Bilateral optic neuropathy in acute cryptococcal meningitis

We reported a case of cryptococcal meningitis presenting with bilateral optic neuropathy in an immunocompetent patient. A 64-year-old Malay gentleman with no medical comorbidities presented with acute bilateral blurring of vision for a week, which was associated with generalised throbbing headache and low grade fever. He also had somnolence and altered consciousness. Visual acuity in both eyes was no perception of light with poor pupillary reflexes. Extraocular muscle movements were normal. Anterior segments were unremarkable bilaterally. Fundoscopy revealed bilateral optic disc swelling. CT scan of the brain showed multifocal infarct, but no meningeal enhancement or mass. Cerebrospinal fluid opening pressure was normal, while its culture grew Cryptococcus neoformans. A diagnosis of cryptococcal meningitis with bilateral optic neuropathy was made. Patient was treated with a six-week course of intravenous fluconazole and started concomitantly on a fortnight's course of intravenous amphotericin B. After that, his general condition improved, but there was still no improvement in his visual acuity. On reviewing at two months post-initiation of treatment, fundi showed bilateral optic atrophy. Bilateral optic neuropathy secondary to cryptococcal meningitis was rare. The prognosis was guarded due to the sequelae of optic atrophy. Anti-fungal medication alone may not be sufficient to manage this condition. However, evidence for other treatment modalities is still lacking and further ...
Source: Journal of Acute Disease - Category: Emergency Medicine Source Type: research

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In this study we analysed the clinical profile of meningoencephalitis and its clinical outcome. METHODS: Fifty adults diagnosed with meningoencephalitis from July 2014 to July 2015 in a tertiary care hospital in South India were studied prospectively and their clinical presentation, aetiology and outcome were analysed. RESULTS: Among 50 patients, 33 (66%) were male; 39 (78%) were
Source: Journal of the Royal College of Physicians of Edinburgh - Category: General Medicine Tags: J R Coll Physicians Edinb Source Type: research
In conclusion, bacterial meningitis in cancer patients is characterized by atypical symptoms and high mortality, which requires physicians' vigilance and a prompt investigation of cerebrospinal fluid in suspected cases. However, multiple regression analysis suggests that differences in clinical presentation and outcomes of bacterial meningitis between cancer and cancer-free patients may also be attributable to other factors, such as age differences. PMID: 31792808 [PubMed - as supplied by publisher]
Source: Advances in Experimental Medicine and Biology - Category: Research Tags: Adv Exp Med Biol Source Type: research
‚ÄčI have been seeing a lot of second disease and fifth disease—it's that time of year. School is back in session, and winter is just around the corner.The rash-numbering system for these diseases is now a historical footnote, but fifth disease is still commonly used by physicians to refer to erythema infectiosum, a parvovirus. I suspect that this system was created as a memory device for similar names and the obscure Latin terms used for these diseases. Erythema infectiosum is also easy to confuse with the many other erythema rashes such as erythema migrans, erythema marginatum, erythema toxicum, and erythema multif...
Source: M2E Too! Mellick's Multimedia EduBlog - Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
Conclusions Despite being a rare condition, Gradenigo syndrome should be taken into account as potential differential diagnosis in children referred to emergency department for recurrent headache and strabismus. An accurate anamnesis to document recent ear infection is mandatory to orientate the diagnosis and focus radiological investigations. Early recognition and timely intervention may allow conservative management to succeed, avoiding the need for surgery and serious sequelae.
Source: Pediatric Emergency Care - Category: Emergency Medicine Tags: Illustrative Cases Source Type: research
Brigid Morgan is not the type of person who shies away from difficult tasks – she’s a medical provider with the U.S. embassy working in Kabul, Afghanistan. In February 2019, she felt some back pain after moving a rug. She thought maybe she pulled a muscle and brushed if off. But when she woke up later that night with the worst headache of her entire life and couldn’t move, she knew it was time to call for reinforcements. She sent a text message to a nurse on her unit, who came to Morgan’s…
Source: Health Care:Biotechnology headlines - Category: Biotechnology Authors: Source Type: news
ConclusionsThis case report raises awareness of pet rodents as sources of leptospirosis. Leptospirosis meningitis should be considered in patients with meningeal symptoms and pet rodents.
Source: Journal of Medical Case Reports - Category: General Medicine Source Type: research
Matthew Griffin, of Stourport-on-Severn, woke up with a migraine and was vomiting. His parents found him lying unconscious on the kitchen floor and he was rushed to hospital.
Source: the Mail online | Health - Category: Consumer Health News Source Type: news
Abstract The combined immunotherapy of nivolumab and ipilimumab causes a variety of autoimmune-related adverse events (irAEs). The current report details a 70-year-old woman with clear cell renal cell carcinoma metastasis in the lung. Two weeks after two courses of treatment, the patient complained of headache, dizziness and nausea. Cerebrospinal fluid (CSF) analysis revealed an elevated protein level of 195 mg/dl and a significantly elevated white blood cell (WBC) count of 830/mm3 (lymphocytes, 825/mm3; neutrophils, 5/mm3). The results excluded malignancy and infection. The patient was diagnosed with aseptic meni...
Source: Clinical Lung Cancer - Category: Cancer & Oncology Authors: Tags: Mol Clin Oncol Source Type: research
J Neurol Surg B DOI: 10.1055/s-0039-3399492This operative video highlights a rare case of a neuroenteric cyst at the ventral craniocervical junction. The case involved a 30-year-old man who initially presented 13 years earlier with acute onset of headache and visual changes. At that time, he was found to have a small, enhancing ventral intradural extramedullary mass at the rostral aspect of C1 thought to be a meningioma. The lesion was managed conservatively, and surveillance imaging tracked its slow progressive enlargement to a size of 1.4 cm (Fig. 1A, B). Although he remained asymptomatic, nonurgent elective resec...
Source: Journal of Neurological Surgery Part B: Skull Base - Category: Neurosurgery Authors: Tags: Skull Base: Operative Videos Source Type: research
Publication date: Available online 24 October 2019Source: Journal of Clinical NeuroscienceAuthor(s): Janelle Cyprich, Daniel A. Donoho, Andrew Brunswick, Kyle Hurth, John D. Carmichael, Martin H. Weiss, Gabriel ZadaAbstractSilent thyrotropin pituitary adenomas (TSHomas) are defined by absence of hyperthyroidism despite TSH immunopositivity. Data pertaining to clinical and surgical characteristics of silent TSHomas remains limited. We aim to describe the clinical presentation, pathological characteristics, and outcomes in silent TSHoma patients treated at a tertiary pituitary center. We retrospectively identified patients w...
Source: Journal of Clinical Neuroscience - Category: Neuroscience Source Type: research
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