Shunting in cryptococcal meningitis.

CONCLUSIONS Neurosurgeons are often asked to consider CSF diversion in cases of cryptococcal meningitis complicated by intracranial hypertension. Most patients do well with serial lumbar punctures combined with antifungal therapy. When required, shunting generally provided sustained relief from intracranial hypertension symptoms. Ventriculoperitoneal shunts are the favored method of diversion. To the authors' knowledge, the present study is the largest series on diversionary shunts in primarily HIV-positive patients with this problem. PMID: 26517766 [PubMed - as supplied by publisher]
Source: Journal of Neurosurgery - Category: Neurosurgery Authors: Tags: J Neurosurg Source Type: research

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We report the fourth rare case.A 61-year-old female with past medical history of diabetes and hypertension presented with the chief complaint of fever with chills and headache of 1-day duration. CT head did not reveal any acute abnormalities. Lumbar puncture was obtained and empiric IV antimicrobial agents were started. CSF analysis showed gram negative diplococci with culture growing Neisseria meningitidis suggesting meningococcal meningitis. Due to persistent headache and lethargy after 24-48 hours, complicated meningitis was suspected and MRI of brain was obtained which reflected a diagnosis of intraventricular e...
Source: IDCases - Category: Infectious Diseases Source Type: research
This study aims to evaluate the role of a non-invasive intracranial pressure (ICP-NI) monitoring in a critically ill HIV-CM patient. PMID: 28793057 [PubMed - in process]
Source: Braz J Med Biol Res - Category: Research Authors: Tags: Braz J Med Biol Res Source Type: research
Conclusions Dural venous sinus stenting may be an effective treatment for patients with symptomatic venous sinus stenosis without IIH in carefully selected cases, but may not be effective in resolving the symptoms of congenital hydrocephalus.
Source: Journal of NeuroInterventional Surgery - Category: Neurosurgery Authors: Tags: Clinical neurology Source Type: research
Purpose of review: Although rare, central nervous system (CNS) infections are increasingly being recognized in immunocompromised patients. The goal of the present review is to provide a practical diagnostic approach for the intensivist, and to briefly discuss some of the most prevalent conditions. Recent findings: Immunocompromised patients presenting with new neurological symptoms should always be suspected of a CNS infection. These infections carry a poor prognosis, especially if intracranial hypertension, severely altered mental status or seizures are present. Clinical examination and serum blood tests should be follow...
Source: Current Opinion in Critical Care - Category: Nursing Tags: NEUROSCIENCE: Edited by Raimund Helbok Source Type: research
A 63-year-old woman with epilepsy and chronic headaches was admitted for status epilepticus. A lumbar puncture revealed increased opening pressure of 320 mm H2O and bacterial meningitis. MRI brain demonstrated a partial empty sella, tortuous optic nerve sheaths, flattening of the optic papillae, and numerous prominent arachnoid granulations, consistent with chronic idiopathic intracranial hypertension (IIH), as well as bright CSF signal and brain parenchyma within a left meningoencephalocele (figure, A). A CT cisternogram confirmed communication of the subarachnoid space of the meningoencephalocele with the left sphenoid s...
Source: Neurology - Category: Neurology Authors: Tags: Idiopathic intracranial hypertension, CT, MRI RESIDENT AND FELLOW SECTION Source Type: research
In this report, we describe a 65-year-old patient with meningoencephalitis caused by C. gattii who developed persistent intracranial hypertension and was successfully managed with antifungal therapy, repeated lumbar puncture and corticosteroids. Our observations suggest a possible benefit of dexamethasone in the management of select cases of C. gattii CNS infection with intracranial hypertension. Further studies are necessary to evaluate the long-term use of steroids in select patients with C. gattii with intracranial hypertension.
Source: Journal of Medical Mycology - Category: Biology Source Type: research
CONCLUSIONS: Idiopathic intracranial hypertension is a clinical syndrome of unclear pathogenesis that is closely related to obesity. KEY WORDS: Cerebrospinal fluid, Idiopathic intracranial hypertension, Pseudotumor cerebri, Obesity. PMID: 27681952 [PubMed - as supplied by publisher]
Source: Annali Italiani di Chirurgia - Category: Surgery Tags: Ann Ital Chir Source Type: research
CONCLUSIONS: IH appears to be a distinct, under-reported cause of PRES. It occurs in susceptible patients, on average 2-5 days after the IH trigger, and seems clinically and radiologically similar to the more common hypertensive cases, both in terms of initial presentation and prognosis. In accord with the Monro-Kellie doctrine stating that the sum of brain, blood and CSF volume is constant, venous sinus engorgement associated with IH could increase the hydrostatic pressure in the brain arterioles and capillaries, resulting in interstitial extravasation and brain edema of PRES. Increased vigilance is required to allow for ...
Source: Neurology - Category: Neurology Authors: Tags: Neurocritical Care: Clinical Science Source Type: research
We present the case of a 52-year-old man with hypertension, diastolic congestive heart failure, end-stage renal disease on hemodialysis 3 times a week and a remote history of a hemorrhagic stroke who presented to the emergency department with a vesicular rash on his left arm. The rash was observed to be in a dermatomal distribution, and a diagnosis of herpes zoster was made. The patient was discharged home on valacyclovir 1 g 3 times a day for a duration of 7 days. The patient took 2 doses of valacyclovir before presenting to the hospital again with irritability and hallucinations. Over the next several days, the patient's...
Source: American Journal of Therapeutics - Category: Drugs & Pharmacology Tags: Case Reports Source Type: research
A 50-year-old Chinese woman reported a sharp paroxysmal headache and abrupt paralysis of the left leg. She then developed ptosis, blurred vision, diplopia and fever. On admission, a neurological examination revealed right III, IV, VI and left V1 cranial nerve palsy, bilateral upper eyelid oedema and left leg monoplegia (Medical Research Council grade 2/5). In addition, a left Babinski sign and nuchal rigidity were observed. Blood tests revealed elevated white cell count (WCC) and a majority of the cells were neutrophils. Lumbar puncture revealed that the WCC (120x106/μL) and protein level (0.79 g/L) of the cerebros...
Source: Journal of Neurology, Neurosurgery and Psychiatry - Category: Neurosurgery Authors: Tags: Open access, Immunology (including allergy), Meningitis, Brain stem / cerebellum, Cranial nerves, Drugs: CNS (not psychiatric), Headache (including migraine), Infection (neurology), Pain (neurology), Stroke, Hypertension, Ophthalmology, Radiology, Musculo Source Type: research
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