The paper presents imaging studies in eight patients with polymerase chain reaction proven Herpes Simplex encephalitis (HSE). MRI studies in the acute phase of infection have presented both typical and unusual changes. 3-year follow-up results of imaging examinations have also been described. DWI (Diffusion-weighted Imaging) and MR spectroscopy (MRS) values in the course of HSE infection have been shown in addition to conventional MR studies. In the article, particular emphasis is put on the importance of ischemic changes during HSE infection, which have not been widely discussed so far.
Intracerebral abscesses are encapsulated intraparenchymal infections associated with a high mortality rate. These abscesses can be caused by a number of different organisms ranging from bacteria to fungi, parasites, and even malignancies. The most common causative agent depends on pre-disposing risk factors. In this article, we report a case of a brain abscess caused by Kocuria rhizophila, a pathogen that has not been previously reported to cause cerebral intraparenchymal abscesses.
Introduction: Guillain-Barré syndrome (GBS) ranks as the most frequent cause of acute flaccid paralysis in the world. It is an autoimmune polyradiculoneuropathy, usually preceded by an acute infection. Rarely, brucellosis may induce a GBS.Objective: To evaluate the clinical and microbiological diagnostic properties of Brucella-induced GBS.Case Report: A 54-year-old woman, with no past medical history, was followed in infectious disease department. She was diagnosed with brucellosis. She had received antibiotic therapy (Rifampicin 600 mg/day and Doxycycline 200 mg/day). After 4 days of treatment, she was referred to our department because of rapidly progressive, ascending, symmetric weakness and bilateral paralysis of muscles of the face. On admission, she was alert. The deep tendon reflexes (DTRs) were absent in all extremities. Muscle strength was 3/5 in the upper extremities and 2/5 in the lower extremities. Proprioception in the lower extremities was impaired, but she did not have any sensory problems. Our patient also presented a facial diplegia. Physical examination was normal, except for splenomegaly. A lumbar puncture showed an albumin-cytologic dissociation in the CSF. Nerve-conduction studies were suggestive of demyelinating polyradiculoneuropathy. Coombs Wright titration was 1/160..Discussion: With a diagnosis GBS preceded by brucellosis, our patient was given an antibiotic therapy (Rifampicin 600 mg/day and Doxycycline 200 mg/day). During hospitalization, she had four plasma exchange sessions and a motor rehabilitation. In a follow-up after 4 weeks, our patient presented a partial recovery, and she was able to walk without support.Conclusion: This case demonstrates that brucellosis can present with a rare neurologic manifestation including GBS. Molecular mimicry seems to be responsible for this complication, through the synthesis of autoantibodies against myelin gangliosides. Thus, brucellosis should be ruled out in all patients who develop acute flaccid paralysis, especially in those who live in endemic areas.
We report a case of tetanus presenting as the facial dystonia and hemiparesis with complete recovery and video accompanied follow-up. A 78-year-old male, who sustained an abrasion to his right forearm, presented with dysarthria, dysphagia, prominent involuntary painful muscle spasms in the face, blepharospasm, risus sardonicus, trismus (lockjaw), neck muscle rigidity and mild weakness of the distal right upper extremity. The combined treatment of human antitetanus immunoglobulin, tetanus vaccine, penicillin, metronidazole and diazepam were given with no effect. He continued to worsen and due to the risk of the respiratory failure (finally not developed) he was sent to the Intensive Care Unit. The combined treatment was continued, and his symptoms started to improve within 2 weeks. As the muscle rigidity has been improving, the patient developed significant right hemiparesis. The imaging of the brain and cervical spine found no significant pathology. At the follow-up visits the patient presented only slightly impaired dexterity of the right hand that gradually resolved. There are many reports of unusual presentations of tetanus, however, hemiparesis is uncommon, and to our knowledge, only one case was reported in the literature. We highlight the variability of clinical presentation of tetanus, the need to consider tetanus in cases of rapidly evolving muscle spasms following peripheral injuries and provide the guidelines on tetanus prophylaxis.
Base of skull osteomyelitis is a rare cause of headaches and cranial neuropathies in general, and cranial nerve VII palsy in particular. Both typical and atypical skull base osteomyelitis can have similar presentation and Magnetic Resonance Imaging of the brain is very important to differentiate between them since each is caused by a different organism and requires different treatment. However, bone sampling remains crucial for diagnosis in atypical cases. We hereby report a case of atypical skull base osteomyelitis presenting as bilateral peripheral facial nerve palsy. We also present a new and less invasive diagnostic and therapeutic approach especially when bone sampling is not possible and intravenous empiric treatment cannot be initiated.
OBJECTIVE:Mitochondrial dysfunction is known to be implicated in stroke, but the complex mechanisms of stroke have led to few stroke therapies. The present study to disrupted mitochondrial oxidative phosphorylation through a known electron transport chain (ETC) uncoupler, Carbonyl cyanide-4 (trifluoromethoxy) phenylhydrazone (FCCP). Analyzing the resulting neurological deficits as well as infarct volume could help determine the role of mitochondria in stroke outcome and determine whether uncoupling the ETC could potentially be a strategy for new stroke therapies. The objective of this study was to determine the effects of uncoupling electron flow on mitochondrial oxidative phosphorylation and stroke infarction.METHODS:Cerebral endovascular cells (CECs) were treated with various concentrations of FCCP, and bioenergetics were measured. For the stroke mouse model, FCCP (1 mg/kg, i.p) or vehicle was administered followed by 1-hour transient middle cerebral artery occlusion (tMCAO). Infarct volume was measured after a 23-hour reperfusion, and triphenyl tetrazolium chloride (TTC) staining was used to assess infarct volume.RESULTS:FCCP significantly decreased basal respiration, ATP turnover, maximal respiration, and spare capacity when the concentration of FCCP was greater than 1000 nM. The mice pretreated with FCCP had a significantly increased infarct volume within the cortex, striatum, and total hemisphere. Mice receiving FCCP had a significantly increased neurological deficit score compared to the vehicle.CONCLUSIONS:FCCP compromised mitochondrial oxidative phosphorylation in CECs in a dose-dependent manner. Uncoupling the electron transport chain with FCCP prior to tMCAO exacerbated stroke infarction in mice.
Neurocysticercosis is an infection of the central nervous system caused by the larval form of the tapeworm, Taenia solium. It is an endemic disease, especially in developing countries of sub-Saharan Africa, Asia and Latin America. The flow of travelers and immigrants from these places to the developed countries has contributed to increase the prevalence also in Europe and North America. It is known that in addition to genetic and structural causes, infectious and inflammatory causes can also be common causes of epilepsy. Some studies points neurocysticercosis as one of the leading causes of epilepsy in the world. The objective of this review is to highlight the main epidemiological, pathophysiological and clinical aspects that correlate neurocysticercosis with epilepsy.
In this histopathological study, we have identified beta amyloid (Aβ) intracellularly in hippocampal specimens of Alzheimer’s disease (AD) patients. This is a continuation of the same histopathological project in which we observed biofilms intracellularly in the same neuronal cells in the same brain samples. To demonstrate that these were intracellular biofilms, we utilized the same techniques that showed biofilms in senile plaques in AD, in occluded eccrine ducts in atopic dermatitis, and in tonsils of psoriasis patients. Lyme spirochetes have recently been cultured from AD brains, and those same cultivated organisms have been shown in vitro to make biofilms, beta amyloid precursor protein (AβPP), and Aβ. We believe these spirochetes (and others) make the in vivo biofilms, and we believe our finding of intracellular Aβ helps confirm the in vitro observations. The Aβ, in turn, has previously been shown to stimulate the production and accumulation of hyperphosphorylated tau protein which has been shown to result in axonal and dendritic disintegration. With neuronal cell deterioration, the biofilms, AβPP, Aβ, and neurofibrillary tangles that were once inside are now present outside the cells. Once in the tissue, biofilms lead to upregulation of Toll-like receptor 2 (TLR2) which by known pathways leads to further production of Aβ. Thus, the Aβ can be derived from two sources: one is the spirochetes themselves and the other is from the activation of the innate immune system. The two major components of AD (tau protein and Aβ) have consequently been shown to be created by the pathogenic spirochetes. The spirochetes themselves have been shown to be of Lyme disease and dental origin.
Nodding syndrome represents a complex encephalopathy in previously healthy children and adolescents that occurs in hot spots of South Sudan, northern Uganda and southern Tanzania. The core feature of this neurological disorder is a repetitive forward bobbing of the head towards the chin of a variable length of time associated with other features such generalized epileptic seizures, psychiatric symptoms/signs, stunted growth, wasting and reduced sexual development, among others. The etiology of this neuropediatric disorder so far has remained obscure, but there seems to be some evidence in support of a post-measles disorder as well as an involvement of the parasite Onchocerca volvulus which can cause skin and eye disease (river blindness). While discussing potential etiology and pathogenesis of nodding syndrome, we also explore reasons while funding for research on nodding syndrome has been so scarce and compare it to other similarly neglected diseases. Furthermore, we discuss the inclusion of nodding syndrome in the WHO list of neglected tropical diseases with the aim of creating a disease specific lobby, thereby supporting financing and collaboration on research and development for nodding syndrome. In the last paragraph we examine a global health approach to nodding syndrome via the sustainable development goals and conclude that by investing in some of the goals concerning health, poverty alleviation and quality education, among others, individuals suffering from nodding syndrome and their families may derive clear benefits which eventually can lead to an overall reduction in morbidity and mortality. However, other diseases will also benefit from employment of the sustainable development goals and therefore awareness of nodding syndrome needs to be raised, so that it will not be forgotten.
CNS Melioidosis is rare and presents as an abscess secondary to haematogenous spread from the lungs. The presentation is typical for a brain abscess and the treatment is surgical excision followed by medical therapy. Prognosis depends greatly on the susceptibility of the bacteria to multimodal chemotherapy, recurrence thus being a major cause of morbidity. The incidence is now much worse since the global explosion of HIV/AIDS where immunosuppression leads to atypical and aggressive presentations. We present two atypical presentations, which required a high index of suspicion along with a multidisciplinary team approach to ensure appropriate treatment and good results. The write up highlights the complexities of presentation, operative dilemmas and eventual course of treatment in a tertiary care centre in south India.
Post-surgical site infections lead to significant morbidity and mortality, as well as significant healthcare costs. Despite intravenous prophylactic antibiotic measures, the rates of surgical site infections, especially those from skin pathogens, have been reported to be up to 15% in individuals undergoing spinal surgery. Thus, the use of vancomycin powder has gained significant popularity in the last few years.
Acute disseminated encephalomyelitis (ADEM) is an acute disorder of the central nervous system that follows an infection or vaccination. It is a non-vasculitic inflammatory condition resulting in perivascular edema, inflammation, and demyelination that bears resemblance to multiple sclerosis. The diagnosis of ADEM can be challenging since there is a wide set of alternative diagnoses, including opportunistic infections, vasculitis, and central nervous system lymphoma.
It is known that mumps is an acute and highly contagious systemic viral infection that occurs in childhood, the hallmark of which is parotid gland swelling. Although mumps infection in the central nervous system (CNS) is uncommon among adults in association with vaccinations generally administered in developed countries, CNS involvement can occur without parotitis. Here, we report such a case of severe meningitis due to reinfection by the mumps virus. Based on our findings, we propose that mumps meningitis can mimic tuberculous meningitis in regard to clinical symptoms and course, as well as laboratory test results of cerebrospinal fluid. Follow-up investigations that include key cytokines such as IL-6, IFN-γ, and TNF-β in the CSF are important for differential diagnosis.
The liver fluke infestation caused by Opisthorchis viverrini , infection is very common in tropical Southeast Asia. This infection can cause chronic liver problem and can induced the carcinogenesis at hepatobiliary system.
Background: Chikungunya is an infection caused by an RNA-virus and transmitted from primates to humans by Aedes aegypti and Aedes albopictus mosquitoes. Usually, it causes fever, widespread exanthema, myalgia and severe diffuse joints pain but may present several complications, such as neurological manifestations. Case presentation: We describe a case of a 38-year-old man with diagnostic confirmation of chikungunya virus infection based on the clinical manifestations of the disease and positivity of the serological tests. He has evolved with peripheral mononeuropathy confirmed by clinical examination and electroneuromyography. Conclusion: Peripheral neuropathy may be a neurological complication of CHIKV infection and to the best of our knowledge this is the first Brazilian case of peripheral mononeuropathy secondary to CHIKV infection.
Rabies in man and animals has been discussed since centuries but still remains one of the neglected zoonotic diseases across the globe. Dogs being reservoir host, bite from an unknown dog and death of the bitten man or animal or of the dog that bit, within a span of ten days to three months, leave a suspicion of rabies especially in endemic areas like India. Though there are strict measures to control rabies by vaccination programmes, abundance of stray dogs makes it difficult to contain the disease. So, choosing the best diagnostic procedure is highly significant.
Varicella zoster virus is an exclusively human double-stranded DNA virus that is the causative factor for two ubiquitous conditions: varicella in children and zoster in adults. Both conditions are associated with neurological complications. Centripetal trans-axonal spread via cranial nerve ganglia appears to afford entry into the central nervous system. There is increasing evidence of varicella zoster virus playing a role in the development of giant cell arteritis. First associated with transient ischemic attacks and ischemic strokes, vasculopathy secondary to varicella zoster virus infections has now been associated with aneurysms that may or may not lead to subarachnoid hemorrhage, multifocal vasculitis, arterial dissection, dolicoectasia, cortical venous sinus thrombosis, ischemic cranial neuropathies and spinal cord infarction. Prior knowledge of the myriad clinical manifestations helps in early diagnosis and treatment of the complications.
Objectives: Syphilis is still a public health problem in the world. Israel is a country with high immigration rates, some of the new immigrants coming from countries with a high prevalence of syphilis. Patients: We want to report a series of 7 patients admitted to the neurology ward at the Kaplan Medical Center in Rechovot, Israel with acute strokes which ultimately were attributed to meningo-vascular syphilis. Methods: Retrospective observational study. Results: Six patients are presented with acute ischemic stroke and 1 with intra parenchymal hematoma. There were 6 male patients and one female. The mean age of the patients was younger than that of stroke patients in Israel. There were 6 patients of Ethiopian origin and one born in Israel. All the patients had positive VDRL and TPHA serology in the blood and all the patients that had LP performed had positive syphilis ELISA in the liver. Conclusion: Neurosyphilis should be considered among patients with stroke and the presence of more “traditional” cardiovascular risk factors should not prevent us from considering it.
