Cat scratch disease (CSD) is an infectious illness caused by a Gram-negative rod namedBartonella henselae. Typical CSD is characterized by a small skin lesion at the site of a scratch or a bite, followed by regional lymphadenopathy, one to two weeks later. Atypical forms may present as ocular manifestations, neurological manifestations, hepatosplenic involvement and vertebral osteomyelitis. Among neurological complications, encephalopathy is by far the most common. Other neurological manifestations are very rare. We report a case of an 11-year-old boy, with a posterior cervical lymphadenopathy and fever. Cat scratch disease was diagnosed and treated after a positive "Whartin-Starry" stain on lymph node biopsy. Two weeks after treatment, the patient was readmitted presenting an acute episode of left hemiplegia. A brain MRI demonstrated a right subcortical fronto-parietal lesion with no contrast enhancement. Complete recovery was observed after corticosteroid treatment.
A 37-year-old man with a three-year history of Acquired Immunodeficiency Syndrome was admitted with impaired consciousness, seizures and fever. He was on highly active antiretroviral therapy and on neurotoxoplasmosis secondary prophylaxis. Laboratory exams from two months before showed a CD4 cell count of 37/microL and a viral load of 230,000 copies/mL. Three months before admission he developed herpetic skin rash in the right trunk and acyclovir was added to his treatment regimen. On physical exam he was drowsy and had motor and sensory aphasia. The patient had elevated protein levels and normal pressure in the cerebrospinal fluid (CSF). Contrast enhanced computed tomography scan of the brain showed a hypodense lesion in the left parietal lobe, with poorly defined margins and no contrast enhancement. The magnetic resonance scan (MRI) showed multiple hyperintensities in T2-weighted image in white and grey matters and hypointense products of hemorrhage in both hemispheres and in the cerebellum. He was empirically treated with intravenous acyclovir and prednisone. Viral DNA of Varicella-zoster virus (VZV) was detected in the CSF by means of polymerase chain reaction (PCR) analysis. Acyclovir was continued for 10 days and the patient became well, with improvement of aphasia. We present a case of VZV encephalitis, confirmed by nested PCR, in a patient with suggestive MRI findings, who succeeded with treatment. VZV encephalitis is a rare opportunistic infection, occurring in 0.1 to 4% of AIDS patients with neurological disease; it is related to severe immunodeficiency and has a high mortality.
-A 5 year-old boy with a cerebellar gangliocytoma with a peripheral right facial paresis and ataxia is presented. His MRI showed a heterogenous, diffuse lesion, isointense on T1 and hyperintense on T2-weigthed sequences, involving the right cerebellar hemisphere with direct extension into the right facial nerve. The present case is the first description of a gangliocytoma with direct facial nerve invasion, as demonstrated for the facial nerve paresis and supported by MRI and surgical inspection.KEY WORDS: gangliocytoma, facial paresis, facial nerve, CNS tumor.Gangliocitoma de fossa posterior com invasão de nervo facial: relato de caso Gangliocitoma de fossa posterior com invasão de nervo facial: relato de caso Gangliocitoma de fossa posterior com invasão de nervo facial: relato de caso Gangliocitoma de fossa posterior com invasão de nervo facial: relato de caso Gangliocitoma de fossa posterior com invasão de nervo facial: relato de caso RESUMO -Um menino de 5 anos de idade com gangliocitoma cerebelar manifestando paralisia facial periférica e ataxia é apresentado. O estudo de ressonância magnética (RM) mostrou lesão difusa e heterogênea isointensa em T1 e hiperintensa em sequências ponderadas em T2, envolvendo o hemisfério cerebelar direito com extensão direta ao nervo facial direito. O presente caso é a primeira descrição de gangliocitoma com invasão direta do nervo facial, tal como demonstrado por paralisia facial periférica a direita e sustentado por RM e inspeção cirúrgica. PALAVRAS-CHAVE: gangliocitoma, paralisia facial, nervo facial, tumor de SNC. A case of conventional gangliocytoma involving the cerebellum, brainstem and superior cervical spinal cord with right facial nerve invasion is presented. Gangliocytomas are rare, benign, well differentiated, slowly growing neuroepithelial tumors composed of neoplastic, mature ganglion cells 1 . Cranial nerve invasion by the lesion is extremely rare, with only one case of trigeminal nerve involvement previously reported in the literature 2 . To our knowledge the present case is the first one showing facial nerve invasion. CASEA 5 year-old boy was referred to our institution for evaluation of peripheral right facial paresis and ataxia. He started with slowly progressive right facial weakness one year before admission. Three months later, his mother noticed gait disturbance and difficulty with his right arm. Two months before admission, he started with vomiting and headache. His neurological examination revealed peripheral right facial paresis, ataxia, and right sided dysmetria. A CT scan showed obstructive hydrocephalus caused by a diffuse right sided cerebellar lesion, hypodense in nature, with heterogenous contrast enhancement. He was submitted to a ventriculoperitoneal (VP) shunt, with relief of syntoms due to intracranial hypertension. A cranial MRI performed three days after VP shunt showed a heterogenous, diffuse lesion, isointense on T1-weigthed images, hyperintense on T2-weigthed sequences, at the right cerebellar hemisphere involving the superior ...
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.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.