RATIONALE: We report the rare case of a 74-year-old man with anti-Ma2-associated paraneoplastic neurologic syndrome (PNS), and review and analyze the clinical manifestations, diagnosis, and treatment of the disease.
PATIENT CONCERNS: The patient presented with a 5-month history of muscle weakness, progressive body aches, and weakness and numbness in both lower extremities. Before his hospitalization, he had experienced cognitive function decline; ptosis, inward gaze, and vertical gaze palsy in the right eye; and occasional visual hallucinations. Brain and spinal cord magnetic resonance imaging (MRI) yielded normal results. Anti-Ma2 antibodies were detected in both serum and cerebrospinal fluid. A 4-hour electroencephalogram showed irregular sharp slow waves and δ waves in the temporal region. Electromyography showed peripheral nerve demyelination. Positron-emission tomography/computed tomography (PET-CT) examination revealed hypermetabolism in the lymph nodes of the whole body. Biopsy of the lymph nodes showed non-Hodgkin lymphoma.
DIAGNOSIS: A clinical diagnosis of lymphoma and PNS was made.
INTERVENTIONS: The patient was treated with intravenous dexamethasone (15 mg/day) for 3 days.
LESSONS: We have presented a rare case of a PNS involving both the central and peripheral nervous systems. The clinical features of this case indicated anti-Ma2-associated encephalitis and chronic inflammatory demyelinating polyneuropathy. PET-CT played a critical role in enabling early diagnosis and prompt treatment in this case.
We evaluated previous multicenter/multinational studies to analyze the frequency and clinical impact of patients without CSF pleocytosis. Neurosyphilis (18%), herpetic meningoencephalitis (7.9%), tuberculous meningitis (3%), brucella meningitis (1.7%), and pneumococcal meningitis (0.2%) did not display CSF pleocytosis. Most patients were not immunosuppressed. Patients without pleocytosis had considerable unfavorable outcomes and should not be underestimated.
AbstractText: Post-operative centralnervoussysteminfections (PCNSIs) are serious complications following neurosurgical intervention. This group previously investigated the incidence and causative pathogens of PCNSIs at a resource-limited, neurosurgical center in South Asia. This follow-up study was conducted to analyze differences in PCNSIs at the same institution following only one apparent change: the operating room air filtration system ...
Infectious Diseases (2) Infections (2), Central Nervous System Infections (2), Meningitis (1), more mentions
We reported a cluster of meningitis cases where next-generation sequencing enabled comprehensive and rapid diagnosis of causative agents. Study attempted a novel application of next-generation sequencing through the dynamic and direct semi-quantitive surveillance of pathogen loads in cerebralspinal fluids, suggesting its potential in reflecting disease progression and therapeutic efficacy evaluation during clinical approach. NGS may perform as a promising tool for infectious disease course surveillance through its ability of revealing the direct connection between pathogen loads and variate disease states in the future.
Infectious Diseases (1) Communicable Diseases (1), Central Nervous System Infections (1), Meningitis (1), more mentions
The choroid plexus (CP) is responsible for the production of a large amount of the cerebrospinal fluid (CSF). As a highly vascularized structure, the CP also presents a significant frontier between the blood and the central nervous system (CNS). To seal this border, the epithelium of the CP forms the blood-CSF barrier (BCSFB), one of the most important barriers separating the CNS from the blood. During the course of infectious disease, cells of the CP can experience interactions with intruding pathogens, especially when the CP is used as gateway for entry into the CNS. In return, the CP answers to these encounters with diverse measures. Here, we will review the distinct responses of the CP during infection of the CNS, which include engaging of signal transduction pathways, the regulation of gene expression in the host cells, inflammatory cell response, alterations of the barrier, and under certain circumstances cell death. Many of these actions may contribute to stage an immunological response against the pathogen and subsequently help in the clearance of the infection.
... infections was related only to immune response in histopathology, steroid tapering and possibly surgical drainage. In a contemporary 16-year cohort of 40 patients with hematologic cancer and mold infections of CentralNervousSystem, 42-day mortality was 48. Improved survival was related to immune response in histopathology, absence of co-infections, corticosteroid tapering and possibly surgical drainage Keyword: Aspergillus.
Oncology (6) Neoplasms (5), Infections (5), Coinfections (2), more mentions
RATIONALE: Spinal epidural abscess is an uncommon complication in clinical practice. If the abscess is large enough, the patient will rapidly develop neurologic signs of spinal injury, and urgent neurosurgical intervention may be required.
PATIENT CONCERNS: Rapid and correct diagnosis and treatment is important for spinal epidural abscess complication.
DIAGNOSES: This report describes a cervical epidural abscess (CEA) caused by epidural analgesia, wherein the patient was punctured twice. A CEA was suspected based on the patient's significant neck pain and elevated white blood cell and neutrophil counts. A CEA from C6 to T8 was confirmed by magnetic resonance imaging scan.
INTERVENTIONS: The patient was treated with a combination of intravenous vancomycin and imipenem/cilastatin for more than 4 weeks.
OUTCOMES: After more than 2 weeks of intensive antibiotic treatment, the epidural abscess gradually diminished in size, the white blood cell count, neutrophil count, hyperallergic C-reactive protein (CRP), and general CRP decreased, and the patient's neck and back pain resolved. After more than 4 weeks of anti-inflammation therapy, the epidural abscess was completely absorbed, and there was no relapse during the 3-month follow-up period.
LESSONS: Although an effective combination of intravenous antibiotics can cure an epidural abscess, caution is warranted when performing epidural steroid injections in immunocompromised patients.
The notion that prion-like spreading of misfolded α-synuclein (α-SYN) causes Parkinson's disease (PD) has received a great deal of attention. Although attractive in its simplicity, the hypothesis is difficult to reconcile with postmortem analysis of human brains and connectome-mapping studies. An alternative hypothesis is that PD pathology is governed by regional or cell-autonomous factors. Although these factors provide an explanation for the pattern of neuronal loss in PD, they do not readily explain the apparently staged distribution of Lewy pathology in many PD brains, the feature of the disease that initially motivated the spreading hypothesis by Braak and colleagues. While each hypothesis alone has its shortcomings, a synthesis of the two can explain much of what we know about the etiopathology of PD.Dual Perspectives Companion Paper: Prying into the Prion Hypothesis for Parkinson's Disease, by Patrik Brundin and Ronald Melki.
Neurological and Central Nervous System Diseases (3) Parkinson Disease (4), Prion Diseases (1), more mentions
The factors that were significantly associated with death in the multivariate analysis were age, history of ischemic cardiac disease, and neurological diagnoses of CNSinfection, cerebrovascular disease, and CNS tumor. Similarly, factors associated with disability were medical history of HIV, and cerebrovascular disease, and neurological diagnoses of cerebrovascular disease and CNS tumor.
Neurological and Central Nervous System Diseases (1), Neuroscience (1) Neoplasms (2), Epilepsy (1), Heart Diseases (1), more mentions
A retrospective medical chart review was performed and the indications and results of surgical interventions were recorded.All surgeries were performed for the treatment of secondary complications of ORN, including central nervous system (CNS) infection (48.4%), blowout bleeding (24.1%), and severe pain (17.2. Endoscopic debridement was done in 12 patients, whereas the rest required either maxillary swing or mandibulotomy, depending ...
We determined the incidence of central nervous system (CNS) infection, intracranial hemorrhage, ischemic stroke, metabolic encephalopathy, posterior reversal encephalopathy syndrome, seizure and peripheral neuropathy. In all, 50 patients experienced 63 NCs-37 early (⩽day +100), 21 late (day +101 to 2 years) and 5 very late (2 to 5 years.
Cardiovascular Diseases (1) Peripheral Nervous System Diseases (2), Intracranial Hemorrhages (1), Stroke (1), more mentions
... B-lymphocyte and moderate macrophage infiltrates, with perivascular predominance as well as diffuse parenchymal infiltration (14/14), present in meninges, white and grey matter, associated with variable tissue destruction, astrogliosis and secondary myelin loss. Clinical, radiological and pathological feature define CLIPPERS syndrome and are differentiated from non-CLIPPERS aetiologies by neuroradiological and neuropathological findings Keyword: CNSinfection. Keyword: T-lymphocytes.
OBJECTIVES: Computed tomography (CT) is the modality of choice to characterise pulmonary arteriovenous malformations (PAVMs) in patients with hereditary haemorrhagic telangiectasia (HHT). Our objective was to determine if CT findings were associated with frequency of brain abscess and ischaemic stroke.
METHODS: This retrospective study included patients with HHT-related PAVMs. CT results, i.e. PAVM presentation (unique, multiple, disseminated or diffuse), the number of PAVMs and the largest feeding artery size, were correlated to prevalence of ischaemic stroke and brain abscess. All CTs were reviewed in consensus by two radiologists.
RESULTS: Of 170 patients, 73 patients had unique (42.9 %), 49 multiple (28.8 %), 36 disseminated (21.2 %) and 12 diffuse (7.1 %) PAVMs. Fifteen patients presented with brain abscess; 26 patients presented with ischaemic stroke. The number of PAVMs was significantly correlated with brain abscess (11.5 vs. 6.2, respectively; p=0.025). The mean diameter of the largest feeding artery was significantly correlated with ischaemic stroke frequency (4.9 vs. 3.2 mm, respectively; p=0.0098).
CONCLUSIONS: The number of PAVMs correlated significantly with risk of brain abscess, and a larger feeding artery significantly with more ischaemic strokes. These findings can lead to a better recognition and management of the PAVMs at risk of cerebral complications.
KEY POINTS: • Chest CT helps clinicians to facilitate appropriate PAVM management strategies. • Pulmonary arteriovenous malformation CT findings are correlated with risk of cerebral complications. • Risk of brain abscess is significantly correlated with number of PAVMs. • Risk of ischaemic stroke is significantly correlated with large feeding artery PAVMs. • Prevalence of observed of brain abscess and ischaemic stroke is 26 %.
Stroke (7), Brain Abscess (7), Arteriovenous Malformations (3), more mentions
A positive result on EITB does not always correlate with the presence of active infections in the centralnervoussystem (CNS), and patients with a single viable brain cyst may be EITB negative. Nonetheless, EITB antibody banding patterns appears to be related with the expression of three protein families of Taenia solium, and in turn with the characteristics of NCC ...
A 35-year-old woman with severe cystic fibrosis was admitted for sudden loss of strength in both legs, revealing a myelitis. The medullar lesion biopsy revealed phaeohyphomycosis caused by Cladophialophora species. Myelitis caused by Cladophialophora bantiana is a rare disease associated with high mortality. This article is protected by copyright. All rights reserved.
Cystic Fibrosis (2), Myelitis (2), Phaeohyphomycosis (1), more mentions