Mastoiditin komplikasyonu sonucu gelişen proteus mirabilis menenjitine ba?li beyin absesi: Olgu sunumu

Meningitis and intracranial abscess due to Proteus mirabilis is seen especially in the neonatal period and among the patients with immune deficiency. It was learned that 35 years old male patient who applied to the emergency room with ongoing fever, nausea and vomiting for three days have had their upper left jaw tooth out 10 days ago. As clinical and laboratory to patients with acute bacterial meningitis empirical ceftriaxone 2x2 gr/day parenteral was started. The cranial MR of the patient, that has P. mirabilis producing in their blood and cerebrospinal fluid (CSF) culture, was taken at the seventh day of hospitalization as his complaints started again. In the MR, abscess was detected in the left temporal brain of the patient and a surgical treatment was applied. Complete healing was seen eight week treatment with antibiotics after surgery. During application it was though that meningitis has occurred due to the dental surgery, however after the temporal BT, mastoiditis was detected. It was thought that meningitis and brain abscess developed on the patient was caused by mastoiditis. Even with sensitive antibiotics if no recovery is observed in patients with meningitis, intracranial abscess should be considered, also it should not be forgotten that in adults and patients with no immune deficiency meningitis due to P. mirabilis may develop. © 2010 Düzce Medical Journal

Brain abscess due to proteus mirabilis meningitis as a complication of mastoiditis: case report

Proteus mirabilis’e bağlı menenjit ve intrakraniyal apse gelişimi, özellikle neonatal dönemde ve immün yetmezliği olan bireylerde görülmektedir. Acil servise; üç gündür devam eden ateş, bulantı ve kusma yakınmalarıyla başvuran 35 yaşında erkek hastanın, 10 gün önce sol üst çeneden diş çektirdiği öğrenildi. Klinik ve laboratuar olarak akut bakteriyel menenjit ile uyumlu olan hastaya ampirik seftriakson 2x2 gr/gün parenteral başlandı. Kan ve beyin omurilik sıvısı (BOS)’nda P. mirabilis üreyen hastanın; yatışın yedinci gününde yakınmalarının tekrar başlaması üzerine, kranial MR çekildi. MR’da sol temporalde beyin apsesi saptanan hastaya cerrahi tedavi uygulandı. Cerrahi sonrası sekiz haftalık antibiyotik tedavisi ile tamamen iyileşme görüldü. Başvuru sırasında menenjitin dental cerrahiye bağlı oluştuğu düşünülen hastada, daha sonra çekilen temporal BT sonrası mastoidit tespit edildi. Olguda gelişen menenjit ve beyin absesinin mastoidite bağlı olduğu düşünüldü. Menenjit olgularında, duyarlı antibiyotiğe rağmen düzelme saptanmaması durumunda intrakranial apse düşünülmeli, erişkin ve immün yetmezliği olmayan olgularda da P. mirabilis’e bağlı menenjit gelişebileceği unutulmamalıdır.Meningitis and intracranial abscess due to Proteus mirabilis is seen especially in the neonatal period and among the patients with immune deficiency. It was learned that 35 years old male patient who applied to the emergency room with ongoing fever, nausea and vomiting for three days have had their upper left jaw tooth out 10 days ago. As clinical and laboratory to patients with acute bacterial meningitis empirical ceftriaxone 2x2 gr/day parenteral was started. The cranial MR of the patient, that has P. mirabilis producing in their blood and cerebrospinal fluid (CSF) culture, was taken at the seventh day of hospitalization as his complaints started again. In the MR, abscess was detected in the left temporal brain of the patient and a surgical treatment was applied. Complete healing was seen eight week treatment with antibiotics after surgery. During application it was though that meningitis has occurred due to the dental surgery, however after the temporal BT, mastoiditis was detected. It was thought that meningitis and brain abscess developed on the patient was caused by mastoiditis. Even with sensitive antibiotics if no recovery is observed in patients with meningitis, intracranial abscess should be considered, also it should not be forgotten that in adults and patients with no immune deficiency meningitis due to P. mirabilis may develop

The role of sympathectomy on the regulation of basilar artery volume changes in stenoocclusive carotid artery modeling after bilateral common carotid artery ligation: an animal model

Gundogdu, Cemal/0000-0003-2857-923XWOS: 000334426000017PubMed: 24557449Stenoocclusive carotid artery disease causes important histomorphologic changes in all craniocervical vasculatures, such as luminal enlargement, vascular wall thinning, elongation, convolutions, and aneurysm formation in the posterior circulation. Although increased pressure, retrograde blood flow, and biochemical factors are described in the pathogenesis of vascular remodelisation, the vasoregulatory role of the autonomic nervous system has not been investigated thus far. We investigated the relationship between the sympathetic nervous system and the severity of histomorphologic alterations of basilar arteries after bilateral common carotid artery ligation (BCCAL). This study was conducted on 21 rabbits. the rabbits were randomly divided into three groups: baseline group (n = 5), sympathectomy non-applied group (SHAM; n = 8), and sympathectomy applied group (n = 8) before bilateral common carotid artery ligation. Permanent ligation of the prebifurcations of the common carotid arteries was performed to replicate stenoocclusive caroid artery disease. Basilar artery volumes were measured after ligation. Volumes of the basilar arteries were estimated by stereologic methods and compared between groups. Luminal enlargement, wall thinning, elongation, convolutions, and doligoectatic configurations were detected in the majority of basilar arteries. the mean basilar arterial volume was 4.27 +/- 0.22 mm3 in the baseline group; 5.28 +/- 0.67 mm(3) in the SHAM group, and 8.84 +/- 0.78 mm3 in the study group. the severity of basilar enlargement was significantly higher in the study group compared with the SHAM (p < 0.005) and baseline groups (p < 0.001). Sympathectomy causes basilar artery enlargment, which is beneficial for maintaining cerebral blood flow; however, it also causes wall thinning, elongation, convolution, and aneurysm formation, which may be hazardous in stenoocclusive carotid artery disease. Sympathectomy can prevent new vessel formation and hyperthyrophic changes at the posterior circulation. Neovascularisation is not detected adequately in sympathectomised animals