scholarly journals Outbreak of bacterial meningitis after spinal anaesthesia in Bangladesh

2014 ◽  
Vol 22 (1) ◽  
pp. 5-11 ◽  
Author(s):  
AKM Akhtaruzzaman ◽  
Begum Maksuda Farida Akhtar ◽  
Joysree Roy ◽  
Manzoorul Hoque Laskar ◽  
Satyajit Dhar ◽  
...  
Keyword(s):  
Bacterial Meningitis ◽  
Spinal Anaesthesia ◽  
Anaesthetic Agent ◽  
Altered Level ◽  
Nuchal Rigidity ◽  
Elevated Protein ◽  
Level Of Consciousness ◽  
Normal Glucose ◽  
Elevated Protein Level ◽  
Iatrogenic Meningitis

Iatrogenic meningitis following spinal anaesthesia is very rare. Recently we have experienced severe headache, vomiting, fever, restlessness, nuchal rigidity and altered level of consciousness 5-6 hours after spinal anaesthesia in one hundred and nineteen patients diagnosed as iatrogenic bacterial meningitis during the period of September 2008 to March 2009. Patients were successfully treated with Inj. Ceftriaxone 2gm BID for 14 days, Inj. Dexamethasone 20mg daily in four divided dose for five days. Purulent CSF, high cell count (1570mm-3), elevated protein level (269mg/dl) and normal glucose (57mg/dl) levels in CSF were noted. There were 5 (4.2%) cases of mortality. No causative organisms were isolated from CSF, blood of the affected patients and anaesthetic agent used for the block. In conclusion, the cause of meningitis was diagnosed as bacterial in origin though no organism was isolated. DOI: http://dx.doi.org/10.3329/jbsa.v22i1.18084 Journal of BSA, 2009; 22(1): 5-11

scholarly journals P.114 Twice negative PCR in a patient with HSV-1 Encephalitis

2018 ◽  
Vol 45 (s2) ◽  
pp. S46-S46
Author(s):  
J Roberts ◽  
G Jewett ◽  
T Raymond ◽  
P Couillard ◽  
S Peters
Keyword(s):  
Lumbar Puncture ◽  
Laboratory Diagnosis ◽  
Altered Level ◽  
Elevated Protein ◽  
Level Of Consciousness ◽  
Mesial Temporal Lobe ◽  
Mr Brain ◽  
Better Than ◽  
Hsv 1

Case Description: A 64 year-old male presented with left-sided weakness and altered level of consciousness after a suspected seizure. MR Brain demonstrated right mesial temporal lobe diffusion restriction. Empiric antiviral and antibiotic treatments were initiated despite CSF negative for HSV/VZV and enteroviruses. Lumbar puncture on admission day five was unchanged and empiric treatments were discontinued. On day 13 he deteriorated into status epilepticus necessitating ICU transfer. A third lumbar puncture demonstrated elevated protein and HSV-1 positive PCR. Acyclovir was restarted with guarded prognosis. Discussion: Detection of HSV-1 in CSF is considered the diagnostic gold standard for HSV-1 encephalitis. The validated multiplex assay used in Alberta, Canada has a 95% level of detection significantly better than the recommended threshold for HSV laboratory diagnosis. Previous reports have indicated that CSF PCR may be negative early in the disease course. Others have suggested that initially negative/follow up positive HSV PCR cases may represent secondary reactivation or release from underlying tissue damage. Consideration of the full clinical picture is crucial in patients with HSV negative PCR. Continuation of antiviral therapy may be appropriate in select HSV PCR negative patients.

Infections of the CNS: Meningitis and Encephalitis (DRAFT)

2018 ◽  
Author(s):  
Tamara Kaplan ◽  
Tracey Milligan
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Herpes Simplex ◽  
Herpes Simplex Encephalitis ◽  
Altered Level ◽  
Limbic Structures ◽  
Temporal Lobes ◽  
Nuchal Rigidity ◽  
Level Of Consciousness ◽  
The Central Nervous System

The video in this chapter discusses infections of the central nervous system (CNS), meningitis including its symptoms (fever, headache, nuchal rigidity, altered level of consciousness), its causes (bacterial, fungal, viral, or aseptic), and how the CSF profile provides clues to the etiology. The chapter also discusses encephalitis, its symptoms (seizures, other focal neurologic symptoms). Patients with Herpes Simplex Encephalitis may show T2 hyperintensities in the anterior temporal lobes and limbic structures on MRI. CSF may show xanthochromia and positive PCR for HSV1 or HSV2.

scholarly journals New-Onset Seizure With Possible Limbic Encephalitis in a Patient With COVID-19 Infection: A Case Report and Review

2021 ◽  
Vol 9 ◽  
pp. 232470962098630
Author(s):  
Riwaj Bhagat ◽  
Barbara Kwiecinska ◽  
Nolan Smith ◽  
Matthew Peters ◽  
Christopher Shafer ◽  
...  
Keyword(s):  
Brain Magnetic Resonance Imaging ◽  
Nasopharyngeal Swab ◽  
Onset Seizure ◽  
Cerebrospinal Fluid Analysis ◽  
Fluid Analysis ◽  
Global Pandemic ◽  
Elevated Protein ◽  
T2 Hyperintensity ◽  
Elevated Protein Level ◽  
New Onset

With the outbreak of COVID-19 (coronavirus disease 2019) as a global pandemic, various of its neurological manifestations have been reported. We report a case of a 54-year-old male with new-onset seizure who tested positive for severe acute respiratory syndrome coronavirus 2 from a nasopharyngeal swab sample. Investigative findings, which included contrast-enhancing right posterior temporal lobe T2-hyperintensity on brain magnetic resonance imaging, right-sided lateralized periodic discharges on the electroencephalogram, and elevated protein level on cerebrospinal fluid analysis, supported the diagnosis of possible encephalitis from COVID-19 infection. The findings in this case are placed in the context of the existing literature.

Direct ophthalmoscopy for the acute physicia – papilloedema and other abnormalities of the optic nerve head

2002 ◽  
Vol 1 (2) ◽  
pp. 60-63
Author(s):  
B Edmunds ◽  
◽  
P J Francis ◽  
Keyword(s):  
Optic Nerve ◽  
Optic Nerve Head ◽  
Visual Disturbance ◽  
Medical Setting ◽  
Altered Level ◽  
Level Of Consciousness ◽  
Systemic Disorder ◽  
Systemic Examination ◽  
Direct Ophthalmoscopy

Direct ophthalmoscopy is an essential part of the full systemic examination. However, the technique is challenging and time-consuming. In the acute medical setting therefore, it is advisable for the physician to identify the subgroup of patients in whom examination of the fundus is most likely to be helpful. Ophthalmoscopy should be performed where papilloedema is suspected, in those with an altered level of consciousness or other focal neurology, those with an unknown systemic disorder, and those complaining of visual disturbance.

scholarly journals Altered Mental Status and Cyanosis in a Pediatric Patient with Methemoglobinemia

2020 ◽  
Vol 2020 ◽  
pp. 1-4
Author(s):  
Phillip M. Grenz ◽  
Robert N. Ray Jr. ◽  
Olivia A. Hardy ◽  
Andrew L. Koons ◽  
Kenneth D. Katz ◽  
...  
Keyword(s):  
Mental Status ◽  
Clinical Manifestations ◽  
Altered Mental Status ◽  
Pediatric Emergency ◽  
Abrupt Onset ◽  
Altered Level ◽  
Sustained Improvement ◽  
Oxygen Dissociation ◽  
Nail Polish ◽  
Level Of Consciousness

Methemoglobinemia results from increased amounts of oxidized hemoglobin in the blood with an ensuing change in oxygen dissociation curve and lack of oxygen delivery to tissue. A previously well, male toddler was brought to the Pediatric Emergency Department (PED) by Emergency Medical Services (EMS) with abrupt onset of altered mental status and cyanosis after a suspected ingestion of “Rush” nail polish remover. He was quickly diagnosed with methemoglobinemia by both clinical presentation and chocolate-colored blood appearance. He emergently received intravenous (IV) methylene blue (MB) with immediate and sustained improvement requiring no further doses. Though inhalation of nitrites and subsequent methemoglobinemia is frequently reported in adolescents, we were unable to find any cases in the literature detailing ingestion of this product and the resulting clinical manifestations. Our objective with this report is to describe a rare case of a toddler with an accidental ingestion of “Rush” nail polish remover, a nitrite compound. Our patient presented to the PED with abrupt onset of altered level of consciousness, hypotension, and cyanosis resulting from acquired methemoglobinemia. This case report demonstrates the importance of emergency clinicians being able to make clinical judgements and decisions based on the history and physical exam when methemoglobinemia is suspected.

scholarly journals Brain Catastrophe presented with endocrine disruption

2020 ◽  
Vol 8 (5) ◽  
pp. 104-110
Author(s):  
Saadi JS AlJadir
Keyword(s):  
Dynamic Testing ◽  
Hemodynamic Instability ◽  
Major Surgery ◽  
Initial Manifestation ◽  
Altered Level ◽  
Identifiable Risk Factor ◽  
Conflicting Evidence ◽  
Level Of Consciousness ◽  
Threatening Condition ◽  
Life Threatening

Pituitary Apoplexy (PA) is an acute critical endocrine condition that is infrequently encountered in daily medical practice. Its life-threatening condition that mandates prompt diagnosis and urgent treatment and may be neurosurgical intervention. Majority of cases are attributed to ischemic infarction or hemorrhage of the pituitary gland usually in the vicinity of pituitary adenoma, and in most cases could be the initial manifestation of these tumors! In reviewing the literatures there is conflicting evidence of which are the predominant, non-functional, or functional adenomas, some reports were showed that prolactin-secreting are at highest risk. There are recognizable risk factors that might precipitate this endocrine emergency like hypertension, medications, major surgery, head injury, radiation, or dynamic testing, but in majority of cases at presentation no identifiable risk factor could be detected. The typical clinical scenario includes persistent worsening headache, vomiting, and altered level of consciousness, visual defect or loss with extreme hormonal derangements which are shown by hemodynamic instability, adrenal crises with variable hormonal deficiencies.

scholarly journals Spectrum of Intracerebral Hemorrhage in Children: A Report from PICU of a Resource Limited Country

2016 ◽  
Vol 2016 ◽  
pp. 1-4 ◽  
Author(s):  
Qalab Abbas ◽  
Qurat ul Ain Merchant ◽  
Bushra Nasir ◽  
Anwar ul Haque ◽  
Basit Salam ◽  
...  
Keyword(s):  
Intracerebral Hemorrhage ◽  
Medical Records ◽  
Vascular Malformations ◽  
Pediatric Intensive Care ◽  
Conventional Angiography ◽  
Altered Level ◽  
Vascular Intervention ◽  
Resource Limited ◽  
Level Of Consciousness ◽  
Gender Presentation

Intracerebral hemorrhage (ICH) in children is a rare but disabling disease that accounts for almost half cases of stroke. We report our experience of ICH in children. Retrospective review of medical records of children (1 month-16 years) admitted in Pediatric Intensive Care Unit between January 2007 and December 2014 was done. Data collected included age, gender, presentation, examination findings, neuroimaging done (CT, MRI, and angiography) management (conservative/intervention), and outcome. Results are presented as frequency and percentages. Of the total 50 patients, 58% were male and 26% were <1 year. On presentation 44% had vomiting, 42% had seizures, and GCS < 8 while 40% had altered level of consciousness. Single bleed was present in 88%, 94% had supratentorial bleed, and 32% had intraventricular extension. 72% had bleed volume of <30 mL and 8% had >60 mL. CT scan was done in 98% patients and MRI in 34%, while 6% underwent conventional angiography. 60% patients were managed conservatively, 36% underwent neurosurgical intervention, and 6% underwent radiological vascular intervention. Hematologic causes were identified in 52% patients and vascular malformations in 14% and in 26% no cause could be identified. 26% of patients expired.

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