csf examination
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2022 ◽  
pp. 33-47
Author(s):  
Rupsi . ◽  
Rakesh Kumar

The term aseptic meningitis encompasses all types of inflammations of the brain meninges other than that caused by pus producing organisms. It is usually a mild illness. Etiology of aseptic meningitis is very wide and includes many infections - both viral and non viral, drugs, malignancy and systemic illness. The most common cause is viral infection and enteroviruses - Coxsackie and ECHO viruses account for more than half of all cases. Clinical manifestations include headache, fever, malaise, photophobia and meningeal signs. Convulsions, neurological deficits and severe obtundation are rare except with certain non viral infectious meningitis. Diagnostic work up includes blood and cerebrospinal fluid (CSF) examination and serology for infectious meningitis. The polymerase chain reaction is a rapid and accurate method for detection of microbial DNA in CSF. Treatment is mainly supportive, except for the nonviral infectious etiology.


2021 ◽  
Vol 12 ◽  
pp. 631
Author(s):  
Yuta Otomo ◽  
Naoki Ikegaya ◽  
Akito Oshima ◽  
Shutaro Matsumoto ◽  
Naoko Udaka ◽  
...  

Background: Intraventricular tumors can generally result in obstructive hydrocephalus as they grow. Rarely, however, some intraventricular tumors develop superficial siderosis (SS) and trigger hydrocephalus, even though the tumor has hardly grown. Here, we present an illustrative case of SS and nonocclusive hydrocephalus caused by subependymoma of the lateral ventricles. Case Description: A 78-year-old man with an intraventricular tumor diagnosed 7 years ago had been suffering from gait disturbance for 2 years. He also developed cognitive impairment. Intraventricular tumors showed little growth on annual magnetic resonance imaging (MRI). MRI T2-star weighted images (T2*WI) captured small intratumoral hemorrhages from the beginning of the follow-up. Three years before, at the same time as the onset of ventricular enlargement, T2*WI revealed low intensity in the whole tumor and cerebral surface. Subsequent follow-up revealed that this hemosiderin deposition had spread to the brain stem and cerebellar surface, and the ventricles had expanded further. Cerebrospinal fluid (CSF) examination revealed xanthochromia. The tumor was completely removed en bloc. Histopathological findings were consistent with those of subependymoma. Although CSF findings improved, SS and hydrocephalus did not improve. Therefore, the patient underwent a lumboperitoneal shunt for CSF diversion after tumor resection. Conclusion: Some intraventricular tumors cause SS and nonobstructive hydrocephalus due to microbleeding, even in the absence of tumor growth. T2*WI and, if necessary, timely CSF examination can allow identification of presymptomatic SS. This follow-up strategy may provide a favorable course by facilitating early intervention in patients with intraventricular lesions, not just subependymomas.


2021 ◽  
Vol 2021 ◽  
pp. 1-2
Author(s):  
Mariam Lagrine ◽  
Karima El fakiri ◽  
Noureddine Rada ◽  
Ghizlane Draiss ◽  
Nabila Soraa ◽  
...  

Only a few cases in the literature have ever reported the reactivation of the varicella zoster virus (VZV) in children especially in the case of immunocompetent patients. It is an uncommon situation that may lead to several neurological complications. We report varicella zoster virus (VZV) meningitis in a 14-year-old healthy boy with no antecedent of rash. On his cerebrospinal fluid (CSF) examination, VZV DNA was detected. The rapid HIV test was negative. The treatment using acyclovir (20 mg/kg/8h) was effective, and the child’s clinical condition rapidly improved.


Author(s):  
Rebecca Hörner ◽  
Jan Kassubek ◽  
Jens Dreyhaupt ◽  
Albert C. Ludolph

Abstract Background Ocular motor nerve palsies (OMNP) frequently cause patients to present in an emergency room. In the following study, we report the differential diagnosis of OMNP by use of magnetic resonance imaging (MRI) and CSF examination as a standard. Method We performed a data analysis of N = 502 patients who presented with oculomotor, trochlear, and/or abducens nerve palsy in the emergency room of the Department of Neurology, University of Ulm, between January 2006 and December 2019. We report clinical and MRI scan findings in all patients; furthermore, the CSF of 398 patients has been analysed. Results Abducens nerve palsies were most common (45%), followed by palsies of the oculomotor (31%) (CNP III) and trochlear nerve (15%). Multiple OMNPs were seen in 9% of our cohort. The most common causes included inflammations (32.7%), space-occupying lesions, such as aneurysms or neoplasms (17.3%), diabetes mellitus (13.3%), and brainstem infarctions (11%). Still 23.4% of the patients could not be assigned to any specific cause after differential diagnostic procedures and were described as idiopathic. One of three patients with an inflammation and 39% of the patients with space-occupying lesions showed additional cranial nerve deficits. Conclusion Inflammation and space-occupying processes were the most frequent causes of OMNP, although brainstem infarctions also play a significant role, in particular in CNP III. The presence of additional CNPs increases the probability of an inflammatory or space-occupying cause.


2021 ◽  
pp. 1-5
Author(s):  
René van den Berg ◽  
Lung Jeung ◽  
René Post ◽  
Bert A. Coert ◽  
Jantien Hoogmoed ◽  
...  

OBJECTIVE In patients presenting within 6 hours after signs and symptoms of suspected subarachnoid hemorrhage (SAH), CSF examination is judged to be no longer necessary if a noncontrast CT (NCCT) scan rules out SAH. In this study, the authors evaluated the performance of NCCT to rule out SAH in patients with positive CSF findings. METHODS Between January 2006 and April 2018, 1657 patients were admitted with a nontraumatic SAH. Of these patients, 1546 had positive SAH findings on the initial NCCT and 111 patients had an NCCT scan that was reported as negative in the acute setting, but with positive CSF examination for subarachnoid blood. Demographic data, World Federation of Neurosurgical Societies grade, and SAH time points (ictus, time of NCCT, and time of lumbar puncture) were collected. All 111 NCCT scans were reevaluated by an experienced neuroradiologist. RESULTS Of the 111 patients with positive CSF findings, SAH was initially missed on NCCT in 25 patients (23%). Reevaluation of 21 patients presenting within 6 hours of symptom onset confirmed NCCT negative findings in 12 (5 aneurysms), an aneurysmal SAH (aSAH) pattern in 8 (7 aneurysms), and a perimesencephalic pattern in 1 patient. Reevaluation of 90 patients presenting after 6 hours confirmed negative NCCT findings in 74 patients (37 aneurysms), aSAH pattern in 10 (4 aneurysms), and a perimesencephalic pattern in 6 (2 aneurysms). CONCLUSIONS CSF examination is still mandatory to rule out SAH as NCCT can fail to show blood, even within 6 hours after symptom onset. In addition, the diagnosis SAH was frequently missed during initial reporting.


2021 ◽  
Author(s):  
Guirong Wang ◽  
Ruixia Liang ◽  
Qing Sun ◽  
Xinlei Liao ◽  
Chenqian Wang ◽  
...  

Abstract BackgroundMiliary tuberculosis (TB) is one of the severest manifestations of TB that can be lethal when concomitant with the central nervous system (CNS) involvement. Bacteriological, biochemical and radiological methods for find CNS comorbidity in miliary TB was evaluated in this study.MethodsConsecutive miliary TB adults were retrospectively enrolled from two designated TB hospitals in China. The capacities of examinations of cerebrospinal fluid (CSF), cerebral computed tomography (CT) and magnetic resonance imaging (MRI) for diagnosis of CNS involvement were assessed.ResultsAssessment of CNS involvement with a lumbar puncture and/or neuroimaging was undertaken in 282 out of 392 of acute miliary TB. Of these 282 patients, 87.59% (247/282) had CNS involvement. Cerebral contrast-enhanced MRI (96.05%, 170/177) and MRI (93.15%, 204/219) yielded significantly higher sensitivities over CSF examination (71.92%, 146/203, P<0.001) and CT (34.69%, 17/49, P<0.001). The sensitivity of CSF examination was superior to CT scan (P<0.001). Although 59.65% (134/225) miliary TB patients acquired bacteriological evidence with sputum examination, the positivity was only 8.82% (21/238) for CSF examination by conventional and molecular tests.ConclusionAlmost all miliary TB had CNS involvement and MRI demonstrated outstanding potential over other methods. Therefore, a routinely screening of CNS TB should be strongly suggested in miliary TB and MRI could be used as the initial approach in resources rich settings.


2021 ◽  
Vol 18 (2) ◽  
pp. 61-63
Author(s):  
Navgeet Mathur ◽  
Medha Mathur ◽  
Anjana Verma

In presence of abnormal neurological features, infective etiology should be kept as one of the differential diagnoses. This case report was about 38 years old male patient who presented with fever with blister-like rashes in centripetal distribution over the body and myoclonus. CSF examination showed the presence of varicella-zoster Ig M antibodies. Diagnosis of chickenpox induced myoclonus was made. Appropriate treatment recovered the patient completely. This case report highlighted the clinical spectrum of chickenpox as well as the possible pathogenesis and diagnostic, therapeutic approach of this uncommon entity.


2021 ◽  
Vol 14 (6) ◽  
pp. e241765
Author(s):  
Melissa Chu ◽  
Shejil Kumar ◽  
Jonathan Sturm

Syphilis is increasingly prevalent in the community. The protean manifestations of neurosyphilis make the recognition, diagnosis and early initiation of treatment challenging. We report a case of early syphilitic meningitis presenting with multiple cranial neuropathies. Cerebrospinal fluid (CSF) examination was inflammatory with predominant lymphocytosis. The patient was diagnosed with neurosyphilis based on serum as well as CSF testing. Intravenous benzylpenicillin treatment resulted in rapid improvement of neurological symptoms. Neurosyphilis should be considered in immunocompetent patients presenting with multiple cranial neuropathies, or isolated cranial neuropathies without vascular risk factors.


2021 ◽  
Vol 11 (5) ◽  
pp. 206-209
Author(s):  
Priyasha Tripathi ◽  
Surendra Singh Raghuwanshi

4 months old female child presented to us with complaints of fever, cough, cold, and poor weight gain. On examination the child had failure to thrive (weight 2.75kg, length 52cms, head circumference 35cms, weight for length <-3SD), cachexic look, severe respiratory distress (bilateral chest retractions and nasal flaring), hepatosplenomegaly, delayed milestones with low birth weight (2.07kg), continuous low grade fever. Mother was an open case of pulmonary Koch, taking antitubercular treatment since 6 months. Investigations revealed anemia, neutrophilia with reactive CRP, raised transaminases, pulmonary fibrosis and cavitary lesions in chest x-ray with normal CSF examination. Mantoux was reactive with gastric aspirate and cerebrospinal fluid negative for TB bacilli in GeneXpert. So the question arises, is it congenital or acquired? Key words: congenital TB, hepatosplenomegaly, respiratory distress, failure to thrive.


2021 ◽  
pp. 44-45
Author(s):  
Moses. P Moorthy ◽  
AV Srinivasan ◽  
Shifa Begum ◽  
K. Prasanthi

11 yr old female child, admitted with history of fever, left ear pain, swelling behind the left ear of 5 days duration, for which she was treated by a nearby doctor. After 1 week the child had left ear discharge, headache, neck pain, recurrent episodes of vomiting. On general examination she is thin built, febrile, toxic and dehydrated. On local examination she had ear discharge, swelling behind the left ear. On neurological examination, she had neck stifness. Routine blood investigations including, CBC, LFT, RFT were normal. On CSF examination Protein-188 mg%,Sugar- 16 mg%,Cell count-165 cells/cumm,85% were Neutrophils. Aural swab C/S showed growth of Klebsiella sensitive to Amikacin, Ciprooxacin, Piperacillin / Tazobactum and Cotrimoxazole. ENT opinion was in favour of doing Mastoidectomy. HRCT Temporal bone showed complete opacication of external auditory canal, tympanic cavity and mastoid air cells with a possibility of lling up with pus. MRI BRAIN showed Left mastoid and postauricular abscess, mastoiditis, ventriculitis, venulitis with thrombosis of left transverse and sigmoid sinuses. Patient was treated with parenteral piperacillin tazobactum, Ciprooxacin, Amikacin, Metronidazole, Mannitol, Dexamethasone and Low molecular weight heparin.Patient improved in 3 weeks.Ear discharge dried up, mastoid abscess subsided, and the child became active and ambulant


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