Dispersed Bone Spicules as a Cause of Postoperative Headache after Retrosigmoid Vestibular Schwannoma Surgery: A Myth?

Objectives Dispersion of bone dust in the posterior fossa during retrosigmoid craniectomy for vestibular schwannoma (VS) resection could be a source of meningeal irritation and lead to development of persistent postoperative headaches (POH). We aim to determine risk factors, including whether the presence of bone spicules that influence POH after retrosigmoid VS resection. Design Present study is a retrospective case series. Setting The study was conducted at a tertiary skull-base referral center. Participants Adult patients undergoing VS resection via a retrosigmoid approach between November 2017 and February 2020 were included for this study. Main Outcome Measures Development of POH lasting ≥ 3 months is the primary outcome of this study. Results Of 64 patients undergoing surgery, 49 had complete data (mean age, 49 years; 53% female). Mean follow-up time was 2.4 years. At latest follow up, 16 (33%) had no headaches, 14 (29%) experienced headaches lasting <3 months, 19 (39%) reported POH lasting ≥3 months. Twenty-seven (55%) patients had posterior fossa bone spicules detectable on postoperative computed tomography (CT). Age, gender, body mass index, length of stay, tumor diameter, size of craniectomy, the presence of bone spicules, or the amount of posterior petrous temporal bone removed from drilling did not differ significantly between patients with POH and those without. On multivariate logistic regression, patients with POH were less likely to have preoperative brainstem compression by the tumor (odds ratio [OR] = 0.21, p = 0.028) and more likely to have higher opioid requirements during hospitalization (OR = 1.023, p = 0.045). Conclusion The presence of bone spicules in the posterior fossa on postoperative CT did not contribute to headaches following retrosigmoid craniectomy approach for VS resection.

Meningitis retention syndrome associated with complicated mild encephalitis/encephalopathy with reversible splenial lesion in a young adult patient: a case report

ABSTRACT Meningitis retention syndrome (MRS), comprising aseptic meningitis and urinary retention, is a self-limiting disease that resolves within a few weeks. Refractory urinary retention and encephalitic syndromes are rare. A 32-year-old man presented with acute fever and headache followed by acute urinary retention (UT). Neurological examination revealed meningeal irritation, UT, constipation and ataxic gait. The cerebrospinal fluid showed mononuclear leukocytosis, and the etiological examination was negative. We suspected MRS. However, magnetic resonance imaging demonstrated an abnormally intense lesion in the splenium of the corpus callosum (SCC). He also developed delirium on day 4 of hospitalization. We diagnosed the patient with MRS associated with mild encephalitis/encephalopathy with a reversible splenial lesion (MERS). While his delirium and constipation improved, and the SCC lesion disappeared, UT was refractory and required 6 months to complete recovery. Our case suggests that severe MRS can exhibit refractory UT and may associate with MERS.

Vaccination Status and Clinical Spectrum of Children with Pyogenic Meningitis in A Tertiary Care Hospital of Hazara Division, Pakistan

Background: Pyogenic meningitis is one of the serious causes of mortality and morbidity in children. It is more prevalent in third world countries with poor vaccination coverage. This study was done to determine the vaccination status and clinical spectrum of pyogenic meningitis in children presenting to a tertiary care hospital. Methods: This cross-sectional study was carried out from August, 2017 till January, 2020 over 2.5 years. Records of children who got admitted in pediatric B ward, of either gender between ages of 1 month to 14 years diagnosed as case of pyogenic meningitis were included. Records of vaccination status along with signs of meningeal irritation, complications and outcome during hospital stay were documented. Data was analyzed by SPSS 20 and chi square test applied. P value < 0.05 was taken as significant. Results: There were 117 patients, 78 males and 39 females. Age ranged from 1 month to 14 years with mean age of 5.51± 4.19 years. Patients who were vaccinated up to date were 49.6% and 37.6% were not vaccinated at all. Main presenting feature was fever and seizures especially under one year of age. There was significant association between seizures and age group with p value of 0.001. Signs of meningeal irritation (neck stiffness, brudzinski sign, kerning sign) and paradoxical irritability were present in 85 (72.6%) patients mostly above 1 year of age. There was significant association between signs of meningeal irritation and age group (5 years and above) with p value of <0.001. 110 (94%) got discharged and one (0.9%) patient was referred while 6 (5.1%) patients expired. There was significant association between stay duration and vaccination status. (p = 0.018) Conclusion: Fever was the most common presentation and vaccinated children with pyogenic meningitis had shorter stay in hospital.

Kushiyaki-related Streptococcus suis meningitis with ventriculitis: A case report

This report describes Streptococcus suis meningitis with ventriculitis in a 66-year-old kushiyaki chef, which presented with fever and meningeal irritation signs. Cerebrospinal fluid testing revealed increased cell counts and protein levels, and presence of gram-positive cocci. Kushiyaki chefs are at high risk of this infection and prophylaxis should be considered.

Case report: Medullary cryptococcosis in a immunocompetent patient

Context: Cryptococcosis is an important fungal infection that, after AIDS development globally, became more common, being an important cause of opportunistic infections. The pathogen normally gets in through the lungs, causes pulmonary infection and then spreads to another systems, particularly the nervous system in most cases. Along the clinical manifestation there was headache, fever, cranial neuropathies, altered mentation, lethargy, memory loss, and signals of meningeal irritation. Case-Report: A 48-year-old male patient with a one-year story of paraparesis in both legs, associated with pain, paresthesia, and progressive worsening to complete walking incapability, seeks medical consultation. Cerebrospinal fluid was turbid appearance, yellow colored, presence of RBC (1.239 cel/mm³) and leukocytes (149 cel/mm³ - 5% neutrophils, 91% lymphocytes and 4% monocytes), glucose of 23 mg/dL, chlorine of 96 mmol/L, and Cryptococcus neoformans was isolated. Immunosuppressive disease wasn´t found. In MRI, there were nodular images in the intradural and extradural sites through T11-T12 levels, compressing the spinal cord. Local biopsy revealed chronic granulomatous inflammatory process, consistent with the cryptococcosis suspect. Conclusions: The case represents an unusual manifestation of cryptococcosis, with an uncommon topography and profile, once it´s manifestation medullary and in a healthy individual is rare. The main differential diagnosis was spinal tuberculosis, an also rare disease yet with similar symptoms and relevant local epidemiology. To reach the diagnosis, laboratory study was necessary. The treatment was the same of cryptococcosis in general.

Meningismus in IgA vasculitis (Henoch–Schönlein purpura)

IgA vasculitis is the most common acute systemic vasculitis in children. Typical symptoms include cutaneous purpura not associated with thrombocytopenia, acute-onset abdominal pain, arthritis, renal symptoms and, less commonly, neurological symptoms. The disease is usually mild and self-limiting. Although the aetiology of IgA vasculitis is unknown, autoimmune involvement is suspected. Symptomatic treatment is mainly used; therapeutic method that would reduce disease duration and prevent recurrence is unknown. Meningococcal sepsis should always be ruled out in a child with cutaneous purpura. We present a case of a 4-year-old boy with IgA vasculitis who developed symptoms of meningeal irritation.

Epstein–Barr Virus-induced Meningitis-Retention Syndrome

Meningitis-retention syndrome (MRS) is a rare disorder where aseptic meningitis is accompanied by urinary retention, which can be easily misdiagnosed as urinary tract infection. We present the case of a 55-year-old man with fever and dysuria. At the time of hospitalization, the patient had no symptoms of meningitis, but signs of meningeal irritation appeared later during the course of the disease. Investigation revealed that this was a case of MRS due to Epstein–Barr virus. We have to consider MRS when examining patients with fever and urinary retention, as dysuria may precede meningitis symptoms.

Sectra 3 D Human Body Visualization Table Use in Brain Abscess Diagnostics in a Child: A Case Report

Summary Brain abscess in children is a rare and particularly severe complication of acute otitis media/Chronic suppurative otitis media (CSOM). Presenting a child with brain abscess, which was developed as a pre-surgical complication of CSOM with cholesteatoma. Visualization of the abscess on a 3-D Sectra Visualization table was performed. An 8-year-old child who often suffered from untreated runny ear was admitted in a critical state. The history and clinical and laboratory data suggested severe chronic inflammation of the right middle ear. The examination did not reveal signs of meningeal irritation, increased intracranial pressure, excitation, sensory disorders, or focal symptoms. Surgical treatment was performed as a radical mastoidectomy with the removal of a cholesteatoma. After a three-day uneventful postoperative period, the patient worsened. A CT scan visualized a brain abscess in the right temporal lobe. A craniotomy was performed by opening the brain abscess, with an aspiration of pus, and lavage of the cavity. After surgical and conservative treatment, the child was discharged clinically healthy on the fourteenth day. Processing the image check-ups on a Sectra 3-D visualization table helped determine the size and localization of the abscess and the choice of surgical access.