Fever, Headache, and Visual Blurring in a 17-Year-Old Woman

A fascinating case, with much to learn about diagnosis and treatment of patients with abnormal CSF results. After learning from the case, take our online qui

Clinical and radiological features of symptomatic central nervous system tuberculomas

Tuberculomas may present with meningitis, may lead to meningitis, or may develop during the treatment of TBM. In this study, we report a series of 22 adult cases of symptomatic central nervous system tuberculomas, in eight of them tuberculomas were coexisting with TBM on admission and in 14 of them symptomatic tuberculomas developed during anti-tuberculosis therapy. We also aimed to compare the clinical, laboratory and outcome data of the 14 TBM patients that developed symptomatic tuberculomas, with the data of 41 TBM that did not, under the same treatment regimen. Most of the patients developed symptomatic tuberculomas in the first 6 weeks of treatment. Five patients developed late tuberculomas. The characteristics of tuberculomas and the role of corticosteroids in TBM patients are discussed. In conclusion, although steroids may diminish neurologic symptoms and improve outcome, tuberculomas may appear during the course of anti-tuberculosis and steroid treatment. Because of the possibility of late development of tuberculomas after initial successful treatment, all TBM patients need to be followed-up carefully for a long period. © 2005 EFNS

Tuberculous meningitis in adults: Review of 61 cases

WOS: 000187423100005PubMed: 14735380Background: Tuberculosis is still a major cause of serious illness in developing countries. The objective of this study was to assess the clinical, laboratory, radiological and prognostic features of tuberculous meningitis (TBM) in immuncompetent adult patients. Patients and Methods: Sixty-one patients with confirmed or presumed TBM seen over a 12-year period at the Neurology Department of Bakirkoy Research and Training Hospital for Psychiatric and Neurological Disease, Istanbul, Turkey, were analyzed retrospectively. Patients were grouped according to the severity of meningitis on admission (stages I, II and III). They were also divided into two groups according to the presence of paradoxical response (progressive increase of lymphocytes or increase of polymorphonuclear cells instead of lymphocytes) in CSF samples. A combination of five antituberculosis drugs was used in the 1st month of treatment. Patients received antituberculosis therapy for at [east 12 months. The outcome of the patients was defined on the basis of the 12-month Barthel index (BI) score (BI < 12 poor; BI greater than or equal to 12 good). For statistical analysis death was included in the poor outcome group. Results: Paradoxical response in CSF findings was seen in 20 patients. There was no statistically significant difference between the outcome of the patients with and without CSF paradoxical response; however, new tuberculomas developed more frequently in the first group (p < 0.05). The overall mortality was 27.8%. Stage of disease was found to be independently associated with the 12-month outcome (OR 7.2; 95% CI 1.7-30.3, p = 0.007). Conclusion: In developing countries such as Turkey, tuberculosis is still an important public health issue. Early suspicion and appropriate Long-term antituberculosis therapy together with corticosteroids may reduce mortality and morbidity in IBM patients

The Correlation of Callosal Atrophy and Hemispheric Disconnection in Multiple Sclerosis

To investigate the correlation of callosal involvement and hemispheric disconnection in multiple sclerosis (MS), 20 patients with definite MS and sex, age and education matched 20 controls were given a standard, easy to use, but detailed neuropsychometric battary exploring interhemispheric transfer. Each subject also underwent a MRI scan to measure the midsagittal callosal area (MICA) and midline internal skull surface (MISS) for calculating a callosal atrophy index (MICA/MISS). Callosal lesion localization and the degree of white matter changes on MRI were also noted for the diseased patients. Test performance of the MS patients were statistically different from the control subjects (p<0.0001). Especially, tests on writing to dictation, cross-replication of hand postures and bimanuel motor coordination were found sensitive. Strikingly, callosal dysfunction was detected even without any visible corpus callosum lesion

THE PROTECTIVE EFFECTS OF METHYL CELLULOSE AND CONOID SHIELDS FOR LAGOPHTHALMOS AND CORNEAL HYPAESTHESIA IN LEPROSY

Lagophthalmos and corneal hypaesthesia are amongst the most frequently encountered lesions in leprosy and they can easily give rise to blindness. Many measures (such as eye drops, protective conoid shields, muscle exercises, surgical treatment etc.) have been used to protect the eyes under such circumstances and this paper examines the protective role of methyl cellulose and conoid shields in 41 patients. All of them had lagophthalmos (5 mm or more) and corneal hypaesthesia. They were divided into three groups. Group one had 15 leprosy control patients (27 eyes) who did not use methyl cellulose or eye shields. Group two had 16 leprosy patients (28 eyes) and they used methyl cellulose and eye shields when they felt discomfort in their eyes. Group three had 10 leprosy patients (17 eyes) and they used methyl cellulose and eye shields regularly. Statistically significant improvement was seen in group three. Further studies on larger groups of patients including the effects of different concentrations of methyl cellulose, on Schirmer test and tear break up time, may be of value

Clinical impact of high-dose intravenous methylprednisolone for ten days in relapses of multiple sclerosis: "Treatment of relapses in multiple sclerosis"

Background: Glucocorticoid treatment is recommended as the first-line treatment of MS relapses, however there is still no clear evidence supporting an optimum therapeutic regime. The high dose (HD) consisted of at least 500 mg/day, but the total dose of intravenous MP administered and the regimen varied among studies. The aim of this study was to assess the improvement following a standard regime of IVMP (1 g/day MP given for 10 days, without tapering) for MS relapses. A second objective was to search baseline predictors of outcome. Method: Consecutive treatments with IVMP for ten days (1 g/day, single dose in 150cc. saline, over 40 min) administered at our Neurology clinic for an episode of acute neurological deterioration in 44 patients (55 relapses) diagnosed with RR MS were recruited retrospectively. Results: Attack severity was mild in three, moderate in 28 and severe in 24 relapses. Significant improvement (? 1.0 EDSS point) occurred in 81 % of attacks at one month. The rate of improvement at ten days was 83.6%, and 85.5% at six months. There was no difference in means of latency to treatment between the patients that responded well to therapy and responded poor, at the first month. However response to therapy was higher at the sixth month in patients with latency to treatment shorter than fifteen days (68.4%, 94.4%). Conclusions: In conclusion the results of our retrospectively designed clinical study support that HD MP, 1 g/day for ten days administered IV can accelerate the recovery from MS relapses. This regimen with proper early timing for starting therapy might determine the optimum benefit. © Universitätsverlag Ulm GmbH 2009

The impact of prolonged hunger strike: Clinical and laboratory aspects of twenty-five hunger strikers

Background - Hunger strike is a very serious entity which may lead to severe diseases and death

Early onset Alzheimer's disease

WOS: 000209194000108