Filter by keywords:



Filtering documents. Please wait...

1/17. Case report. recurrence of increased intracranial pressure with antiretroviral therapy in an AIDS patient with cryptococcal meningitis.

    We present the case of an AIDS patient with cryptococcal meningitis who, after an excellent clinical and mycological response to antifungal therapy, developed an exacerbation of signs and symptoms, including elevated intracranial pressure and an increase in cerebrospinal fluid cryptococcal antigen and white blood cells, following the initiation of highly active antiretroviral therapy (HAART). Cultures yielded no growth and the patient responded to repeated lumbar punctures without changing or intensifying antifungal therapy. To our knowledge, this is the first report of symptomatic elevated intracranial pressure occurring during HAART-related immune recovery in a patient with cryptococcal meningitis. Exacerbation of symptoms does not necessarily reflect mycological failure that requires a change in antifungal therapy, but may relate to acutely increased intracranial pressure that will respond to simple measures, such as repeated lumbar punctures.
- - - - - - - - - -
ranking = 1
keywords = puncture
(Clic here for more details about this article)

2/17. Subdural hematoma following lumbar puncture.

    A post-dural puncture headache is a potential complication of a lumbar puncture. physicians should be able to readily diagnose and treat this potential complication. Described here is a patient who developed an unresolving post-dural puncture headache that then developed into a subdural hematoma. A subdural hematoma is a rare complication following lumbar punctures. Unresolving headaches following a lumbar puncture should prompt aggressive investigation.
- - - - - - - - - -
ranking = 4.5
keywords = puncture
(Clic here for more details about this article)

3/17. Cerebral trypanosomiasis and AIDS.

    A 36 year-old black female, complaining of headache of one month's duration presented with nausea, vomiting, somnolence, short memory problems, loss of weight, and no fever history. Smoker, intravenous drugs abuser, promiscuous lifestyle. physical examination: left homonimous hemianopsia, left hemiparesis, no papilledema, diffuse hyperreflexia, slowness of movements. Brain CT scan: tumor-like lesion in the splenium of the corpus calosum, measuring 3.5 x 1.4 cm, with heterogeneous enhancing pattern, suggesting a primary CNS tumor. Due to the possibility of CNS infection, a lumbar puncture disclosed an opening pressure of 380 mmH(2)0; 11 white cells (lymphocytes); glucose 18 mg/dl (serum glucose 73 mg/dl); proteins 139 mg/dl; presence of trypanosoma parasites. serum Elisa-hiv tests turned out to be positive. Treatment with benznidazole dramatically improved clinical and radiographic picture, but the patient died 6 weeks later because of respiratory failure. T. cruzi infection of the CNS is a rare disease, but we have an increasing number of cases in hiv immunocompromised patients. diagnosis by direct observation of CSF is uncommon, and most of the cases are diagnosed by pathological examination. It is a highly lethal disease, even when properly diagnosed and treated. This article intends to include cerebral trypanosomiasis in the differential diagnosis of intracranial space-occupying lesions, especially in immunocompromised patients from endemic regions.
- - - - - - - - - -
ranking = 0.5
keywords = puncture
(Clic here for more details about this article)

4/17. Tuberculous brain abscess in a patient with AIDS: case report and literature review.

    Tuberculous brain abscesses in AIDS patients are considered rare with only eight cases reported in the literature. We describe the case of a 34-year-old woman with AIDS and previous toxoplasmic encephalitis who was admitted due to headache and seizures. A brain computed tomography scan disclosed a frontal hypodense lesion with a contrast ring enhancement. brain abscess was suspected and she underwent a lesion puncture through a trepanation. The material extracted was purulent and the acid-fast smear was markedly positive. Timely medical and surgical approaches allowed a good outcome. Tuberculous abscesses should be considered in the differential diagnosis of focal brain lesions in AIDS patients. Surgical excision or stereotactic aspiration, and antituberculous treatment are the mainstay in the management of these uncommon lesions.
- - - - - - - - - -
ranking = 0.5
keywords = puncture
(Clic here for more details about this article)

5/17. The use of ventriculoperitoneal shunts for uncontrollable intracranial hypertension without ventriculomegally secondary to hiv-associated cryptococcal meningitis.

    BACKGROUND: The risks associated with implanting a cerebrospinal fluid (CSF) shunt in immunocompromised patients with ongoing CSF infection have historically discouraged surgeons from implanting CSF shunts in patients with hiv and cryptococcal meningitis. However, this patient population often requires frequent lumbar punctures to manage elevated intracranial pressure (ICP) secondary to cryptococcal infection. To date, only 7 cases of ventriculoperitoneal (VP) shunting for the treatment of intracranial hypertension in patients with hiv-associated cryptococcal meningitis have been reported. Few of these reports have included outcomes more than 3 months postsurgery. It remains unclear if VP shunts are an effective long-term treatment of intracranial hypertension in this patient population. CASE DESCRIPTIONS: Two patients with hiv/AIDS (CD4 counts of 8 and 81 cells/mm(3)) presented with altered mental status, visual changes, florid cryptococcal meningitis, and elevated ICP (>500 mm CSF) without evidence of hydrocephalus on computed tomography scan. Both patients experienced rapid reversal of symptoms with external lumbar CSF drainage, and remained lumbar drain-dependent after 2 weeks of amphotericin b and flucytosine therapy. Despite evidence of unresolved cryptococcal meningitis, each patient underwent implantation of a VP shunt without complication and was discharged on lifetime fluconazole therapy. They remained asymptomatic at 12 and 16 months after surgery without evidence of shunt infection or malfunction. CONCLUSION: patients with intracranial hypertension and hiv-associated cryptococcal meningitis who cannot tolerate cessation of external lumbar CSF drainage or frequent lumbar punctures may be considered for VP shunt placement despite severe immunosuppression and persistent CSF cryptococcal infection.
- - - - - - - - - -
ranking = 1
keywords = puncture
(Clic here for more details about this article)

6/17. Treatment of impaired consciousness with lumbar punctures in a patient with cryptococcal meningitis and AIDS.

    A 50 year old man with AIDS, cryptococcal meningitis and a normal CT-scan developed impaired consciousness and even deep coma associated with very high CSF pressure. After lumbar CSF drainage consciousness improved dramatically. We conclude that in patients with cryptococcal meningitis who have impaired consciousness and a normal CT scan, CSF drainage to improve the level of consciousness should be considered.
- - - - - - - - - -
ranking = 2
keywords = puncture
(Clic here for more details about this article)

7/17. Discontinuation of highly active antiretroviral therapy leads to cryptococcal meningitis/choroiditis in an AIDS patient.

    BACKGROUND: cryptococcus neoformans is an opportunistic pathogen that can manifest in immunocompromised patients with acquired immune deficiency syndrome. Prevention of cryptococcosis and other opportunistic diseases is an objective in the management of human immunodeficiency virus (hiv)-infected patients. The goal of highly active antiretroviral therapy (HAART) is to reduce the viral loads and enhance CD4 counts in hiv-infected patients. These 2 mechanisms keep hiv-infected patients healthier and enhance their immune systems, thus reducing and often preventing opportunistic infections such as ocular cryptococcal infections. Discontinuation of HAART can lead to ocular opportunistic infections such as cryptococcal choroiditis. CASE REPORT: Presented here is a case of a patient who was treated successfully with HAART of stavudine (D4T), abacavir (Ziagen), ritonavir (Norvir), and saquinavir (Invirase). His last CD4 count before HAART was discontinued was 131 cells/mm(3), and viral load was less than 50 copies/mL. He discontinued his HAART regimen for 2 years and presented to the emergency room with complaints of a severe headache with neck pain, lightheadedness, nausea, disorientation, and unsteady gait. Lumbar puncture results showed cryptococcal infection, and the patient was admitted for the treatment of cryptococcal meningitis with amphotericin b and 5-flucytosine. Cryptococcal choroiditis was diagnosed after treatment of the meningitis. After resolution, his resultant visual acuities were 10/350 in the right eye and 10/600 in the left eye. He is on a maintenance dose of antifungal therapy and has been reinitiated on HAART of abacavir/zidovudine/lamivudine (Trizivir) and lopinavir/ritonavir (Kaletra). CONCLUSION: This case exemplifies the importance of HAART in the prevention of opportunistic infections, cryptococcal meningitis/choroiditis in particular. eye care professionals can play a role in encouraging patients to comply with their HAART regimens.
- - - - - - - - - -
ranking = 0.5
keywords = puncture
(Clic here for more details about this article)

8/17. Cryptococcal choroiditis.

    Two patients with acquired immune deficiency syndrome presented with headaches and fevers. A diagnosis of cryptococcal meningitis was made by lumbar puncture and elevated cryptococcal antigens. Complaints of decreased vision in both patients led to the diagnosis of optic disc edema and cryptococcal choroiditis with yellow-white choroidal infiltrates noted in both eyes of the two patients. Systemic treatment with amphotericin b and 5' flucytosine led to resolution of the choroidal infiltrates. Late visual acuity loss was believed to be secondary to optic atrophy.
- - - - - - - - - -
ranking = 0.5
keywords = puncture
(Clic here for more details about this article)

9/17. Ultrasonographic and microbiological diagnosis of mycetic liver abscesses in patients with AIDS.

    A rare case of multiple mycetic abscesses in a patient with AIDS is reported: the diagnosis was suspected after an ultrasound (US) examination and was obtained with US guided percutaneous puncture. The US appearance and differential diagnosis of mycetic liver abscesses are discussed and the increasing role of US and US guided percutaneous puncture in the screening of these patients is stressed.
- - - - - - - - - -
ranking = 1
keywords = puncture
(Clic here for more details about this article)

10/17. Cryptococcal meningitis. False-negative antigen test results and cultures in nonimmunosuppressed patients.

    All cases of cryptococcal meningitis at Yale-New Haven (Conn) Hospital seen during a 4 1/2-year period were reviewed to calculate the rate of false-negative antigen test results and cultures preceding diagnosis. Of 13 patients, 9 were immunosuppressed and were diagnosed following the initial lumbar puncture, with both antigen test results and cultures positive in all cases. Among 4 nonimmunosuppressed patients, the rate of false-negative antigen test results was 77%, and of cultures, 89%. The diagnosis was consequently delayed in 3, 2 of whom died despite treatment. Cryptococcal meningitis may be underdiagnosed and undertreated to a significant degree in nonimmunosuppressed patients.
- - - - - - - - - -
ranking = 0.5
keywords = puncture
(Clic here for more details about this article)
| Next ->


Leave a message about 'Acquired Immunodeficiency Syndrome'


We do not evaluate or guarantee the accuracy of any content in this site. Click here for the full disclaimer.