1/123. cauda equina syndrome complicating pneumococcal meningitis.A 14-month-old female with pneumococcal meningitis presented with flaccid paraplegia, saddle anesthesia, and bladder and bowel dysfunction. magnetic resonance imaging of the spine demonstrated intense gadolinium enhancement of the cauda equina, whereas the conus medullaris appeared normal. This finding indicated that lumbosacral polyradiculopathy caused her symptoms.- - - - - - - - - - ranking = 1keywords = ear (Clic here for more details about this article) |
2/123. purpura fulminans associated with streptococcus pneumoniae infection in a child.BACKGROUND: neisseria meningitidis is the most frequent isolate associated with purpura fulminans in children. Although streptococcus pneumoniae infection has been associated with purpura fulminans, with the exception of one adult, it has only been reported in immunocompromised hosts. PURPOSE: We report an apparently previously healthy child who presented with purpura fulminans associated with pneumococcal meningitis. methods: Case report and review of the medical literature from September 1966 to June 1997, using a medline search. CONCLUSION: While systemic pneumococcal infection is common in childhood, progression to purpura fulminans does not typically occur in overtly healthy children. Our patient illustrates that invasive pneumococcal infection should be considered and empirically treated in a child who presents with purpura fulminans, even in the absence of preexisting functional or anatomic asplenia.- - - - - - - - - - ranking = 1keywords = ear (Clic here for more details about this article) |
3/123. Decreased susceptibility to extended-spectrum cephalosporins of a penicillin-susceptible streptococcus pneumoniae in meningitis.A 69-year-old woman was admitted to the hospital with meningitis due to streptococcus pneumoniae. The strain was susceptible to penicillin but intermediate to cefotaxime. In europe the decrease of susceptibility generally pertains more to penicillin than to cefotaxime. Such a strain is perhaps a forewarning of the existence of high-level cephalosporin-resistant strains. Despite the possible detection of the resistance by oxacillin disk, it underlines the need to determine the MICs of different beta-lactams without delay and to choose the most efficient treatment.- - - - - - - - - - ranking = 1keywords = ear (Clic here for more details about this article) |
4/123. Cerebellar involvement as a rare complication of pneumococcal meningitis.A 4-year old girl with meningitis, caused by streptococcus pneumoniae, developed a subcoma with respiratory insufficiency, followed by a severe cerebellar syndrome. Cerebellar involvement after regaining consciousness consisted of a symmetrical ataxia and mutism. This mutism changed into dysarthria and finally into normal speech. magnetic resonance imaging revealed lesions in both cerebellar hemispheres, suggesting cerebellitis. She recovered with prompt antibiotic treatment.- - - - - - - - - - ranking = 1keywords = ear (Clic here for more details about this article) |
5/123. Flaccid quadriplegia from tonsillar herniation in pneumococcal meningitis.A young woman with fulminant pyogenic meningitis became quadriplegic, areflexic and flaccid due to herniation of the cerebellar tonsils and compression of the upper cervical cord. This state of spinal shock was associated with absent F-waves. intracranial pressure was greatly elevated and there was an uncertain relationship of tonsillar descent to a preceding lumbar puncture. Partial recovery occurred over 2 years. Tonsillar herniation can cause flaccid quadriplegia that may be mistaken for critical illness polyneuropathy. This case demonstrates cervicomedullary infarction from compression, a mechanism that is more likely than the sometimes proposed infectious vasculitis of the upper cord.- - - - - - - - - - ranking = 1keywords = ear (Clic here for more details about this article) |
6/123. meningitis following stapedotomy: a rare and early complication.Controversy exists concerning stapedotomy for patients with small unilateral air-bone gaps. Surgical treatment of otosclerosis involves an opening to the labyrinth and accordingly, a risk of complications, usually vertigo and sensorineural hearing loss and infrequently anacusis. In this paper we present a 33-year-old woman with a small unilateral air-bone gap, who developed bacterial labyrinthitis with meningitis and anacusis three days after stapes surgery. The patient had a stapedotomy with the small fenestra piston prosthesis technique. Due to the potential for serious complications, patients with unilateral otosclerosis and mild hearing loss should be given the possibility to choose between a hearing aid and surgery. Although stapedotomy in the vast majority of interventions is a highly successful procedure and the best method of treatment for otosclerosis if successful, there is a high price to pay in the event of failure.- - - - - - - - - - ranking = 8keywords = ear (Clic here for more details about this article) |
7/123. recurrence of pneumococcal meningitis due to primary spontaneous cerebrospinal fluid fistulas.The authors report a case of pneumococcal meningitis which recurred 3 times in a Taiwanese boy due to spontaneous cerebrospinal fluid (CSF) fistulas. The first time occurred at the age of 2 years, and the second episode presented as meningoencephalomyelitis at the age of 6 years 10 months. Studies including serum levels of immunoglobulin and complements, brain magnetic resonance imaging, and coronal cranial computed tomography (CT) were negative for a specific etiology. The third episode of meningitis developed 2 months after the second episode. Repeated immunological studies and high-resolution CT of paranasal sinuses and temporal bones were negative. technetium-99m diethylenetriamine pentaacetic acid (Tc-99m-DTPA) radionuclide cisternography revealed abnormal retention of radioactivity over the right mastoid area. neurosurgery was undertaken to seal the dural tear and pack the petrosal fissure. Two years after surgery, he has had no further CSF leak age or meningitis. Tracing back the history, there was no head injury, cranial surgery, brain tumor, or hydrocephalus, which might have created CSF fistulas. Primary spontaneous CSF fistulas constitute the most reasonable diagnosis. In cases of recurrent bacterial meningitis, underlying anatomic defects should be carefully evaluated if there is no immune defect.- - - - - - - - - - ranking = 4keywords = ear (Clic here for more details about this article) |
8/123. Group a streptococcal meningitis in adults: report of 41 cases and a review of the literature.Chart review of 41 adult patients with group A streptococcal (GAS) meningitis in The netherlands revealed that this is a community-acquired disease and occurs mainly in patients with predisposing factors: of the 41 patients in this case series, 24 (60%) of 40 evaluable patients had otitis or sinusitis. fever and neck stiffness were the most common clinical manifestations of disease, but, in addition, high rates of seizures (12 [32%] of 38 patients), focal neurological findings (13 [36%] of 36 patients), and hyponatremia (20 [58%] of 35 patients) were found. In contrast with data from the literature that describes 27 adult cases, we found that GAS meningitis is a fulminant disease with a mortality rate of 27% (10 of 37 patients), and that neurological sequelae occur in 36% (12 of 38) of surviving patients.- - - - - - - - - - ranking = 52.870469069065keywords = otitis (Clic here for more details about this article) |
9/123. The subcranial approach to trauma of the anterior cranial base: preliminary report.The subcranial approach to the cranio-orbito-frontal junction allows direct access to the central anterior cranial base for repair of fractures, dural tears, and cerebrospinal fluid fistulae. It provides good visualization without brain retraction and is suitable in primary or delayed traumatic cases. For extended visualization, a portion of the frontal sinus may be removed and repositioned at the end of the procedure. Because the brain is not retracted, morbidity is low. Potential and active cerebrospinal fluid fistulae can be successfully managed with the use of free fascial grafts and often do not require a pericranial flap. Contraindications include parenchymal brain injury or bleeding that may require a more standard frontal craniotomy for management. The purpose of this report is to highlight the use of the subcranial approach to repair cerebrospinal fluid fistulae in immediate and delayed traumatic cases.- - - - - - - - - - ranking = 1keywords = ear (Clic here for more details about this article) |
10/123. Recurrent pneumococcal meningitis in homozygous C3 deficiency.Congenital deficiencies of complement system proteins are rare. A 4-year-old girl was admitted for meningitis. She had had repeated attacks of pneumococcal meningitis and otitis media at the age of 3 years. Analysis of cerebrospinal fluid showed that this meningitis was due to pneumococcal infection. Complement 3 and CH50 values of the proband and her brother were low, while her parents were normal. The patient was given polyvalent pneumococcal and anti-haemophilus vaccines plus ceftriaxone. Recovery was complete after 15 days of antibiotic therapy. This is the first description of a case of recurrent meningitis with C3 and CH50 deficiency in a Turkish family.- - - - - - - - - - ranking = 54.870469069065keywords = otitis, ear (Clic here for more details about this article) |
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