1/6. role of plasmapheresis in acute disseminated (postinfectious) encephalomyelitis.Acute disseminated encephalomyelitis (ADEM) is a demyelinating central nervous system disease that is associated with high morbidity and mortality. Although the recognition of ADEM may be facilitated by newer imaging techniques, the optimal treatment of this disease remains uncertain. We describe 4 patients with severe ADEM who responded to treatment that included intensive plasmapheresis. Two of the patients were in coma at the time that plasmapheresis was instituted, and all 4 patients made an excellent recovery. Immunologic studies revealed increased serum IgA levels, increased circulating immune complex levels as measured by the Raji cell assay, and decreased numbers of T and B cells prior to treatment of ADEM. These abnormalities improved following plasma exchange. plasmapheresis appears to be effective in reversing the neuropathologic process in ADEM. The role of this treatment modality in ADEM requires further evaluation in controlled clinical trials.- - - - - - - - - - ranking = 1keywords = central nervous system, nervous system (Clic here for more details about this article) |
2/6. movement disorders possibly induced by traditional chinese herbs.The authors describe the neurological presentation and CT/MRI findings in 4 patients exposed to overdoses of decoctions of two different Chinese herbs. Case 1, a 15-year-old boy, ingested herba serissae along with the safe-dosage salvia miltiorrhiza for treating a left renal stone. sophora subprostrata root (SSR) was primarily used for treating three other diseases: viral B hepatitis in case 2, a 9-year-old boy; infection of the throat and a low fever in case 3, a 11-year-old girl, and a minor facial infection in case 4, a 12-year-old boy. All patients showed complex neurological manifestations primarily including convulsions, mental changes and dystonia syndromes. Their CT and/or MRI revealed abnormal density lesions in the striatum and globus pallidus bilaterally. They excluded the possibility of Wilson's disease in each of the 4 patients and suggested that overdosage of SSR and herba serissae could cause intoxications of the central nervous system, particularly damage to the basal ganglia. Chemically, coumarin (case 1) and matrine and oxymatrine (cases 2-4) in the two medicinal herbs are suggested to be possibly responsible for the morbidity.- - - - - - - - - - ranking = 1keywords = central nervous system, nervous system (Clic here for more details about this article) |
3/6. New methodologies. Their role in pediatric pathology.Recombinant dna technology is providing the means for early and specific etiologic diagnoses of infectious and immunologic diseases, replacing or complementing older methodologies. The new tools that have been so useful in detecting gene rearrangements in leukemias and lymphomas are being applied to the unresolved questions of embryogenesis and disorderly cell differentiation and are being used to completely re-map the nervous system. flow cytometry and cell sorting are becoming standard features of clinical laboratories and are instrumental not only in defining alterations in lymphoid cell populations but in examining cellular functions as well as surface markers. bone marrow and organ transplantation for genetic, metabolic, and neoplastic diseases will be performed much more effectively as these newer technologies are applied to the selection of compatible donors and to the follow-up of rejection and infectious complications.- - - - - - - - - - ranking = 0.24570068691114keywords = nervous system (Clic here for more details about this article) |
4/6. cerebrospinal fluid formula in patients with central nervous system infection.knowledge of the CSF formula is clinically useful and at times critical in the analysis of a number of diagnostic problems presented by patients with CNS infections. The decision to withhold antimicrobial therapy in the patient with an acute meningitis syndrome, when viral etiology is suspected, is justified in the presence of a polymorphonuclear cellular reaction provided the CSF glucose is greater than 45 mg per dl and the protein less than 130 mg per dl. patients who fail to improve clinically should be retapped in 8 to 12 hours. A persisting PMN reaction or the combination of a PMN pleocytosis and hypoglycorrachia virtually rules out viral infection and, in the face of negative routine cultures, requires a diligent search for focal parameningeal suppuration and consideration of CNS tuberculosis and fungal infection. Careful re-evaluation of the patient emphasizing factors such as duration of illness and potential sites of parameningeal suppuration will be useful in guiding further diagnostic studies. head CT scanning including views of the sphenoid sinuses may be especially helpful in this regard.- - - - - - - - - - ranking = 4keywords = central nervous system, nervous system (Clic here for more details about this article) |
5/6. reticulum cell sarcoma with unusual presenting features: fever and low cerebrospinal fluid glucose levels.reticulum cell sarcoma of the central nervous system usually presents as a focal mass lesion. A patient is described who presented with declining intellectual function, fever, and low glucose levels and pleocytosis in the cerebrospinal fluid, which initially suggested an infectious process. This clinical presentation has not been documented previously. The patient's condition improved following treatment with dexamethasone and radiation.- - - - - - - - - - ranking = 1keywords = central nervous system, nervous system (Clic here for more details about this article) |
6/6. Multiple central nervous system infections in progressive multifocal leukoencephalopathy.Clinical, pathologic, and immunologic features of two patients with progressive multifocal leukoencephalopathy and multiple coexisting central nervous system infections are presented. Both showed impaired cell-mediated immunity whereas immunoglobulins were normal, suggesting that defective cellular rather than humoral immunity predisposes to progressive multifocal leukoencephalopathy. Continued neurologic deterioration might be due not only to progression of the condition but also to simultaneous opportunistic bacterial and fungal infections that may be amenable to treatment. Unusual features in case 1 included striking neurologic remission for 8 months and a positive brain scan corresponding to a large demyelinated lesion in the frontal lobe.- - - - - - - - - - ranking = 5keywords = central nervous system, nervous system (Clic here for more details about this article) |