scholarly journals ADULT PNEUMOCOCCAL MENINGITIS PRESENTING WITH STROKE LIKE SYMPTOMS

2021 ◽  
Vol 71 (4) ◽  
pp. 1496-97
Author(s):  
Muhammad Mohsin Sajjad ◽  
Sidra Yousaf
Keyword(s):  
Clinical Symptoms ◽  
Leukocyte Count ◽  
Sudden Onset ◽  
Acute Ischemia ◽  
Resonance Imaging ◽  
Neck Stiffness ◽  
Gram Staining ◽  
Accident And Emergency ◽  
Low Glucose ◽  
Stroke Mimic

Meningitis can present as a stroke mimic. We report a case of a 69 years old lady who presented to accident and emergency 2-hours after an episode of vomiting followed by sudden onset left sided weakness and drowsiness. Examination revealed left sided weakness with dysphasia. Initial plan was to decide if the patient was for thrombolysis. An urgent CT scan ruled out hemorrhage. On re-examination the patient was febrile and there was some degree of neck stiffness. Magnetic resonance imaging of brain was performed (DW1 no stroke) which ruled out acute ischemia. A lumber puncture was done eventually that showed low glucose, high leukocyte count, and gram staining revealed diplococci in chains. Clinicians should bear in mind the differential diagnosis of meningitis when there are risk factors and overlapping clinical symptoms.

scholarly journals Vermal cerebellar hemorrhage as the initial manifestation of undiagnosed hypertension

2016 ◽  
Vol 5 (1) ◽  
pp. 357 ◽  
Author(s):  
Alagoma Iyagba ◽  
Arthur Onwuchekwa
Keyword(s):  
Sudden Onset ◽  
Lower Limbs ◽  
Neck Stiffness ◽  
Cerebellar Haemorrhage ◽  
Initial Manifestation ◽  
Truncal Ataxia ◽  
Accident And Emergency ◽  
Undiagnosed Hypertension ◽  
History Of ◽  
Clonic Seizures

Vermal cerebellar haemorrhage is bleeding affecting the midline region of the cerebellum. It is uncommon, accounting for 5-13% of all intracerebral haemorrhages. It is a grave condition with a high mortality. The diagnosis must be made early, if not, most patients would die within 48 hours. A 70-year-old lady presented to the accident and emergency department with a six hours history of sudden onset generalized tonic-clonic seizures following activity and loss of consciousness. She was unconscious with a Glasgow coma score of 3/15 with neck stiffness, generalized hypotonia and globally diminished reflexes. Her blood pressure was 240/120 mmHg with a mean arterial pressure of 160 mmHg. The brain computerized tomographic scan showed a hyperdense area in the cerebellar vermis with extension to both hemispheres and fourth ventricle. Consciousness was regained after three weeks of conservative management following which she became extremely restless and noticed to have developed titubations with nystagmus of both eyes. She also developed intention tremors, scanning dysarthria, generalized hypotonia, dysmetria, dysdiadochokinesia and intentional bilateral tremors. Her recovery was slow and gradual. Once she was able to stand with support, she was noticed to have florid truncal ataxia, lower limbs ataxia, and titubations.

scholarly journals A Report of a Case Involving Body Lateropulsion with Numbness of the Ipsilesional Fingers Caused by a Small Infarction in the Dorsal Part of the Middle Medulla

2018 ◽  
Vol 10 (1) ◽  
pp. 54-59
Author(s):  
Yumiko Yamaoka ◽  
Sadahiro Kishishita ◽  
Yohei Takayama ◽  
Seiji Okubo
Keyword(s):  
Clinical Symptoms ◽  
Functional Anatomy ◽  
Sudden Onset ◽  
Dorsal Part ◽  
Section Thickness ◽  
Resonance Imaging ◽  
First Case ◽  
Weighted Magnetic Resonance Imaging ◽  
Vestibular Symptoms ◽  
Left Middle

Based on the complexity of functional anatomy, a small infarction in the medulla can produce various types of clinical symptoms or signs depending on the location of this infarction. We describe the case of a 46-year-old man who presented with sudden onset of body lateropulsion to the left side and numbness of the ipsilateral fingers. 3-tesla diffusion-weighted magnetic resonance imaging with a section thickness of 2 mm revealed a small infarction in the dorsal part of the left middle medulla. To our knowledge, this is the first case report describing vestibular dysfunction apparent upon otoelectrophysiological examination but without vestibular symptoms or signs except for body lateropulsion.

scholarly journals Substantia nigra neuromelanin magnetic resonance imaging in patients with different subtypes of Parkinson disease

2021 ◽  
Author(s):  
Lu Wang ◽  
Yayun Yan ◽  
Liyao Zhang ◽  
Yan Liu ◽  
Ruirui Luo ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Substantia Nigra ◽  
Parkinson Disease ◽  
Clinical Symptoms ◽  
Dopamine Neurons ◽  
Substantia Nigra Pars Compacta ◽  
Resonance Imaging ◽  
Mean Values

AbstractNeuromelanin (NM) is a dark pigment that mainly exists in neurons of the substantia nigra pars compacta (SNc). In Parkinson disease (PD) patients, NM concentration decreases gradually with degeneration and necrosis of dopamine neurons, suggesting potential use as a PD biomarker. We aimed to evaluate associations between NM concentration in in vivo SN and PD progression and different motor subtypes using NM magnetic resonance imaging (NM-MRI). Fifty-four patients with idiopathic PD were enrolled. Patients were divided into groups by subtypes with different clinical symptoms: tremor dominant (TD) group and postural instability and gait difficulty (PIGD) group. Fifteen healthy age-matched volunteers were enrolled as controls. All subjects underwent clinical assessment and NM-MRI examination. PD patients showed significantly decreased contrast-to-noise ratio (CNR) values in medial and lateral SN (P < 0.05) compared to controls. CNR values in lateral SN region decreased linearly with PD progression (P = 0.001). PIGD patients showed significant decreases in CNR mean values in lateral SN compared to TD patients (P = 0.004). Diagnostic accuracy of using lateral substantia nigra (SN) in TD and PIGD groups was 79% (sensitivity 76.5%, specificity 78.6%). NM concentration in PD patients decreases gradually during disease progression and differs significantly between PD subtypes. NM may be a reliable biomarker for PD severity and subtype identification.

Aggressive Intramedullary Melanotic Schwannoma: Case Report

Neurosurgery ◽  
2004 ◽  
Vol 55 (6) ◽  
pp. E1430-E1434 ◽  
Author(s):  
Carlo Santaguida ◽  
Abdulrahman J. Sabbagh ◽  
Marie-Christine Guiot ◽  
Rolando F. Del Maestro
Keyword(s):  
Clinical Presentation ◽  
Magnetic Resonance Imaging Scan ◽  
Resonance Imaging ◽  
Total Resection ◽  
Neck Stiffness ◽  
Neck Extension ◽  
Melanotic Schwannoma ◽  
Pathological Characteristics ◽  
Intramedullary Lesion

Abstract OBJECTIVE AND IMPORTANCE: Intramedullary melanotic schwannomas are very rare lesions; only four cases have been reported previously. We describe a patient with an intramedullary melanotic schwannoma that had a more aggressive course than those reported in the literature, and we review the theories regarding the cause of these lesions. CLINICAL PRESENTATION: A 35-year-old man presented with neck stiffness and paraesthesia extending down his right arm upon neck extension. A magnetic resonance imaging scan revealed an intramedullary lesion extending from C4 to C5. INTERVENTION: Gross total resection of the mass was performed, and pathological characteristics were consistent with a melanotic schwannoma. Two years after resection the tumor recurred, and the patient was treated with radiation therapy. The tumor progressed 2 years after radiotherapy, and at repeat resection, multiple pigmented foci were present on the surface of the spinal cord and dura consistent with metastatic seeding. CONCLUSION: In a patient with intramedullary melanotic schwannoma with an unusually aggressive course, careful follow-up may be essential.

scholarly journals Obesity, The Single Most Important Risk Factor for OSA: A Case Report

Pulse ◽  
2018 ◽  
Vol 10 (1) ◽  
pp. 38-41
Author(s):  
SMAA Mamun
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Clinical Symptoms ◽  
Upper Airway ◽  
Resonance Imaging ◽  
Cross Sectional ◽  
Airway Narrowing ◽  
Fat Deposits ◽  
Obstructive Sleep ◽  
Normal Controls

Obstructive sleep apnea (OSA) is characterized by repetitive airflow reduction caused by collapse of the upper airway during sleep in addition to daytime sleepiness, clinical symptoms include fatigue, insomnia, and snoring. The condition is associated with adverse clinical outcomes, including cardiovascular disease, hypertension, cognitive impairment, and metabolic abnormalities.1 Among the risk factors for OSA, obesity is probably the most important. Several studies have consistently found an association between increased body weight and risk of OSA. Tomographic scanned images have shown that obesity causes increased fatty deposits in the pharyngeal area.2 The deposits encroach on the airway and contribute to airway narrowing. Also, among obese patients as compared to normal controls, fat deposits appear to alter the shape of the upper airway without necessarily reducing the cross-sectional area. M. A. Ciscar et al used magnetic resonance imaging to investigate differences between obese and normal controls.2 Ultrafast magnetic resonance imaging was used to study the upper airway and surrounding soft tissue in 17 patients with OSA during wakefulness and sleep, and in eight healthy subjects whilst awake. Coronal sections of awake OSA patients showed elliptical-shaped airways with long axes that were oriented anteroposterior; normal controls had airways that were oriented transversely. Studies using computed tomography have produced similar results.14Pulse Vol.10 January-December 2017 p.38-41

scholarly journals Non traumatic spinal epidural haematoma

2019 ◽  
Vol 18 (4) ◽  
pp. 255-258
Author(s):  
Naureen Abdul Khalid ◽  
◽  
Nainal Shah ◽  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Trauma Surgery ◽  
Epidural Haematoma ◽  
Rare Condition ◽  
Sudden Onset ◽  
Resonance Imaging ◽  
Spinal Epidural Haematoma ◽  
History Of ◽  
Magnetic Resonance Imaging Mri ◽  
Spinal Epidural

Spinal epidural haematoma is a rare condition, which may be due to trauma, surgery, epidural catheterisation or disorders of coagulation. We report a case of 60 year old lady who was on warfarin for Atrial fibrillation (AF) presented with history of non-traumatic sudden onset pain in both legs and difficulty in walking. Magnetic resonance imaging (MRI) spine demonstrated epidural haematoma which was treated conservatively. Another dilemma was anticoagulation for AF. We examine the options to manage such case.

scholarly journals Orbital Schwannoma: Case Report and Review

2019 ◽  
Vol 38 (03) ◽  
pp. 199-202 ◽  
Author(s):  
Ricardo Lourenço Caramanti ◽  
Mário José Goes ◽  
Feres Chaddad ◽  
Lucas Crociati Meguins ◽  
Dionei Freitas de Moraes ◽  
...  
Keyword(s):  
Clinical Symptoms ◽  
Previous History ◽  
Mass Effect ◽  
Complete Resection ◽  
High Signal ◽  
Resonance Imaging ◽  
History Of Disease ◽  
Orbital Pain ◽  
History Of ◽  
Magnetic Resonance Imaging Mri

AbstractOrbital schwannomas are rare, presenting a rate of incidence between 1 and 5% of all orbital lesions. Their most common clinical symptoms are promoted by mass effect, such as orbital pain and proptosis. The best complementary exam is the magnetic resonance imaging (MRI), which shows low signal in T1, high signal in T2, and heterogeneous contrast enhancement. The treatment of choice is surgical, with adjuvant radiotherapy if complete resection is not possible. We report the case of a 24-year-old male patient with orbital pain and proptosis, without previous history of disease. The MRI showed a superior orbital lesion compatible with schwannoma, which was confirmed by biopsy after complete resection using a fronto-orbital approach.

scholarly journals Changes of Myelin Organization in Patients with Alzheimer’s Disease Shown by q-Space Myelin Map Imaging

2019 ◽  
Vol 9 (1) ◽  
pp. 24-33 ◽  
Author(s):  
Miho Ota ◽  
Noriko Sato ◽  
Yukio Kimura ◽  
Yoko Shigemoto ◽  
Hiroshi Kunugi ◽  
...  
Keyword(s):  
Alzheimer’S Disease ◽  
Alzheimer's Disease ◽  
Healthy Subjects ◽  
Clinical Symptoms ◽  
Imaging Modality ◽  
Significant Negative Correlation ◽  
Anterior Cingulate ◽  
Resonance Imaging ◽  
Duration Of Illness ◽  
The Central Nervous System

Background: Recent studies detected the aberrant myelination of the central nervous system (CNS) in Alzheimer’s disease (AD). Here, we compared the change of myelination between patients with AD and controls by a novel magnetic resonance imaging modality, “q-space myelin map (MM) imaging.” Methods: Twenty patients with AD and 18 healthy subjects underwent MM imaging. We compared the MM metric between the 2 groups and examined the relationships between the metric and the clinical symptoms of AD. Results: AD patients showed a significant reduction of MM metric in the hippocampus, insula, precuneus, and anterior cingulate regions. There was also a significant negative correlation between the duration of illness and the MM metric in the temporoparietal region. Conclusion: Our findings suggest that MM imaging could be a clinically proper modality to estimate the myelination changes in AD patients.

scholarly journals Isolated nausea and vomiting as the cardinal presenting symptoms of clozapine-induced myocarditis: a case report

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
M. Z. van der Horst ◽  
F. van Houwelingen ◽  
J. J. Luykx
Keyword(s):  
Magnetic Resonance Imaging ◽  
Case Report ◽  
Clinical Symptoms ◽  
Early Recognition ◽  
Nausea And Vomiting ◽  
Resonance Imaging ◽  
Treatment Resistant ◽  
Laboratory Examination ◽  
Case Presentation ◽  
Presenting Symptoms

Abstract Background Clozapine is an atypical antipsychotic proven to be superior in the treatment of treatment-resistant schizophrenia. Myocarditis is a rare, but well-known complication of treatment with clozapine. Only few cases have been reported in which nausea and vomiting were prominent symptoms. This is the first described report in which nausea and vomiting were the only presenting symptoms of clozapine-induced myocarditis. Case presentation We report a case of a 58-year-old woman, suffering from schizoaffective disorder, who is being treated with clozapine. Two weeks after initiation of clozapine, she developed nausea and vomiting, in absence of any other clinical symptoms. Laboratory examination and magnetic resonance imaging confirmed the diagnosis of clozapine-induced myocarditis. Clozapine was discontinued and the patient recovered fully. Conclusions This case emphasizes the importance of recognizing myocarditis as a cause of isolated nausea and vomiting in patients treated with clozapine. Early recognition improves clinical outcome and reduces mortality.

A Magnetic Resonance Imaging Study of Schizophrenia: Brain Structure and Clinical Symptoms

1991 ◽  
Vol 158 (2) ◽  
pp. 158-164 ◽  
Author(s):  
A. H. Young ◽  
D. H. R. Blackwood ◽  
H. Roxborough ◽  
J. K. McQueen ◽  
M. J. Martin ◽  
...  
Keyword(s):  
Negative Symptoms ◽  
Clinical Symptoms ◽  
Imaging Study ◽  
Cerebral Atrophy ◽  
Parahippocampal Gyrus ◽  
Positive Symptoms ◽  
Resonance Imaging ◽  
Schizophrenic Group ◽  
Two Measures ◽  
The Right

Thirty-one patients with schizophrenia and 33 normal control subjects underwent MRI. The BPRS was used to rate clinical symptoms and the NART to estimate premorbid IQ. All were right handed. The temporal lobe was significantly smaller on the left than the right in both the control and schizophrenic groups. The amygdala was smaller on the left than the right in controls but not in schizophrenics. The parahippocampal gyrus was smaller on the left side in the schizophrenic group but not in controls. In the schizophrenic group, ventricular enlargement and cerebral atrophy were significantly related to severity of symptoms. Patients with marked negative symptoms had a bilateral reduction in the size of the head of caudate and the two measures were significantly correlated. Patients with marked positive symptoms had larger VBRs and again the clinical and morphometric changes were significantly correlated. There were no morphometric differences between patients with short duration (two years or less) and chronic symptoms.

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