1/29. Spinal subdural hematoma: a rare complication of lumbar puncture. Case report and review of the literature.Spinal subdural hematoma, though rare, is an established complication of lumbar puncture. A young man with persistent back and neck pain after a traumatic lumbar puncture for the diagnosis of lymphocytic meningitis is presented. A diagnosis of spinal subdural hematoma at T2 to T8 levels without significant spinal cord compression was confirmed by magnetic resonance imaging. Symptoms resolved after one month of analgesics and muscle relaxants.- - - - - - - - - - ranking = 1keywords = muscle (Clic here for more details about this article) |
2/29. Simultaneous bilateral painful ophthalmoplegia and exudative retinal detachment in rheumatoid arthritis.A 47-year-old woman who suffered from chronic rheumatoid arthritis presented with bilateral painful ophthalmoplegia with proptosis and exudativeretinal detachment. The painful ophthalmoplegia with proptosis might have been caused by pachymeningitis involving the cavernous sinus bilaterally, or bilateral posterior scleritis spreading to the extraocular muscles and tendons. The exudative retinal detachment might have been a result of bilateral posterior scleritis which had spread to the choroid. These two unusual complications of rheumatoid arthritis occurred simultaneously in this case. Both complications responded to corticosteroid treatment.- - - - - - - - - - ranking = 1keywords = muscle (Clic here for more details about this article) |
3/29. dysarthria as the isolated clinical symptom of borreliosis--a case report.This report presents a case of dysarthria due to hypoglossal nerve mono-neuropathy as the only consequence of neuroborreliosis. The 65-year-old man with a seven-months history of articulation disturbances was examined. The speech of the patient was slow and laboured. A slight weakness of the muscles of the tongue (left-side) was observed. The patient suffered from meningitis due to borrelia burgdorferi infection in 1999 and initially underwent a successful antibiotic treatment. Detailed radiological investigation and psychological tests were performed and co-existing neurological diseases were excluded. To describe profile of speech abnormalities the dysarthria scale was designed based on S. J. Robertson dysarthria Profile. There were a few disturbances found in self-assessment of speech, intelligibility, articulation, and prosody but especially in the morphology of the articulation muscles, diadochokinesis, the reflexes (in the mouth, larynx and pharynx). Needle EMG examination confirmed the diagnosis of mono-neuropathy of left hypoglossal nerve. The study confirms the fact that neuroborreliosis may evoke chronic consequences.- - - - - - - - - - ranking = 2keywords = muscle (Clic here for more details about this article) |
4/29. Spontaneous cerebrospinal fluid otorrhea.A case of spontaneous cerebrospinal fluid otorrhea with recurrent meningitis is reported. The route of cerebrospinal fluid leak was through the internal auditory meatus. The cerebrospinal fluid otorrhea was stopped by packing the meatus with muscle and Gelfoam.- - - - - - - - - - ranking = 1keywords = muscle (Clic here for more details about this article) |
5/29. Metastatic chondroblastoma with elevated creatine kinase and paraneoplastic neurologic autoimmunity.A 17-year-old girl presented with chondroblastoma of the fibula and pulmonary metastases. serum creatine kinase (CK) was elevated for a decade preoperatively and fell to near normal after tumor excision. An episode of aseptic meningitis 3 months later led to serologic detection of three antibody markers of paraneoplastic neurologic autoimmunity that in adult patients are characteristic of thymoma and lung carcinoma: muscle-type acetylcholine receptor (AChR) autoantibody (Ab), type 2 Purkinje cell cytoplasmic Ab (PCA-2), and collapsin response-mediator protein-5-IgG (CRMP-5-IgG). Locally recurrent chondroblastoma was excised 1 year later. serum CK was elevated, CRMP-5-IgG was positive, PCA-2 was lower, and AChR Ab was undetectable. Three years after diagnosis she has stable pulmonary metastases, with elevated CK, higher PCA-2, positive CRMP-5-IgG, and undetectable AChR Ab. The association of metastatic chondroblastoma, elevated CK, and an evolving profile of paraneoplastic autoantibodies reveals a previously unrecognized immunobiologic dimension of chondroblastoma.- - - - - - - - - - ranking = 1keywords = muscle (Clic here for more details about this article) |
6/29. Too quiet.The child with a fever (or a reported fever, as in this case) has a wide range of potential illnesses that must be considered. The pediatric community approaches children in three age groups: those younger than three months, those between 3-24 months, and those over 24 months. Those under three months of age are most at risk for serious problems, and the physical examination of the child is most unreliable. Infants most at risk for infection have smaller birth weights, mothers with infectious diseases such as chlamydia or hiv, and labor following premature rupture of membranes. Infants cannot offer complaints; have poorly functional muscles that do not allow the demonstration of neck stiffness or stiff joints; and cannot cough productively to demonstrate pneumonia. The most strenuous activity for an infant is eating, so ill infants will often feed poorly. The emergency physician or pediatrician will want the prehospital emergency provider to observe the behavior of an ill child to gain an indication of the seriousness of the illness. The Yale observation Scale uses six criteria to stratify the ill child. The ill child will have poor color, a weak or high-pitched cry, poor hydration (dry diaper and mucous membranes), little reaction to parental stimulation, little arousal or continuous sleeping and no smile. This child demonstrated many criteria of an ill child. Her temperature was likely high at the onset of illness (while in her crib), which was not detectable by the time the EMS crew did its evaluation. Difficulty breathing is a common observation in ill infants by their parents, and the child had a dry diaper. A quiet child is not to be considered a healthy child, and like many EMS situations, the crew was appropriately "worried most about the quiet one."- - - - - - - - - - ranking = 1keywords = muscle (Clic here for more details about this article) |
7/29. Bilateral facial nerve paresis in eosinophilic meningitis.A 29-year-old man presented with headache, nuchal rigidity and bilateral facial paralysis. Lumbar puncture revealed eosinophilic CSF pleocytosis. Facial diplegia was improved by supportive treatment. Thus, eosinophilic meningitis is one of the etiologies of bilateral facial nerve paresis.- - - - - - - - - - ranking = 774370.35929777keywords = nuchal rigidity, rigidity (Clic here for more details about this article) |
8/29. Neurogenic pulmonary edema associated with meningitis.A 17-year-old man presented with acute febrile, obtundation, nuchal rigidity and CSF pleocytosis with polymorphonuclear cell predominate. He developed acute pulmonary edema which could not be explained by other mechanisms. meningitis appears to be another cause of neurogenic pulmonary edema.- - - - - - - - - - ranking = 774370.35929777keywords = nuchal rigidity, rigidity (Clic here for more details about this article) |
9/29. Cysticercal meningitis--a pernicious form of neurocysticercosis which responds poorly to praziquantel.Chronic cysticercal meningitis was diagnosed in 6 of 260 cases of neurocysticercosis. Clinical features usually associated with meningitis, such as fever, cranial nerve palsies and nuchal rigidity, were absent and the diagnosis was reached because of persistently abnormal cerebrospinal fluid (CSF) associated with active neurocysticercosis on computed tomography. Other causes of chronic meningitis were excluded. hydrocephalus, either obstructive or communicating, was present in all 6 patients. The results of medical treatment with praziquantel were poor and there was no improvement either clinically or in the CSF. Severe clinical sequelae, such as dementia, blindness and gait ataxia, were common despite protracted medical treatment and ventriculoperitoneal shunting.- - - - - - - - - - ranking = 774370.35929777keywords = nuchal rigidity, rigidity (Clic here for more details about this article) |
10/29. sulindac-induced aseptic meningitis in mixed connective tissue disease.A 21-year-old female with mixed connective tissue disease (MCTD) experienced nausea, headache, consciousness disturbance, nuchal rigidity, and a temperature of 38.5 less than or equal to C three days after the intake of sulindac (300 mg/day). Cerebrospinal fluid analysis revealed an opening pressure of 310 mm of water, a predominantly lymphocytic pleocytosis, and elevated protein content of 89 mg/dl. After discontinuing sulindac, the aseptic meningitis improved in five days. In the acute stage, CT scan disclosed contrast enhancement in the cerebral hemispheres, which suggests that hypersensitivity may be involved in the pathogenesis of nonsteroidal antiinflammatory drug (NSAID) induced aseptic meningitis.- - - - - - - - - - ranking = 774370.35929777keywords = nuchal rigidity, rigidity (Clic here for more details about this article) |
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