scholarly journals Leptomeningeal Carcinomatosis Secondary to Gastroesophageal Adenocarcinoma: A Case Report and Review of the Literature

2002 ◽  
Vol 16 (11) ◽  
pp. 807-811 ◽  
Author(s):  
Ayman A Abdo ◽  
Sylvain Coderre ◽  
Ronald J Bridges
Keyword(s):  
Computed Tomography ◽  
Cerebrospinal Fluid ◽  
English Literature ◽  
Gastroesophageal Junction ◽  
Leptomeningeal Carcinomatosis ◽  
Neurological Deficits ◽  
Solid Organ ◽  
Meningeal Enhancement ◽  
Altered Level ◽  
Level Of Consciousness

BACKGROUND: Leptomeningeal carcinomatosis (LC) is a rare metastatic complication of solid tumours. It has been mainly described in association with breast cancer, lung cancer and melanoma.CASE PRESENTATION: A patient presenting with progressive solid food dysphagia with documented adenocarcinoma of the lower esophagus and gastroesophageal junction is reported. One month after the initial diagnosis, the patient developed gradual onset of increasing headache and progressive decrease in the level of consciousness. Computed tomography of the head showed evidence of meningeal enhancement, and cerebrospinal fluid examination showed the presence of adenocarcinoma cells, making the diagnosis of LC. The patient died one month after LC was diagnosed.DISCUSSION: LC is a poor prognostic sign in solid organ malignancies. It usually presents with headache, altered level of consciousness and focal neurological deficits. Diagnosis is established by finding malignant cells in the cerebrospinal fluid and supported by marked meningeal enhancement on computed tomography of the brain. A review of the English literature found only three reported cases of LC secondary to esophageal malignancy.CONCLUSION: A case of LC complicating esophageal and gastroesophageal junction malignancy is described. A high index of suspicion and early diagnosis may influence the poor outcome of these patients.

scholarly journals Sudden ‘Stroke-Like’ Onset of Hemiparesis Due to Herpetic Encephalitis

1995 ◽  
Vol 22 (4) ◽  
pp. 320-321 ◽  
Author(s):  
Mohammad AbdulJabbar ◽  
Ibrahim Ghozi ◽  
Anwar Haq ◽  
Hanz Korner
Keyword(s):  
Herpes Simplex ◽  
Young Patients ◽  
Acute Onset ◽  
Neurological Deficits ◽  
Type I ◽  
Focal Neurological Deficit ◽  
Altered Level ◽  
Level Of Consciousness ◽  
Herpetic Encephalitis ◽  
Magnetic Resonance Imaging Mri

AbstractBackground/ObjectiveHerpes simplex encephalitis usually has a progressive cause. Sudden neurological deficits are unusual.MethodCase study.ResultsA 17-year-old girl presented with an acute onset focal neurological deficit followed one week later by the more classical feature of altered level of consciousness, fever and focal seizures. The diagnosis of hepetic encephalitis was made by magnetic resonance imaging (MRI) and by the significant increase in cerebrospinal fluid titres of antibodies against herpes simplex type I.ConclusionHerpetic encephalitis should be considered in the differential diagnosis of acute stroke in young patients even in the absence of encephalitic features, if common etiological factors such as embolization and intracerebral bleed are excluded.

Clinico-Pathological Profiles and Outcomes of Acute Viral Encephalitis in Children

2020 ◽  
Vol 7 (1) ◽  
pp. 8-11
Author(s):  
Sarjina Anwar ◽  
Nazma Begum ◽  
Soofia Khatoon ◽  
Rafia Rashid
Keyword(s):  
Cerebrospinal Fluid ◽  
Herpes Simplex ◽  
Medical College Hospital ◽  
College Hospital ◽  
Altered Level ◽  
Medical College ◽  
Cranial Nerve Palsies ◽  
Level Of Consciousness ◽  
Normal Colour ◽  
Simplex Virus

Background: Encephalitis is an acute inflammatory process that affects brain tissue and is almost always accompanied by inflammation of the adjacent meninges. The disease is most commonly caused by viral infection. Objective: The purpose of the present study was to determine the clinical and cerebrospinal fluid profile of childhood encephalitis and to document Herpes simplex antibody status in cerebrospinal fluid. Methodology: This descriptive analytical study was conducted in Department of Paediatrics of Shaheed Suhrawardy Medical College Hospital and Dhaka Medical College Hospital from May 2011 to October 2011. A total of 30 children of encephalitis were included in this study. Cerebrospinal fluid (CSF) routine and Herpes Simplex virus (HSV) antibody in CSF were done to all patient. Result: Fever and convulsion was found in 29(96.7%) and 28(93.3%) cases respectively in studied patients. Altered level of consciousness was present in 29(96.7%) cases. Fever, convulsion and altered level of consciousness was statistically significant (p<0.05). Glasgow coma scale (GCS) between 4 to 8 was found in 27 (90%) cases. Signs of meningeal irritation and cranial nerve palsies was found in 9 (30%) and 4 (13.3%) cases respectively. Exaggerated deep reflex was found in 23 (76.6%) cases whereas diminished deep reflex was found in 7 (23.3 %) cases. In cytological study of CSF, lymphocyte was found in 28 (93.3%) patients. Raised protein was found in 16(53.3%) and normal in 14 (46.7%) cases. Among the 30 studied cases 9(30%) cases were IgG positive for HSV, 21 (70.0%) were IgG negative and none were IgM positive. Conclusion: Fever, convulsion, altered sensorium and low GCS were common clinical profile in children. Normal colour, increase lymphocyte count, normal sugar level were significant findings in CSF study. Bangladesh Journal of Infectious Diseases 2020;7(1):8-11

Diagnosis of cerebral hemorrhage before the era of computed tomography

2013 ◽  
Vol 154 (44) ◽  
pp. 1743-1746
Author(s):  
Gergely Hofgárt ◽  
Rita Szepesi ◽  
Bertalan Vámosi ◽  
László Csiba
Keyword(s):  
Computed Tomography ◽  
Cerebrospinal Fluid ◽  
Positive Predictive Value ◽  
Predictive Value ◽  
Hemorrhagic Stroke ◽  
Cranial Computed Tomography ◽  
Cerebral Stroke ◽  
Daily Routine ◽  
Stroke Patients ◽  
The Difference

Introduction: During the past decades there has been a great progress in neuroimaging methods. Cranial computed tomography is part of the daily routine now and its use allows a fast diagnosis of parenchymal hemorrhage. However, before the availability of computed tomography the differentiation between ischemic and hemorrhagic stroke was based on patient history, physical examination, percutan angiography and cerebrospinal fluid sampling, and the clinical utility could be evaluated by autopsy of deceased patients. Aim: The authors explored the diagnostic performance of cerebrospinal fluid examination for the diagnosis of ischemic and hemorrhagic stroke. Method: Data of 200 deceased stroke patients were retrospectively evaluated. All patients had liquor sampling at admission and all of them had brain autopsy. Results: Bloody or yellowish cerebrospinal fluid at admission had a positive predictive value of 87.5% for hemorrhagic stroke confirmed by autopsy, while clear cerebrospinal fluid had positive predictive value of 90.7% for ischemic stroke. Patients who had clear liquor, but autopsy revealed hemorrhagic stroke had higher protein level in the cerebrospinal fluid, but the difference was not statistically significant (p = 0.09). Conclusions: The results confirm the importance of pathological evaluation of the brain in cases deceased from cerebral stroke. With this article the authors wanted to salute for those who contributed to the development of the Hungarian neuropathology. In this year we remember the 110th anniversary of the birth, and the 60th anniversary of the death of professor Kálmán Sántha. Professor László Molnár would be 90 years old in 2013. Orv. Hetil., 154 (44), 1743–1746.

Evaluation of structural variations in the pituitary gland, hormonal status and laboratory markers of the central nervous system functioning in patients with chronic disorders of consciousness

2021 ◽  
Vol 70 (5) ◽  
pp. 23-36
Author(s):  
Ekaterina A. Kondratyeva ◽  
Alina O. Ivanova ◽  
Maria I. Yarmolinskaya ◽  
Elena G. Potyomkina ◽  
Natalya V. Dryagina ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Blood Serum ◽  
Minimally Conscious State ◽  
Conscious State ◽  
Disorders Of Consciousness ◽  
Unresponsive Wakefulness Syndrome ◽  
Level Of Consciousness ◽  
Chronic Disorders ◽  
Minimally Conscious ◽  
Chronic Disorders Of Consciousness

BACKGROUND: Consciousness is the state of being awake and aware of oneself and the environment. The disorders of consciousness result from pathologies that impair awareness. The development of effective comprehensive personalized interventions contributing to the recovery of consciousness in patients with chronic disorders of consciousness is one of the most pressing and challenging tasks in modern rehabilitation. AIM: The aim of this study was to understand structural problems of the pituitary gland, blood levels of gonadotropins and melatonin as well as brain damage markers in the blood and cerebrospinal fluid in patients with chronic disorders of consciousness and to analyze the levels of the above markers among different groups of patients depending on the level of impaired consciousness. MATERIALS AND METHODS: We examined 61 chronic disorders of consciousness patients and identified three groups depending on the level of consciousness including 24 patients with unresponsive wakefulness syndrome, 24 patients with a minus minimally conscious state, and 13 patients with minimally conscious state plus. We performed magnetic resonance imaging of chiasmatic-sellar region and determined blood serum levels of follicle-stimulating and luteinizing hormones and melatonin, as well as urinary level of 6-sulfatoxymelatonin and the content of brain derived neurotrophic factor (BDNF), apoptosis antigen (APO-1), FasL, glutamate, and S100 protein in the blood serum and cerebrospinal fluid. RESULTS: The patients were examined in the age ranging from 15 to 61 years old. Patient groups were homogeneous by the level of consciousness in terms of age and duration of chronic disorders of consciousness by the time of examination. The patients did not differ in the pituitary volume regardless of the level of consciousness. No significant differences were found between the groups with different levels of consciousness when studying the levels of melatonin in the blood serum and its metabolite in the urine. A peak in melatonin secretion was detected at 3 a.m. in 54.5 % of the patients, which can be considered as a favorable prognostic marker for further recovery of consciousness. Hypogonadotropic ovarian failure was found in 34 % of the patients, with normogonadotropic ovarian failure in the remaining patients. Serum APO-1 and BDNF levels were significantly higher in patients with minimally conscious state relative to those with unresponsive wakefulness syndrome. Significantly lower levels of glutamate in the cerebrospinal fluid were detected in women with unresponsive wakefulness syndrome compared to patients with minimally conscious state. CONCLUSIONS: Further in-depth examination and accumulation of data on patients with chronic disorders of consciousness may provide an opportunity to identify highly informative markers for predicting outcomes and to develop new effective approaches to rehabilitation of consciousness in this category of patients.

Direct ophthalmoscopy for the acute physicia – papilloedema and other abnormalities of the optic nerve head

2002 ◽  
Vol 1 (2) ◽  
pp. 60-63
Author(s):  
B Edmunds ◽  
◽  
P J Francis ◽  
Keyword(s):  
Optic Nerve ◽  
Optic Nerve Head ◽  
Visual Disturbance ◽  
Medical Setting ◽  
Altered Level ◽  
Level Of Consciousness ◽  
Systemic Disorder ◽  
Systemic Examination ◽  
Direct Ophthalmoscopy

Direct ophthalmoscopy is an essential part of the full systemic examination. However, the technique is challenging and time-consuming. In the acute medical setting therefore, it is advisable for the physician to identify the subgroup of patients in whom examination of the fundus is most likely to be helpful. Ophthalmoscopy should be performed where papilloedema is suspected, in those with an altered level of consciousness or other focal neurology, those with an unknown systemic disorder, and those complaining of visual disturbance.

scholarly journals Subclinical rhythmic electrographic discharge in adults: an atypical evolution

1995 ◽  
Vol 53 (2) ◽  
pp. 266-269 ◽  
Author(s):  
Délrio F. Silva ◽  
Edmar Zanoteli ◽  
Márcia Marques Lima ◽  
Renato Anghinah ◽  
José Geraldo C. Lima
Keyword(s):  
Computed Tomography ◽  
Cerebrospinal Fluid ◽  
Transient Ischemic Attack ◽  
Computed Tomography Scan ◽  
Ischemic Attack ◽  
Tomography Scan

The subclinical rhythmic electrographic discharge in adults (SREDA) has been rarely reported. We describe the case of a 71 year-old man with transient ischemic attack, whose EEG showed an atypical evolution of this uncommon pattern. The computed tomography scan and cerebrospinal fluid were normal. We are not aware of any other report in the literature with this atypical evolution of SREDA.

scholarly journals Altered Mental Status and Cyanosis in a Pediatric Patient with Methemoglobinemia

2020 ◽  
Vol 2020 ◽  
pp. 1-4
Author(s):  
Phillip M. Grenz ◽  
Robert N. Ray Jr. ◽  
Olivia A. Hardy ◽  
Andrew L. Koons ◽  
Kenneth D. Katz ◽  
...  
Keyword(s):  
Mental Status ◽  
Clinical Manifestations ◽  
Altered Mental Status ◽  
Pediatric Emergency ◽  
Abrupt Onset ◽  
Altered Level ◽  
Sustained Improvement ◽  
Oxygen Dissociation ◽  
Nail Polish ◽  
Level Of Consciousness

Methemoglobinemia results from increased amounts of oxidized hemoglobin in the blood with an ensuing change in oxygen dissociation curve and lack of oxygen delivery to tissue. A previously well, male toddler was brought to the Pediatric Emergency Department (PED) by Emergency Medical Services (EMS) with abrupt onset of altered mental status and cyanosis after a suspected ingestion of “Rush” nail polish remover. He was quickly diagnosed with methemoglobinemia by both clinical presentation and chocolate-colored blood appearance. He emergently received intravenous (IV) methylene blue (MB) with immediate and sustained improvement requiring no further doses. Though inhalation of nitrites and subsequent methemoglobinemia is frequently reported in adolescents, we were unable to find any cases in the literature detailing ingestion of this product and the resulting clinical manifestations. Our objective with this report is to describe a rare case of a toddler with an accidental ingestion of “Rush” nail polish remover, a nitrite compound. Our patient presented to the PED with abrupt onset of altered level of consciousness, hypotension, and cyanosis resulting from acquired methemoglobinemia. This case report demonstrates the importance of emergency clinicians being able to make clinical judgements and decisions based on the history and physical exam when methemoglobinemia is suspected.

scholarly journals Ventricle Boundary in CT: Partial Volume Effect and Local Thresholds

2010 ◽  
Vol 2010 ◽  
pp. 1-6 ◽  
Author(s):  
Ihar Volkau ◽  
Fiftarina Puspitasari ◽  
Wieslaw L. Nowinski
Keyword(s):  
Computed Tomography ◽  
Cerebrospinal Fluid ◽  
Grey Matter ◽  
Ground Truth ◽  
Gaussian Mixture ◽  
Volume Effect ◽  
Partial Volume Effect ◽  
Partial Volume ◽  
Image Histogram ◽  
Global Threshold

We present a mathematical frame to carry out segmentation of cerebrospinal fluid (CSF) of ventricular region in computed tomography (CT) images in the presence of partial volume effect (PVE). First, the image histogram is fitted using the Gaussian mixture model (GMM). Analyzing the GMM, we find global threshold based on parameters of distributions for CSF, and for the combined white and grey matter (WGM). The parameters of distribution of PVE pixels on the boundary of ventricles are estimated by using a convolution operator. These parameters are used to calculate local thresholds for boundary pixels by the analysis of contribution of the neighbor pixels intensities into a PVE pixel. The method works even in the case of an almost unimodal histogram; it can be useful to analyze the parameters of PVE in the ground truth provided by the expert.

Comparison of cerebrospinal fluid dynamics studied by computed tomography (CT) and radioisotope (RI) Cisternography

1978 ◽  
Vol 16 (1) ◽  
pp. 193-198 ◽  
Author(s):  
N. Tamaki ◽  
Y. Kanazawa ◽  
M. Asada ◽  
T. Kusunoki ◽  
S. Matsumoto
Keyword(s):  
Fluid Dynamics ◽  
Computed Tomography ◽  
Cerebrospinal Fluid ◽  
Cerebrospinal Fluid Dynamics
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