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Papathanasiou A, Yeo JM, Humberstone M, Hosseini AA. MOG-antibody-associated hypertrophic pachymeningitis. Mult Scler Relat Disord 2020; 42:102074. [PMID: 32361264 DOI: 10.1016/j.msard.2020.102074] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2020] [Revised: 03/22/2020] [Accepted: 03/25/2020] [Indexed: 12/01/2022]
Abstract
BACKGROUND The clinical spectrum of myelin oligodendrocyte glycoprotein (MOG)-antibody-associated disease is expanding. OBJECTIVE To describe an unusual case of MOG-antibody-associated hypertrophic pachymeningitis (HP). METHODS Case study. RESULTS A 57-year-old female presented with a generalised seizure on a background of 3 months history of progressive cognitive decline and behavioural changes. Brain Magnetic Resonance Imaging (MRI) revealed widespread pachymeningeal enhancement and hyperintense signal in both hippocampi. Cerebrospinal Fluid (CSF) examination was normal. The patient was found positive for MOG-antibody. She clinically improved with steroids and the MRI abnormalities completely resolved. CONCLUSIONS Clinicians might consider testing for MOG-antibody in cases with HP.
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Affiliation(s)
- Athanasios Papathanasiou
- Department of Neurology, Queen's Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, NG7 2UH, UK.
| | - Jing-Ming Yeo
- Department of Neurology, Queen's Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, NG7 2UH, UK
| | - Miles Humberstone
- Department of Neurology, Queen's Medical Centre, United Lincolnshire Hospitals NHS Trust, Nottingham, UK
| | - Akram A Hosseini
- Department of Neurology, Queen's Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, NG7 2UH, UK
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2
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Garcia-Santamarina S, Probst C, Festa RA, Ding C, Smith AD, Conklin SE, Brander S, Kinch LN, Grishin NV, Franz KJ, Riggs-Gelasco P, Lo Leggio L, Johansen KS, Thiele DJ. A lytic polysaccharide monooxygenase-like protein functions in fungal copper import and meningitis. Nat Chem Biol 2020; 16:337-344. [PMID: 31932719 PMCID: PMC7036007 DOI: 10.1038/s41589-019-0437-9] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Accepted: 11/22/2019] [Indexed: 12/21/2022]
Abstract
Infection by the fungal pathogen Cryptococcus neoformans causes lethal meningitis, primarily in immune-compromised individuals. Colonization of the brain by C. neoformans is dependent on copper (Cu) acquisition from the host, which drives critical virulence mechanisms. While C. neoformans Cu+ import and virulence are dependent on the Ctr1 and Ctr4 proteins, little is known concerning extracellular Cu ligands that participate in this process. We identified a C. neoformans gene, BIM1, that is strongly induced during Cu limitation and which encodes a protein related to lytic polysaccharide monooxygenases (LPMOs). Surprisingly, bim1 mutants are Cu deficient, and Bim1 function in Cu accumulation depends on Cu2+ coordination and cell-surface association via a glycophosphatidyl inositol anchor. Bim1 participates in Cu uptake in concert with Ctr1 and expression of this pathway drives brain colonization in mouse infection models. These studies demonstrate a role for LPMO-like proteins as a critical factor for Cu acquisition in fungal meningitis.
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Affiliation(s)
- Sarela Garcia-Santamarina
- Department of Pharmacology and Cancer Biology, Duke University School of Medicine, Durham, NC, USA
- Genome Biology Unit, Structural and Computational Biology Unit, European Molecular Biology Laboratory, Heidelberg, Germany
| | - Corinna Probst
- Department of Pharmacology and Cancer Biology, Duke University School of Medicine, Durham, NC, USA
| | - Richard A Festa
- Department of Pharmacology and Cancer Biology, Duke University School of Medicine, Durham, NC, USA
- Irvine Scientific, Santa Ana, CA, USA
| | - Chen Ding
- Department of Pharmacology and Cancer Biology, Duke University School of Medicine, Durham, NC, USA
- College of Life and Health Sciences, Northeastern University, Shenyang, China
| | - Aaron D Smith
- Department of Pharmacology and Cancer Biology, Duke University School of Medicine, Durham, NC, USA
| | - Steven E Conklin
- Department of Chemistry, Duke University, Durham, NC, USA
- Division of Clinical Chemistry, Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Søren Brander
- Department of Geoscience and Natural Resource, University of Copenhagen, Copenhagen, Denmark
| | - Lisa N Kinch
- Howard Hughes Medical Institute, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Nick V Grishin
- Howard Hughes Medical Institute, University of Texas Southwestern Medical Center, Dallas, TX, USA
- Departments of Biophysics and Biochemistry, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | | | | | - Leila Lo Leggio
- Department of Chemistry, University of Copenhagen, Copenhagen, Denmark
| | - Katja Salomon Johansen
- Department of Geoscience and Natural Resource, University of Copenhagen, Copenhagen, Denmark
| | - Dennis J Thiele
- Department of Pharmacology and Cancer Biology, Duke University School of Medicine, Durham, NC, USA.
- Department of Biochemistry, Duke University School of Medicine, Durham, NC, USA.
- Department of Molecular Genetics and Microbiology, Duke University School of Medicine, Durham, NC, USA.
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Giamberardino MA, Affaitati G, Costantini R, Guglielmetti M, Martelletti P. Acute headache management in emergency department. A narrative review. Intern Emerg Med 2020; 15:109-117. [PMID: 31893348 DOI: 10.1007/s11739-019-02266-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Accepted: 12/17/2019] [Indexed: 12/12/2022]
Abstract
Headache is a significant reason for access to Emergency Departments (ED) worldwide. Though primary forms represent the vast majority, the life-threatening potential of secondary forms, such as subarachnoid hemorrage or meningitis, makes it imperative for the ED physician to rule out secondary headaches as first step, based on clinical history, careful physical (especially neurological) examination and, if appropriate, hematochemical analyses, neuroimaging or lumbar puncture. Once secondary forms are excluded, distinction among primary forms should be performed, based on the international headache classification criteria. Most frequent primary forms motivating ED observation are acute migraine attacks, particularly status migrainous, and cluster headache. Though universally accepted guidelines do not exist for headache management in an emergency setting, pharmacological parenteral treatment remains the principal approach worldwide, with NSAIDs, neuroleptic antinauseants, triptans and corticosteroids, tailored to the specific headache type. Opioids should be avoided, for their scarce effectiveness in the acute phase, while IV hydration should be limited in cases of ascertained dehydration. Referral of the patient to a Headache Center should subsequently be an integral part of the ED approach to the headache patients, being ascertained that lack of this referral involves a high rate of relapse and new accesses to the ED. More controlled studies are needed to establish specific protocols of management for the headache patient in the ED.
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Affiliation(s)
- Maria Adele Giamberardino
- Headache Center, Geriatrics Clinic, Department of Medicine and Science of Aging and Ce.S.I.-Met, G. D'Annunzio University of Chieti, 66100, Chieti, Italy
| | - Giannapia Affaitati
- Headache Center, Geriatrics Clinic, Department of Medicine and Science of Aging and Ce.S.I.-Met, G. D'Annunzio University of Chieti, 66100, Chieti, Italy
| | - Raffaele Costantini
- Institute of Surgical Pathology, G. D'Annunzio University of Chieti, Chieti, Italy
| | - Martina Guglielmetti
- Department of Clinical Pathology, University of Sassari, Sassari, Italy
- Department of Clinical and Molecular Medicine, Sapienza University, Via di Grottarossa, 1035, 00189, Rome, Italy
| | - Paolo Martelletti
- Department of Clinical and Molecular Medicine, Sapienza University, Via di Grottarossa, 1035, 00189, Rome, Italy.
- UOC Medicina Interna, AOU Sant'Andrea, Rome, Italy.
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Riabokon Y, Zadyraka D. DYNAMICS OF THE VEGETATIVE NERVOUS SYSTEM FUNCTIONAL STATE IN INTERACTION WITH THE CHANGES IN ADRENOCORTICOTROPIC AND SOMATOTROPIC HORMONES IN PATIENTS WITH SEROUS MENINGITIS. Georgian Med News 2019:90-95. [PMID: 30958296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
The study included 64 patients with serous meningitis, in which the heart rate variability (HRV) spectrum, the content of ACTH and STH in serum was studied in the course of the commonly accepted treatment. The purpose of the study was to analyze the dynamics of indicators of functional state of the autonomic nervous system in correlation with changes of adrenocorticotropic and somatotropic hormones in patients with serous meningitis. According to the results, serous meningitis were predominantly moderate in severity, with generalization in the clinical picture dominated through general toxicosis, general cerebral and meningeal syndromes, but changes in the spectral parameters of HRV showed a marked imbalance with a shift in the functional activity of the autonomic nervous system towards vagotonia in combination with an ACTH level increase and STH decrease in serum (p<0.01). The purpose of the study was to analyze the dynamics of indicators of functional state of the autonomic nervous system in correlation with changes of adrenocorticotropic and somatotropic hormones in patients with serous meningitis. According to the results, serous meningitis were predominantly moderate in severity, with generalization in the clinical picture dominated by general toxicosis, general cerebral and meningeal syndromes, but changes in the spectral parameters of HRV showed a marked imbalance with a shift in the functional activity of the autonomic nervous system towards vagotonia in combination with an ACTH level increase and STH decrease in serum (p<0.01).
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Affiliation(s)
- Yu Riabokon
- Zaporizhzhia State Medical University, Ukraine
| | - D Zadyraka
- Zaporizhzhia State Medical University, Ukraine
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5
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Mekinian A, Maisonobe L, Boukari L, Melenotte C, Terrier B, Ayrignac X, Scheinlitz N, Sène D, Hamidou M, Konaté A, Guilpain P, Abisror N, Ghrenassia E, Lachenal F, Cevallos R, Roos-Weil R, Du LTH, Lhote F, Larroche C, Bergmann JF, Humbert S, Fraison JB, Piette JC, Guillevin L, Dhote R, Amoura Z, Haroche J, Fain O. Characteristics, outcome and treatments with cranial pachymeningitis: A multicenter French retrospective study of 60 patients. Medicine (Baltimore) 2018; 97:e11413. [PMID: 30045263 PMCID: PMC6078725 DOI: 10.1097/md.0000000000011413] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The aim of this study was to determine the characteristics, treatment, and outcome according to each etiology of pachymeningitis.We conducted a retrospective multicenter French nationwide study between 2000 and 2016 to describe the characteristics, outcome, and treatment of pachymeningitis.We included 60 patients (median age 55.5 years; interquartile range [IQR] 30-80, female/male ratio 0.43). Neurologic signs were present in 59 patients (98%) and consisted of headache in 43 (72%), cranial nerve palsy in 33 (55%), confusion in 10 (17%), seizures in 7 (12%), and focal neurologic signs in 9 (15%). Fever and weight loss were present in 8 (13%) and 13 cases (22%), respectively. Cerebral venous thrombosis was present in 8 cases (13%). Analysis of cerebrospinal fluid showed moderate hyperproteinorachia (median 0.68 g/L; IQR 0.46-3.2) with or without pleiocytosis. Diagnosis included idiopathic pachymeningitis (n = 18; 30%); granulomatosis with polyangiitis (n = 13; 17%); Erdheim-Chester disease (n = 10; 17%); IgG4-related disease and tuberculosis (n = 3; 5% each); Rosai-Dofman disease, microscopic polyangiitis, and sarcoidosis (n = 2, 3% each); cryptococcal meningitis, Lyme disease, ear-nose-throat infection, postlumbar puncture, low spinal-fluid pressure syndrome, and lymphoma (n = 1 each). We found no difference in demographics and neurologic presentation among idiopathic pachymeningitis, Erdheim-Chester disease, and granulomatosis with polyangiitis. In contrast, frequencies were lower with idiopathic pachymeningitis than Erdheim-Chester disease for general signs (6% and 40%, respectively, P = .041) and complete neurologic response (0% vs 39%, P = .045).The detection of extraneurologic signs and routine screening are needed to classify the pachymeningitis origin. Prospective studies are warranted to determine the best treatment in each case.
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Affiliation(s)
- Arsene Mekinian
- AP-HP, Hôpital Saint Antoine, Service de Médecine Interne et Inflammation-Immunopathology-Biotherapy Department (DHU i2B), Paris
| | - Lucas Maisonobe
- AP-HP, Hôpital Saint Antoine, Service de Médecine Interne et Inflammation-Immunopathology-Biotherapy Department (DHU i2B), Paris
| | | | - Cléa Melenotte
- Département de Médecine Interne, CHU de la Timone, Aix-Marseille Université, AP-HM, Marseille
| | - Benjamin Terrier
- Université Paris Descartes, Paris
- AP-HP, Hôpital Cochin, Centre de Référence des Maladies Auto-immunes et Systémiques Rares, Service de Médecine Interne, Paris
| | - Xavier Ayrignac
- Département de Neurologie, Hôpital Gui de Chauliac, CHU de Montpellier
| | - Nicolas Scheinlitz
- Département de Médecine Interne, CHU de la Timone, Aix-Marseille Université, AP-HM, Marseille
| | - Damien Sène
- Département de Médecine Interne, GH Saint-Louis Lariboisière Fernand Widal
- Université Paris Diderot, Paris
| | | | - Amadou Konaté
- Service de Médecine Interne et Vasculaire, CHU Montpellier, Montpellier
| | - Philippe Guilpain
- Service de Médecine Interne et Vasculaire, CHU Montpellier, Montpellier
| | - Noémie Abisror
- AP-HP, Hôpital Saint Antoine, Service de Médecine Interne et Inflammation-Immunopathology-Biotherapy Department (DHU i2B), Paris
| | - Etienne Ghrenassia
- AP-HP, Hôpital Saint Antoine, Service de Médecine Interne et Inflammation-Immunopathology-Biotherapy Department (DHU i2B), Paris
| | | | - Ramiro Cevallos
- Service de Médecine Interne, Clinique Sainte Anne, rue Philippe Thyss, Strasbourg
| | | | - Le Thi Huong Du
- Service de Médecine Interne, Hôpital Pitié Salpetrière, Université Paris, APHP, Paris
- Université Pierre et Marie Curie, Paris, UPMC
- Centre National de Référence des Maladies Auto-immunes et Systémiques Rares
| | - Francois Lhote
- Service de Médecine Interne, Hôpital Delafontaine, Saint Denis
| | - Claire Larroche
- Service de Médecine Interne, Université Paris, AP-HP, Avicenne, Bobigny
| | - Jean-Francois Bergmann
- Département de Médecine Interne, GH Saint-Louis Lariboisière Fernand Widal
- Université Paris Diderot, Paris
| | | | - Jean Baptiste Fraison
- Université Paris Descartes, Paris
- AP-HP, Hôpital Cochin, Centre de Référence des Maladies Auto-immunes et Systémiques Rares, Service de Médecine Interne, Paris
| | - Jean Charles Piette
- Service de Médecine Interne, Hôpital Pitié Salpetrière, Université Paris, APHP, Paris, France
| | - Loïc Guillevin
- Université Paris Descartes, Paris
- AP-HP, Hôpital Cochin, Centre de Référence des Maladies Auto-immunes et Systémiques Rares, Service de Médecine Interne, Paris
| | - Robin Dhote
- Service de Médecine Interne, Université Paris, AP-HP, Avicenne, Bobigny
| | - Zahir Amoura
- Service de Médecine Interne, Hôpital Pitié Salpetrière, Université Paris, APHP, Paris
- Université Pierre et Marie Curie, Paris, UPMC
- Centre National de Référence des Maladies Auto-immunes et Systémiques Rares
| | - Julien Haroche
- Service de Médecine Interne, Hôpital Pitié Salpetrière, Université Paris, APHP, Paris
- Université Pierre et Marie Curie, Paris, UPMC
- Centre National de Référence des Maladies Auto-immunes et Systémiques Rares
| | - Olivier Fain
- AP-HP, Hôpital Saint Antoine, Service de Médecine Interne et Inflammation-Immunopathology-Biotherapy Department (DHU i2B), Paris
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Freundt-Revilla J, Heinrich F, Zoerner A, Gesell F, Beyerbach M, Shamir M, Oevermann A, Baumgärtner W, Tipold A. The endocannabinoid system in canine Steroid-Responsive Meningitis-Arteritis and Intraspinal Spirocercosis. PLoS One 2018; 13:e0187197. [PMID: 29408878 PMCID: PMC5800546 DOI: 10.1371/journal.pone.0187197] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2016] [Accepted: 10/16/2017] [Indexed: 12/30/2022] Open
Abstract
Endocannabinoids (ECs) are involved in immunomodulation, neuroprotection and control of inflammation in the central nervous system (CNS). Activation of cannabinoid type 2 receptors (CB2) is known to diminish the release of pro-inflammatory factors and enhance the secretion of anti-inflammatory cytokines. Furthermore, the endocannabinoid 2-arachidonoyl glycerol (2-AG) has been proved to induce the migration of eosinophils in a CB2 receptor-dependent manner in peripheral blood and activate neutrophils independent of CB activation in humans. The aim of the current study was to investigate the influence of the endocannabinoid system in two different CNS inflammatory diseases of the dog, i.e. Steroid-Responsive Meningitis-Arteritis (SRMA) and Intraspinal Spirocercosis (IS). The two main endocannabinoids, anandamide (AEA) and 2-AG, were quantified by mass spectrometry in CSF and serum samples of dogs affected with Steroid- Responsive Meningitis-Arteritis in the acute phase (SRMA A), SRMA under treatment with prednisolone (SRMA Tr), intraspinal Spirocercosis and healthy dogs. Moreover, expression of the CB2 receptor was evaluated in inflammatory lesions of SRMA and IS and compared to healthy controls using immunohistochemistry (IHC). Dogs with SRMA A showed significantly higher concentrations of total AG and AEA in serum in comparison to healthy controls and in CSF compared to SRMA Tr (p<0.05). Furthermore, dogs with IS displayed the highest ECs concentrations in CSF, being significantly higher than in CSF samples of dogs with SRMA A (p<0.05). CSF samples that demonstrated an eosinophilic pleocytosis had the highest levels of ECs, exceeding those with neutrophilic pleocytosis, suggesting that ECs have a major effect on migration of eosinophils in the CSF. Furthermore, CB2 receptor expression was found in glial cells in the spinal cord of healthy dogs, whereas in dogs with SRMA and IS, CB2 was strongly expressed not only in glial cells but also on the cellular surface of infiltrating leukocytes (i.e. neutrophils, eosinophils, lymphocytes, plasma cells, and macrophages) at lesion sites. The present study revealed an upregulated endocannabinoid system in dogs with inflammatory CNS diseases, highlighting the endocannabinoid system as a potential target for treatment of inflammatory CNS diseases.
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Affiliation(s)
- Jessica Freundt-Revilla
- Department of Small Animal Medicine and Surgery, University of Veterinary Medicine Hannover, Hannover, Germany
- Center for Systems Neuroscience, Hannover, Germany
- * E-mail:
| | - Franciska Heinrich
- Center for Systems Neuroscience, Hannover, Germany
- Department of Pathology, University of Veterinary Medicine Hannover, Hannover, Germany
| | - Alexander Zoerner
- Institute for Clinical Pharmacology, Hannover Medical School, Hannover, Germany
| | - Felix Gesell
- Department of Small Animal Medicine and Surgery, University of Veterinary Medicine Hannover, Hannover, Germany
| | - Martin Beyerbach
- Institute for Biometry, Epidemiology, and Information Processing, University of Veterinary Medicine Hannover, Hannover, Germany
| | - Merav Shamir
- Koret School of Veterinary Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Anna Oevermann
- Department Clinical Research and Veterinary Public Health, Vetsuisse Faculty, University of Bern, Bern, Switzerland
| | - Wolfgang Baumgärtner
- Center for Systems Neuroscience, Hannover, Germany
- Department of Pathology, University of Veterinary Medicine Hannover, Hannover, Germany
| | - Andrea Tipold
- Department of Small Animal Medicine and Surgery, University of Veterinary Medicine Hannover, Hannover, Germany
- Center for Systems Neuroscience, Hannover, Germany
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Abstract
Community-acquired meningitis can be classified into acute and subacute presentations by the duration of illness of ≤ or >5 days, respectively. There are currently no studies comparing the clinical features, management decisions, etiologies, and outcomes between acute and subacute presentations.It is a retrospective study of adults with community-acquired meningitis hospitalized in Houston, TX between January 2005 and January 2010. An adverse clinical outcome was defined as a Glasgow Outcome Scale score of ≤4.A total of 611 patients were identified, of which 458 (75%) were acute and 153 subacute (25%). The most common etiologies were unknown in 418 (68.4%), viral in 94 (15.4%), bacterial in 47 (7.7%), fungal in 42 patients (6.9%), and other noninfectious etiologies in 6 (1%). Patients with subacute meningitis were more likely to be immunosuppressed or have comorbidities, had fungal etiologies, and had higher rates of hypoglycorrachia and abnormal neurological findings (P <.05). Patients with an acute presentation were more likely to be treated empirically with intravenous antibiotics and had higher cerebrospinal fluid pleocytosis and serum white blood cell counts (P <.05). On logistic regression, age >65 years and abnormal neurological findings were predictive of an adverse clinical outcome in both acute and subacute meningitis, whereas fever was also a significant prognostic factor in acute meningitis. (P <.05).Acute and subacute meningitis differ in regards to clinical presentations, etiologies, laboratory findings, and management decisions, but did not differ in rates of adverse clinical outcomes. Future studies including thoroughly investigated patients with new diagnostic molecular methods may show different results and outcomes.
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Udassi S, Udassi JP, Giordano BP, Lew JF. An Unusual Cause of Neonatal Meningitis. J Pediatr Health Care 2015; 29:547-50. [PMID: 25825073 DOI: 10.1016/j.pedhc.2015.03.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2015] [Revised: 03/01/2015] [Accepted: 03/01/2015] [Indexed: 11/29/2022]
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Chhibber AV, Hill PC, Jafali J, Jasseh M, Hossain MI, Ndiaye M, Pathirana JC, Greenwood B, Mackenzie GA. Child Mortality after Discharge from a Health Facility following Suspected Pneumonia, Meningitis or Septicaemia in Rural Gambia: A Cohort Study. PLoS One 2015; 10:e0137095. [PMID: 26353110 PMCID: PMC4564213 DOI: 10.1371/journal.pone.0137095] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2015] [Accepted: 08/12/2015] [Indexed: 01/12/2023] Open
Abstract
OBJECTIVE To measure mortality and its risk factors among children discharged from a health centre in rural Gambia. METHODS We conducted a cohort study between 12 May 2008 and 11 May 2012. Children aged 2-59 months, admitted with suspected pneumonia, sepsis, or meningitis after presenting to primary and secondary care facilities, were followed for 180 days after discharge. We developed models associating post-discharge mortality with clinical syndrome on admission and clinical risk factors. FINDINGS One hundred and five of 3755 (2.8%) children died, 80% within 3 months of discharge. Among children aged 2-11 and 12-59 months, there were 30 and 29 deaths per 1000 children per 180 days respectively, compared to 11 and 5 respectively in the resident population. Children with suspected pneumonia unaccompanied by clinically severe malnutrition (CSM) had the lowest risk of post-discharge mortality. Mortality increased in children with suspected meningitis or septicaemia without CSM (hazard ratio [HR] 2.6 and 2.2 respectively). The risk of mortality greatly increased with CSM on admission: CSM with suspected pneumonia (HR 8.1; 95% confidence interval (CI) 4.4 to 15), suspected sepsis (HR 18.4; 95% CI 11.3 to 30), or suspected meningitis (HR 13.7; 95% CI 4.2 to 45). Independent associations with mortality were: mid-upper arm circumference (MUAC) of 11.5-13.0 cm compared to >13.0 cm (HR 7.2; 95% CI 3.0 to 17.0), MUAC 10.5-11.4 cm (HR 24; 95% CI 9.4 to 62), and MUAC <10.5 cm (HR 44; 95% CI 18 to 108), neck stiffness (HR 10.4; 95% CI 3.1 to 34.8), non-medical discharge (HR 4.7; 95% CI 2.0 to 10.9), dry season discharge (HR 2.0; 95% CI 1.2 to 3.3), while greater haemoglobin (HR 0.82; 0.73 to 0.91), axillary temperature (HR 0.71; 95% CI 0.58 to 0.87), and oxygen saturation (HR 0.96; 95% CI 0.93 to 0.99) were associated with reduced mortality. CONCLUSION Gambian children experience increased mortality after discharge from primary and secondary care. Interventions should target both moderately and severely malnourished children.
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Affiliation(s)
| | - Philip C. Hill
- Centre for International Health, University of Otago, Dunedin, New Zealand
| | - James Jafali
- Medical Research Council (UK), The Gambia Unit, Fajara, The Gambia
| | - Momodou Jasseh
- Medical Research Council (UK), The Gambia Unit, Fajara, The Gambia
| | | | - Malick Ndiaye
- Medical Research Council (UK), The Gambia Unit, Fajara, The Gambia
| | | | - Brian Greenwood
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Grant A. Mackenzie
- Medical Research Council (UK), The Gambia Unit, Fajara, The Gambia
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Infection & Immunity Theme, Murdoch Childrens Research Institute, Melbourne, Australia
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10
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Wang L, Feng Y, Niu Z, Cai Y, Mei L, He C. [Clinical analysis of Mondini dysplasia with cerebrospinal fluid leakage and preliminary genetic research of it]. Lin Chuang Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 2015; 29:874-877. [PMID: 26595997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
OBJECTIVE To summarize and analyze the clinical characteristics of Mondini dysplasia with cerebrospinal fluid leakage, as well as preliminarily investigate the genetic mechanism of the disease. METHOD The clinical data of 2 patients diagnosed as Mondini dysplasia with cerebrospinal fluid leakage treated in our hospital were analyzed. Blood samples of these two patients were obtained to extract DNA. We screened DNA samples for gene SLC26A4 mutations by using polymerase chain reaction and direct sequencing. The sequencing results were analyzed in DNASTAR software. RESULT Both patients came to our hospital because of recurrent meningitis, and the fistula were both located in vestibular window. Patients were cured one-time after surgical closure of the leakages with temporalis + temporalis fascia + temporalis through the mastoid approach. No pathogenic mutations of gene SLC26A4 with exome sequencing were found. CONCLUSION Mondini dysplasia with cerebrospinal fluid leakage should be considered in patients with recurrent meningitis and hearing disorder. Temporal bone HRCT is helpful to the diagnosis. Surgical closure is an effective therapeutic method and may prevent recurrent meningitis. The molecular mechanism of simple Mondini dysplasia needs further study.
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Begaydarova RK, Starikov IG, Devdariani KG, Dusembaeva AE, Alshinbekova GK. [Clinical characteristics of mumps infection in children and adult patients]. Georgian Med News 2014:62-66. [PMID: 25541828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
The aim of the article was to study clinical manifestations of mumps infection (infectious parotitis) - a viral illness that affects glands that produce saliva, pancreas, and nervous system in children and adult patients. 219 patients (42 children and 177 adults) with mumps infection were studied. The investigation showed that parotid salivary gland disorder was the most common in adults; sublinguitis - inflammation of the sublingual gland was the most common in children. Serous meningitis occurred exclusively in preschool and early school age. Pancreatitis was less common in children than in adults. Infectious parotitis involving the parotid salivary gland was taking its normal course with positive outcome. Pancreatitis and serous meningitis occurred at the 3-5 day of illness with infectious parotitis. Pancreatitis was with positive outcome, with the exceptions of adult patients with pain syndrome (repair process delayed to 1-1.5 months). Mean duration of hospitalization for children with infectious parotitis was 7 days, for adults - 10-14 days. Mean duration of hospitalization for patients with serous meningitis was 14 days. Study showed that in 20,1% of 16-27 years old males developed orchitis.
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Giavoli C, Tagliabue C, Profka E, Senatore L, Bergamaschi S, Rodari G, Spada A, Beck-Peccoz P, Esposito S. Evaluation of pituitary function after infectious meningitis in childhood. BMC Endocr Disord 2014; 14:80. [PMID: 25287789 PMCID: PMC4196011 DOI: 10.1186/1472-6823-14-80] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2014] [Accepted: 09/29/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A number of studies of adults have shown that pituitary deficiencies can develop in a considerable proportion of subjects during the acute phase of meningitis or years after the infection has disappeared. The results of the very few studies of the impact of pediatric meningitis on hypothalamic-pituitary function are conflicting. METHODS In order to determine the incidence of pituitary dysfunction in children with central nervous system infection, we evaluated pituitary function and anthropometric parameters in 19 children with meningitis of different etiologies (15 males; mean age ± standard deviation [SD] at pituitary evaluation, 5.9 ± 4.0 years; mean time from the acute event ± SD, 18 ± 10 months). RESULTS All of the subjects had a normal stature and growth velocity for their age and gender, and none of them was obese. On the basis of Tanner's reference charts, 17 subjects (13 boys and all four girls) were pre-pubertal; two boys were in Tanner stage 2. None of the subjects had central hypothyroidism. All of the patients had normal serum of insulin growth factor (IGF)-I and prolactin. Their sex steroid and gonadotropin levels were concordant with their age and pubertal status. Early morning urine osmolality and serum electrolyte levels showed no signs of diabetes insipidus. All of the patients had normal plasma adrenocorticotropic hormone (ACTH) levels. Peak cortisol responses to the standard dose Synacthen test (SDST) were normal in all cases. CONCLUSIONS The results showed that hypopituitarism following infectious meningitis appears to be infrequent in childhood and children's pituitary glands seem to be less vulnerable to damage than those of adults.
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Affiliation(s)
- Claudia Giavoli
- />Endocrinology and Diabetology Unit, Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Claudia Tagliabue
- />Pediatric Highly Intensive Care Unit, Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, Via Commenda 9, 20122 Milan, Italy
| | - Eriselda Profka
- />Endocrinology and Diabetology Unit, Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Laura Senatore
- />Pediatric Highly Intensive Care Unit, Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, Via Commenda 9, 20122 Milan, Italy
| | - Silvia Bergamaschi
- />Endocrinology and Diabetology Unit, Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Giulia Rodari
- />Endocrinology and Diabetology Unit, Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Anna Spada
- />Endocrinology and Diabetology Unit, Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Paolo Beck-Peccoz
- />Endocrinology and Diabetology Unit, Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Susanna Esposito
- />Pediatric Highly Intensive Care Unit, Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, Via Commenda 9, 20122 Milan, Italy
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Abstract
Recent studies in adults suggest that pituitary deficiencies develop in a considerable proportion of patients who recover from infectious meningitis. The aim of this study was to evaluate pituitary function of children with a history of meningitis. Seventy-nine children were admitted to the Safra Children's Hospital due to meningitis between 2007 and 2010. Twenty-four families were lost for follow-up, 55 were interviewed by phone and 14 (9 males) participated in the study. Evaluation included medical history, physical examination, auxological measurements and basal levels of TSH, fT4, cortisol and IGF1. Children with abnormal results were followed for a year and dynamic testing was performed when indicated. Mean age at time of infectious meningitis was 3.8 ± 5.4 years (range 0.03-15.8), and at clinical evaluation 6.4 ± 6.4 (range 1.2-20). The interval between the acute event and evaluation was 2.7 ± 1.2 years. Thyroid function tests and basal cortisol levels were normal for all children. Three children had low IGF1 levels; however over a year of follow-up two of them had normal height and growth velocity, making growth hormone deficiency unlikely. One child had low height SDS, but exhibited a normal response to a growth hormone stimulation test. Pituitary dysfunction with overt clinical symptoms is not a frequent consequence of acute meningitis in children. Follow-up of growth and puberty of children post-meningitis by the primary care physician is probably sufficient. Invasive assessments should be reserved for selected cases where there is slow growth or other clinical suspicion of hypopituitarism.
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Affiliation(s)
- Yael Levy-Shraga
- Pediatric Endocrine and Diabetes Unit, Safra Children's Hospital, Sheba Medical Center, 52621, Tel Hashomer, Israel,
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Sabina-Molina D, Dorta-Contreras AJ, Padilla-Docal B, Bu-Coifiú Fanego R. [Two patients with chronic meningitis due to Angiostrongylus cantonensis]. Rev Neurol 2011; 52:60-61. [PMID: 21246496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
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15
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Abstract
Mollaret meningitis is a syndrome characterized by recurrent bouts of meningitis that occur over a period of several years in an affected patient. Also known as recurrent lymphocytic meningitis, this entity involves repeated episodes of headache, stiff neck, fever, and cerebrospinal fluid pleocytosis. Herpes simplex virus type 2 is the most frequently implicated causative agent, and treatment involves the use of antiviral medications. We describe a case of Mollaret meningitis in a 47-year-old man who presented to the emergency department with his eighth episode of meningitis during a period of 20 years. Cerebrospinal fluid polymerase chain reaction testing for herpes simplex virus type 2 was positive, and further testing excluded other common viral, bacterial, and inflammatory causes of meningeal irritation. The patient's family history was significant for a brother who also had multiple episodes of aseptic meningitis during a period of several years. This represents the first published report of a possible familial association involving Mollaret meningitis. It is likely that Mollaret meningitis is underrecognized among emergency physicians, and improved recognition of this entity may limit unwarranted antibiotic use and shorten or eliminate unnecessary hospital admission.
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Affiliation(s)
- Christopher W Jones
- Department of Emergency Medicine, University of North Carolina, Chapel Hill, NC 27599-7594, USA.
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16
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Valle-Arcos MD, Villarejo-Galende A, Martínez-González M, Martín-Gil L, Calleja-Castaño P, García-Reyne A, Lizasoain M. [Acute lymphocytic meningitis presenting as Kikuchi's disease]. Rev Neurol 2010; 51:314-315. [PMID: 20669132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
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17
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Hunt WG. Meningitis and encephalitis in adolescents. Adolesc Med State Art Rev 2010; 21:287-x. [PMID: 21047030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
The overall incidence of bacterial meningitis has decreased due to numerous factors, but substantial disease burden remains from both bacterial and nonbacterial meningitis with or without accompanying encephalitis. Recently developed or validated surrogate markers of disease--including polymerase chain reaction, inflammatory markers, and magnetic resonance imaging--enhance diagnostic utility. Current guidelines and studies have modified the use of particular antibiotics and expanded the role of adjunctive steroid therapy in selected patients. This review provides an update to the general diagnostic evaluation, epidemiology, pathophysiology, clinical assessment, antibiotic treatment, adjunctive therapy, prognosis, and prevention of meningitis and encephalitis in the adolescent population.
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Affiliation(s)
- W Garrett Hunt
- Section of Infectious Diseases, Department of Pediatrics, College of Medicine, The Ohio State University, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, USA.
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18
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Abstract
AIM To investigate the longitudinal course and prognostic value of amplitude integrated EEG (aEEG) in infants with neonatal sepsis or meningitis. METHODS Amplitude integrated EEG recordings of 22 infants with sepsis/meningitis were retrospectively evaluated. Mean gestational age was 38 weeks (range: 34-42 weeks). Thirteen infants had meningitis. Survivors were seen for neurological follow-up. Four infants died, two were severely abnormal at 24 months. Amplitude integrated EEG background pattern, sleep wake cycling (SWC) and electrographic seizure activity (EA) were appraised. RESULTS All infants with continuous low voltage or flat trace on aEEG (n = 4) had an adverse outcome. Low voltage aEEGs (n = 9) had a positive LR (LR+) for an adverse outcome of 5.3 (95% CI: 1.9-14.8) at 6 h and 8.3 (95% CI: 1.3-55) at 24 h after admission. EA was more frequent in infants with adverse outcome (p < 0.01) and had a LR+ for adverse outcome of 10.6 (95% CI: 1.5-76). SWC appeared more frequent in infants with good outcome (p < 0.05). CONCLUSION Low voltage background pattern, SWC and EA on aEEG are helpful to predict neurological outcome in infants with neonatal sepsis or meningitis.
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Affiliation(s)
- H J ter Horst
- Division of Neonatology, Department of Pediatrics, University Medical Center Groningen, The Netherlands.
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Ikeda K, Takazawa T, Ito H, Ishikawa Y, Miura K, Yoshii Y, Kawabe K, Iwasaki Y. Rheumatoid leptomeningitis: radiological alteration of cerebral hypoperfusion and subarachnoid lesions. Intern Med 2010; 49:1911-6. [PMID: 20823656 DOI: 10.2169/internalmedicine.49.3492] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
A 56-year-old man with rheumatoid arthritis developed emotional lability and myoclonic seizure in the left arm, followed by fever and generalized convulsion. Brain magnetic resonance imaging (MRI) revealed leptomeningeal lesions with abnormal enhancement. MRI lesions were localized predominantly in the right cerebral subarachnoid spaces. Electroencephalogram showed epileptogenic focus at the right frontal and central points. After administration of valproate sodium improved convulsion and myoclonus, single photon emission computed tomography (SPECT) using N-isopropyl-p-(123)I-iodoamphetamine was performed. Brain SPECT displayed hypoperfusion predominantly in the right cerebral hemisphere. Cerebrospinal fluid (CSF) disclosed mild pleocytosis and marked elevations of interleukin-6 levels. Repeated CSF analyses showed cytology of class I and negative results for infectious pathogens. Methylprednisolone pulse therapy (1 g for 3 days, iv) and subsequent prednisolone administration (daily 50 mg, po) ameliorated neurological symptoms dramatically. Prednisolone was tapered to 20 mg/day for 5 months. Leptomeningeal MRI lesions were attenuated gradually followed by restoration of cerebral hypoperfusion on SPECT. He was diagnosed as rheumatoid leptomeningitis (RLM). Although clinical features of RLM exhibited variable deficits of the central nervous system (CNS), MRI failed to detect the corresponding CNS lesions. We first highlighted neuroradiological changes of cerebral hypoperfusion and leptomeningeal lesions in RLM. These neuroimages of our patient supported that leptomeningeal inflammation and the adjacent cerebrocortical ischemia could cause encephalitis-like symptoms in RLM patients.
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Affiliation(s)
- Ken Ikeda
- Department of Neurology, Toho University Omori Medical Center, Tokyo, Japan.
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20
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Santos MCD, de Albuquerque BC, Monte RL, Filho GG, Alecrim MDGC. Outbreak of chemical meningitis following spinal anesthesia caused by chemically related bupivacaine. Infect Control Hosp Epidemiol 2009; 30:922-4. [PMID: 19653822 DOI: 10.1086/599358] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Kanji S, Jones E, Goddard R, Meggison HE, Neilipovitz D. Efficiency and safety of a standardized protocol for intravenous insulin therapy in ICU patients with neurovascular or head injury. Neurocrit Care 2009; 12:43-9. [PMID: 19777385 DOI: 10.1007/s12028-009-9275-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2009] [Accepted: 08/28/2009] [Indexed: 12/19/2022]
Abstract
BACKGROUND To evaluate the safety and efficiency of a protocol for glycemic control in intensive care unit (ICU) patients with neurovascular or head injury. METHODS Two cohorts of 50 consecutive patients admitted to the ICU with an admission diagnosis of neurovascular or head injury before and after protocol implementation were evaluated. All patients in the interventional cohort received insulin using a standardized intravenous insulin infusion protocol targeting blood glucose levels of 7-9 mmol/l. Efficiency (time to reach and time within target range), safety (hypoglycemia), and nursing compliance (protocol violations) were evaluated. RESULTS The median time to reach the target blood glucose range was shorter in the interventional cohort than the conventional cohort (5.0 h [0.5-20.5 h] vs. 12.9 h [1.3-90.3 h]; P < 0.001). More time was spent within target range in the interventional cohort than in the conventional cohort (36.4 +/- 16.3% vs. 27.1 +/- 19.0%; P < 0.001). The median prevalence of mild (<4.9 mmol/l) hypoglycemia (0 [0-1.11]% vs. 0.58 [0-2.79]%; P < 0.001) and moderate (<3.9) hypoglycemia (0[0-0.55]% vs. 0 [1-1.25]%; p < 0.001) was significantly lower in the interventional cohort. CONCLUSIONS The intravenous insulin infusion protocol improved the safety and efficiency of glycemic control for ICU patients with neurovascular or head injury.
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Affiliation(s)
- Salmaan Kanji
- Department of Pharmacy, The Ottawa Hospital, 501 Smyth Rd, Ottawa, ON, K1H 8L6, Canada.
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22
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Ramesh G, Borda JT, Gill A, Ribka EP, Morici LA, Mottram P, Martin DS, Jacobs MB, Didier PJ, Philipp MT. Possible role of glial cells in the onset and progression of Lyme neuroborreliosis. J Neuroinflammation 2009; 6:23. [PMID: 19706181 PMCID: PMC2748066 DOI: 10.1186/1742-2094-6-23] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2009] [Accepted: 08/25/2009] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Lyme neuroborreliosis (LNB) may present as meningitis, cranial neuropathy, acute radiculoneuropathy or, rarely, as encephalomyelitis. We hypothesized that glia, upon exposure to Borrelia burgdorferi, the Lyme disease agent, produce inflammatory mediators that promote the acute cellular infiltration of early LNB. This inflammatory context could potentiate glial and neuronal apoptosis. METHODS We inoculated live B. burgdorferi into the cisterna magna of rhesus macaques and examined the inflammatory changes induced in the central nervous system (CNS), and dorsal root nerves and ganglia (DRG). RESULTS ELISA of the cerebrospinal fluid (CSF) showed elevated IL-6, IL-8, CCL2, and CXCL13 as early as one week post-inoculation, accompanied by primarily lymphocytic and monocytic pleocytosis. In contrast, onset of the acquired immune response, evidenced by anti-B. burgdorferi C6 serum antibodies, was first detectable after 3 weeks post-inoculation. CSF cell pellets and CNS tissues were culture-positive for B. burgdorferi. Histopathology revealed signs of acute LNB: severe multifocal leptomeningitis, radiculitis, and DRG inflammatory lesions. Immunofluorescence staining and confocal microscopy detected B. burgdorferi antigen in the CNS and DRG. IL-6 was observed in astrocytes and neurons in the spinal cord, and in neurons in the DRG of infected animals. CCL2 and CXCL13 were found in microglia as well as in endothelial cells, macrophages and T cells. Importantly, the DRG of infected animals showed significant satellite cell and neuronal apoptosis. CONCLUSION Our results support the notion that innate responses of glia to B. burgdorferi initiate/mediate the inflammation seen in acute LNB, and show that neuronal apoptosis occurs in this context.
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Affiliation(s)
- Geeta Ramesh
- Division of Bacteriology and Parasitology, Tulane National Primate Research Center, Covington, LA, USA
| | - Juan T Borda
- Division of Comparative Pathology, Tulane National Primate Research Center, Covington, LA, USA
| | - Amy Gill
- Division of Comparative Pathology, Tulane National Primate Research Center, Covington, LA, USA
| | - Erin P Ribka
- Division of Veterinary Medicine, Tulane National Primate Research Center, Covington, LA, USA
| | - Lisa A Morici
- Department of Microbiology and Immunology, Tulane University Medical School, New Orleans, LA, USA
| | - Peter Mottram
- Division of Bacteriology and Parasitology, Tulane National Primate Research Center, Covington, LA, USA
| | - Dale S Martin
- Division of Bacteriology and Parasitology, Tulane National Primate Research Center, Covington, LA, USA
| | - Mary B Jacobs
- Division of Bacteriology and Parasitology, Tulane National Primate Research Center, Covington, LA, USA
| | - Peter J Didier
- Division of Comparative Pathology, Tulane National Primate Research Center, Covington, LA, USA
| | - Mario T Philipp
- Division of Bacteriology and Parasitology, Tulane National Primate Research Center, Covington, LA, USA
- Department of Microbiology and Immunology, Tulane University Medical School, New Orleans, LA, USA
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Brubakk O. Non-invasive assessment of cardiac function in meningitis. Acta Med Scand 2009; 205:67-72. [PMID: 760406 DOI: 10.1111/j.0954-6820.1979.tb06005.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Non-invasive registration of systolic time intervals (STI) and ECG were used in evaluating cardiac function in 12 patients with bacterial and 16 with viral meningitis. On admission, 14 (50%) of the patients had abnormal STI. The preejection period (PEP) was prolonged in 11 patients, while left ventricular ejection time (LVET) was prolonged in two and shortened in four. The PEP/LVET index was increased in eight patients. At discharge PEP was still prolonged in eight patients; seven of these were from the viral meningitis group. LVET increased significantly (p less than 0.02) from the first to the last registration. In the patients with abnormal PEP and PEP/LVET on admission, there was a significant fall (p less than 0.05 and p = 0.02, respectively) to discharge. There was no difference in STI between the patients with viral or bacterial meningitis. Eighteen (64%) of the patients had abnormal STI on one or more registration. ST-T changes in ECG and prolongation of the Q-T interval were found in three patients. Cardiac affection in meningitis seems to occur more often than can be shown by ECG.
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Abstract
Acute meningitis is associated with headache, but the natural history of the headache following recovery is unknown. We addressed this issue in 141 patients admitted during 1990 to 1993 with laboratory-confirmed meningitis. We excluded patients younger than 5 years (n=44), elderly demented patients (n=6), and those with potential causes of headache other than meningitis (n=4). Seventeen candidates could not be traced. The remaining 70 patients were interviewed using a semistructured questionnaire that documented age, sex, type of meningitis, time of headache onset after infection, and headache description as well as any past and/or family history of headache. These patients were compared to age- and sex-matched controls (n=70). Prior to meningitis, 13 patients (19%) had had headaches (migrainous in 8) as did 18 controls (26%; migrainous in 8). Headache first appeared after meningitis in 19 patients (33%; migrainous in 6), increasing the total prevalence to 46%. We found no association between sex, type of meningitis, or family history and the development of postmeningitis headache. Patients who developed postmeningitis headache were significantly younger than those who did not. We conclude that there is an association between meningitis, either bacterial or aseptic, and subsequent persistent recurrent migrainous or nonmigrainous headache.
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Affiliation(s)
- M Y Neufeld
- Department of Neurology, Sourasky Medical Center, Tel Aviv University, Tel Aviv, Israel
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25
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Fritsch P, Gruber-Sedlmayr U, Pansi H, Zöhrer B, Mutz I, Spork D, Zenz W. Tick-borne encephalitis in Styrian children from 1981 to 2005: a retrospective study and a review of the literature. Acta Paediatr 2008; 97:535-8. [PMID: 18394095 DOI: 10.1111/j.1651-2227.2008.00763.x] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Tick-borne encephalitis in children appears to be more benign than in adults and shows also a more favourable outcome. Only some authors report of sequelae like paralysis, paresis or seizures and behavioural abnormalities. The aim was to describe the clinical features of tick-borne encephalitis in children with special attention to sequelae and to review the literature. METHODS Retrospective review of all charts of children with serologically confirmed tick-borne encephalitis hospitalised in Styria between 1981 and 2005. RESULTS One hundred sixteen children were diagnosed with tick-borne encephalitis. Ninety-two children (79.3%) developed meningitis and 24 (20.7%) meningoencephalitis. Eleven patients with meningoencephalitis showed somnolence, 5 confusion, 5 tremors, 2 facial palsy, 1 ataxia, 1 epileptic seizure and 1 hemi paresis. Seven patients had to be admitted to the intensive care unit. Two children (1.7%) developed long time neurological sequelae: one epileptic seizure with requirement of antiepileptic therapy and one left-sided hemi paresis. One hundred twelve children had been not and 3 incompletely vaccinated against tick-borne encephalitis. Only one child had been fully vaccinated according to the Austrian vaccination schedule. CONCLUSION Our study provides further evidence that tick-borne encephalitis in children has a substantial morbidity and in single cases severe long-time neurological sequelae are observed.
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Affiliation(s)
- Peter Fritsch
- Department of General Paediatrics, Medical University of Graz, Austria.
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Abstract
Meningococcus, an obligate human bacterial pathogen, remains a worldwide and devastating cause of epidemic meningitis and sepsis. However, advances have been made in our understanding of meningococcal biology and pathogenesis, global epidemiology, transmission and carriage, host susceptibility, pathophysiology, and clinical presentations. Approaches to diagnosis, treatment, and chemoprophylaxis are now in use on the basis of these advances. Importantly, the next generation of meningococcal conjugate vaccines for serogroups A, C, Y, W-135, and broadly effective serogroup B vaccines are on the horizon, which could eliminate the organism as a major threat to human health in industrialised countries in the next decade. The crucial challenge will be effective introduction of new meningococcal vaccines into developing countries, especially in sub-Saharan Africa, where they are urgently needed.
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Affiliation(s)
- David S Stephens
- Emory University School of Medicine, Atlanta, GA, USA; Research Service (151I), Atlanta VA Medical Center, Decatur, GA, USA.
| | | | - Petter Brandtzaeg
- Departments of Paediatrics and Clinical Chemistry, Ullevål University Hospital and Faculty of Medicine, University of Oslo, Oslo, Norway
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Rönnbäck L, Persson M, Olsson T. ["Brain fatigue"--an invisible disability with possible severe problems. Disturbed glutamate regulation can explain reduced filtration of information]. Lakartidningen 2007; 104:1137-42. [PMID: 17472102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Affiliation(s)
- Lars Rönnbäck
- Sahlgrenska Universitetssjukhuset/ Sahlgrenska, Göteborg.
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28
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Affiliation(s)
- Monika A Starosta
- Department of Medicine, Lutheran General Hospital, Park Ridge, IL 60068, USA
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Rudnik A, Larysz D, Gamrot J, Rudnik A, Skorupa A, Bierzyńska-Macyszyn G, Bazowski P. Idiopathic hypertrophic pachymeningitis - case report and literature review. Folia Neuropathol 2007; 45:36-42. [PMID: 17357010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/14/2023] Open
Abstract
Idiopathic hypertrophic pachymeningitis (IHPM) is a rare pathological state, with still unclear aetiopathogenesis. We present a case of a 63-year-old woman with cranial variety of that disease. The manifestations of the disease included headaches, paresis of VI, IX, X nerves and cerebellar ataxia. The disease was diagnosed with magnetic resonance imaging (MRI) and histopathological assessment of the pachymeninx biopsy specimen. The MRI revealed significant thickening of the cranial base pachymeninx, compressing the pons and medulla oblongata. MRI examinations could be misinterpreted as extensive meningioma of the skull base. Dura mater biopsy revealed however inflammation with abundant lymphocytic infiltrations. Clinical improvement was obtained after the application of corticosteroids. We noted the subsidence of all symptoms of the disease, as well as radiological improvement, manifested through substantial regression of the described changes in the pachymeninx. The patient has been presented in the context of 65 cases of idiopathic hypertrophic pachymeningitis, described in the literature of English-speaking countries in the last five years. Recently, the importance of the autoimmunogenic background of IHPM has been underlined. In that respect IHPM has become an interdisciplinary problem. Its diagnosis and treatment requires not only radiologists, neurologists, pathomorphologists and neurosurgeons, but also specialists in internal medicine, including immunologists, allergologists and rheumatologists as well - in other words, physicians that rarely take part in the processes of diagnosing and treating intracranial pathologies.
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Affiliation(s)
- Adam Rudnik
- Department of Neurosurgery, Medical University of Silesia, Medyków 14, Katowice, Poland
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Abstract
Neoplastic meningitis (NM) is the result of the diffuse or multifocal localization of cancer cells in the cerebral spinal fluid (CSF). NM is more often a late complication of solid tumor or lymphoproliferative malignancies. At present, the goal of therapeutic strategies is palliative and the evaluation of high or low risk is important in identifying which patients could benefit from aggressive treatments such as radiation therapy and chemotherapy. Given that NM is a cancer complication that can spread throughout the entire subarachnoid space, chemotherapy, whether intrathecal or systemic, is currently considered the best treatment option, but optimal treatment is still controversial. This review summarizes intrathecal and systemic chemotherapeutic options in the treatment of NM and the related toxicities.
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Affiliation(s)
- Andrea Pace
- Regina Elena National Cancer Institute, Rome, Italy.
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Kamimura T, Shimazaki H, Morita M, Nakano I, Okazaki H, Minota S. Limited Wegener's Granulomatosis Manifested by Abducens Nerve Palsy Resulting From Pachymeningitis. J Clin Rheumatol 2006; 12:259-60. [PMID: 17023814 DOI: 10.1097/01.rhu.0000239904.62352.5e] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Takeshi Kamimura
- Department of Medicine, Utsunomiya Social Insurance Hospital, Minamitakasago-chou, Utsunomiya-city, Tochigi, Japan.
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Ruiz-Sandoval JL, Bernard-Medina G, Ramos-Gómez EJ, Romero-Vargas S, Gutiérrez-Ureña S, González-Cornejo S, Chiquete E. Idiopathic hypertrophic cranial pachymeningitis successfully treated with weekly subcutaneous methotrexate. Acta Neurochir (Wien) 2006; 148:1011-4. [PMID: 16614804 DOI: 10.1007/s00701-006-0775-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2005] [Accepted: 02/26/2006] [Indexed: 11/30/2022]
Abstract
Idiopathic hypertrophic cranial pachymeningitis is a very infrequent disorder. Adequate management is still a matter of debate. We describe the use of low-dose pulse methotrexate in treating a 63-year-old woman with idiopathic hypertrophic cranial pachymeningitis. A weekly scheme with subcutaneous methotrexate was tried. Clinical improvement occurred in one week. Total remission of the clinical and neuro-imaging abnormalities was evident 6 months later, with minimal side effects. The patient is in complete remission after one year of follow-up without treatment. Hence, low-dose weekly subcutaneous methotrexate may be safe and effective in inducing complete and sustained remission of this condition. The experience with subcutaneous methotrexate to treat this entity has never been reported.
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Affiliation(s)
- J L Ruiz-Sandoval
- Department of Neurology and Neurosurgery, Hospital Civil "Fray Antonio Alcalde", Universidad de Guadalajara, Guadalajara Jalisco, México.
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Ebert S, Phillips DJ, Jenzewski P, Nau R, O'Connor AE, Michel U. Activin A concentrations in human cerebrospinal fluid are age-dependent and elevated in meningitis. J Neurol Sci 2006; 250:50-7. [PMID: 16920154 DOI: 10.1016/j.jns.2006.06.026] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2006] [Revised: 06/06/2006] [Accepted: 06/28/2006] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Activin A, and its binding protein, follistatin (FS), are expressed in the central nervous system (CNS). We have previously shown elevated concentrations of FS in the cerebrospinal fluid (CSF) of patients with meningitis and increased concentrations of activin A in the CSF of rabbits with bacterial meningitis. METHODS We measured CSF and serum concentrations of activin A and FS in normal subjects and in patients with various neurological diseases using previously validated immunoassays specific for activin A or FS. RESULTS In healthy persons, serum concentrations of both activin A and FS were age-dependent. In CSF, concentrations of activin A ranged from 0.03 to 0.33 ng/ml and were strongly correlated with age in both sexes, whereas FS CSF concentrations were below the assay detection limit in most of the patients. Activin A concentrations in CSF of patients with various neurological diseases, including meningitis, chronic inflammatory CNS diseases, neurodegenerative diseases, tumors in the CNS, cerebral ischemia, intracerebral/subarachnoid hemorrhages, subdural hemorrhages and epileptic seizures, were compared with age- and sex-matched control patients. The comparisons revealed significantly elevated concentrations of activin A in patients with meningitis (P=0.017). Serum concentrations of activin A or FS were not affected by any of the neurological diseases examined. CONCLUSIONS Our results show for the first time that in normal subjects concentrations of activin A in CSF are correlated with age, and furthermore, that activin A CSF concentrations are elevated in patients with meningitis. The latter underlines a role for activin A in acute inflammatory processes within the CNS.
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Affiliation(s)
- Sandra Ebert
- Department of Neurology, University of Göttingen, Robert-Koch-Str. 40, 37075 Göttingen, Germany.
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Kumar KK, Ganapathy K, Sumathi V, Rangachari V, Sundararajan I, Govindaraj R. Adult intranasal meningoencephalocele presenting as a nasal polyp. J Clin Neurosci 2006; 12:594-6. [PMID: 15936196 DOI: 10.1016/j.jocn.2005.03.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2003] [Revised: 06/18/2004] [Indexed: 11/24/2022]
Abstract
We present an isolated purely intranasal meningoencephalocele, presenting as a nasal polyp in an adult, which is uncommon. Based on a review of the literature, we emphasize that nasal obstruction may be the only presenting symptom of an intranasal meningoencephalocele.
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Affiliation(s)
- K Krishna Kumar
- Department of Otorhinolaryngology, Sundaram Medical Foundation, Chennai, India.
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Matsushita T, Murai H, Kawajiri M, Muratani H, Iwaki T, Taniwaki T, Kira JI. Character changes from idiopathic cranial pachymeningoencephalitis. J Neurol Sci 2006; 244:163-6. [PMID: 16504209 DOI: 10.1016/j.jns.2006.01.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2005] [Revised: 01/03/2006] [Accepted: 01/04/2006] [Indexed: 11/24/2022]
Abstract
A 66-year-old man with idiopathic cranial pachymeningoencephalitis was described. He suffered from left orbital pain, and character changes. He became short tempered, and was very attached to trifles. Two years prior to these symptoms, he had developed transient left abducent nerve palsy. Head MRI showed a thickening and enhancement of the dura mater on gadolinium-enhanced T1-weighted images, and high signal intensity lesions at bilateral frontal lobes predominantly in the white matter on T2-weighted images. Biopsies revealed microglial proliferation in the cerebral parenchyma, and mild lymphocytic perivascular infiltration. No evidence of intracranial infection was detected. We therefore treated him with methylprednisolone pulse therapy followed by oral prednisolone. His character became gradually normalized, and bilateral frontal lobe lesions seen on MRI disappeared. This is the first case to describe recurrent pachymeningoencephalitis with character changes, and symptoms were probably due to frontal lobe dysfunction.
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Affiliation(s)
- Takuya Matsushita
- Department of Neurology, Neurological Institute, Graduate School of Medical Sciences, Kyushu University, Fukuoka, 812-8582, Japan
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Helbok R, Pongpakdee S, Yenjun S, Dent W, Beer R, Lackner P, Bunyaratvej P, Prasert B, Vejjajiva A, Schmutzhard E. Chronic Meningitis in Thailand. Neuroepidemiology 2005; 26:37-44. [PMID: 16254452 DOI: 10.1159/000089236] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
The charts of 114 consecutive patients with chronic meningitis admitted to a general hospital in Bangkok, Thailand, between 1993 and 1999 were retrospectively reviewed. The most common causative agents were Cryptococcus neoformans (54%) and Mycobacterium tuberculosis (37%). HIV and other underlying diseases had a major impact on the presentation of chronic cryptococcal meningitis patients. Compared to HIV-negative cryptococcal meningitis patients (21%), HIV-positives (79%) had a significantly lower incidence of focal signs (p = 0.02), hydrocephalus (p = 0.03) and seizures (p = 0.001) during hospital stay, furthermore, a lower leucocyte level, a significantly higher glucose level (p = 0.02) and a lower protein level (p = 0.03) in the first cerebrospinal fluid examination. Of the 43 patients with chronic tuberculous meningitis, only 3 were HIV positive. Focal neurologic deficits were found more frequently in tuberculous meningitis patients (p = 0.001) when compared to cryptococcal meningitis patients without HIV. Cerebral infarction on cerebral CT was indicative of tuberculous meningitis. Cryptococcal meningitis patients with HIV infection had a worse outcome compared to non-AIDS patients. Advanced stage of the disease on admission, decreased level of consciousness prior to and on the admission day and raised intracranial pressure above 40 cm H(2)O at any given time were predictive of a poor outcome in tuberculous meningitis patients.
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Affiliation(s)
- R Helbok
- Clinical Department of Neurology, Medical University Innsbruck, Innsbruck, Austria.
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Abstract
UNLABELLED This study determined the prevalence of serious sequelae among a national cohort of 5-year old children, born in England and Wales in 1996-7, who had had neonatal meningitis. The results were compared with those from two matched control groups. In addition the results from this study were compared with those from a previous 5-year follow-up of children who had had neonatal meningitis in 1985-7. Follow-up questionnaires requesting information about the children's health and development were sent to the general practitioners (GPs) and parents of the index children and controls. Information was collected on 166 of 232 (72%) children who had had meningitis as neonates, 109 general practice controls and 191 hospital controls. At 5 years, 39/166 (23%) index children had a serious disability compared to 2% of GP controls and 7% of hospital controls. There was a 16-fold increase in risk of serious disability compared to GP-matched controls and a 4-fold increase in risk compared to hospital controls. The isolation of bacteria from the CSF was the best single predictor of serious long-term disability. Although there was a 70% fall in acute phase mortality between 1985 (22%) and 1996 (6.6%), the overall incidence of serious disability remained alarmingly high, 25.5% in 1985 compared to 23.5% in 1996. In the present study, however, fewer children had cerebral palsy or seizure disorders. CONCLUSION Despite the dramatic improvement in acute phase survival following neonatal meningitis, the prevalence of serious sequelae remains alarmingly high.
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Affiliation(s)
- John de Louvois
- Department of Paediatrics, Imperial College School of Medicine, Hammersmith Hospital, London, UK.
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Abstract
HISTORY AND ADMISSION FINDINGS A 37-year-old woman was admitted with total loss of vision of the left eye within 24 hours. Additionally, she complained about fatigue, headache, chills, fever, muscle pain and neck stiffness since 4 days. At admission, the body temperature was 38.7 degrees C. Neurological examination revealed papilledema and meningism. INVESTIGATIONS Ophthalmologic findings were consistent with a papillitis. The vision was lost, the pattern-shift checkerboard visual evoked potentials were not measurable. MRI of the brain and the optical nerve was without pathological findings, meningeal or cerebral Gadolinium enhancement was not present. The CSF analysis yielded a lymphocytic meningitis with 249 cells/mm (3), the glucose ratio of cerebrospinal fluid and serum was normal. DIAGNOSIS, TREATMENT AND COURSE The papillitis was treated unsuccessfully with high-dose methylprednisolone, the left eye remained blind. Persistence of the pleocytosis under initial treatment with aciclovir and ceftriaxone, reduction of the glucose ratio of cerebrospinal fluid and serum and intrathecal immunoglobuline A -- synthesis required a change of the diagnostic and therapeutic regimen. Various common and rare differential diagnoses were considered and ruled out, a chronic meningitis of unclear aetiology with the complication of amaurosis was diagnosed. In consideration of the most probable diagnosis, a tuberculostatic therapy was initiated. A prolonged reduction of the pleocytosis and normalization of cerebrospinal fluid parameters could be observed. CONCLUSIONS A large number of aetiologies can cause chronic meningitis; this case report reviews the most important differential diagnoses and highlights the limitations of the diagnostic work-up although various methods are available. Clinical course and symptoms of chronic meningitis are mild to moderate and may even be absent, but it can cause severe complications.
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Affiliation(s)
- N Galldiks
- Klinik und Poliklinik für Neurologie der Universität zu Köln.
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Vankan Y, Lambrechts I, Janssen L. Pachymeningitis in intracranial liquor hypotension syndrome. JBR-BTR 2005; 88:247. [PMID: 16302336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Affiliation(s)
- Y Vankan
- Department of Radiology, Imelda Hospital, Bonheiden, Belgium.
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Muthukumar N, Senthilbabu S, Usharani K. Idiopathic hypertrophic cranial pachymeningitis masquerading as Tolosa-Hunt syndrome. J Clin Neurosci 2005; 12:589-92. [PMID: 16051099 DOI: 10.1016/j.jocn.2004.08.016] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2003] [Accepted: 08/05/2004] [Indexed: 10/25/2022]
Abstract
Idiopathic hypertrophic cranial pachymeningitis is a rare condition. A case of idiopathic hypertrophic cranial pachymeningitis presenting as Tolosa-Hunt syndrome is being reported. The importance of neuroimaging in patients with suspected Tolosa-Hunt syndrome is discussed. Tolosa-Hunt syndrome might represent a focal manifestation of Idiopathic hypertrophic cranial pachymeningitis. Future studies are necessary to further clarify the relationship between these two conditions.
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Affiliation(s)
- N Muthukumar
- Department of Neurosurgery, Madurai Medical College, Madurai, India.
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Ivey NS, Martin EN, Scheld WM, Nathan BR. A new method for measuring blood-brain barrier permeability demonstrated with Europium-bound albumin during experimental lipopolysaccharide (LPS) induced meningitis in the rat. J Neurosci Methods 2005; 142:91-5. [PMID: 15652621 DOI: 10.1016/j.jneumeth.2004.07.015] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2004] [Revised: 07/27/2004] [Accepted: 07/29/2004] [Indexed: 11/21/2022]
Abstract
The blood-brain barrier (BBB) is a critical extrameningeal site of injury during bacterial meningitis, manifested by enhanced BBB permeability (BBBP). Previous methods to measure altered BBBP during meningitis involve radioactive materials, or are poorly quantified. Europium (EU) is a fluorescent, non-radioactive metal that is a sensitive and stable marker. Europium fluorescence can be measured with a spectrophotometer capable of time-resolved fluorescence (TRF). We used EU-albumin (EU-A) to examine BBBP in experimental lipopolysaccharide (LPS) induced meningitis. The results presented here introduce a simple and accurate method for measuring BBB permeability.
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Affiliation(s)
- N Scott Ivey
- Department of Infectious Diseases, University of Virginia, Charlottesville, VA 22908, USA
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Abstract
This study investigated whether perivascular inflammation is necessary in the process of cortical spreading depression (CSD)-induced trigeminovascular nociception. CSD was induced by application of potassium chloride on rat parietal surface. Cortical microcirculation was studied using intravital fluorescent videomicroscopy, laser Doppler flowmetry and electron microscopy. Trigeminal nociception was determined using Fos immunoreactivity as the indicator. We found that KCl application caused cyclic cortical hyperaemia and pial microvascular dilation. Neither increased leukocyte-endothelial adhesion nor extravasation of macromolecule was demonstrated. Ultrastructural study revealed increased endothelial pinocytosis but tight junction remained intact. Despite no intense perivascular inflammation, we observed significantly increased Fos-immunoreactivity in trigeminal nucleus caudalis. These results suggest that perivascular inflammation is not necessary in the process of CSD-evoked trigeminovascular nociception.
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Affiliation(s)
- Supang Maneesri
- Department of Physiology, King Chulalongkorn Memorial Hospital and Faculty of Medicine, Chulalongkorn University, Rama IV Rd., Patumwan, Bangkok 10330, Thailand
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Rossi S, Giannini F, Cerase A, Bartalini S, Tripodi S, Volpi N, Vatti G, Passero S, Galluzzi P, Ulivelli M. Uncommon findings in idiopathic hypertrophic cranial pachymeningitis. J Neurol 2004; 251:548-55. [PMID: 15164187 DOI: 10.1007/s00415-004-0362-y] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2003] [Revised: 11/20/2003] [Accepted: 12/01/2003] [Indexed: 10/26/2022]
Abstract
BACKGROUND Idiopathic hypertrophic cranial pachymeningitis (IHCP) is a rare, poorly understood, inflammatory disease, usually involving the dura mater of skull base, tentorium, and falx, and presenting with headache, progressive cranial nerve palsies, and cerebellar dysfunction. PATIENTS AND METHODS In four patients, the diagnosis of IHCP has been made on the basis of extensive clinical, and radiological investigation, and confirmed by dural biopsy in three patients. The clinical follow-up ranges from 24 to 120 months. RESULTS At diagnosis, all the patients complained of severe, progressively increasing headache, two had simple or complex partial seizures, but none had cranial nerve palsies. Two patients had electrophysiological evidence of axonal peripheral neuropathy, biopsy-proved in one of them. In all the patients, MRI showed linear or focal thickening of the dura mater of the tentorium and/or of the convexity, sparing the skull base. In one patient, MRI findings resembled chronic subdural hematoma. Dural biopsy demonstrated fibrosis and prominent CD4+ T-cells inflammatory infiltrate. Pachymeningitis was highly responsive to steroid therapy, as was the peripheral neuropathy. In three patients, temporary steroids withdrawal led to dramatic clinical worsening including status epilepticus in one. CONCLUSIONS In the patients here reported, absence of cranial nerve impairment, seizures, MRI findings resembling chronic subdural hematoma, and association with polineuropathy were unusual findings of IHCP. Moreover, the type of inflammatory infiltrate, lacking in previous reported cases, suggests a probable pathogenetic role for cell-mediated immunity of unknown origin.
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Affiliation(s)
- Simone Rossi
- Dipartimento di Neuroscienze, Sezione Neurologia, Università di Siena Azienda Ospedaliera, Universitaria Senese Policlinico "Santa Maria alle Scotte", Viale Bracci, 53100, Siena, Italy.
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Kuncz A, Roos A, Lujber L, Haas D, Al Refai M. Traumatic prepontine tension pneumocephalus--case report. Ideggyogy Sz 2004; 57:313-5. [PMID: 15597994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Abstract
OBJECTIVE A case of prepontine tension pneumocephalus after temporal bone fracture is presented. CASE REPORT An 8-year-old girl suffered a head injury due to a fall off her bicycle. She lost her consciousness, and when she was admitted to the local hospital the Glasgow Coma Score (GCS) was 8/15 (eye opening: 2; verbal answer: 2; motor response: 4) and there was bleeding from the right ear. The patient's condition deteriorated rapidly and she needed intubation and ventilation. CT of the brain revealed large amount of air in the prepontine region, displacing the brainstem posteriorly. Patient was kept ventilated, meanwhile cerebrospinal fluid (CSF), as otorrhea appeared on the right side. CT was repeated 36 hours later, showing significantly less air in the prepontine area. The patient was weaned off the respirator, extubated and the level of consciousness improved. Later the patient developed meningitis, which was treated by systemic antibiotics with lumbar CSF drainage applied for five days. A high resolution CT scan of the petrous bone revealed a fracture crossing the middle part of the pyramid. Patient showed a full recovery except a right-sided mixed hearing loss. CONCLUSION Rapid neurological deterioration following head injury can be a consequence of tension pneumocephalus. Prepontine pneumocephalus can be caused by minor fracture of petrous bone. High resolution CT is necessary to visualize minor fracture of the petrous bone. Conservative treatment may be satisfactory to treat tension hydrocephalus.
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Affiliation(s)
- Adám Kuncz
- Division of Neurosurgery, Tawam Hospital, Al Ain, United Arab Emirates.
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Ruberu NN, Saito Y, Honma N, Sawabe M, Yamanouchi H, Murayama S. Granulomatous meningitis as a late complication of iodized oil myelography. Neuropathology 2004; 24:144-8. [PMID: 15139592 DOI: 10.1111/j.1440-1789.2003.00535.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The present report is an autopsy case of an 83 year old man with severe kyphoscoliosis and granulomatous meningitis as a late complication of iodized oil myelography. He suffered from mild cognitive impairment and died of pneumonia. At autopsy, the brain showed yellow-brown granular material on its surface, mainly in the Sylvian fissure. Microscopically, granulation tissue was seen around areas of ossification encasing the foreign material. Iodized oil apparently changed into two types of foreign bodies: eosinophilic membranous lipodystrophy-like features and homogenous yellow crystals of various sizes. The pathology was identical to foreign-body granulomatous meningitis, caused by iodized oil myelography, and caused cognitive impairment in this patient.
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Affiliation(s)
- Nyoka N Ruberu
- Department of Neuropathology, Tokyo Metropolitan Institute of Gerontology, Japan
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Abstract
BACKGROUND Hypertrophic pachymeningitis is an uncommon disorder that causes a localized or diffuse thickening of the dura mater and has been associated with rheumatoid arthritis, syphilis, Wegener's granulomatosis, tuberculosis, and cancer. Few series of the idiopathic variety have been described, particularly with respect to MRI correlation to clinical outcome and treatment. OBJECTIVE To investigate the clinical and laboratory evaluation, course, and treatment of patients with idiopathic hypertrophic pachymeningitis (IHP), to correlate the MRI findings with the clinical course, and to review the literature on IHP. METHODS Retrospective case series of 12 patients (9 men, 3 women), with a mean age of 55 years (range 39 to 88 years), who had IHP by imaging studies, meningeal or orbital biopsy, or both. The clinical features, laboratory evaluation, contrast-enhanced MRI, treatment, and clinical outcome were documented for each case. The mean duration of follow-up was 3.5 years (range 3 months to 16 years). RESULTS The main clinical features at presentation were headache (11 cases), loss of vision (7 cases), diplopia (4 cases), papilledema (2 cases), other cranial nerve involvement (3 cases), ataxia (2 cases), and seizures (1 case). On the initial MRI, the location of abnormal enhancement of the dura mater correlated with the clinical findings and the sphenoid wing area was affected in all patients. The sedimentation rate was elevated in five cases. The CSF had increased protein in six cases and lymphocytosis in four cases. Biopsy of the dura mater in five cases and the orbital soft tissue in one case showed infiltrates of small mature lymphocytes, plasma cells, and epithelioid histiocytes, but no neoplasia, vasculitis, or infectious agents. Cultures of the CSF and biopsy material remained sterile. Corticosteroid therapy improved the vision in 7 of 8 cases and controlled headache in 10 of 11 cases. Five cases had partial improvement of other neurologic symptoms and signs. Recurrence developed with steroid tapering in six cases. One case had progressive deterioration and died. In four cases methotrexate or azathioprine was added with reduction of the steroid dose. Follow-up MRI performed in 11 patients correlated 80% with the clinical state (p = 0.01). CONCLUSION IHP can be suspected on MRI and defined pathologically on biopsy. Untreated, the clinical course is usually marked by severe headache and progressive neurologic deterioration and vision loss. Although initially steroid-responsive, clinical manifestations frequently recur with corticosteroid taper, requiring the addition of immunosuppressive agents in some cases.
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Affiliation(s)
- M J Kupersmith
- Institute of Neurology and Neurosurgery at Beth Israel Medical Center, New York Eye and Ear Infirmary, New York University School of Medicine, New York, NY, USA.
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Abstract
Idiopathic hypertrophic pachymeningitis is a rare disorder of unknown origin. It is a fibrosing inflammatory process that involves the dura mater. Herein are described 14 patients with idiopathic hypertrophic pachymeningitis; their clinical, laboratory and radiological findings, as well as their treatment, are analyzed. Neuropathological findings of six cases including two autopsied cases are also presented. The main clinical features were headache and cranial nerve palsies. Many patients had mild to moderate elevation of C-reactive protein, and three patients had perinuclear antineutrophil cytoplasmic antibody. The CSF in most cases showed inflammatory changes. Neuroimaging studies revealed diffuse or localized thickening of the dura, and MRI findings were key to diagnosis of this disorder. The clinical course was chronic. All patients were treated with corticosteroid and improved intially, but half of them experienced relapses. Two patients received surgical intervention. Pathological examination in two autopsied cases revealed diffuse thickening of the dura, especially in the posterior part of the falx cerebri and the tentorium cerebelli. Microscopic examination of the dura showed dense fibrosis with inflammatory cell infiltration composed mainly of lymphocytes. The cell infiltration was marked at the surface of the dura mater. One case had necrotizing vasculitis of the small arteries located in the dura and the cerebral surface. There were no giant cells, caseation necrosis, or epitheloid granuloma. Four patients underwent biopsy of the dura, and the pathological study showed non-specific inflammatory changes. The relationship of idiopathic hypertrophic pachymeningitis with connective tissue disease or vasculitis syndrome is discussed.
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Affiliation(s)
- Shigeo Riku
- Department of Neurology, Social Insurance Chukyo Hospital, Minami, Nagoya, Japan.
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Affiliation(s)
- Trevor Duke
- Centre for International Child Health, Department of Paediatrics, University of Melbourne, Royal Children's Hospital, Victoria, Parkville, Australia.
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49
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Abstract
Mollaret's meningitis (MM) is a rare disease of benign nature characterized by recurrent episodes of aseptic meningitis. Cerebrospinal fluid (CSF) examination remains the sole diagnostic modality. Eighteen CSF samples from 14 patients were studied along with the clinical data. Specimens were prepared by cytocentrifugation and Millipore filtration and were stained with Diff-Quik and Papanicolaou stains. Eight patients were men and six were women, with an age range of 17-74 yr (mean age 37 yr). Most common clinical presentation was recurrent episodes of headaches and photophobia followed by a sustained mild fever lasting 5-7 days. The CSF showed markedly increased cellularity with pleocytosis. The differential count showed predominant monocytosis ranging from 84% to 100% (mean 96). In our series, two patients had herpes simplex virus type 2 (HSV-2) DNA detected by polymerase chain reaction (PCR) in the CSF. The monocytes were seen predominantly singly, but three cases showed a strong tendency to aggregate in small groups. Phenotypically, these cells had bean-shaped bilobed nuclei as well as multiple deep nuclear clefts depicting the so-called "footprint" appearance. In four cases, multiple blunt-tipped cytoplasmic pseudopods were noted. Degenerated monocytes with the appearance of the so-called "ghost cells" were noted in one-half of the cases. Background cells were mostly small mature lymphocytes; however, one-half of cases showed a significant amount of plasma cells and/or polymorphonuclear leukocytes (PMNs). Lysed blood with hemosiderin-laden macrophages and numerous leptomeningeal cells were seen in two cases. CSF examination of MM presents a spectrum of cytomorphologic features. When interpreted in light of the appropriate clinical setting. the latter, although nonspecific, provides an accurate diagnosis. The differential diagnosis includes various degenerative, inflammatory/infectious, and lymphoproliferative disorders of the central nervous system.
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Affiliation(s)
- Theresa Y Chan
- Department of Pathology, John K. Frost Cytopathology Laboratory, The Johns Hopkins Hospital, Baltimore, Maryland, USA
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Zaĭtsev IA, Gerasimov IG, Zaplotnaia AA, Zhidkikh VN. [Local low pressure in rehabilitation of patients with meningitis]. Vopr Kurortol Fizioter Lech Fiz Kult 2003:23-6. [PMID: 12924188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
Abstract
We studied the validity and effectiveness of interrupted local negative pressure (ILNP) in rehabilitation of patients who had had acute meningitis. ILNP on the lower part of the body was applied in 28 meningitis convalescents having residual manifestations detected at tetrapolar rheography and psychovegetative testing. As the result of the treatment the patients felt better, their psychovegetative status improved, pulse blood filling of cerebral vessels increased while tonicity of microcirculation vessels diminished. Side effects of ILNP were not registered. Thus, ILNP is effective in convalescents after meningitis.
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