Serial MRI and CSF Analysis in a Dog Treated with Intrathecal Amphotericin B for Protothecosis

2012 ◽  
Vol 48 (2) ◽  
pp. 125-131 ◽  
Author(s):  
Martin Young ◽  
William Bush ◽  
Melissa Sanchez ◽  
Pat Gavin ◽  
Mathew Williams
Keyword(s):  
Cerebrospinal Fluid ◽  
Amphotericin B ◽  
Head Tilt ◽  
Mri Findings ◽  
Lipid Complex ◽  
Fluid Analysis ◽  
Csf Analysis ◽  
Transient Improvement ◽  
The Right ◽  
The Brain

A 3 yr old female spayed English setter mixed-breed dog presented with diarrhea, weight loss, side stepping to the right, and a right head tilt. Rectal and cerebrospinal fluid cytology and culture confirmed a diagnosis of Prototheca zopfii. MRI of the brain showed inflammation of the brain and meninges, ventriculomegaly, and syringomyelia. Treatment with prednisone, itraconazole, and amphotericin B lipid complex administered intrathecally yielded transient improvement. Progressive brainstem signs were noted, and a repeat MRI and cerebrospinal fluid analysis documented persistent disease. This is the first description of the MRI findings and treatment with intrathecal amphoteracin B lipid complex for protothecosis of the central nervous system. Protothecosis should be considered in dogs with chronic diarrhea and compatible MRI findings.

scholarly journals Ultrasonographic detection of meningoencephalitis in a dog

2021 ◽  
Vol 26 (3) ◽  
pp. e2218
Author(s):  
Marcus Antônio Rossi-Feliciano ◽  
Rafael Kretzer-Carneiro ◽  
Igor Cezar Kniphoff da Cruz ◽  
Tainara Moraes-Pereira ◽  
Ricardo Pozzobon ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Rapid Test ◽  
Moderate Amount ◽  
Fluid Analysis ◽  
Divergent Strabismus ◽  
Ultrasound Findings ◽  
Ultrasound Guided Puncture ◽  
The Right ◽  
Guided Puncture ◽  
The Brain

The aim of this report is to disseminate ultrasound findings of meningoencephalitis in a dog, diagnosed by analysis of cerebrospinal fluid collected by guided-ultrasound puncture. The patient presented walking in circles, absence of bilateral threat reflex, decreased left eyelid reflex, divergent strabismus of the right eye, negative nasal sensation on the right side, and an increase in volume of skullcap with the presence of open fontanelle. The clinical suspicion was hydrocephalus and/or inflammatory/infectious disease. The distemper rapid test was negative. The hematological profile showed an increase in alanine aminotransferase enzyme. Ultrasound examination was performed with patient in sternal decubitus, using a linear transducer (9.0 MHz). Images were obtained in longitudinal and transverse sections through the temporal windows and bregmatic fontanelle. The presence of a marked anechogenic content with moderate amount of floating hyperechogenic spots was observed, with retraction and increased echogenicity of the brain. Cerebrospinal fluid was collected using the bregmatic fontanelle for ultrasound-guided puncture, under general anesthesia. Meningoencephalitis was indicated by mononucleated cells and red blood cells founded in cerebrospinal fluid analysis. However, the patient not return to start treatment and investigate the cause of the meningoencephalitis.

scholarly journals Cerebrospinal Fluid Analysis Predicts Enhancement on MRI in Bacterial and Tuberculous Meningitis: A Retrospective Observational Study

2021 ◽  
Author(s):  
Ryoji Goto ◽  
Yurino Horiuchi ◽  
Haruka Kawakami ◽  
Ayaka Chikada ◽  
Tsutomu Yasuda ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Tuberculous Meningitis ◽  
Mri Findings ◽  
Fluid Analysis ◽  
Csf Analysis ◽  
Enhanced Mri ◽  
Contrast Enhanced ◽  
Discriminant Ability ◽  
Mri Scans ◽  
Contrast Enhanced Mri

Abstract Background Along with cerebrospinal fluid (CSF) analysis, enhancement on contrast-enhanced MRI scans are useful to diagnose and presume the pathogen of meningitis. However, the conditions for its appearance have not been clarified. This study aimed to investigate the possibility of CSF parameters as predictors of the existence of enhancement on contrast-enhanced head or spinal MRI scans in patients with bacterial meningitis (BM) or tuberculous meningitis (TM).Methods A total of 12 patients with BM and 23 patients with TM who underwent both CSF analyses and contrast-enhanced MRI scans were included in this study. The correlation between CSF analyses and MRI findings has been examined using receiver operating characteristic (ROC) analysis.Results Contrast enhancement was found in 7 and 10 patients with BM and TM, respectively. In patients with BM, higher CSF protein and lower CSF glucose were associated with the presence of the enhancement on MRI, while the CSF leukocyte or neutrocyte count did not show any difference. In contrast, not only the CSF protein and glucose but also the leukocyte and lymphocyte counts were associated with the enhancement in patients with TM. Furthermore, CSF adenosine deaminase (ADA) in patients with TM showed neither correlation with CSF leukocyte count nor discriminant ability of the MRI findings.Conclusions CSF analysis predicts the existence of enhancement on contrast-enhanced MRI scans of the central nervous system both in patients with BM and those with TM. Our findings about the CSF cell count and CSF ADA indicate the mechanism of the blood–brain barrier (BBB) breakdown in BM and TM.

Rapidly progressive vision loss due to fulminant idiopathic intracranial hypertension: a diagnostic and management dilemma

2020 ◽  
Vol 13 (11) ◽  
pp. e236188
Author(s):  
Jagadeesh Sutraye ◽  
Mohan Kannam ◽  
Rajat Kapoor ◽  
Virender Sachdeva
Keyword(s):  
Intracranial Hypertension ◽  
Idiopathic Intracranial Hypertension ◽  
Vision Loss ◽  
Obese Woman ◽  
Visual Fields ◽  
Csf Analysis ◽  
Contrast Enhanced ◽  
Grade Ii ◽  
The Right ◽  
The Brain

A 44-year-old obese woman presented with decrease in vision in the right eye (RE) for 3 days. She reported a simultaneous onset of holocranial headache that worsened on bending forward. She denied eye pain, pain on eye movements, and other ocular or neurological complaints. On examination, her distance best-corrected visual acuity was counting fingers at 1 m in the RE and 20/20 in the left eye (LE). Colour vision was subnormal in both eyes (BE). There was grade II relative afferent pupillary defect in the RE. Fundus examination showed disc oedema in BE . Visual fields in the LE showed central scotoma extending nasally. A provisional diagnosis of papillitis was considered. However, contrast-enhanced MRI of the brain and orbits showed evidence of elevated intracranial pressure. Cerebrospinal fluid (CSF) opening pressure was 42 cm H2O while rest of the CSF analysis was normal. Diagnosis was revised to fulminant idiopathic intracranial hypertension. Management with medical therapy and urgent thecoperiteoneal shunt improved visual function in BE.

scholarly journals Follistatin (FS) in human cerebrospinal fluid and regulation of FS expression in a mouse model of meningitis

2000 ◽  
pp. 809-816 ◽  
Author(s):  
U Michel ◽  
S Ebert ◽  
O Schneider ◽  
Y Shintani ◽  
S Bunkowski ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Cerebrospinal Fluid ◽  
Specific Binding ◽  
In Situ Hybridisation ◽  
Viral Meningitis ◽  
Csf Analysis ◽  
Mrna And Protein Expression ◽  
Leukocyte Counts ◽  
The Brain

OBJECTIVE: Follistatin (FS) is the specific binding protein of activin and expression of both factors is regulated by inflammatory agents. Therefore, FS concentrations were determined in cerebrospinal fluid (CSF) of patients with bacterial and viral meningitis or multiple sclerosis (MS), as well as in the CSF of patients without meningial inflammation or autoimmune diseases. Furthermore, a mouse pneumococcal meningitis model was used to localise the cellular sources of FS in brains of normal and meningitic mice. METHODS: FS concentrations in CSF were determined by ELISA; FS in mice was localised by in situ hybridisation and immunohistochemistry. RESULTS: FS concentrations were > or =0.4 microg/l in 22 of 66 CSF samples of meningitis patients versus 2 of 27 CSF samples from patients with multiple sclerosis (P<0.05) and 2 of 41 CSF specimen from patients without neuroinflammatory diseases (P<0.01). In the CSF of patients with meningitis, the concentration of FS was correlated with total protein (P<0.005) and lactate concentrations (P<0.05), but not with leukocyte counts, interval between onset of disease and CSF analysis, or clinical outcome. The CSF-to-serum ratios of FS and albumin also correlated significantly (P<0.0005). In some patients with meningitis the CSF-to-serum ratios suggested that the elevated FS in CSF did not originate from serum alone. FS was localised in mice brains to neurones of the hippocampus, dentate gyrus, neocortex, and to the choroid plexus. Analyses of brains and other organs from uninfected and infected animals sacrificed 6-36 h after infection did not reveal any obvious differences in the distribution and intensity of FS mRNA and protein expression. CONCLUSIONS: The concentration of FS in humans is elevated during meningitis. In some patients the increase is caused by a release of FS from brain into CSF. Data from the mouse meningitis model suggest that increased CSF concentrations of FS in meningitis appear not to be accompanied by an elevated number of cells containing FS mRNA or protein in the brain.

scholarly journals Diagnosing Ring-Enhancing Lesions in the Brain of a Patient With AIDS Without Brain Biopsy: A Case of Central Nervous System Histoplasmoma

2017 ◽  
Vol 8 (2) ◽  
pp. 86-91 ◽  
Author(s):  
Rachel Beekman ◽  
Jessica M. Hu ◽  
Steven I. Aronin ◽  
Maricar F. Malinis
Keyword(s):  
Central Nervous System ◽  
Cerebrospinal Fluid ◽  
Nervous System ◽  
Histoplasma Capsulatum ◽  
Brain Mri ◽  
Central Nervous System Involvement ◽  
Brain Biopsy ◽  
Empiric Therapy ◽  
Fluid Analysis ◽  
The Brain

We report a case of a Puerto Rican male with advanced AIDS who presented with multiple falls and pancytopenia. Magnetic resonance imaging (MRI) of the brain, as initial workup, revealed 2 ring-enhancing brain lesions. Initial cerebrospinal fluid analysis revealed minimal cells, mildly elevated protein, and no organism seen on gram stain. Due to prohibitive thrombocytopenia, brain biopsy was deferred. He had neither clinical nor radiographic improvement despite empiric therapy for both toxoplasmosis and bacterial abscesses. Indicated by pancytopenia, bone marrow (BM) aspiration was performed. Culture of BM aspirate grew Histoplasma capsulatum. Urine histoplasma antigen was markedly elevated. He was treated with liposomal amphotericin B (LamB) for progressive disseminated histoplasmosis with probable central nervous system involvement. Cerebrospinal fluid histoplasma antigen obtained after 2 months of LamB was detected. After prolonged course of LamB, he took itraconazole. Brain MRI at 7-month follow-up revealed significant improvement from baseline study.

scholarly journals Cerebrospinal fluid analysis in 58 ruminants showing neurological disorders

2020 ◽  
Vol 40 (5) ◽  
pp. 346-354
Author(s):  
Antônio Carlos L. Câmara ◽  
Mariana C. Gonzaga ◽  
Thaís M. Ziober ◽  
Cintia Regina R. Queiroz ◽  
Tayná C.M. Fino ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Neurological Disorders ◽  
Viral Infections ◽  
Experimental Studies ◽  
Clinical Signs ◽  
Pathological Findings ◽  
Cerebrospinal Fluid Analysis ◽  
Cns Diseases ◽  
Fluid Analysis ◽  
Csf Analysis

ABSTRACT: Ruminants may be affected by a wide variety of central nervous system (CNS) diseases. Cerebrospinal fluid (CSF) analysis forms the basis for ante mortem diagnostic evaluation of ruminants with clinical signs involving the CNS. Despite its importance as a tool to aid diagnosis, data regarding CSF examinations in spontaneous cases of CNS diseases in ruminants from Brazil are limited, and most reports involve experimental studies. Therefore, this study aimed to report the results of CSF analysis in 58 ruminants showing signs of neurological disorders. CSF samples for analysis were obtained from 32 cattle, 20 sheep, and 6 goats by cerebello-medullary cistern (n=54) or lumbosacral space (n=4) puncture. These ruminants showed neurological signs related to viral (n=13), mycotic (n=3), or bacterial (n=15) infections, and toxic (n=21), traumatic (n=4), or congenital disorders (n=2). CSF analysis from ruminants with viral infections presented lymphocytic pleocytosis, even though CSF showed no changes in several cases of rabies. Neutrophilic pleocytosis, cloudiness, presence of fibrin clots, and abnormal coloration were evident in the CSF of most cases of CNS bacterial infection, such as meningoencephalitis, meningitis, abscesses, myelitis, and a case of conidiobolomycosis. On the other hand, CSF was unchanged in most cases of toxic disorders, as botulism and hepatic encephalopathy. Elevated CSF density was observed in 60% of ruminants diagnosed with polioencephalomalacia. Our findings show that evaluation of CSF is a valuable diagnostic tool when used in association with epidemiological, clinical and pathological findings for diagnosis of CNS diseases in ruminants.

scholarly journals Utility of PCR Assay in Diagnosis of En-Plaque Tuberculoma of the Brain

1999 ◽  
Vol 37 (2) ◽  
pp. 467-470 ◽  
Author(s):  
K. K. Singh ◽  
M. D. Nair ◽  
K. Radhakrishnan ◽  
J. S. Tyagi
Keyword(s):  
Magnetic Resonance Imaging ◽  
Cerebrospinal Fluid ◽  
Resonance Imaging ◽  
Pcr Assay ◽  
Mri Findings ◽  
Antitubercular Drugs ◽  
Specific Pcr ◽  
Specific Pcr Assay ◽  
Magnetic Resonance Imaging Mri ◽  
The Brain

This is the first report of a case in which diagnosis of en-plaque tuberculoma on the basis of magnetic resonance imaging (MRI) findings was confirmed by a Mycobacterium tuberculosiscomplex-specific PCR assay of cerebrospinal fluid. The accuracy of the diagnosis was supported by good response to antitubercular drugs, which was shown by repeat MRI studies performed after treatment.

scholarly journals Cerebrospinal fluid features in COVID-19 patients with neurologic manifestations: correlation with brain MRI findings in 58 patients

2020 ◽  
Author(s):  
François Lersy ◽  
Ilies Benotmane ◽  
Julie Helms ◽  
Olivier Collange ◽  
Maleka Schenck ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Clinical Laboratory ◽  
Brain Mri ◽  
Oligoclonal Bands ◽  
Neurologic Manifestations ◽  
Neurological Manifestations ◽  
Rt Pcr ◽  
Mri Findings ◽  
Leptomeningeal Enhancement ◽  
Csf Analysis

Abstract Background Neurological manifestations are common in patients with COVID-19, but little is known about pathophysiological mechanisms. In this single-center study, we describe neurological manifestations of 58 patients, regarding cerebrospinal fluid (CSF) analysis and neuroimaging findings. Methods 58 COVID-19 patients with neurologic manifestations and SARS-CoV-2 RT-PCR screening on CSF analysis were included. Clinical, laboratory, and brain MRI data were retrospectively collected and analyzed. Results Patients were mostly men (66%) with a median age of 62 years. Encephalopathy was frequent (81%), followed by a pyramidal dysfunction (16%), seizures (10%), and headaches (5%). Protein and albumin levels in CSF were increased in 38% and 23%, respectively. A total of 40% of patients displayed an elevated albumin quotient suggesting impaired blood-brain barrier integrity. CSF-specific IgG oligoclonal band was found in five (11%) cases, suggesting an intrathecal synthesis of IgG, and 26 (55%) patients presented identical oligoclonal bands in serum and CSF. Four (7%) patients harbored a positive SARS-CoV-2 RT-PCR in CSF. Regarding brain MRI, 20 (38%) patients presented leptomeningeal enhancement. Conclusions Brain MRI abnormalities, especially leptomeningeal enhancement, and increased inflammatory markers in CSF are frequent in patients with neurological manifestations related to COVID-19, whereas SARS-CoV 2 detection in CSF remained scanty.

scholarly journals Clinical parameters do not predict infection in patients with external ventricular drains: a retrospective observational study of daily cerebrospinal fluid analysis

2008 ◽  
Vol 57 (2) ◽  
pp. 207-209 ◽  
Author(s):  
Sharmini Muttaiyah ◽  
Stephen Ritchie ◽  
Arlo Upton ◽  
Sally Roberts
Keyword(s):  
Cerebrospinal Fluid ◽  
Staphylococcus Epidermidis ◽  
City Hospital ◽  
Coagulase Negative Staphylococci ◽  
Cerebrospinal Fluid Analysis ◽  
Fluid Analysis ◽  
Csf Analysis ◽  
Clinical Records ◽  
Culture Positive

A retrospective review was conducted of patients with external ventricular drains (EVDs) in situ in order to ascertain the utility of daily cerebrospinal fluid (CSF) analysis in such patients. All laboratory requests for CSF analysis, which were sent to the Microbiology Department, Auckland City Hospital, New Zealand, were reviewed to identify patients with EVDs in situ. The patients' clinical records were reviewed and information was obtained regarding their age, ethnicity, indication for EVD, duration of EVD, CSF analysis results, daily temperatures, Glasgow Coma Scale (GCS) and the presence of other infections. For CSF samples that grew organisms, the patients' notes were reviewed to ascertain whether the organism was a contaminant or was representative of EVD-associated ventriculitis. A total of 454 CSF specimens from 60 patients were reviewed. Of the 56 CSF specimens that were culture-positive, 40 (71 %) were found to reflect clinical infection. Routine CSF analysis identified nine episodes of EVD-associated ventriculitis. Coagulase-negative staphylococci and Staphylococcus epidermidis were the most common isolates and were associated with ventriculitis approximately half of the time. Gram-negative isolates were less frequently isolated, but, when present, were always associated with ventriculitis. This study found that patient temperature and GCS did not allow early prediction of EVD-associated ventriculitis.

scholarly journals Special aspects of the course and diagnosis of neurosyphilis on the example of a clinical case

2021 ◽  
Keyword(s):  
Cerebrospinal Fluid ◽  
Clinical Case ◽  
Structural Changes ◽  
Treponema Pallidum ◽  
State Institution ◽  
Neurological Status ◽  
Diagnostic Methods ◽  
Cerebrospinal Fluid Analysis ◽  
Fluid Analysis ◽  
The Brain

Neurosyphilis is an infectious disease caused by Treponema pallidum and characterized by damage of the central nervous system. This disease may be asymptomatic or have an atypical clinical course, which leads to late diagnosis. The most informative diagnostic methods for this disease are specific serological reactions to syphilis, MRI of the brain and cerebrospinal fluid analysis. Aim. To show the features of the course, treatment and diagnosis of neurosyphilis using the example of a clinical case. Materials and methods. Patient S., born in 1963, complained about significant memory impairment, difficulties with orientation in time and space, mood swings, verbosity and exaggeration, and was hospitalized at the State Institution “Institute of Neurology, Psychiatry and Narcology of the National Academy of Medical Sciences of Ukraine”. Neurological status: eye slits and pupils were uniform. The movements of the eyeballs were painless. Insufficiency of the act of convergence was found. Corneal reactions were reduced. The patient felt pain after the palpation of supra- and infraorbital points. There was an asymmetry in the facial innervation. The tongue was on the midline, swollen, with tooth imprints. There were no pathological signs, sensitive violations. Shaking movements were noticed during the Romberg test. During the examination of the cognitive function using the Mini-Mental State Examination (MMSE) scale, the patient scored 21 points, which corresponds to mild dementia. Results. 1. According to the results of MRI examination of the brain, there was an MR-picture of areas of cystic-gliosis transformation of the poles of the temporal lobes and structural changes of the hippocampal gyrus (most likely, caused by the chronic inflammatory process); vascular foci of the brain as manifestations of dyscirculatory changes, moderate external hydrocephalus. 2. A serological examination for the presence of the antigen of the Treponema pallidum pathogen was performed, the result was positive. 3. Cerebrospinal fluid analysis revealed the following results. Cytosis was 1x106/l, protein was 0.21 g/l, glucose 3.4 mmol/l, Pandy test positivity. Based on the obtained data, the patient was diagnosed with neurosyphilis. The patient underwent etiopathogenetic treatment with benzylpenicillin sodium. After treatment the patient's condition gradually improved. Conclusions. Specific serological reactions to syphilis, MRI of the brain and cerebrospinal fluid analysis are mandatory tests for the diagnosis of neurosyphilis. Early detection of Treponema pallidum and rational therapy can prevent the development of severe consequences and improve the patient's condition. Syphilis is a multidisciplinary problem today and needs the attention of general practitioners, dermatologists and neurologists.

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