 had been deemed “possible.” The disease in the remaining 4 patients had been categorized as “other” prior to neuropathological confirmation of CJD. The results of 15 brain biopsies showed no features of prion disease. None of these 15 patients had received a probable diagnosis of CJD, 4 had a possible diagnosis, and 11 had received a diagnosis of “other.” Three of the cases classified as other and none of those with CJD presented with pleocytosis in the CSF. In 73% of the other cases, biopsy sampling did not reveal any results characteristic of CJD but did not provide specific findings on which to base a differential diagnosis. Autopsy confirmed the biopsy diagnosis of CJD in all cases, and additionally confirmed that CJD was not present in 3 patients who had nondiagnostic biopsy results. Conclusions Biopsy sampling may be helpful in the diagnostic approach to rare cases of dementia for which a reliable diagnosis cannot be established on the basis of clinical symptoms, CSF parameters, electroencephalography, and MR imaging results.

scholarly journals Baseline procalcitonin as a predictor of bacterial infection and clinical outcomes in COVID-19: A case-control study

PLoS ONE ◽  
2022 ◽  
Vol 17 (1) ◽  
pp. e0262342
Author(s):  
Natalie J. Atallah ◽  
Hailey M. Warren ◽  
Matthew B. Roberts ◽  
Ramy H. Elshaboury ◽  
Monique R. Bidell ◽  
...  
Keyword(s):  
Bacterial Infection ◽  
Clinical Symptoms ◽  
Wide Spectrum ◽  
Care Center ◽  
Tertiary Care ◽  
Laboratory Data ◽  
Ordinal Scale ◽  
Infection Group ◽  
Bacterial Superinfection ◽  
Control Study

Purpose Coronavirus disease-2019 (COVID-19) is associated with a wide spectrum of clinical symptoms including acute respiratory failure. Biomarkers that can predict outcomes in patients with COVID-19 can assist with patient management. The aim of this study is to evaluate whether procalcitonin (PCT) can predict clinical outcome and bacterial superinfection in patients infected with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). Methods Adult patients diagnosed with SARS-CoV-2 by nasopharyngeal PCR who were admitted to a tertiary care center in Boston, MA with SARS-CoV-2 infection between March 17 and April 30, 2020 with a baseline PCT value were studied. Patients who were presumed positive for SARS-CoV-2, who lacked PCT levels, or who had a positive urinalysis with negative cultures were excluded. Demographics, clinical and laboratory data were extracted from the electronic medical records. Results 324 patient charts were reviewed and grouped by clinical and microbiologic outcomes by day 28. Baseline PCT levels were significantly higher for patients who were treated for true bacteremia (p = 0.0005) and bacterial pneumonia (p = 0.00077) compared with the non-bacterial infection group. Baseline PCT positively correlated with the NIAID ordinal scale and survival over time. When compared to other inflammatory biomarkers, PCT showed superiority in predicting bacteremia. Conclusions Baseline PCT levels are associated with outcome and bacterial superinfection in patients hospitalized with SARS-CoV-2.

scholarly journals Prevalence and clinical correlation of hepatitis E virus antibody in the patients’ serum samples from a tertiary care hospital in Thailand during 2015–2018

2021 ◽  
Vol 18 (1) ◽  
Author(s):  
Atiporn Boonyai ◽  
Anchalee Thongput ◽  
Thidarat Sisaeng ◽  
Parisut Phumchan ◽  
Navin Horthongkham ◽  
...  
Keyword(s):  
Pregnant Women ◽  
Tertiary Care ◽  
Laboratory Data ◽  
Organ Transplant ◽  
Hospital Setting ◽  
Antibody Detection ◽  
Enzyme Linked Immunosorbent Assay ◽  
Care Hospital ◽  
Serum Samples ◽  
Igm Antibodies

Abstract Background Prevalence and incidence of hepatitis caused by HEV infection are usually higher in developing countries. This study demonstrated the HEV seroprevalence and incidence of HEV infection in patients with clinical hepatitis in a tertiary hospital in Thailand. Methods A laboratory-based cross-sectional study was conducted using 1106 serum samples from patients suspected of HEV infection sent to the Serology laboratory, Siriraj Hospital, for detecting HEV antibodies during 2015–2018. Prevalence of anti-HEV IgG and IgM antibodies in general patients, including organ transplant recipients and pregnant women in a hospital setting, were determined using indirect enzyme-linked immunosorbent assay (ELISA) kits. Comparison of laboratory data between groups with different HEV serological statuses was performed. Results HEV IgG antibodies were detected in 40.82% of 904 serum samples, while HEV IgM antibodies were detected in 11.75% of 1081 serum samples. Similar IgG and IgM antibody detection rates were found in pregnant women. Interestingly, anti-HEV IgM antibodies were detected in 38.5% of patients who underwent organ transplantation. Patients who tested positive for anti-HEV IgM antibodies had higher alanine aminotransferase levels than those who had not. In contrast, patients who tested positive for anti-HEV IgG had more elevated levels of total bilirubin than those who tested negative. Conclusions HEV seroprevalence and incidence in patients with clinical hepatitis were relatively high in the Thai population, including the pregnancy and organ transplant subgroups. The results potentially benefit the clinicians in decision-making to investigate HEV antibodies and facilitating proper management for patients.

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