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