Varicella zoster presenting as cranial polyneuropathy
Cranial polyneuropathy is commonly caused by Lyme disease. We discuss the case of a man who presented with cranial nerve deficits causing dysphagia, dysphonia and facial weakness. This diagnostic dilemma stemmed from a workup that ruled out Lyme and vascular causes leading to an expanded search for infectious explanations, which revealed varicella zoster in the cerebrospinal fluid. On review, this phenomenon is rarely reported, but has been observed with a number of herpes family viruses. In emergency department settings, clinical suspicion should be raised for VZV infection even in the absence of rash in patients that present with multiple cranial nerve palsies.
Authors: Sekelj A, Đanić D Abstract Lyme borreliosis is a vector-borne infectious disease characterized by three disease stages. In the areas endemic for borreliosis, every acute facial palsy indicates serologic testing and implies specific approach to the disease. Th e aim of the study was to identify and confirm the value of acoustic refl ex and House-Brackman (HB) grading scale as prognostic indicators of facial palsy in neuroborreliosis. Th e study included 176 patients with acute facial palsy divided into three groups based on serologic testing: borreliosis, Bell's palsy, and facial palsy caused by herpes si...
Conclusions: The clinical presentation of unilateral, posterior interstitial keratitis may be a rare manifestation of herpes simplex virus keratitis.
The facial paralysis and drooping is caused by nerve inflammation, but the cause of that inflammation “ is a question for the ages ” says one expert.
We report such a case of bilateral rickettsial retinitis proven by serology which worsened on systemic steroids and responded dramatically to therapy with oral doxycycline and steroid taper. We thus believe that direct bacterial invasion plays a major role in the pathogenesis of rickettsial retinitis.
ConclusionsAutonomic dysfunction may be responsible for additional morbidity in some infectious diseases.
Conclusions:LE is an uncommon manifestation of neurosyphilis requiring prompt recognition and treatment. It can present with a clinical syndrome and MRI appearance similar to other causes of LE. In contrast to autoimmune/paraneoplastic LE, brain PET imaging reveals hypometabolism of the affected temporal lobe and may be a useful adjunct.Disclosure: Dr. Al-Louzi has nothing to disclose. Dr. Mason has nothing to disclose. Dr. Rondeau has nothing to disclose. Dr. Rubin has nothing to disclose. Dr. Lyons has nothing to disclose. Dr. Bhattacharyya has received personal compensation for activities with Advance Medical.
Conclusions:Neuroimaging findings of neurosyphilis commonly are cerebral infarctions, leptomeningeal enhancement or nonspecific white matter lesions. Less common features on a fluid-attenuated inversion recovery (FLAIR) sequences are cortical atrophy and mesial temporal parenchymal signal changes. It is prudent to keep Neurosyphilis in differential of mesial temporal lobe white matter changes as early diagnosis and treatment results in better prognosis.Study Supported by: NoneDisclosure: Dr. Tiwana has nothing to disclose. Dr. Ahmed has nothing to disclose.
Discussion Inflammation of the middle layer of the eye, or uvea, is termed uveitis. Uveitis can be divided into anterior, intermediate or posterior uveitis by involving the anterior (iris and ciliary body), intermediate (vitreous) or posterior (choroid and usually retina) compartments. Panuveitis involves all 3 compartments. Duration can also be used to classify uveitis. Acute is 6 weeks and> 3 months is chronic persistent uveitis. Episodic periods of inactivity and reactivity that last more than 3 months are called recurrent uveitis. A third way to characterize uveitis is if it is granulomatous or not. Uveitis increase...
Conclusion: In this small case series of eyes with macular edema secondary to infectious uveitis, treatment with dexamethasone intravitreal implants was not associated with reactivation of the infectious ocular disease. Furthermore, significant improvements in visual acuity and macular thickness were observed in our patients.
Just when you thought your brain could unwind on a Friday, you realise that it would rather be challenged with some good old fashioned medical trivia…introducing Funtabulously Frivolous Friday Five 139 Question 1 Who is likely to have given one of the first blood transfusion in the United States (clue: famous surgeon)? + Reveal the Funtabulous Answer expand(document.getElementById('ddet589941155'));expand(document.getElementById('ddetlink589941155')) William Halsted, at the age of 29. His sister had delivered her first baby and severe haemorrhage followed. His sister had uncontrolled haemorrhage and others tho...