Transient meningism in children after non-autologous duraplasty for Chiari Malformation surgery: A case series.

BACKGROUND: Increasing the posterior fossa volume is the mainstay of treatment for Chiari type 1 Malformation (C1M) and type 1.5 (C1.5M). Different options to restore CSF flow have been described but no consensus has been reached yet. Bony decompression of posterior cranial fossa with dural opening provides good results but at the price of complications such as pseudomeningocele and aseptic meningitis. A single center retrospective analysis was conducted to find any relationships between outcome and perioperative factors. As a second goal a specific analysis was conducted on the complications and their hypothetical causes. METHODS: All the pediatric patients who underwent to posterior fossa bony decompression and dural opening for C1M or C1.5M in the period 2008-2020 were included in the study. A minimum period of three-months follow-up was considered among the inclusion criteria. RESULTS: A population of fifty-three consecutive patients was collected. Pseudomeningocele and a mild meningeal irritation resulted the most frequent complications. Considering preoperative and intraoperative factors, the type of dural graft showed a relatively strong correlation (P<.01) with pseudomeningocele appearance and the development of meningism. In the latter case, a short course of steroids was the only treatment required to control symptoms. CONCLUSIONS: Different factors could influence the outcome in Chiari Malformation surgery and eventually the development of complications. An adequate dural graft selection is of paramount importance when a dural opening for posterior fossa augmentation is planned. In case of mild meningeal irritation, a trial with short course steroids could avoid revision surgery.

Meningismus in children with chronic headache is most likely due to streptococcal infection.

We previously found that 97% of children diagnosed with chronic tension-type headaches had meningismus. In the present study, we investigate the relationship between streptococcal infection and meningismus in children suffering from chronic headaches. Six hundred and forty children suffering from idiopathic chronic headaches were examined by a neurologist in an outpatient setting. Antistreptolysin titer (ASOT) was determined from blood samples taken from all the children. Meningismus was diagnosed in 337 patients. Patients were divided into two groups: 337 children (Group 1) with meningismus with an increased ASOT (200-1790 IU/ml) in 264 children (78%), and 303 children (Group 2) without meningismus with an increased ASOT (200-1030 IU/ml) in 117 children (39%). We report herein that a majority of children with headaches associated with meningismus, had evidence of a streptococcal infection when compared to a non-meningismus group. We postulate that streptococcal infection may play an important role in the etiology of meningismus-positive chronic headaches in children.

Lumbar pseudomeningocele causing hydronephrosis.

BACKGROUND/OBJECTIVE: Pseudomeningocele is most commonly the result of a rent in the meninges during spine surgery. Noniatrogenic causes exist but are rare. Pseudomeningoceles may heal spontaneously, but they may also slowly enlarge. They rarely present as a mass within the abdomen. The objective of this study was to present the first case report of hydronephrosis secondary to lumbar pseudomeningocele. DESIGN: Single case report and literature review. METHODS: Single case report. RESULTS: This man had undergone extensive lumbar spine surgery for pain and spondylolisthesis. He subsequently developed a pseudomeningocele that caused hydronephrosis of the left kidney. He was treated with surgical intervention and had resolution of his hydronephrosis and his flank and groin pain. He also had improvement of his back pain. CONCLUSIONS: This report shows an unusual cause of hydronephrosis-a pseudomeningocele presenting as an abdominal mass that compressed the ureter.

Meningismus is a commonly overlooked finding in tension-type headache in children and adolescents.

At present, both migraine and tension-type headaches in children are believed to be chronic primary headaches. Meningeal signs in both cases are ignored or not examined, and the neurologic status is considered normal. This is the first study that focuses on meningeal signs in children with chronic headaches. The study population comprised 1738 patients aged 5 to 17 years who were examined in an outpatient neurologic clinic over a 6-year period. Particular attention was paid to examination of meningeal signs, including nuchal rigidity, Kernig's sign, Brudzinski's three signs (upper, middle, and lower), the "tripod" sign, and Guillain's and facial signs; the presence of these signs was regarded as meningismus syndrome. Some meningeal signs were found in 12% of 1007 children suffering from migraine, whereas 97% of 731 children with tension-type headaches had the whole set of meningeal signs. This suggested that meningismus is the major clinical syndrome in chronic tension-type headaches in children and adolescents. Chronic mild sterile (possibly autoimmune) inflammation of meninges (dura mater) can be caused by a preceding infection, as well as minor trauma of the head and/or back. Prolonged rest in a recumbent position usually resulted in relief or complete disappearance of both headache and meningeal signs. Monitoring of the meningeal signs is helpful for evaluation of the patient's condition in the course of treatment.

Association between severity of inflammation in CNS and development of sunset glow fundus in Vogt-Koyanagi-Harada disease.

PURPOSE: To investigate the association between central nervous system (CNS) inflammation at disease onset and the appearance of sunset glow fundus (SGF) in Vogt-Koyanagi-Harada (VKH) disease. DESIGN: Retrospective case series. METHODS: Charts of 102 patients with VKH disease followed from from initial onset were reviewed. The frequency of cerebrospinal fluid (CSF) pleocytosis and the number of cells in the CSF were compared among the patients who eventually developed SGF and the patients who had not developed SGF as of final follow-up. RESULTS: SGF was observed in 69 (67.6%) of 102 patients. The frequency of CSF pleocytosis was 77 (82.7%) of 93 patients examined. The frequency of CSF pleocytosis and the number of cells in CSF were significantly higher in patients who eventually developed SGF (both P = .0029). CONCLUSIONS: Severe inflammatory response in CNS sites at disease onset may influence the development of SGF in VKH disease.

Ceguera cortical como forma de presentación de hemorragia subaracnoidea / Cortical blindness as onset of subarachnoid hemorrhage

Presentamos el caso de una paciente de 51 años que acude a urgencias por cuadro de cefalea, meningismo y pérdida de visión de aparición brusca. Fue diagnosticada de hemorragia subaracnoidea (HSA) y la pérdida de visión fue explicada como un caso de ceguera cortical. La ceguera cortical es un síntoma poco habitual que puede estar causado por diversas causas a nivel del SNC, en este caso por isquemia secundaria a vasoespasmo intenso tras HSA (AU)

Case of a 51-year-old woman who comes to the Emergency suffering from headache, menigism and sudden loss of vision. She was diagnosed of SAH and loss of vision explained as cortical blindness. Cortical blindness is a rare syntomathology and can be produced by several CNS pathologies. In this case, it was caused by ischemia secondary to severe vasoespasm after SAH (AU)

[Prognostic factors in hemorrhagic cerebrovascular accidents in a population register]. / Facteurs pronostiques des accidents vasculaires cérébraux hémorragiques dans un registre de population.

Since 1985, cases of acute vascular cerebral diseases observed among the inhabitants of the city of Dijon have been systematically recorded: 88 cerebral haemorrhages were reported from 1985 to 1988. Twenty-five variables have been defined from antecedents, clinical and para-clinical data. Seven variables, were statistically associated with death at the end of the first month: age, severity of neurological palsy, meningeal syndrome, coma or comatose state, hyperglycemia and mass effect on CAT-scan. Using a step-down variable selection procedure, two prognostic factors were found: loss of consciousness and advanced age.

Disorders that mimic CNS infections.

A variety of inflammatory and neoplastic disorders can cause signs, symptoms, and laboratory abnormalities suggesting CNS infection. The distinction usually can be made through careful consideration of the entire clinical picture and the judicious use of additional laboratory tests.

[Acute myelomonocytic and monoblastic leukemia with polyradicular symptoms]. / Akute myelomonozytäre und Monoblastenleukämien mit polyradikulärer Symptomatik.

Meningeal leukaemia, developed in 4 female patients with M4 or M5 leukaemia during a period of haematological remission. Polyradicular symptoms and signs dominated neurologically, but 3 patients also exhibited cranial nerve palsies. The neurological findings showed no reversal following intrathecal chemotherapy with normalization of liquor cytology. Patchy demyelinization in the region of the anterior spinal roots and of the proximal segments of the affected cranial nerves were responsible for the neurological features. Peripherally located streaky demyelinization of the olfactory bulb and of the optic chiasm were not found to cause any neurological manifestations.

Seizures due to central nervous system rheumatoid meningovasculitis.

A patient with rheumatoid arthritis and seizures had rheumatoid meningovasculitis on brain biopsy. Infection was excluded as a cause of the seizures and cerebrospinal fluid abnormalities, which resolved with corticosteroids and azathioprine therapy.

[Changes in the number of immunocompetant cerebrospinal fluid cells in epileptic patients following air insufflation into the subarachnoid space]. / Ob i zmenenii kolichestva immunokompetentnykh kletok spinnomozgovoi zhidkosti u bol'nykh épilepsiei pri insuffliatsii vozdukha v subarakhnoidal'noe prostranstvo.

In 10 patients with various forms of epilepsy the effect of air insufflation into the subarachnoidal space on the number of immunocompetent cells in the cerebrospinal liquor and the peripheral blood was studied. A sharp rise of the percentage of the T- and B-lymphocytes in the cerebrospinal liquor was noted as a result of the insufflation. Examinations of the blood before the insufflation and in the presence of the pronounced post-insufflation meningeal syndrome did not reveal any distinct regularity. A direct relationship between the liquor immune reaction and the intensity of the post-insufflation meningeal syndrome was noted.

[Tabular method of evaluation in the diagnosis of complicated brain infarct]. / Tablichnyi vychislitel'nyi metod v diagnostike oslozhnennogo infarkta mozga.

On the basis of a clinico-anatomical comparison in 70 cases of complicated infarctions and 77 observations of white infarctions the author elaborated computing tables. It was established that the following signs have certain diagnostic significance: the degree of changed consciousness, meningeal symptoms, symptoms indicating a secondary lesion of the brain stem and symptoms characterizing the degree of focal neurological disturbances. Among the supplementary methods of special significance is CSF analysis.