T cell acute lymphoblastic leukaemia presenting with sudden onset right oculomotor nerve palsy with normal neuroradiography and cerebrospinal fluid studies.

Leptomeningeal disease presenting with neurological dysfunction is not uncommon in leukaemia. However, it is often accompanied by abnormalities in cerebrospinal fluid (CSF) studies and/or neuroradiography. Here, the authors describe a case of a young patient presenting with sudden onset right oculomotor nerve palsy with normal neuroradiography and CSF studies, who was subsequently diagnosed to have T cell acute lymphoblastic leukaemia (T-ALL). This case highlights that neurological manifestations can be the initial presenting feature of T-ALL and can occur suddenly despite normal neuroradiography and initial CSF studies.

Isolated oculomotor nerve palsy as the presenting clinical manifestation of a meningeal carcinomatosis: a case report.

We present a previously unreported case of isolated oculomotor nerve palsy as the inaugural clinical sign of meningeal carcinomatosis (MC). Gadolinium-enhanced magnetic resonance images (MRI) were unremarkable. Cerebrospinal fluid (CSF) analysis showed malignant cells consistent with a pulmonary adenocarcinoma; the chest CT revealed a small pulmonary mass in the upper right lobe. This case highlights the importance of considering MC in all patients who develop sudden oculomotor palsy; lumbar punctures should always be performed on patients with normal MRI when other possible causes of oculomotor palsy have been ruled out.

[Bacterial meningitis as a complication of Fusobacterium necroforum infection in adults]. / Bakterielle Meningitis als Komplikation einer Fusobacterium-necroforum-Sepsis beim Erwachsenen.

Fusobacterium necrophorum, an anaerobic, gram-negative rod, belongs to the physiological flora of the oropharynx. It causes Lemierre's syndrome characterized by oropharyngeal infection, septic thrombophlebitis of the neck, in particular of the internal jugular vein, and metastatic abscesses, predominantly in the lungs. Rarely, and mainly in children, it causes meningitis. Here we report the clinical course of a 25-year-old woman with F. necrophorum meningitis. She presented with incomplete, right third nerve palsy. Within a few days, she developed fever, meningism and progressive reduction of vigilance. Cerebrospinal fluid analysis showed typical signs of bacterial meningitis. After the identification of F. necrophorum, the antibiotic treatment was changed to meropenem, which led to continuous improvement of the clinical symptoms. Due to persistent signs of inflammation in the CSF, metronidazole was added to the antibiotic regime. This case report demonstrates that F. necrophorum should always be considered in the diagnostic workup of bacterial meningitis in adults.

Listeria monocytogenes rhomboencephalitis with cranial-nerve palsies: a case report.

Listeria monocytogenes rhomboencephalitis is an uncommon complication of L. monocytogenes meningitis. It presents in a typical biphasic pattern characterized by a non-specific prodromal period followed by any combination of asymmetrical, cranial-nerve palsies; cerebellar signs; hemiparesis or hypesthesia; and diminished consciousness. The survival rate is greater than 70% when appropriate antibiotic therapy is initiated early. However, approximately 60 percent of the survivors develop neurological sequelae. We present the case of a 33-year-old woman who developed L. monocytogenes meningitis with subsequent rhomboencephalitis and cranial-nerve palsie, and review the literature on this syndrome.

Cranial nerve palsies and cerebral infarction in a young infant with meningococcal meningitis.

A previously healthy 30-day-old male infant became ill with fever, poor activity, and refusal to feed for 2 days. A cerebrospinal fluid examination revealed 7.15 x 10(8) leukocytes/l with 72% neutrophils, protein 4.6g/l, and glucose 7 mg/dl. Neisseria meningitidis was isolated from the blood and cerebrospinal fluid. On the fourth day of hospitalization, the baby was found to have left oculomotor and facial palsies, which resolved gradually. He was treated with intravenous penicillin for 2 weeks. A repeat CSF examination revealed a high persisting protein level of 2.9 g/l and a computerized tomographic brain scan revealed a cerebral infarction in the bilateral frontal lobes. The treatment was extended to 4 weeks. No relapse of the infection was noted. This is the first case report of an infant with meningococcal meningitis complicated by cranial nerve palsies and cerebral infarction. This and previous reports, show that meningococcal meningitis at an extremely young age is associated with a greater risk of developing neurological complications.