Management of cerebral infection.

Anderson, M

doi:10.1136/jnnp.56.12.1243

Cited by 29 publications

(6 citation statements)

References 129 publications

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“…Clinical presentation of this cohort was consistent with available literature 2,3 . The finding of papilloedema in a small number of patients (4.5%) in our series was similar with reports which maintain that papilloedema is an unusual initial manifestation of meningitis 33 . Seizures were seen in 50% of patients which was at variance with the 5% -23% rate reported in other studies 2,3 .…”

Section: Discussionsupporting

confidence: 93%

Clinical features and management strategies of Meningitis in adult patients: A hospital based study from Kuwait

Shammri

Chattopadhyay

Chadha

et al. 2021

J. Drug Delivery Ther.

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Introduction: High mortality rate of meningitis has been reported in Kuwait, however, limited data is available describing this disease in adult patients. With this background, we conducted a prospective study on patients admitted with meningitis, with an objective to describe the risk factors, clinical presentation, disease course and outcome; focus given on diagnostic problems and consequent management difficulties. Methods: Our team diagnosed, managed and documented hospital records of patients (n=44) admitted with suspected meningitis at a referral hospital during 2010-12. Detailed information was collected regarding clinical presentation, CSF analysis, treatment, hospital course and outcome as per Glasgow Outcome Scale (GOS). Results: Bacterial, viral, and tuberculosis (TB) meningitis were seen in 22.8%, 52.3%, and 15.9% of patients. Clinical features of our cohort were consistent with available literature. Positive identification of organism by culture, gram stain, or antigen test was possible in only 6 patients i.e. Streptococcus pneumonae-(n=3), Streptococcus agalactiae-(n=2), Neisseria meningitides-(n=1). CSF polymerase chain reaction was detected positive for Enterovirus RNA, and Herpes simplex virus DNA for one patient each. Empirical antimicrobial treatment directed against common causative organisms was the mainstay of management of bacterial meningitis. Viral meningitis was managed symptomatically. TB meningitis patients were administered anti-tubercular treatment. As per GOS, 38(85.4%) patients recovered with no neurological deficit. Six patients recovered with mild to moderate deficit. Conclusion: Low positive culture rates and inability to identify pathogens have been a diagnostic challenge faced by our team. Strong clinical suspicion, early empiric antibiotic and dexamethasone therapy perhaps contributed to very good recovery in our study. Keywords: Meningitis, Kuwait, Clinical Suspicion, Antibiotic, Dexamethasone

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Section: Discussionsupporting

confidence: 93%

Clinical features and management strategies of Meningitis in adult patients: A hospital based study from Kuwait

Shammri

Chattopadhyay

Chadha

et al. 2021

J. Drug Delivery Ther.

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“…26 Most ocular manifestations occur with secondary syphilis. Meningitis frequently complicates secondary syphilis 27 with spirochetes sometimes seen on dark field examination of the CSF. General paresis, tabes dorsalis, and meningovascular neurosyphilis occur in the tertiary stage of this disease.…”

Section: Bacterial Infectionsmentioning

confidence: 99%

The Uveo-Meningeal Syndromes

Brazis

Stewart

Lee³

2004

The Neurologist

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Inflammatory or autoimmune diseases are probably the most common clinically recognized causes of true uveo-meningeal syndromes. These entities often cause inflammation of various tissues in the body, including ocular structures and the meninges (eg, Wegener granulomatosis, sarcoidosis, Behcet disease, Vogt-Koyanagi-Harada syndrome, and acute posterior multifocal placoid pigment epitheliopathy). The association of an infectious uveitis with an acute or chronic meningoencephalitis is unusual but occasionally the eye examination may suggest an infectious etiology or even a specific organism responsible for a meningeal syndrome. One should consider the diagnosis of primary ocular-CNS lymphoma in patients 40 years of age or older with bilateral uveitis, especially with prominent vitritis, that fails to respond to treatment or who has associated neurologic findings. A paraneoplastic disorder has been described in patients who have combined optic neuritis and retinitis defined serologically by the presence of a paraneoplastic IgG autoantibody CRMP-5-IgG. These patients may have an inflammatory vitritis and may have signs of cerebrospinal fluid inflammation.

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“…Out of 12 cases of cerebral involvement due to vivax malaria reported by Nadkar et al 3 had multiple convulsions; 5 had impaired consciousness and 4 had deep coma [7]. Published reports by various authors have found presentations ranging from seizures, decreased level of consciousness, aphasia, hemiparesis, delirium, coma, stupor, psychosis associated with Plasmodium vivax [10,11].…”

Section: Issn-2321-127xmentioning

confidence: 99%

Outcome analysis of patients presenting with neurological manifestations of Plasmodium Vivax malaria in tertiary care hospital of Mumbai.

Salagre¹,

Sahay²,

Holkar³

2017

Int J Med Res Rev

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Objective: Plasmodium vivax (P. vivax) infection has been considered for a long time a benign and self-limited disease. Percentage of complicated cases of vivax malaria is on the increasing trend, cerebral malaria being the most dreaded and a potentially life-threatening complication. Material and Methods: A prospective observational study was done after institutional ethics committee approval from July 2011 to February 2012 at tertiary care hospital in Mumbai. We studied the clinical profile and outcome of all the 48 patients above the age of 12 years diagnosed with Cerebral Malaria. Results: Incidence of neurological manifestations of vivax malaria in our hospital was 14.15%, with 32 (66.7%) out of 48 patients being males. The mean age of patients with neurological manifestations of vivax malaria was 29.66 years in discharged patients and 50.88 years in expired patients. Altered sensorium 37 (77.1%) followed by convulsion 28 (58.3%) were common findings, but focal neurological deficit, Bell's palsy, ataxia, psychosis were also seen. Mortality was higher (62.5%) in patients with premorbid conditions (p value <0.05) and that of with other system involvements (87.5%) including hepatic, renal, hepatorenal, pulmonary involvement (p value<0.05). Association between outcome with older age & high parasite index patients is significant (p value<0.001), however no such significant association was found in terms of gender distribution. Conclusion: Plasmodium vivax, as has been traditionally believed, is no longer a benign species and is causing presentations akin to P. falciparum. It is imperative that clinicians are aware of and ready to handle the complications caused by Plasmodium vivax.

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Management of cerebral infection.

Cited by 29 publications

References 129 publications

Clinical features and management strategies of Meningitis in adult patients: A hospital based study from Kuwait

Clinical features and management strategies of Meningitis in adult patients: A hospital based study from Kuwait

The Uveo-Meningeal Syndromes

Outcome analysis of patients presenting with neurological manifestations of Plasmodium Vivax malaria in tertiary care hospital of Mumbai.

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