Unusual case of tuberculous meningitis with discordant ventricular and lumbar cerebrospinal fluid; lessons in the era of world-wide migration

2017 ◽  
Vol 54 (1) ◽  
pp. 93-95
Author(s):  
Mirvat Said ◽  
Preena Uppal ◽  
Annie Bye ◽  
Pamela Palasanthiran
Keyword(s):  
Cerebrospinal Fluid ◽  
Tuberculous Meningitis ◽  
World Wide ◽  
Unusual Case ◽  
Lumbar Cerebrospinal Fluid

Lumbar Cerebrospinal Fluid Evolution in Childhood Tuberculous Meningitis

2018 ◽  
Vol 33 (11) ◽  
pp. 700-707 ◽  
Author(s):  
Madelein Grobbelaar ◽  
Ronald van Toorn ◽  
Regan Solomons
Keyword(s):  
South Africa ◽  
Cerebrospinal Fluid ◽  
Early Diagnosis ◽  
Tuberculous Meningitis ◽  
Protein Concentration ◽  
Initial Increase ◽  
Gradual Decline ◽  
Lumbar Cerebrospinal Fluid ◽  
Normal Variability ◽  
Fluid Parameters

As early diagnosis of childhood tuberculous meningitis cannot rely on mycobacterial confirmation, clinical, cerebrospinal fluid and neuroimaging features are essential. We aimed to describe the evolution of serially analyzed lumbar cerebrospinal fluid parameters. We performed a retrospective observational study including children <13 years with suspected tuberculous meningitis at Tygerberg Hospital, Cape Town, South Africa. Cerebrospinal fluid parameters at admission and weeks 1, 2, and 3 were analyzed. Of 318 children with suspected tuberculous meningitis, 53 (17%) had “definite” tuberculous meningitis and 265 (83%) “probable” tuberculous meningitis. Longitudinal clustering revealed 3 distinct profiles, with 1 group atypically demonstrating initial increase in lymphocyte count, neutrophil count, and protein concentration. The decreasing cerebrospinal fluid glucose trend remained uniform among all groups. A gradual decline in cerebrospinal fluid lymphocyte, neutrophil and protein count, and rise in cerebrospinal fluid glucose concentration is expected; however, normal variability exists.

scholarly journals cerebrospinal fluid Gene XPERT (CBNAAT) in children with tuberculous meningitis

2021 ◽  
pp. 100255
Author(s):  
Annapurna Rai ◽  
Rajniti Prasad ◽  
B.K. Das ◽  
Shampa Anupurba ◽  
Utpal Kant Singh
Keyword(s):  
Cerebrospinal Fluid ◽  
Tuberculous Meningitis

Unusual Transoral Penetrating Injury of the Foramen Magnum: Case Report

Neurosurgery ◽  
2003 ◽  
Vol 53 (4) ◽  
pp. 989-991 ◽  
Author(s):  
Bradley J. Bartholomew ◽  
Charla Poole ◽  
Emilio C. Tayag
Keyword(s):  
Cerebrospinal Fluid ◽  
Unusual Case ◽  
Spinal Injury ◽  
Foramen Magnum ◽  
Penetrating Injuries ◽  
Computed Tomographic ◽  
Foreign Objects ◽  
Computed Tomographic Scan ◽  
Posterior Pharynx ◽  
The Right

Abstract OBJECTIVE AND IMPORTANCE Penetrating injuries of the cranium and spine are frequent to the civilian neurosurgical practice. Although a variety of unusual objects have been reported, to our knowledge, there has never been a craniocerebral or spinal injury caused by a fish. An unusual case of transoral penetration of the foramen magnum by a billed fish is described. The history, radiographic studies, and treatment are presented. CLINICAL PRESENTATION A fisherman struck by a jumping fish initially presented with severe neck pain and stiffness, bleeding from the mouth, and a laceration in the right posterior pharynx. A computed tomographic scan of the cervical spine revealed a wedge-shaped, hyperdense object extending from the posterior pharynx into the spinal canal between the atlas and the occiput. Because of the time factor involved, the fisherman was brought directly to surgery for transoral removal of the object. INTERVENTION The patient was placed under general anesthesia, and with a tonsillar retractor, a kipner, and hand-held retractors, the object was visualized and identified as a fish bill. Further dissection above the anterior aspect of the atlas permitted removal of the object by means of a grabber from an arthroscopic set. No expression of cerebrospinal fluid was noted, and a Penrose drain was placed. CONCLUSION The patient was treated under the assumption that penetrating foreign objects in continuity with the cerebrospinal fluid space and the outside environment should be removed as soon as possible. The patient was provided appropriate antibiotics to treat potential infection of normal pharyngeal flora and organisms unique to the marine environment. The patient recovered and did not experience any residual neurological deficit.

Lumbar Cerebrospinal Fluid Opening Pressure Measured in a Flexed Lateral Decubitus Position in Children

PEDIATRICS ◽  
1994 ◽  
Vol 93 (4) ◽  
pp. 622-623
Author(s):  
Robert Ellis
Keyword(s):  
Cerebrospinal Fluid ◽  
Intrathecal Chemotherapy ◽  
Lateral Decubitus Position ◽  
Normal Range ◽  
Opening Pressure ◽  
Csf Pressure ◽  
Normal Ranges ◽  
Extended Position ◽  
Lateral Decubitus ◽  
Lumbar Cerebrospinal Fluid

Objective. Lumbar punctures in children are generally performed in a flexed position. Published normal ranges for cerebrospinal fluid (CSF) opening pressure require measurement in an extended position, and flexion is known to increase lumbar CSF pressure. This study sought to determine a normal range (mean ± 2 SD) for lumbar CSF opening pressure measured in a flexed lateral decubitus position in children. Methods. Opening pressure was measured in 33 children receiving diagnostic lumbar punctures or prophylactic intrathecal chemotherapy. Measurements were performed in a flexed lateral decubitus position. Patients with medical conditions affecting CSF pressure were excluded. Results. Opening pressure (mean ± SD) was 19.0 ± 4.4 cm H2O. Opening pressure was not significantly affected by patient age or sex. Intrathecal chemotherapy and sedation also did not affect CSF pressure. Conclusions. The normal range for lumbar CSF opening pressure measured in a flexed lateral decubitus position in children is 10 to 28 cm H2O.

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