scholarly journals Neurological findings and outcome in adult cerebral malaria

2009 ◽  
Vol 35 (1) ◽  
pp. 15-17 ◽  
Author(s):  
M.A. Sattar ◽  
Hasnat Waheedul Hoque ◽  
M. Robed Amin ◽  
M.A. Faiz ◽  
M. Ridwanur Rahman
Keyword(s):  
Cerebral Malaria ◽  
Neurological Deficit ◽  
Retinal Hemorrhage ◽  
Deep Coma ◽  
Focal Neurological Deficit ◽  
Decerebrate Rigidity ◽  
Neurological Findings ◽  
Corneal Reflex ◽  
Discharge From Hospital ◽  
Pupillary Size

The neurological findings of 100 patients of adult cerebral malaria were studied. The commonest neurological feature was symmetrical upper motor neuron lesion as evidenced by exaggerated tendon reflexes and bilateral planter extensor (61%). Twenty two percent had features of meningeal irritation and/or meningism. Abnormal posturing occurred decerebrate rigidity (6%) and decorticate rigidity (4%) with or without opisthotonus, focal neurological deficit was noted in 5% cases. Pupillary size and reaction were normal in 86%, poor in 14%. Corneal reflexes were absent in 4% cases. Fundoscopy showed retinal hemorrhage in 16%, papilloedema is 3% and exudates in 1%. Majority of the patients recovered (80%) without any persistent neurological sequelae at the time of discharge from hospital and death rate was 20%.  Patients having focal neurological deficit, disconjugate gaze, poor pupillary reaction, absent corneal reflex and papilloedema were more susceptible to death. Delay in hospitalization and deep coma were also associated with increased mortality, whereas early hospitalization and proper nursing care could reduce mortality. Keywords: Cerebral malaria; Neurological; BangladeshOnline: 21 May 2009 DOI: 10.3329/bmrcb.v35i1.2313Bangladesh Med Res Counc Bull 2009; 35: 15-17

Hypoglycemic Hemiparesis Masquerading As Ischemic Stroke: When Guideline Fails

2020 ◽  
Vol 15 (4) ◽  
pp. 420-422
Author(s):  
Dhruvkumar M. Patel ◽  
Mukundkumar V. Patel ◽  
Jayanti K. Gurumukhani ◽  
Maitri M. Patel ◽  
Himal J. Mahadevia ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Thrombolytic Therapy ◽  
Neurological Deficit ◽  
Clinical Case ◽  
Complete Recovery ◽  
Acute Onset ◽  
Diabetic Patients ◽  
Focal Neurological Deficit ◽  
Random Blood Sugar ◽  
Resident Doctor

Background: Hypoglycemia may rarely present as hemiparesis and sometimes it is difficult to differentiate from ischemic stroke. When random blood sugar (RBS) value is between 50 and 80 mg % in patients presenting with focal neurological deficit, no guideline exists to consider the possibility of hypoglycemia before initiating thrombolytic therapy. Clinical Case: A 58-year-old male, who was a known case of diabetes and hypertension, was brought to the emergency room with acute onset of right hemiparesis and dysarthria of 90 minutes duration. His NIHSS Score was 9, blood pressure was 150/90 mm of Hg and RBS was 79 mg% on admission. His CT scan brain was normal and was considered for thrombolysis. Resident doctor not aware of previous sugar repeated RBS before thrombolysis which was surprisingly 60 mg% 60 minutes after the first RBS. Even though he was a candidate for thrombolysis, intravenous 25 % dextrose was administered considering the possibility of hypoglycemia. He made a complete recovery within 20 minutes and thrombolytic therapy was withheld. : In Diabetic patients with focal neurological deficit and RBS less than 80 mg% on admission, RBS should be rechecked and in appropriate cases should be challenged with IV dextrose considering the possibility of hypoglycemia before commencing thrombolytic therapy.

THE INFLUENCE OF ADRENAL STEROIDS AND CORTICOTROPIN ON MASSIVE MYOCLONIC SEIZURES OF INFANCY

PEDIATRICS ◽  
1963 ◽  
Vol 32 (2) ◽  
pp. 169-174
Author(s):  
Patrick F. Bray
Keyword(s):  
Neurological Deficit ◽  
Prognostic Value ◽  
Rational Expectation ◽  
Initial Response ◽  
Response To Therapy ◽  
Adrenal Steroids ◽  
Focal Neurological Deficit ◽  
Rational Treatment ◽  
Follow Up Study

A 4-year follow-up study is reported on 10 infants whose minor motor seizures were treated intensively with cortisone and/or corticotropin. No correlation was found between the infants' initial clinical and electroencephalographic response to therapy and their follow-up intelligence quotients. The similar initial electroencephalographic findings, contrasted with the marked followup differences in levels of intellectual functioning, illustrate the limited prognostic value of the electroencephalogram in this syndrome. Similarly, no correlation was noted in the patients' initial response to therapy, and the presence or absence of microcephaly or focal neurological deficit. In the absence of any other rational treatment, and despite the dismal prospect suggested by this report and those of others, renewed efforts to treat patients earlier and more intensively with cortisone and corticotropin could be undertaken. However, in the light of 4 years' experience, such an approach might be a reflection more of therapeutic desperation than of rational expectation of good results.

Focal Neurological Deficit with Sudden Onset as the First Manifestation of Sarcoidosis: A Case Report with MRI Follow-Up

1991 ◽  
Vol 31 (6) ◽  
pp. 376-379 ◽  
Author(s):  
A. Michotte ◽  
P. Dequenne ◽  
D. Jacobovitz ◽  
J. Hildebrand
Keyword(s):  
Case Report ◽  
Neurological Deficit ◽  
Sudden Onset ◽  
Focal Neurological Deficit

scholarly journals 085 Syndrome of transient headache and neurologic deficits with cerebral fluid lymphocytosis (HANDL) as a mimic for transient ischaemic attack (TIA)

2019 ◽  
Vol 90 (e7) ◽  
pp. A27.2-A27
Author(s):  
Jasmine F Ashhurst ◽  
Rami Haddad
Keyword(s):  
Differential Diagnosis ◽  
Neurological Deficit ◽  
Unknown Aetiology ◽  
Focal Neurological Deficit ◽  
Benign Condition ◽  
Mri Brain ◽  
Ischaemic Attack ◽  
Ct Brain ◽  
Patient Presentation ◽  
New Onset

IntroductionHaNDL is a rare neurological disorder of unknown aetiology that is characterised by headache, neurological deficit and pleocytosis in the cerebrospinal fluid (CSF). It is a benign condition that has spontaneous resolution of symptoms within months.A 50 year old female presented to Emergency with an acute focal neurological deficit of right sided weakness, dysphasia and dysarthria lasting less than one hour. Over the preceding months she had a new onset of headache. She was worked up for a likely diagnosis of TIA.MethodsCase report.ResultsInitial CT Brain(angiography) showed no stroke or other identifiable cause of symptoms.MRI brain showed excessive nonspecific T2 hyperintensities, requiring further investigation for possible vasculitis. MR angiography was normal and there was no evidence of stroke.Viral PCR’s were negative.Lumbar puncture (LP) showed pleocytosis (leucocytes 309×10E6/L), raised intracranial pressure and high protein, raising suspicion for HaNDL. This normalised on subsequent outpatient LP, along with symptoms.ConclusionsA diagnosis of HaNDL is made as a diagnosis of exclusion, though should be considered as a differential diagnosis for various presentations in which transient acute focal neurology is a presenting complaint.Due to relatively few reported cases of HaNDL, it is possible that HaNDL is being underdiagnosed due to variability in patient presentation and lack of understanding of the syndrome.As in this case, when a patient presents with transient acute focal neurology in the absence of headache as a prominent presenting symptom, it is reasonable to consider HaNDL as a differential diagnosis.

scholarly journals Is computed tomography of the brain necessary in patients with clinically suspected depressed skull fracture and no focal neurological deficit?

2010 ◽  
Vol 14 (2) ◽  
pp. 28
Author(s):  
J A Rabie ◽  
S Otto ◽  
A J Le Roux
Keyword(s):  
Computed Tomography ◽  
Neurological Deficit ◽  
Descriptive Analysis ◽  
Skull Fracture ◽  
Neurological Deficits ◽  
Ct Scans ◽  
Trauma Patients ◽  
Focal Neurological Deficit ◽  
Depressed Skull Fracture ◽  
The Brain

Objective. The objective of the study was to determine whether computed tomography (CT) of the brain is necessary in all head trauma patients with clinically suspected depressed skull fractures, Glasgow Coma Scale (GCS) scores of 13 and above, and no focal neurological deficits. Design. A retrospective descriptive analysis was undertaken of patients of all ages who presented at the trauma unit of the Pelonomi Hospital Complex in Bloemfontein with GCS of 13 to 15, depressed skull fracture, no clinical focal neurological deficit, and who also underwent CT of the brain. Data were obtained from patients' files, and radiological reports and were analysed by the Department of Statistics, University of the Free State. Results. One hundred and thirty-one patients were included in the study, of whom 56 (42.7%) were found to have substantial intracranial pathology as determined by CT. Twenty-four (18.3%) of these patients had a GCS of 13, of whom 6 (25%) had normal CT scans and 18 (75%) intracranial pathology. Twenty-eight (21.37%) of the 56 patients with intracranial pathology had a GCS of 14, of whom 11 (39.3%) had normal CT scans and 17 (60.7%) intracranial pathology. A GCS of 15 was determined in 79 (60.3%) of the 131 patients, of whom 58 (73.4%) had normal CT scans and 21 (26.6%) intracranial pathology. Conclusion. Based on our findings, CT imaging of the brain in patients with a clinically suspected depressed skull fracture despite any clinical neurological deficit and a GCS of 13 or more is warranted in our setting. The likelihood of injury on CT correlated inversely with the GCS.

scholarly journals TEN-YEAR CONSISTENCY IN NEUROLOGICAL TEST PERFORMANCE OF CHILDREN WITHOUT FOCAL NEUROLOGICAL DEFICIT

2008 ◽  
Vol 28 (4) ◽  
pp. 417-427 ◽  
Author(s):  
Stephen Q. Shafer ◽  
Cornells J. Stokman ◽  
David Shaffer ◽  
Stephen K-C. Ng ◽  
Patricia A. O'Connor ◽  
...  
Keyword(s):  
Neurological Deficit ◽  
Test Performance ◽  
Focal Neurological Deficit

Antegrade selective cerebral perfusion reduced in-hospital mortality and permanent focal neurological deficit in patients with elective aortic arch surgery†

2019 ◽  
Vol 56 (5) ◽  
pp. 1001-1008 ◽  
Author(s):  
Sergey Leontyev ◽  
Piroze M Davierwala ◽  
Mikhail Semenov ◽  
Konstantin von Aspern ◽  
Gunter Krog ◽  
...  
Keyword(s):  
Hospital Mortality ◽  
Aortic Arch ◽  
Neurological Deficit ◽  
Circulatory Arrest ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Focal Neurological Deficit ◽  
Ventricular Ejection Fraction ◽  
Aortic Arch Surgery ◽  
Antegrade Selective Cerebral Perfusion

AbstractOBJECTIVESWe retrospectively evaluated the outcome after elective aortic arch surgery with circulatory arrest to determine the impact of different brain protection strategies on neurological outcome and early and late survival.METHODSA total of 925 patients were included. The patients were assigned to 2 groups based on the type of cerebral protection strategy used during circulatory arrest [hypothermic circulatory arrest (HCA) n = 224; antegrade selective cerebral perfusion (ASCP) n = 701]. The propensity score matching (1:1; 210 vs 210 patients) approach was used to minimize selection bias and to obtain comparable groups.RESULTSThe overall in-hospital mortality and permanent focal neurological deficit rates were 5.6% (n = 52) and 5.4% (n = 50) and were significantly lower in patients who received ASCP (4.4% and 3.4%, respectively) as compared to those who underwent HCA (9.4% and 11.6%, respectively) (P = 0.005 and P < 0.001). The propensity-matched analysis showed significantly lower rates of in-hospital mortality [3.8% vs 9.5% (HCA)] and permanent focal neurological deficit in ASCP group [2.9% vs 11.9% (HCA)]. Multivariable logistic regression analysis revealed left ventricular ejection fraction <30%, age >70 years, coronary artery disease, circulatory arrest time >40 min and mitral valve disease as independent predictors of in-hospital mortality. The use of ASCP was protective for early survival. Cox regression analysis revealed that long-term mortality was independently predicted by age, left ventricular ejection fraction <30%, total arch replacement, prior cardiac surgery, PVD, chronic obstructive pulmonary disease and previous stroke, whereas ASCP was protective for late survival.CONCLUSIONSElective aortic arch surgery is associated with acceptable early and late outcomes. The ASCP is associated with a significant reduction in-hospital mortality and occurrence of permanent neurological deficits.

Stent placement for management of a small parasagittal meningioma

2008 ◽  
Vol 108 (2) ◽  
pp. 377-381 ◽  
Author(s):  
Dharmendra Ganesan ◽  
J. Nicholas P. Higgins ◽  
Timothy Harrower ◽  
Neil G. Burnet ◽  
Nicholas J. C. Sarkies ◽  
...  
Keyword(s):  
Intracranial Hypertension ◽  
Stent Placement ◽  
Neurological Deficit ◽  
Symptomatic Relief ◽  
Benign Intracranial Hypertension ◽  
Endovascular Stent ◽  
Focal Neurological Deficit ◽  
Technical Aspects ◽  
Endovascular Stent Placement ◽  
Parasagittal Meningioma

✓ The patient in this report had a parasagittal meningioma with an intrasinus extension that presented with features of benign intracranial hypertension and no focal neurological deficit or seizure. The meningioma was managed with a combination of endovascular stent placement and radiotherapy. The authors describe the investigation and technical aspects of stent placement for the stenosed sinus. Good symptomatic relief in the patient was achieved.

scholarly journals Risk factors for traumatic blunt cerebrovascular injury diagnosed by computed tomography angiography in the pediatric population: a retrospective cohort study

2015 ◽  
Vol 15 (6) ◽  
pp. 599-606 ◽  
Author(s):  
Vijay M. Ravindra ◽  
Jay Riva-Cambrin ◽  
Walavan Sivakumar ◽  
Ryan R. Metzger ◽  
Robert J. Bollo
Keyword(s):  
Risk Factors ◽  
Neurological Deficit ◽  
Pediatric Population ◽  
Blunt Cerebrovascular Injury ◽  
Focal Neurological Deficit ◽  
Cerebrovascular Injury ◽  
Cranial Trauma ◽  
Carotid Canal ◽  
Independent Risk Factors ◽  
Gcs Score

OBJECT Computed tomography angiography (CTA) is frequently used to examine patients for blunt cerebrovascular injury (BCVI) after cranial trauma, but the pediatric population at risk for BCVI is poorly defined. Although CTA is effective for BCVI screening in adults, the increased lifetime risk for malignant tumors associated with this screening modality warrants efforts to reduce its use in children. The authors' objective was to evaluate the incidence of BCVI diagnosed by CTA in a pediatric patient cohort and to create a prediction model to identify children at high risk for BCVI. METHODS Demographic, clinical, and radiographic data were collected retrospectively for pediatric patients who underwent CTA during examination for traumatic cranial injury from 2003 through 2013. The primary outcome was injury to the carotid or vertebral artery diagnosed by CTA. RESULTS The authors identified 234 patients (mean age 8.3 years, range 0.04–17 years, 150 [64%] boys) who underwent CTA screening for BCVI. Of these, 24 (10.3%) had a focal neurological deficit, and 153 (65.4%) had intracranial hemorrhage on a head CTA. Thirty-seven BCVIs were observed in 36 patients (15.4%), and 16 patients (6.8%) died. Multivariate regression analysis identified fracture through the carotid canal, petrous temporal bone fracture, Glasgow Coma Scale (GCS) score of < 8, focal neurological deficit, and stroke on initial CT scan as independent risk factors for BCVI. A prediction model for identifying children at high risk for BCVI was created. A score of ≤ 2 yielded a 7.9% probability of BCVI and a score of ≥ 3 a risk of 39.3% for BCVI. CONCLUSIONS For cranial trauma in children, fracture of the petrous temporal bone or through the carotid canal, focal neurological deficit, stroke, and a GCS score of < 8 are independent risk factors for BCVI.

Primary intracerebral malignant lymphoma: a clinicopathological study of 89 patients

1995 ◽  
Vol 82 (4) ◽  
pp. 558-566 ◽  
Author(s):  
Francis H. Tomlinson ◽  
Paul J. Kurtin ◽  
Vera J. Suman ◽  
Bernd W. Scheithauer ◽  
Judith R. O'Fallon ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
Family History ◽  
Neurological Deficit ◽  
Age At Diagnosis ◽  
Cell Type ◽  
Focal Neurological Deficit ◽  
Family History Of Cancer ◽  
Clinicopathological Study ◽  
History Of ◽  
History Of Cancer

✓ The authors report on a clinicopathological study of 89 surgical patients with histologically proven primary parenchymal brain lymphoma, all diagnosed between January 1975 and December 1990. The cohort included 60 men and 29 women whose median age at diagnosis was 60 years (range 14 to 84 years). The duration of symptoms was less than 8 weeks in 48% of the patients. Symptom groups included focal neurological deficit (73%), neuropsychiatric symptoms (28%), seizures (9%), and increased intracranial pressure (3%). A total of 132 tumors were seen in 89 patients: the most common sites were frontal (32 patients), temporoparietal (31 patients), and basal ganglia (17 patients); multiple lesions were reported in 23 patients. No patient had antecedent of human immunodeficiency virus positivity or acquired immunodeficiency syndrome. A family history of cancer was present in 33% of the patients, three-quarters of whom were first-degree relatives. Histological subtypes (National Cancer Institute Working Formulation) included 64 large cell (72%) and 13 immunoblastic (15%) tumors. Phenotype was determined in 66 patients: 63 were B-cell type and three were T-cell type. Surgical resection was performed in 47% of the cases, with the remainder undergoing biopsy only. All but six patients received radiation therapy. Thirty-one patients received chemotherapy, whereas 46 patients did not; data on the remaining 12 patients were unavailable. The end point of the study was death from any cause. At the time of last contact, 69 of the patients (78%) had died; the median survival time for this study group was 20.9 months. On univariate analysis, prognostic factors significantly associated with survival included age at diagnosis, family history of cancer, and focal neurological deficit. Multivariate analysis revealed four unfavorable prognostic factors: age greater than or equal to 60 years, history of cancer in first-degree relatives, focal deficit, and ependymal contact. After adjustment for these variables, clinical syndrome, size and number of lesions, extent of surgery, histological cell type, radiation dose, and use of chemotherapy were not significantly associated with survival.

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