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1/21. Divergence paralysis & intracranial hypertension due to neurobrucellosis. A case report.

    CASE REPORT: A 22 year old female presented with sudden onset of uncrossed diplopia at distance, intracranial hypertension, esotropia and was evaluated. Microbiological tests of CSF and sera showed for brucellosis and the patient received therapy for this and her intracranial hypertension. The papilledema, headache, esotropia and diplopia all disappeared after therapy. CONCLUSIONS: Diagnostic tests for brucella must be considered for patients who have divergence palsy and papilledema, especially those living in endemic areas. ( info)

2/21. Mycobacterial spindle cell pseudotumor of the brain: a case report and review of the literature.

    Spindle cell pseudotumors found in the skin, lymph nodes, bone marrow, spleen, lungs, and retroperitoneum have been reported recently in immunosuppressed patients, including those with acquired immunodeficiency syndrome. The authors report a similar lesion limited to the brain in a 38-year-old human immunodeficiency virus-negative man receiving steroid therapy for treatment of sarcoidosis. Histopathologically the lesions were composed of spindle and epithelioid histiocytes, small foci of necrosis, and numerous acid-fast bacilli. The acid-fast bacilli were determined by culture and polymerase chain reaction to be mycobacterium avium intracellulare. Because of the uncommon histologic appearance of this lesion and the potential for treatment if recognized, mycobacterial spindle cell pseudotumors should be included in the differential diagnosis of spindle cell lesions in the brain in immunosuppressed patients. ( info)

3/21. diabetes insipidus in neurobrucellosis.

    brucellosis is an infection due to brucella species and is characterized by acute febrile illness, chilly sensations, sweats, weakness, generalized malaise, body aches and headache. The involvement of the nervous system is rare. A few cases have been reported with symptoms and sign of optic neuritis, meningoencephalitis, meningomyelitis and cranial nerve palsy. We report a case with culture proven neurobrucellosis who presented with diabetes insipidus along with systemic signs. neuroimaging revealed multiple lesions in brain parenchyma, including the suprasellar region. Both diabetes and suprasellar lesions improved markedly with specific antibiotic therapy. ( info)

4/21. Infection of central nervous system by motile enterococcus: first case report.

    A 66-year-old man with four indwelling ventriculoperitoneal shunts for multiloculated hydrocephalus from a complicated case of meningitis a year before developed shunt infection based on a syndrome of fever, drowsiness, and cerebrospinal fluid neutrophil pleocytosis in the background of repeated surgical manipulation to relieve successive shunt blockages. The cerebrospinal fluid culture, which yielded a motile enterococcus species, was believed to originate from the gut. This isolate was lost in storage and could not be characterized further. The patient improved with vancomycin and high-dose ampicillin therapy. He relapsed a month later with enterococcus gallinarum shunt infection, which responded to high-dose ampicillin and gentamicin therapy. This is probably the first case report of motile enterococcus infection of the central nervous system. ( info)

5/21. Neurobrucellosis--a rare complication of renal transplantation.

    brucellosis is an intracellular bacterial infection contracted by consuming raw milk or by contact with infected cattle. Neurobrucellosis is a rather rare manifestation of brucellosis and has protean clinical presentations characterized by meningoencephalitis, myelitis, myelopathies, subarachnoid hemorrhage and psychiatric manifestations. A depressed immune status is believed to be a risk factor for developing neurobrucellosis. We report a case of neurobrucellosis in a patient 13 years after a cadaveric renal transplantation. Even though a brucella organism was not isolated from body fluids she satisfied other criteria for establishing the diagnosis. Treatment with doxycycline and rifampin led to a clinical cure as well as to marked improvement in the brucella titer. ( info)

6/21. Multiple nocardial abscesses of cerebrum, cerebellum and spinal cord, causing quadriplegia.

    In this paper we present a case of a diabetic patient with nocardial abscesses of cerebrum, cerebellum and the spinal cord. The present case is the first case in the literature of solitary intramedullary abscess in cervical spinal cord, causing tetraplegia. nocardia asteroides grew in a culture of the abscess pus. After either surgical excision or drainage of lesions, a triple combination regimen of chemotherapy (amikacin, ceftriaxone and trimethoprim-sulfamethoxazole) was given, but the patient was lost in the postoperative period. This case gives suggestive evidence of an association between cervical spinal cord involvement and poor prognosis in CNS nocardiosis. ( info)

7/21. Neurogenic pulmonary oedema induced by bacterial meningitis: a case report.

    We report a case of neurogenic pulmonary oedema occurring in association with bacterial meningitis. An 87 year old man suddenly developed severe dyspnoea without cardiac failure (MUGA scan ejection fraction 47%). Radiographs showed pulmonary oedema. A few hours later he developed signs of meningitis and lumbar puncture suggested a partially treated bacterial meningitis. We suspect that the bacterial meningitis had induced neurogenic pulmonary oedema. ( info)

8/21. Intracranial salmonella infections: meningitis, subdural collections and brain abscess. A series of six surgically managed cases with follow-up results.

    Focal intracranial infections due to Salmonella are rare. So far, around 80 cases have been reported in the world literature. The authors present their experience of 6 cases of intracranial salmonella infections, mainly subdural empyema in 5 and effusion in 1. In 1 case, subdural empyema was bilateral, and in another case, there was an associated brain abscess. Positive blood cultures and positive Widal tests were noticed in 2 patients each. early diagnosis and prompt evacuation of subdural collections and brain abscess and antibiotic therapy lead to satisfactory results. This study suggests that a high index of suspicion, early diagnosis and quick evacuation lead to success; this point is highlighted with the help of a review of the literature. ( info)

9/21. Cerebellar abscess due to listeria monocytogenes.

    brain abscess due to listeria monocytogenes mainly involves the cerebral hemispheres. Cerebellar abscess is an infrequent event, which could lead to rapid neurological deterioration if unrecognized. We present a case of multiple brain stem and cerebellar abscesses in a previously healthy individual exposed to unpasteurized milk. This is the 2nd case of cerebellar abscess due to listeria monocytogenes reported in the English literature. The diagnosis of listeria monocytogenes was made in the surgical specimen. Our case illustrates the difficulty of early diagnosis of cerebellar listeria monocytogenes abscesses and the importance of prompt neurosurgical intervention. ( info)

10/21. Spinal epidural abscess successfully treated with percutaneous, computed tomography-guided, needle aspiration and parenteral antibiotic therapy: case report and review of the literature.

    OBJECTIVE AND IMPORTANCE: We describe a case of a posterior spinal epidural abscess that was successfully treated with percutaneous, computed tomography-guided, needle aspiration and parenteral antibiotic therapy. CLINICAL PRESENTATION: A 48-year-old man experienced acute pain in the paralumbar region for 1 week, followed by gait disturbance and micturition difficulty. Laboratory studies demonstrated leukocytosis and hyperglycemia. blood cultures yielded staphylococcus aureus. magnetic resonance imaging scans of the thoracolumbar spine revealed a posterior spinal epidural abscess located between L2 and the lower cervical spine. INTERVENTION: The patient's low back pain persisted despite 10 days of antibiotic therapy. Therefore, percutaneous, computed tomography-guided, needle aspiration was performed. The low back pain was relieved dramatically and immediately after the procedure. The spinal epidural abscess completely resolved after 6 weeks of antibiotic treatment. CONCLUSION: Surgical decompression and antibiotic therapy are the treatments of choice for patients with spinal epidural abscesses. Selected patients may be treated nonsurgically. Rarely, percutaneous drainage of the abscess has been reported to be helpful. Our case suggests that percutaneous, computed tomography-guided, needle aspiration might be a rational alternative to surgical decompression for treatment of spinal epidural abscesses. ( info)
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