Aspergillus arachnoiditis post intrathecal baclofen pump insertion.

This report describes an unusual fungal infection of an intrathecal baclofen pump which, to our knowledge, has not been reported previously. We describe a 39-year-old man with severe lower limb spasticity due to secondary progressive multiple sclerosis that was managed with insertion of an intrathecal baclofen pump. He subsequently presented with distinct neurological decline secondary to an intrathecal baclofen pump infection with Aspergillus terreus.

Spinal toxoplasmic arachnoiditis associated with osteoid formation: a rare presentation of toxoplasmosis.

STUDY DESIGN: An extremely rare presentation of an isolated spinal toxoplasmic arachnoiditis is described. OBJECTIVE: To draw attention to the fact that spinal arachnoid membranes may be a potential reservoir for Toxoplasma gondii. SUMMARY OF BACKGROUND DATA: Central nervous system toxoplasmosis is a common manifestation in patients who are immunodeficient. Reports on the spinal toxoplasmosis are rare and focused on spinal cord involvement. METHODS: An adult patient presented with symptoms of spastic paraparesis that had begun 13 years before admission. Thoracic spinal magnetic resonance imaging showed small lesions in posterior subarachnoid space at Th7-Th8. A Th7-Th8 laminectomy was performed. Intradural-extramedullary lesions were excised. RESULTS: Clinical, immunologic, and pathologic examinations showed adhesive spinal arachnoiditis associated with osteoid formation caused by past toxoplasmic infection. There was no impairment of the immunologic defense system. CONCLUSION: Where no causative factor is found in serious spinal adhesive arachnoiditis, the possibility of spinal toxoplasmosis should also be investigated.

Neurocysticercosis presenting as stroke.

Stroke is a common but under recognized complication of neurocysticercosis (NCC). We report six patients having NCC who presented with stroke. All patients were young with no vascular risk factors. The arteritis which resulted in ischaemic infarct in these patients was related to the presence and severity of arachnoiditis. All patients responded well to steroids and albendazole therapy with minimal residual deficit.

Frequency of cerebral arteritis in subarachnoid cysticercosis: an angiographic study.

BACKGROUND AND PURPOSE: Subarachnoid cysticercosis is a well-recognized cause of cerebral infarction. However, few patients with this infection develop cerebral infarction, and the reason for this is not known. The aim of this study was to determine the frequency of cerebral arteritis in these patients. METHODS: Using cerebral arteriography, we studied 28 patients with subarachnoid cysticercosis admitted to our hospital from July 1993 to February 1996. All patients underwent MRI to detect the presence of basal arachnoiditis. We analyzed demographic data, time to cysticercosis since the first symptom onset, mode of onset, stroke syndromes, neuroimaging features of cysticercosis and cerebral infarction, and arteriographic findings for each patient. RESULTS: Of the 28 patients (mean age, 37 years), 15 patients had angiographic evidence of cerebral arteritis (53%); 12 of the 15 had a stroke syndrome (P=.02). Eight of the 15 patients (53%) with cerebral arteritis had evidence of cerebral infarction on MRI, whereas only one patient without cerebral arteritis had cerebral infarction (P=.05). The most commonly involved vessels were the middle cerebral artery and the posterior cerebral artery. CONCLUSIONS: The frequency of cerebral arteritis in subarachnoid cysticercosis is higher than previously reported, and middle-size vessel involvement is a common finding, even in those patients without clinical evidence of cerebral ischemia.

Meningitis cisticercosa / Cysticerci meningitis

La neurocisticercosis (NC) es la parasitosis que afecta con mayor frecuencia el Sistema Nervioso Central (SNC) en todo el mundo. Casi la mitad de los pacientes con NC presenta meningitis cisticercosa, a pesar de lo cual, existe poca información actualizada con respecto a esta entidad. Esta forma de presentación puede ser de extraorinaria gravedad y por lo regular sigue un curso crónico. Hay controversia con respecto al manejo y algunos autores señalan que el uso de esteroides no reporta beneficio. Presentamos 5 casos de meningitis cisticercosa, seguidos durante un promedio de 18 meses y hacemos algunas consideraciones clínicas importantes, enfatizando la utilidad de los esteroides en el tratamiento de esta grave condición

Postcontrast MRI of cranial meninges: leptomeningitis versus pachymeningitis.

OBJECTIVE: Our goal was to characterize the patterns of meningeal enhancement in postcontrast MR images and correlate these patterns with the clinical disorders. MATERIALS AND METHODS: The MR scans, medical records, and laboratory findings of 83 patients, whose postcontrast MR studies of the head demonstrated meningeal enhancement, were reviewed retrospectively. The patterns of enhancement of the different layers of the meninges were divided into two types: leptomeningeal (pia and arachnoid), when enhancement of the meninges followed the convolutions of the gyri and/or involved the meninges around the basal cisterns; and pachymeningeal (dura), when the enhancement was thick and linear or nodular along the inner surface of the calvarium, falx, or tentorium without extension into the cortical gyri or basal cistern involvement. Enhancement around the basal cistern was considered leptomeningeal, since the dura-arachnoid is widely separated from the pia-arachnoid in this region. Further, the meningeal enhancement was divided into five etiologic subgroups, i.e., carcinomatous, infectious, inflammatory, reactive, and chemical. The medical history, clinical presentation, and findings on CSF analysis were used to distinguish infectious from carcinomatous meningitis. Meningeal enhancement due to surgery, shunt, or trauma was considered reactive, while ruptured cysts (dermoid or cysticercoid) or intrathecal chemotherapy were classified as chemical meningitis. Meningitis secondary to involvement by collagen vascular disease or sarcoidosis was considered to be inflammatory. RESULTS: Thirty of the 83 subjects had carcinomatous, 28 infectious, 14 reactive, 8 chemical, and 3 inflammatory etiology for meningitis. Twenty-five cases (83%) of the carcinomatous, 14 (100%) of the reactive, 3 (100%) of the inflammatory, and 1 (12%) of the chemical meningitis subgroups demonstrated pachymeningeal enhancement, while 28 cases (100%) of the infectious meningitis and 7 (78%) of the chemical meningitis subgroups had leptomeningeal enhancement. Only five cases (17%) of the carcinomatous meningitis subgroup showed leptomeningeal enhancement. Four of these five cases were as a result of direct spread of intraparenchymal tumors or through perineural extension, rather than hematogenous involvement. Only one patient with carcinomatous meningitis demonstrated leptomeningeal enhancement without clear intraparenchymal lesion. CONCLUSION: The recognition of various patterns of meningeal enhancement (leptomeningitis versus pachymeningitis) may help in differentiating between infectious and carcinomatous meningitis. This study demonstrated that infectious meningitis presents mostly as leptomeningitis, while carcinomatous meningitis presents as pachymeningitis.

A rare case of Toxocara canis arachnoidea.

The Authors present a case of Toxocara canis arachnoidea located in the cervical zone. The rarity of the case and the extreme rarity of the position are emphasized. In fact in medical literature there exists a description of only one similar case which was also observed by one of the authors.

Evaluation of the hypothalamic-hypophyseal axis in patients with hypertensive hydrocephalus due to neurocysticercosis.

Four patients with hydrocephalus secondary to neurocysticercosis, were evaluated making a comparative analysis of their pre- and post-operative state. The results showed that intracranial hypertension "per se" does not generate changes in the hypothalamopituitary axis function. The cortisol response to its appropriate stimulus was subnormal indicating that the intracranial hypertension affects the adrenocorticotrophic or the ACTH system.