Acute bacterial meningitis in adults: an analysis of 95 cases from Saudi Arabia

To study the clinical features, laboratory profiles, treatment especially door-to-antibiotic time and outcome in adult patients admitted with acute bacterial meningitis in a tertiary care hospital. Neurology and medical department, King Abdul Aziz Hospital and Oncology Center, Jeddah, Saudi Arabia. Retrospective analysis of 95 consecutive cases of acute bacterial meningitis in adults admitted during study period from January 2000 till June 2005. Clinical and laboratory features, treatment and outcome were analyzed. Total of 95 patients were identified. There were 78[82%] males and 17[18%] females. The mean age was 30 years with range from 14 to 74. Out of the 95 patients, 52[54.7%] cases had meningitis caused by Neisseria meningitides and 16 [16.8%] by Streptococcus pneumoniae. There was one case of meningitis caused by Klebsiella and E. coli each. Latex agglutination [bacterial antigen detection] test was positive in 72 [75%] cases, Gram stain in 40 [42%], and CSF culture in 27 [28.4%]. Triad of fever, headache and neck stiffness or altered conscious level was seen in only 52% of cases. Sixty-five [68%] cases belonged to an African ethnic background and a low socio-economic class. Unfavorable outcome was seen in 19 [20%]. Overall mortality was 6.3% [6 out 95 cases]. Mortality was more with pneumococcal meningitis 12.5% [2out of the 16 cases] compared with meningococcal meningitis 4% [2 out of 52 cases]. Patients, who died, were admitted in deep coma [Glasgow coma scale below 8]. Acute bacterial meningitis remained common and life threatening infection in the community. Neisseria meningitides and Streptococcus pneumoniae are the two most common pathogens for bacterial meningitis in immuno-competent adults. An African ethnic background, poor socioeconomic class and overcrowding were the main predisposing factors. Triad of fever, headache and neck stiffness or altered mental status was seen in about half of the cases

Cerebral venous thrombosis: clinical and radiological features and outcome in 20 cases

To study the clinical and radiological features of cerebral venous thrombosis [CVT], the response to treatment with anticoagulation, and the outcome. A five year prospective study was performed from Febraary 2000 to January 2005. Diagnosis of cerebral venous thrombosis was confirmed by magnetic resonance venography [MRV] or CT venography [CTV]. All patients were treated with unfractionated heparin [UFH] for 7-10 days followed by treatment with warfarin for 6 months. The outcome in each case was assessed by modified Rankin Scale [mRS] score at the end of six months from the time of presentation. A total of 20 cases were identified, 14 were female [70%] and 6 male [30%] with F: M ratio of 2.3: 1. Mean age was 34.5 years [range 10-65 years]. The most common symptoms were headache [90%], vomiting [65%], seizures [40%], and impairment in conscious level [35%]. Most common signs were bilateral papilloedema [45%], hemiparesis or hemiplegia [30%], quadriparesis [25%], and cranial nerve palsies [20%]. Neuroimaging features on pre and post contrast CT scan and/or MRI were variable among all patients and revealed features like ischemic infarctions and/or intracerebral hemorrhages in various locations, sulcal sub-arachnoid hemorrhages, and intraluminal signal abnormalities due to presence of thrombus inside the dural sinuses. The most frequently involved dural sinus [85%] was one of the lateral sinuses [transverse and sigmoid dural sinus], followed by superior sagittal sinus [75%], and straight sinus [20%]. At the end of six months, 16 [80%] cases recovered completely while 2 [10%] were moderately impaired [mRS = 3], and one [5%] had mild impairment [mRS = 2]. Only one [5%] patient died. Cerebral venous thrombosis is a rare condition with variable clinical and radiological features at presentation making the diagnosis difficult. Early diagnosis and prompt treatment with anticoagulation resulted in better outcome even in the presence of hemorrhagic lesions

Etiology of posterior reversible encephalopathy syndrome [PRES]

To study the causes and risk factors for the development of Posterior Reversible Encephalopathy Syndrome [PRES]. Prospective hospital based study over a period of five years from July 1999 to June2004.Patients and methods: Patients with clinical and neuroimaging features consistent with PRES were included in the study. All patients had detail clinical evaluation on presentation, and recovery from PRES. All had CT and/or MRI brain scan and other hematological and serological investigations to determine the most likely cause of the syndrome. Most patients also underwent follow up neuroimaging to demonstrate resolution of brain lesions. Thirteen patients fulfilled the clinical and radiological features consistent with PRES. Seizures and altered conscious level were most common clinical manifestations. Main radiological feature on CT and/or MRI brain was extensive subcortical edema mainly confined to the posterior parieto-occipital lobes. Hypertensive encephalopathy, immunosuppressive treatment, renal failure and eclampsia were main causes of PRES in our study. We also found that this syndrome was more common in females than males. Clinically all patients recovered with control of blood pressure and discontinuation or reduction in dose of the offending drug within 2-7 days. There was almost complete resolution of radiological abnormalities within 2-4 weeks in patients who underwent follow up imaging. Hypertensive encephalopathy, immunosuppressive treatment, renal failure and eclampsia are most common causes of posterior reversible encephalopathy syndrome with a greater predilection for females than males. Multiple factors may be contributory in some patients who develop PRES

Risk factors in stroke

Risk factors in stroke were studied in fifty consecutive patients admitted to the Neurology ward and North medical ward of Mayo hospital, Lahore. The diagnosis was confirmed on CT scan of brain in all patients. There were 24 males and 26 females with mean age 52 years and range from 19-80 years. Hypertension was present in 31 [62%], Diabetes mellitus 16 [32%], Obesity 16 [32%], Ischcmic heart disease 10 [20%], Valvular heart disease 8 [16%] and 21 [42%] patients had history of heavy smoking

Paroxysmal ataxia and dysarthria

Three cases with transient episodes of ataxia and dysarthria are described. The episodes lasted for 10-20 seconds with frequency from 20-200/day. The primary diagnosis was multiple sclerosis in two cases and acute disseminated encephalomyelitis in one case. An electroencephalogram [EEG] recorded during the episodes in these patients was normal. All patients responded to low doses of carbamazepine with complete amelioration of episodes. Recovery from relapse was associated with spontaneous cessation of these paroxysmal symptoms

Live events and depression

This paper describes the frequency of life events in a group on one hundred Pakistani depressed patients. The results showed an excess of such events among the patients than the controls and were observed more both at three months and six months period prior to the onset of the illness. The findings are discussed in terms of the association of life events with the depressive illness with special reference to methodological problems and issues of cause and effect inherent in life events research

Life events and psychiatric problems among overseas students

This paper describes the relationship between life events and mental health problems among two groups of overseas and British students studying in Edinburgh University. The overseas students experienced more events than the local students and a significant association was observed between the total number of events and psychiatric morbidity. The practical implications of these findings are discussed in terms of preventive measures and provision of better facilities to the foreign students in the host countries

Phenomenology of obsessive compulsive disorders in Pakistan patients

This study provides information about the form and contents of obsessions and compulsions in a group of seventy five Pakistani obsessional patients. An attempt is made to ascertain the frequency of these symptoms and the interpretation of phenomenology is discussed in terms of socio-cultural settings

Mental health of medical students

Recent studies looking at the mental health of medical students have suggested a high level of stress in this group of students. This paper describes the findings of a study, which shows an increased psychopatholog among medical students studying at a local medical college. Male students reported more symptoms than female students and living in the hostel was associated with more psychological disturbances. Issues of early identification and provision of better health facilities are discussed in terms of the practical implications