Three cases of meningitis with initial and exclusive neurological involvement prompted a review of the clinical, cerebrospinal fluid, and pathological findings in an additional 78 patients with central nervous system blastomycosis. The first patient of the 3 had progressive cerebellar dysfunction as the result of chronic basilar meningitis. The second had a C8-T1 radiculopathy without other evidence of superior sulcus syndrome, and subsequent acute fatal meningitis. The third had aseptic, benign, self-limited meningitis followed by clinically obvious systemic blastomycosis. Diagnosis is difficult, and it is likely that other cases have been presumptively treated for tuberculous meningitis. A more aggressive approach to diagnosis is proposed that takes into account the condition of the patient, the likelihood of dissemination at necropsy, and the frequent meningeal infections that are negative on culture of lumbar CSF.
In a series of 72 cases of internuclear ophthalmoplegia, 12 of 41 bilateral lesions were associated with occlusive cerebrovascular disease. Two were verified pathologically.This frequency is more in keeping with the pathologic substrate of brain stem infarction in general, and of those with medial longitudinal fasciculus (MLF) involvement in particular, than has been acknowledged previously.Convergence, abducting nystagmus, and tropias were not reliable in differentiating midbrain and pontine involve-ment. Bilateral vascular involvement is
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.