ABSTRACT
Neuromyelitis optica spectrum disorder (NMOSD) is an inflammatory demyelinating autoimmune disease of central nervous system characterized by relapsing attacks that target the optic nerves and spinal cord, as well as aquaporin-4 (AQP4) enriched periventricular brain regions. The area postrema (AP), located in the dorsal medulla, is the chemosensitive vomiting center and has high AQP-4 expression. The AP syndrome with unexplained hiccups, nausea, and vomiting is one of the core clinical characteristics in the NMOSD and maybe the first presenting symptom. We experienced a 25-year-old woman presented with intractable vomiting, dizziness and oscillopsia. Upbeat nystagmus detected on the bedside examination led to comprehensive neurological workups including magnetic resonance imaging, and she was diagnosed as the AP syndrome. Ten months later, she experienced a recurrence as a longitudinally extensive transverse myelitis and the diagnosis was finally compatible with NMOSD without AQP4-IgG. NMOSD, especially the AP syndrome, should be considered in any dizzy patient with intractable vomiting, and detailed neuro-otologic and neuro-ophthalmologic examinations are warranted for the correct diagnosis.
Subject(s)
Adult , Female , Humans , Area Postrema , Autoimmune Diseases , Brain , Central Nervous System , Diagnosis , Dizziness , Hiccup , Magnetic Resonance Imaging , Myelitis, Transverse , Nausea , Neuromyelitis Optica , Nystagmus, Pathologic , Optic Nerve , Recurrence , Spinal Cord , VomitingABSTRACT
Listeria monocytogenes (L. monocytogenes) is a rare, but important bacterial pathogen causing central nervous system infection in the elderly, pregnant women, and immunocompromised patients. A 60-year-old man with diabetes presented with headache, fever and rapidly progressive ophthalmoplegia. Based on serological and MRI studies, he was diagnosed with rhombencephalitis due to L. monocytogenes. The patient recovered without complications with urgent initiation of empirical antibiotics and the pathogen-specific antibiotic treatment. L. monocytogenes should be considered as a cause of rhombencephalitis presenting as external ophthalmoplegia.
Subject(s)
Aged , Female , Humans , Middle Aged , Anti-Bacterial Agents , Brain Stem , Central Nervous System Infections , Cerebellum , Encephalitis , Fever , Headache , Immunocompromised Host , Listeria monocytogenes , Listeria , Magnetic Resonance Imaging , Ophthalmoplegia , Pregnant WomenABSTRACT
Herpes zoster oticus, also called Ramsay-Hunt syndrome, involves the geniculate ganglion and presents with facial nerve palsy, sensorineural hearing loss, vestibular dysfunction, and auricular vesicular lesion. In this case, the patient presented with isolated vestibular dysfunctions without facial palsy and hearing impairment, and these findings were confirmed by electrophysiologic studies including video head impulse testing. Clinicians should be aware of this variation, and differentiate it from vestibular neuritis which usually does not require intensive antiviral therapies.
Subject(s)
Humans , Facial Nerve , Facial Paralysis , Geniculate Ganglion , Head Impulse Test , Hearing Loss , Hearing Loss, Sensorineural , Hearing , Herpes Zoster Oticus , Herpes Zoster , Paralysis , Vestibular NeuronitisABSTRACT
BACKGROUND: Herpes zoster (HZ) is caused by reactivation of latent varicella-zoster virus (VZV) infection. HZ-associated aseptic meningitis, a rare complication of HZ, can require hospitalization and a long treatment period. OBJECTIVE: A retrospective study was performed to identify potential factors associated with HZ-associated aseptic meningitis development. METHODS: We included all outpatients and patients admitted in the neurology and dermatology departments of a single tertiary center, who were diagnosed with HZ for two years. Among 818 patients, 578 patients were eligible for analysis. RESULTS: The demographics and potential risk factors were compared between the uncomplicated HZ group (n=554) and aseptic meningitis group (n=24). Among the potential factors, the dermatological distribution of skin rash and gender showed statistically significantly different between the two groups. Patients with craniocervical distribution of HZ accounted for 87.5% (n=21) of the aseptic meningitis group and 54.3% (n=301) of the uncomplicated HZ group (p=0.043). The aseptic meningitis group had more men (66.7%, n=16) than the uncomplicated HZ group (42.8%, n=237, p=0.033). Patients with craniocervical distribution had an odds ratio (OR) of 5.884 (p=0.001) for developing aseptic meningitis when compared with the other dermatome involvements. Additional logistic regression analysis resulted in a fading between gender difference (p=0.050) and craniocervical involvement having an OR of 5.667 for aseptic meningitis (p=0.006). CONCLUSION: In HZ patients, skin rash with craniocervical distribution and male gender were associated with a higher risk of aseptic meningitis.
Subject(s)
Humans , Male , Demography , Dermatology , Exanthema , Herpes Zoster , Herpesvirus 3, Human , Hospitalization , Logistic Models , Meningitis , Meningitis, Aseptic , Neurology , Odds Ratio , Outpatients , Retrospective Studies , Risk FactorsABSTRACT
No abstract available.
Subject(s)
Child , Humans , Papilledema , Pseudotumor Cerebri , StentsABSTRACT
Inflammation might be associated with cognitive impairment and be involved in the pathogenesis of Parkinson’s disease (PD). High-sensitivity C-reactive protein (hs-CRP) is a sensitive biomarker of systemic inflammation. This study aimed to investigate whether serum concentrations of hs-CRP are related to cognitive function in patients with PD. Patients with PD (n = 113, Hoehn and Yahr [H-Y] stage 1-4) underwent evaluation of serum hs-CRP and comprehensive neuropsychological tests that covered the cognitive domains of attention, language, visuospatial function, memory, and executive functions. We categorized subjects with PD as having normal cognition (n=48), mild cognitive impairment (MCI) (n=41), or dementia (n=24). Patients with dementia had a higher hs-CRP level than patients with MCI or normal cognition (2.76 ± 2.53 vs. 1.27 ± 1.99 vs. 0.73 ± 0.88 mg/L, P=0.001). Serum hs-CRP levels were inversely associated with the Mini-Mental State Examination scores and performance on neuropsychological tests of language, visuospatial function, visual memory, and executive function. After controlling for age, sex, symptom duration, education, H-Y stage, and Unified Parkinson’s Disease Rating Scale motor score, multiple regression analyses indicated statistically significant associations between hs-CRP levels and performance on neuropsychological tests of visuospatial function, visual memory, and executive function. This study suggests a possible relationship between serum hs-CRP levels and cognitive function in patients with PD, with higher levels of hs-CRP being associated with poor performance on tests of visuospatial function, visual memory, and executive function.
Subject(s)
DementiaABSTRACT
The head impulse test (HIT) is an established way to test the angular vestibulo-ocular reflex (aVOR) at the bedside. When the aVOR is normal, the eyes rotate opposite to the head movement through the angle required to keep images stable on the fovea. If the aVOR is impaired, the eyes move less than required and, at the end of the head rotation, the eyes are not directed at the intended target and the visual image is displaced from the fovea. A promptly-generated corrective saccade brings the image of the target back on the fovea. The identification of this corrective saccade is the signature feature of vestibular hypofunction and has greatly increased the utility of the bedside examination for identifying an aVOR deficit. However, sometimes it is not easy to detect corrective saccades without quantitative HIT devices. Exact execution and interpretation of the HIT are warranted to reduce the diagnostic errors, because the HIT has become an important part of the differential diagnosis of both acute and chronic vestibular disturbances.
Subject(s)
Diagnosis, Differential , Diagnostic Errors , Head , Head Impulse Test , Head Movements , Reflex, Vestibulo-Ocular , Saccades , Stroke , Vestibular NeuronitisABSTRACT
Lemierre's syndrome is characterized by anaerobic bacterial infection in the head and neck, causing thrombophlebitis of the jugular vein. This disease is usually associated with a history of pharyngitis. The most common pathogens are Fusobacterium species, particularly Fusobacterium necrophorum. Lemierre's syndrome is seen most commonly in teenagers and young adults. We present a case report of a 67-year-old man with an atypical clinical manifestation of an uncommon pathogen in Lemierre's syndrome with epilepsia partialis continua.
Subject(s)
Adolescent , Aged , Humans , Young Adult , Bacterial Infections , Epilepsia Partialis Continua , Fusobacterium , Fusobacterium necrophorum , Head , Jugular Veins , Lemierre Syndrome , Neck , Pharyngitis , Thrombophlebitis , Venous ThrombosisABSTRACT
A hyperintensity in the subarachnoid space on fluid-attenuated inversion-recovery (FLAIR) images is often caused by diseases such as subarachnoid hemorrhage or meningitis. Oxygen has a known paramagnetic effect and also causes signal changes in the subarachnoid space on FLAIR images. These changes usually develop when the inspired air contains a high oxygen fraction. Here we present a patient with a hyperintensity in the subarachnoid space on FLAIR images whose inspired air contained only a low oxygen fraction.
Subject(s)
Humans , Meningitis , Oxygen , Subarachnoid Hemorrhage , Subarachnoid SpaceABSTRACT
Vestibular neuritis, one of common causes of acute spontaneous vertigo, is characterized by a sudden onset of vertigo with horizontal-torsional spontaneous nystagmus and unsteadiness with a falling tendency. Herpes zoster is a common infection caused by varicella-zoster virus (VZV), and herpes zoster ophthalmicus (HZO) occurs when this virus is reactivated in the ophthalmic branch of the trigeminal nerve. VZV can cause vestibular neuritis with cochlear dysfunction as a form of herpes zoster oticus, also known as Ramsay-Hunt syndrome. However, to our knowledge, isolated vestibular neuritis associated with HZO has been rarely reported, because of distance between the trigeminal nerve and the vestibulocochlear nerve. We present an unusual case of vestibular neuritis complicated by the HZO.
Subject(s)
Dizziness , Herpes Zoster , Herpes Zoster Ophthalmicus , Herpes Zoster Oticus , Herpesvirus 3, Human , Trigeminal Nerve , Vertigo , Vestibular Neuronitis , Vestibulocochlear NerveABSTRACT
BACKGROUND: The outcome of spontaneous intracranial hypotension (SIH) is unpredictable and some patients have persistent and often incapacitating symptoms. This study was aimed to investigate whether abnormalities on initial magnetic resonance imaging (MRI) can predict the outcome in patients with SIH. METHODS: We retrospectively included 44 patients with SIH. Brain MRI was available for all patients. Treatment consisted of conservative treatment and/or high-volume epidural blood patching. Patients were divided into two groups: favorable or non-favorable group. Favorable group was defined as clinical improvement by conservative therapy or one trial of autologous epidural blood patching; non-favorable group as more than two week of admission, two or more trials of autologous epidural blood patching, or relapse of orthostatic headache. RESULTS: Twenty-one (48%) of 44 patients were classified as the favorable group. The non-favorable group had several abnormal findings on brain MRI (16 cases vs. 5 cases in favorable group, p<0.003), including platybasia (1), skull base tumor (1), Chiari I malformation (1), diffuse mild thickening and enhancement of dural and epidural layer of thoracic spine (1), pituitary enlargement (3), sagging brain (3) and subdural hemorrhage (4). In the non-favorable group, 13 out of 23 patients (57%) showed pachymeningeal enhancement in brain MRI (2 patients in favorable group, p<0.001). CONCLUSIONS: Brain MRI abnormalities were more frequently related with non-favorable outcomes in SIH. Pachymeningeal enhancement in particular could suggest an unfortunate prognosis.
Subject(s)
Humans , Blood Patch, Epidural , Brain , Headache , Hematoma, Subdural , Intracranial Hypotension , Magnetic Resonance Imaging , Platybasia , Prognosis , Recurrence , Retrospective Studies , Skull Base , SpineABSTRACT
No abstract available.
Subject(s)
Aneurysm , Carotid Artery, Internal , Cluster Headache , Headache , Intracranial AneurysmABSTRACT
Cavernous sinus syndrome is characterized by multiple cranial nerve palsies manifesting with ophthalmoplegia, ptosis, facial sensory loss due to involvement of adjacent cranial nerves. Tumor, trauma, and non-infectious inflammatory disorders are principal causes of cavernous sinus syndrome. Rhinocerebral mucormycosis is one of the fatal causes of cavernous sinus syndrome usually in immunocompromised patients. Here is a case of cavernous sinus syndrome complicating occlusion of the internal carotid artery by necrotizing fungal sinusitis, which is highly suspicious of rhinocerebral mucormycosis with non-immunocompromised state.