Intracranial tuberculoma is one of the most devastating forms of Mycobacterium tuberculosis infection, presenting in 1% of all tuberculosis cases. This condition is significantly associated with high morbidity and mortality and frequently occurs in immunocompromised patients such as patient with human immunodeficiency virus (HIV) infection. Symptoms of intracranial tuberculoma include headache, nausea, vomiting, ataxia, diplopia, hemiparesis, and seizure. We reported a 34-years-old male patient presented with progressive left side weakness for 1 month prior to admission. Patient also complained of intermittent fever, headache, productive cough, night sweats, and unintentional weight loss. On neurological examination, power of left upper and lower limb was 3. Patient had a positive test result for HIV serologic examination. Chest X-ray showed infiltrate in the apical segment of right lower lobe of the lung. Mycobacterium tuberculosis was found on sputum gene expert examination. Head computed tomography (CT) scan showed multiple hypodense lesions with contrast enhancement in right caudate nucleus and right lentiform nucleus, suggestive for tuberculoma. Patient was treated with fixed-dose combination of antituberculosis, corticosteroid, and other symptomatic medication and showed a significant clinical improvement.
Meralgia paresthetica (MP) or so-called as lateral femoral cutaneous nerve (LFCN) entrapment is a mononeuropathy characterized by a localized area of paresthesia, dysesthesia, tingling, burning, and numbness on the anterolateral aspect of the thigh, between the inguinal ligament and the knee without associated loss of reflexes and motor weakness. The incidence of MP increases with obesity and diabetes. Ultrasound-guided has been demonstrated useful for visualization of peripheral nerves, in particular very small nerves such as the LFCN. Hereby, we reported a case of 63-year-old man diagnosed with MP. The patient complained of numbness, and no pain when pinched in his anterolateral aspect of the left thigh since 3 weeks ago. On physical examination, his body mass index (BMI) was 27 (overweight) with normal vital signs. Neurological examination revealed normal motoric function and refleks; but decreased sensation to pinprick in the left anterolateral thigh in the LFCN distribution. No abnormal findings on plain radiographs of the pelvis and lumbar spine. Ultrasound-guided injection was performed in this patient.
Coronavirus disease 2019 (COVID-19) has become outbreak in the world since December 2020. The higher incidence and transmission of COVID-19, the higher virulence of the disease. Besides respiratory manifestations, the most common symptoms in COVID-19 are neurological manifestations. The major neurological manifestations in COVID-19 are headache and dizziness. Headache is more common as chief complaint in emergency room and hospitalized patients than dizziness. Therefore, this review aims to outline the characteristics of headache in COVID-19. The conclusion of this review is that the characteristics of headache in COVID-19 are moderate-severe intensity, frontal-temporal region, pulsatile and tightening quality, constant duration and commonly associate with one or more COVID-19 symptoms.
The term "expanded dengue syndrome" was introduced to describe the severe clinical manifestations that result from dengue fever (DF), namely severe multi-organ involvement including disorders of the nervous system. Neurological complications occur in 1-5% of dengue patients, including haemorrhagic stroke. A 68-year-old man presented with complaints of full-body convulsions for 1 minute. Four days earlier the patient complained of headache, fever, and nausea. Non-contrast CT scan of the head showed abnormal hyperdense lesions with focal intraparenchymal oedema in the frontoparietoocipital region, cortical sulci and gyri appeared dilated, ventricular system and sisterna were dilated. Anti-dengue IgG and IgM were positive. Neuropathogenesis that may play an important role in dengue-related neurological syndromes include direct CNS invasion by the virus, autoimmune reactions, and metabolic changes. The diagnosis of neurological complications related to dengue haemorrhagic fever (DHF) requires special attention, especially for areas where DF is still endemic.
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