Subject(s)
Cysts/therapy , Epiglottis , Intubation, Intratracheal , Laryngeal Diseases/therapy , Female , Humans , Middle AgedABSTRACT
Eight patients with intracranial cysts presenting with primary psychiatric diagnoses were studied. The cysts were visible on computed tomography (CT) and magnetic resonance imaging (MRI), and they produced neurologic, electroencephalographic (EEG), and neuropsychologic abnormalities. Descriptions of psychiatric manifestations associated with intracranial cysts are rare, and their potential neuropsychiatric significance has been minimized. This study demonstrates that intracranial cysts can cause neuropsychiatric symptoms, that surgical intervention may resolve the psychiatric manifestations in selected cases, and, in cases not warranting surgery, that psychopharmacological therapy to treat the behavioral manifestations is indicated. These cases mandate consideration of intracranial cysts in the diagnostic and therapeutic formulation of atypical neuropsychiatric disorders.
Subject(s)
Arachnoid Cysts/diagnosis , Brain Diseases/diagnosis , Mental Disorders/diagnosis , Adult , Aged , Animals , Antipsychotic Agents/therapeutic use , Arachnoid Cysts/complications , Arachnoid Cysts/surgery , Brain/diagnostic imaging , Brain/surgery , Brain Diseases/complications , Brain Diseases/surgery , Electroencephalography , Female , Humans , MMPI , Magnetic Resonance Imaging , Male , Mental Disorders/drug therapy , Mental Disorders/etiology , Middle Aged , Neurocognitive Disorders/diagnosis , Neurocognitive Disorders/drug therapy , Neurocognitive Disorders/etiology , Neurologic Examination , Neuropsychological Tests , Prospective Studies , Radionuclide Imaging , Schizophrenia/diagnosis , Schizophrenia/drug therapy , Schizophrenia/etiology , Tomography, X-Ray ComputedABSTRACT
Twelve patients with fungal meningitis (ten cases were due to Coccidioides immitis, two were from Cryptococcus neoformans) were treated with brief courses of intravenous (IV) miconazole. Eleven patients, including patients with severe, chronic disease, had been treated unsuccessfully with amphotericin B. Four patients also received miconazole injected directly into the CSF. The drug was well tolerated by any route, with mild reversible side effects. After IV administration the miconazole concentration in the CSF rarely exceeded the minimal inhibitory concentration (MIC) of the infecting organism. Intra-CSF administration of 20 mg generally produced levels above the MIC for 24 hours. Five of ten patients with coccidiodial meningitis responded clinically. Of these five, four received only IV miconazole; three relapsed after therapy was stopped. Miconazole appears promising as a treatment of fungal meningitis, but trials of longer duration might prevent relapse.
Subject(s)
Coccidioidomycosis/drug therapy , Cryptococcosis/drug therapy , Imidazoles/therapeutic use , Meningitis/drug therapy , Miconazole/therapeutic use , Adolescent , Adult , Aged , Coccidioidomycosis/cerebrospinal fluid , Cryptococcosis/cerebrospinal fluid , Female , Humans , Infusions, Parenteral , Male , Meningitis/cerebrospinal fluid , Miconazole/administration & dosage , Miconazole/cerebrospinal fluid , Middle AgedABSTRACT
Miconazole was administered intravenously in six consecutive patients with, active coccidioidal infection. Such treatment was associated with progressive anemia and thrombocytosis. The hematological abnormalities appeared to be dose related and potentially reversible. Bone marrow studies demonstrated erythroid hypoplasia and increased or active platelet production in three subjects. No hemorrhagic or thrombotic episodes were identified. It is suggested that careful hematological monitoring be performed in subjects undergoing systemic miconazole therapy.
