Nuchal Rigidity
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Author(s):  
Amalina Che Din ◽  
Celine Fong ◽  
Chon Sum Ong

The occurrence of symptomatic Rathke's cleft cyst (RCC) apoplexy is extremely rare. This is often misdiagnosed due to similar presentations to subarachnoid haemorrhage and pituitary apoplexy. This case highlights an excellent example of similar clinical presentation and serves as a learning case for clinicians. A 40-year-old lady presented to a district hospital with 9 days of worsening severe headache associated with blurring of vision, photophobia, stiff neck, nausea and vomiting. Nuchal rigidity and Brudzinski’s positive. Blood test showed hyponatremia, raised inflammatory markers and normal dynamic pituitary function test. CT Head demonstrated no evidence of space-occupying lesion or intracranial haemorrhage. Lumbar puncture showed xanthochromia positive consistent with subarachnoid haemorrhage. MRI head advised by Neurosurgery team and revealed a focal lesion involving anterior pituitary macroadenoma with mass effect on optic chiasm with possible haemorrhage within. Further assessment in tertiary hospital confirmed loss of visual acuity and field deficit. Patient underwent emergency endoscopic transnasal transsphenoidal resection of apoplectic tumour and repair of CSF leak with graft from thigh. Histopathology report showed a Rathke’s cleft cyst with squamous metaplasia. Post operatively, the patient developed sinusitis which fully recovered, and MRI showed good decompression. The author demonstrated a rare case of symptomatic RCC which was initially presumed to be pituitary apoplexy. Radiology imaging and treatment approach for both conditions are quite similar and can only be differentiated by histopathology. Further research is required to identify the causes and risk factors of RCC apoplexy to aid early detection and diagnosis.International Journal of Human and Health Sciences Supplementary Issue-2: 2021 Page: S23


2021 ◽  
Vol 7 (2) ◽  
pp. 146-148
Author(s):  
Achmad Firdaus Sani ◽  
Dedy Kurniawan

Duplicated middle cerebral artery (DMCA) is an anomalous vessel arises from the internal carotid artery (ICA). This anatomical variation is rare. Aneurysm with this anatomical variation and unusual form was very rare. Even though this kind of aneurysm is rare, it was often ruptured. In this paper, we report a case of 40-years old female with abrupt decreased of consciousness as a chief complaint, along with severe headache one day earlier, no history of head trauma, and there was nuchal rigidity. She didn’t had history of hypertension before. Head computed tomography showed subarachnoid hemmorrhage (SAH) mostly on the left sylvian fissure with Hunt and Hess scale was 3 and Fisher scale was 2, while the cerebral angiography showed duplication of the left middle cerebral artery in which the inferior part of the MCA duplication has ruptured aneurysm at the origin. Treatment option for this aneurysm is endovascular coiling with preserved of the inferior part of duplicated MCA. Result of this treatment shows a good outcome.


2021 ◽  
Author(s):  
Jingru Zhao ◽  
Tiantian Huo ◽  
Xintong Luo ◽  
Litao Li ◽  
Baoming Yang

Abstract Background: Despite the progress of modern neurosurgical techniques, new antibiotics and modern imaging techniques, brain abscess is still a potentially fatal infection. Streptococci have always been the common organisms resulting in brain abscess. Nevertheless, Klebsiella species, once thought to be a less common cause of brain abscess in adults, have become an increasingly important cause of brain abscess, especially in Asia. Case presentation: A 64-year-old woman felt sudden onset severe continuous headache, accompanied by intermittent nausea, vomiting and fever. Meanwhile, she felt tinnitus and had a feeling of swelling in the right ear. Electroencephalogram (EEG) examination showed mild abnormality. A neurological examination revealed obvious nuchal rigidity with four transverse fingers under the chin. Cranial magnetic resonance imaging (MRI) revealed abnormal hyperintensities signals in the left head of caudate nucleus. The cerebral spinal fluid (CSF) common results indicated bacterial infection The next generation sequencing (NGS) of CSF showed the infection of K pneumoniae. The patient was diagnosed with Klebsiella pneumoniae-related brain abscess and meningitis. After positive antimicrobial treatment for nearly two months. The patient got a good recovery.Conclusion: K pneumoniae is once thought to be a less common cause of brain abscess in adults and mainly hospital-acquired. Community-acquired CNS infection (brain abscess and meningitis) caused by K pneumoniae without other metastatic septic abscesses is exceedingly rare. Therefore, we present a rare adult patient with invasive cerebral abscess and meningitis without other invasive abscesses related to K pneumoniae.


2021 ◽  
Vol 14 (4) ◽  
pp. e241401
Author(s):  
Sayonee Das ◽  
Sidhartha Chattopadhyay ◽  
Kausik Munsi ◽  
Sagar Basu

This is a rare presentation of scrub typhus with cerebral venous thrombosis. A 32-year-old woman presented with signs of raised intracranial tension. Examination revealed maculopapular skin rashes and an ‘eschar’ over the right thigh. Nuchal rigidity and bilateral papilloedema were found. Scrub typhus was diagnosed by the presence of IgM antibody in serum. CT scan of the brain showed cerebral oedema. MRI of the brain was normal. Magnetic resonance venography of the brain showed thrombosis of several venous sinuses. Cerebrospinal fluid analysis revealed lymphocytic pleocytosis with raised protein level. Other causes of prothrombotic states were ruled out by doing specific test results. There was no history of hormonal contraception and prolonged bed rest. A case of scrub typhus complicated with meningoencephalitis and cerebral venous thrombosis was diagnosed. She responded to treatment with doxycycline, anticoagulants, antipyrectics and intravenous saline. Early identification of such atypical neurological involvement in scrub typhus was helpful in satisfactory outcome.


2020 ◽  
Vol 2 (10) ◽  
Author(s):  
Elizabeth Ranson ◽  
Hannah Ship ◽  
Omai Garner ◽  
Shangxin Yang ◽  
Debika Bhattacharya

We present an unusual case of a previously healthy 74-year-old man who presented with diffuse weakness, severe myalgias, petechial palmar rash and hypotension, but without fever, altered mental status, nuchal rigidity or headache, who was ultimately found through PCR testing to have meningococcal meningitis.


2019 ◽  
Vol 207 ◽  
pp. 255
Author(s):  
Kazuki Iio ◽  
Yuichi Ogawa ◽  
Takateru Ihara ◽  
Yuho Horikoshi ◽  
Hiroshi Hataya

Author(s):  
Alexander Tracy ◽  
Thomas Waterfield

Meningitis is a critical diagnosis not to miss in children presenting with fever. Since the early 20th century, classical clinical signs have been used to aid the diagnosis of meningitis. These classical signs are nuchal rigidity, Kernig’s sign and Brudzinski’s sign. Each of these relies on the principle that stretching the inflamed meningeal membranes causes clinically detectable irritation. Several primary studies have quantified the diagnostic performance of clinical examination in detecting meningitis in children. The results of these studies vary significantly due to methodological differences, clinical heterogeneity and interobserver variability. However, their findings demonstrate that positive meningitic signs increase the likelihood of a diagnosis of meningitis, and the absence of meningitic signs reduces this probability. These signs have greatest utility when combined with other features in the history and examination to contribute to a comprehensive clinical assessment.


2018 ◽  
Author(s):  
Karen L. Roos ◽  
Jared R. Brosch

Acute viral meningitis refers to inflammation of the meninges of the brain in response to a viral pathogen. Viruses cause meningitis, encephalitis, myelitis, or a combination of these, meningoencephalitis or encephalomyelitis. Viral meningitis is typically a self-limited disorder with no permanent neurologic sequelae. This chapter reviews the epidemiology, etiology, diagnosis, differential diagnosis, treatment, complications, and prognosis. Tables describe Wallgren’s criteria for aseptic meningitis, important arboviral infections found in North America, herpes family viruses and meningitis, classic cerebrospinal fluid (CSF) abnormalities with viral meningitis, Centers for Disease Control and Prevention criteria for confirming arboviral meningitis, basic CSF studies for viral meningitis, and etiology of CSF pleocytosis. Figures depict common causes of viral meningitis, nuchal rigidity, examination for Kernig sign, and Brudzinski sign for meningeal irritation. This review contains 4 highly rendered figures, 8 tables, and 17 references.


2018 ◽  
Author(s):  
Karen L. Roos ◽  
Jared R. Brosch

Acute viral meningitis refers to inflammation of the meninges of the brain in response to a viral pathogen. Viruses cause meningitis, encephalitis, myelitis, or a combination of these, meningoencephalitis or encephalomyelitis. Viral meningitis is typically a self-limited disorder with no permanent neurologic sequelae. This chapter reviews the epidemiology, etiology, diagnosis, differential diagnosis, treatment, complications, and prognosis. Tables describe Wallgren’s criteria for aseptic meningitis, important arboviral infections found in North America, herpes family viruses and meningitis, classic cerebrospinal fluid (CSF) abnormalities with viral meningitis, Centers for Disease Control and Prevention criteria for confirming arboviral meningitis, basic CSF studies for viral meningitis, and etiology of CSF pleocytosis. Figures depict common causes of viral meningitis, nuchal rigidity, examination for Kernig sign, and Brudzinski sign for meningeal irritation. This review contains 4 highly rendered figures, 8 tables, and 17 references.


Author(s):  
Tamara Kaplan ◽  
Tracey Milligan

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.


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