Acute viral encephalitis associated with human parvovirus B19 infection: unexpectedly diagnosed by metagenomic next-generation sequencing.

We report here a case of a 17-year-old boy with viral encephalitis associated with human parvovirus B19 who presented consciousness disturbance, left hemiparesis, and focal neurologic signs. The diagnosis was based on the specific sequence reads corresponding to human parvovirus B19 (PVB19) in a CSF sample as analyzed by metagenomic next-generation sequencing (mNGS). Thus, PVB19 should be considered in the differential diagnosis of encephalitis and encephalopathy of unknown etiology. The introduction of mNGS into the diagnostic protocol of neuropathies, especially for those undiagnosed, could interrogate all genetic information in a biologic sample and facilitate the identification of the etiological agent.

Different cerebrospinal fluid levels of Alzheimer-type biomarker Aß42 between general paresis and asymptomatic neurosyphilis.

BACKGROUND AND PURPOSE: Neurosyphilis is a neurological disease that involves infection of the central nervous system with Treponema pallidum. With increases in unsafe sexual behaviour, syphilis has re-emerged worldwide. To explore the amyloid and tau metabolism in neurosyphilis patients in different stages, the levels of Alzheimer-type biomarkers in general paresis (GP) and asymptomatic neurosyphilis (ANS) patients in comparison to patients with Alzheimer's disease (AD) and normal controls (NCs) were investigated. METHODS: ß-amyloid peptide 1-42 (Aß42) and Aß 1-40 (Aß40), tau hyperphosphorylated at threonine 181 (p-tau181) and total tau (t-tau) in cerebrospinal fluid (CSF) were measured by enzyme-linked immunosorbent assay kits in 44 patients with GP, 10 patients with ANS, 45 patients with AD and 39 NCs. RESULTS: Alzheimer's disease patients had lower CSF Aß42 levels combined with higher CSF t-tau and p-tau181 levels than other groups (all P < 0.001). The CSF Aß42 levels decreased in GP compared to ANS and NCs (P < 0.001). CSF Aß40, t-tau and p-tau181 levels were not different between the GP, ANS or NC groups. CONCLUSIONS: Our research has demonstrated that GP, ANS and AD patients are characterized by distinct patterns of the CSF biomarkers Aß and tau. The distinct CSF Aß pattern in GP suggests the existence of abnormal Aß metabolism. Furthermore, different levels of CSF Aß will be helpful for the differentiation between different stages of neurosyphilis.

Post-varicella angiopathy: a series of 4 patients with focus on virologic and neuroimaging findings.

BACKGROUND: Post-varicella angiopathy is an important cause of childhood stroke and follows a particular pattern. Specific treatment guidelines have not been developed because of a lack of epidemiological, laboratory, and neuroimaging data. Prospective randomized controlled trials evaluating different treatment strategies have not been performed, and expert opinions on diagnostic criteria, prognosis, and treatment are diverging. METHODS: This case series describes the clinical course, laboratory, and neuroimaging findings of four children with post-varicella angiopathy, who all underwent cerebrospinal fluid assessment and received antiviral, immunosuppressive, and antiplatelet treatment. RESULTS: Cerebrospinal fluid analysis was positive for varicella-zoster virus markers in three children. At follow-up, three children had a mild hemiparesis and one child had no neurological symptoms. Neuroimaging showed complete vascular remission in three patients and improvement in one. CONCLUSIONS: Systematic search for virologic markers in cerebrospinal fluid will contribute to the understanding of the pathogenesis of idiopathic childhood stroke and can be considered as a prerequisite for the development of clear diagnostic criteria and relevant treatment strategies for post-varicella angiopathy. The role of antiviral and immunosuppressive medication needs to be clarified.

Hyperintensity in the subarachnoid space on contrast-enhanced fluid-attenuated inversion-recovery magnetic resonance imaging after central venous catheter removal.

Cerebral air embolism is a rare complication of central venous catheterization. A 61-year-old man developed a left-sided hemiparesis immediately after his right jugular venous catheter removal. A diffusion-weighted magnetic resonance imaging (MRI) obtained 2 h after the symptom onset was normal. However, postgadolinium cerebral spinal fluid enhancement was seen on fluid-attenuated inversion-recovery MRI. A repeat diffusion-weighted MRI, 18 h later, showed restricted diffusion in the bilateral hemispheres. Disruption of the blood-brain barrier caused by the air bubbles might lead to accumulation of gadolinium in the subarachnoid space. Postgadolinium cerebral spinal fluid enhancement may be an early, sensitive predictor of blood-brain barrier disruption and impending cerebral infarct after air embolism.

Tetraparesis resembling acute transverse myelitis in a captive chimpanzee (Pan troglodytes): long-term care and recovery.

BACKGROUND: A 24-year-old, male chimpanzee (Pan troglodytes) developed acute tetraparesis. Magnetic resonance imaging showed a diffuse T2-weighted hyperintensive lesion, indicating inflammation at the C1-2 level. All infective, autoimmune, and vascular investigations were unremarkable. RESULTS AND CONCLUSIONS: The chimpanzee's condition most resembled acute transverse myelitis (ATM) in humans. The chimpanzee was in severe incapacitated neurological condition with bedridden status and required 24-hour attention for 2 months followed by special care for over a year. Initially, corticosteroid therapy was performed, and his neurological symptoms improved to some extent; however, the general condition of the chimpanzee deteriorated in the first 6 months after onset. Pressure ulcers had developed at various areas on the animal's body, as the bedridden status was protracted. Supportive therapy was continued, and the general condition, appetite, mobility, and pressure ulcers have slowly but synergistically recovered over the course of 2 years.

Acquired demyelinating disorders of childhood in the Western Cape, South Africa.

In a retrospective review of patients with acquired demyelinating disorders of the central nervous system, 19 children (0.6%) were identified from the Paediatric Neurology database of 3159 patients; 7 had acute disseminated encephalomyelitis, 1 had Schilder's disease, 5 had multiple sclerosis, and 6 had acute transverse myelitis. The median age of presentation was 83 months, with increased incidence during the summer and winter months. The commonest presentation was hemiparesis. The commonest regions of magnetic resonance imaging (MRI) abnormalities were the deep white matter (68%) and cerebellum (48%).The patients with multiple sclerosis had more monosymptomatic presentations (P < .02), raised cerebrospinal fluid protein (P = .022), and contrast enhancement of lesions (P = .05) compared with the acute disseminated encephalomyelitis group. Neuroepidemiological published surveillances of African children provide no data about these disorders. The prevalence of acquired demyelinating disorders in resource-poor settings is under-estimated because of the large burden of infections and limited access to neuroimaging.

Serial cerebrospinal fluid neurofilament concentrations in bacterial meningitis.

Neurofilament (NF) is one of the major cytoskeleton proteins of neurons. We investigated the concentrations of the heavy subunit of NF (NF-H) in cerebrospinal fluid (CSF) as biomarkers of neuronal injury in bacterial meningitis. Concentrations of NF-H in CSF of 26 children with bacterial meningitis and in 16 control subjects were measured by ELISA. The CSF NF-H levels were elevated in 22 of the 26 children (85%) with bacterial meningitis. The peak CSF NF-H level occurred at a median period of 10.5 days after onset of illness (range, 1 to 35 days). The peak CSF NF-H levels of the patients with neurological sequelae (n=4) were significantly higher than those without sequelae (n=22) (7.06 vs. 2.46 ng/mL as median, p=0.048). There was no significant difference in CSF NF-H levels between patients with and without severe neurological sequelae up to day 14 of illness, but the CSF NF-H levels in patients with sequelae were significantly higher than in those without sequelae after day 14 of illness (2.04 vs. 1.19 ng/mL as median, p=0.024). We suggest that neuronal injury occurs in bacterial meningitis regardless of the presence or absence of neurological sequelae.

The increase of neuron-specific enolase in cerebrospinal fluid and plasma as a marker of neuronal damage in patients with acute brain infarction.

Our goal was to determine the neuron-specific enolase (NSE) concentration in cerebrospinal fluid (CSF) and plasma in patients with the acute brain infarction (BI) and analyze the correlation between the measured NSE concentration and infarct volume and the degree of neurological and functional deficit. The study included 55 patients aged 56-68 with BI in the acute phase. The control group consisted of 16 patients subjected to diagnostic radiculography. The results showed a significant increase of NSE concentration within the first seven days in patients compared to the controls (2.838 +/- 0.504 ng/ml CSF and 4.479 +/- 0.893 ng/ml plasma). A significant correlation was found between NSE concentration and infarction volume and the degree of neurological and functional deficit both in the CSF (r = 0.828, r = 0.735, r = 0.796; p < 0.001) and in plasma (r = 0.810, r = 0.681, r = 0.783; p < 0.001). The results suggest that an early determination of this marker in CSF and plasma in patients with BI could be a valuable diagnostic factor.

Chronic active VZV infection manifesting as zoster sine herpete, zoster paresis and myelopathy.

After lumbar-distribution zoster, an HTLV-1-seropositive woman developed chronic radicular sacral-distribution pain (zoster sine herpete), cervical-distribution zoster paresis and thoracic-distribution myelopathy. Detection of anti-varicella zoster virus (VZV) IgM and VZV IgG antibody in cerebrospinal fluid (CSF), with reduced serum/CSF ratios of anti-VZV IgG compared to normal serum/CSF ratios for albumin and total IgG, proved that VZV caused the protracted neurological complications. Diagnosis by antibody testing led to aggressive antiviral treatment and a favorable outcome.

[Syndrome of headache, transitory neurological deficits and lymphocytosis in the cerebrospinal fluid]. / Syndrom med hovedpine, transitoriske neurologiske udfald og lymfocytose i spinalvaesken.

The authors report three case stories of patients who experienced a transient syndrome consisting of headache with neurologic al deficits and CSF lymphocytic pleocytosis (HaNDL). The diagnostic criteria for this benign syndrome are presented and differential diagnoses are discussed.

Lissauer form of paretic neurosyphilis with a cerebral mass lesion.

A 40-year-old male patient with progressive dementia presented adversive seizures, and CT scan showed an enlarging focal mass lesion in the right cerebral hemisphere. Cerebrospinal fluid examination and brain biopsy confirmed the diagnosis of neurosyphilis. After a course of penicillin therapy there was disappearance of the cerebral mass lesion and the CT scan showed focal atrophy in the right cerebral hemisphere. This case suggests that Lissauer form of paretic neurosyphilis may present as a focal mass lesion.

DNA blotting analysis of human retroviruses in cerebrospinal fluid of spastic paraparesis patients: the viruses are identical to human T-cell leukemia virus type-1 (HTLV-1).

The structure of the integrated provirus in cell lines established from the cerebrospinal fluid (CSF) of patients with human T-cell leukemia virus type-1 (HTLV-1)-associated myelopathy (HAM) was analyzed. The digestion patterns with 3 restriction endonucleases, Sac I, Eco RI and PstI, of the proviruses integrated in T-lymphoid cell lines derived from the CSF of 4 HAM patients were similar to those of HTLV-1 from adult T-cell leukemia (ATL) patients. Integrated proviruses in one of these cell lines derived from the CSF were further analyzed in detail with 2 more restriction enzymes, BamHI and Sma I. The results indicate that the retrovirus found in lymphocytes of the CSF from patients with HAM are very similar, if not identical, to HTLV-1 found in the leukemic lymphocytes of ATL patients.

Treatment of neurosyphilis with chloramphenicol. A case report.

Although penicillin is the drug of choice in syphilis, treatment failures with benzathine and procaine penicillin have occurred in neurosyphilis. Patients allergic to penicillin have traditionally been treated with tetracycline but, since this drug diffuses poorly into the cerebrospinal fluid, its use in neurosyphilis is uncertain. In the case reported here, a penicillin allergic patient with general paresis of the insane was successfully treated with chloramphenicol. This drug has been used in the treatment of syphilis and achieves high concentrations in the cerebrospinal fluid. Thus chloramphenicol may be a more appropriate agent than tetracycline in treating patients with neurosyphilis who are allergic to penicillin.

[Biological, psychometric and tomodensitometric study of treated neurosyphilis]. / Etude biologique, psychométrique et tomodensitométrique de la neurosyphilis traitée.

Results of follow-up examinations of the CSF in 6 patients with neurosyphilis, including 5 with general paresis, following treatment with high doses of aqueous penicillin G are reported. Persistence of any residual active infection of the nervous system could be eliminated since as well as fairly rapid restoration of normal CSF cytology and chemistry there was a slow reduction (and sometimes return to normal) of initially very high levels of immunoglobulins G, disappearance of their oligoclonal distribution (3 cases), and negativation of quantitative immunofluorescence serology (F.T.A. ABS). Clinical efficacy of treatment was shown by stabilization of the intellectual deficit investigated by serial psychometric tests. Memory disturbances were prominent mainly in the initial stages, and sometimes adopted a rather frontal nature. Psychometric tests can contribute to the assessment of initial extension of the treponemic infection in the aborted types of general paresis. The atrophy observed constantly on CT scans appeared to be stationary on serial examinations (2 cases). It was of a diffuse type affecting cortical sulci and ventricles. The onset of anomalies such as ischemic complications was not related to recurrence of infection.

[Pathomorphosis of progressive paralysis]. / Patomorfoz progressivnogo paralicha.

The author analyses 34 cases of general paresis. All the cases had been verified by laboratory findings. Some peculiarities of the disease manifestation in present-day conditions were discovered. A prolongation of the life-span and the disease incubation period in treated patients, as well as an increase of the disease incidence among women and a rarity of the formerly "classical" expansive form of the disease are noted. Data on the time course of CSF findings are presented.