- TB Meningitis and TB Peritonitis: Abdominal Pseudocyst and VP-Shunt Link. [Case Reports]
- CRCase Rep Radiol 2019; 2019:4893547
- TB meningitis (TBM) carries high morbidity and mortality and is a relatively common extrapulmonary TB in the third world countries. TBM as thick exudative disease manifests on MRI and CT as nodular b…
TB meningitis (TBM) carries high morbidity and mortality and is a relatively common extrapulmonary TB in the third world countries. TBM as thick exudative disease manifests on MRI and CT as nodular basal leptomeningitis, hydrocephalus, basal infarcts, and tuberculomas. Hydrocephalus is treated with ventriculoperitoneal shunting (VPS). Shunt malfunction and revision are common. We report a case of multidrug-resistant TBM with spinal involvement and dissemination of the disease via VPS causing TB peritonitis (TBP). TBP presented as a large abdominal pseudocyst around the catheter tip with shunt malfunction. There was no evidence for any other site of extra-CNS disease. TBP per se is relatively less common. This is the first case reporting VPS as a means of TB spread.
- Histological and virological findings in severe meningoencephalitis associated with border disease virus in Alpine chamois (Rupicapra rupicapra rupicapra) in Aosta Valley, Italy. [Case Reports]
- OVOpen Vet J 2019; 9(1):81-87
- In 2015, a young female Alpine chamois (Rupicapra rupicapra rupicapra), originated from the Aosta Valley Region, Northernwestern Italy, was conferred to the National Reference Centre for Wild Animal …
In 2015, a young female Alpine chamois (Rupicapra rupicapra rupicapra), originated from the Aosta Valley Region, Northernwestern Italy, was conferred to the National Reference Centre for Wild Animal Diseases for pathologic examinations. Histological analysis revealed a severe meningoencephalitis characterized by lymphocytic and plasmacellular infiltration, gliosis, perivascular cuffs, and leptomeningitis at the level of brain and brain stem. Laboratory investigations included polymerase chain reaction, sequencing and characterization by phylogenetic analysis, and evaluation of the internal ribosome entry site secondary structure in the 5' untranslated region. These tests identified the pathological agent as border disease virus, a known health risk in domestic small ruminants. Genetic characteristics of the isolated strains, closely related to ovine and caprine strain sequences from neighboring regions of Piedmont, France, and Switzerland, suggested geographic segregation and micro-evolutive steps within the species.
- Ruptured cerebral abscess with ventriculitis and leptomeningitis; A rare complication in the setting of metastatic esophageal cancer: Case report and literature review. [Case Reports]
- RCRadiol Case Rep 2019; 14(6):782-785
- Esophageal cancer is one of the deadliest cancers worldwide, and metastatic esophageal carcinoma carries a very poor prognosis. Patients tend to decline rapidly, with an overall 5-year survival rate …
Esophageal cancer is one of the deadliest cancers worldwide, and metastatic esophageal carcinoma carries a very poor prognosis. Patients tend to decline rapidly, with an overall 5-year survival rate less than 20%. Furthermore, understanding the eventual cause of death in patients with esophageal cancer may serve to guide treatment and hopefully improve the patient's quality of life. Less common causes of death in patients with metastatic esophageal cancer have infrequently been described in the literature. Our report outlines a unique case of metastatic esophageal carcinoma, complicated by ruptured intracranial abscess, with subsequent ventriculitis and leptomeningitis.
- A Highly Sensitive Sandwich ELISA to Detect CSF Progranulin: A Potential Biomarker for CNS Disorders. [Journal Article]
- JNJ Neuropathol Exp Neurol 2019 May 01; 78(5):406-415
- Progranulin (PGRN) plays critical roles in inflammation, tumorigenesis, and neurodegeneration. PGRN levels in blood and cerebrospinal fluid (CSF) are being increasingly investigated as potential biom…
Progranulin (PGRN) plays critical roles in inflammation, tumorigenesis, and neurodegeneration. PGRN levels in blood and cerebrospinal fluid (CSF) are being increasingly investigated as potential biomarkers for these disorders. However, the value of CSF PGRN as a biomarker has been limited because currently available commercial enzyme-linked immunosorbent assay (ELISA) kits have suboptimal sensitivity for detecting CSF PGRN. In this study, pairs of monoclonal antibodies (MAbs) were first screened from eleven monoclonal antiPGRN antibodies using indirect ELISA, then a sandwich ELISA was established using the 2 optimized MAbs. This system displayed high sensitivity, with a lower limit of detection of 60.0 pg/mL and a lower limit of quantification of 150 pg/mL. By using this ELISA system, we showed varied CSF PGRN levels in different brain disorders. For example, as compared with the normal controls, patients with Alzheimer disease or multiple sclerosis showed mildly increased CSF PGRN; those with aseptic encephalitis or neuropsychiatric systemic lupus erythematosus showed moderately increased CSF PGRN; those with bacterial leptomeningitis showed severely increased CSF PGRN. Additionally, determining CSF PGRN levels could monitor CNS metastasis and CSF seeding of carcinomas. These results indicate that this system can be valuable in studying the diagnostic and prognostic value of CSF PGRN in brain disorders.
- Magnetic resonance imaging spectrum of intracranial tubercular lesions: one disease, many faces. [Review]
- PJPol J Radiol 2018; 83:e524-e535
- Tuberculosis is a devastating disease and has shown resurgence in recent years with the advent of acquired immunodeficiency syndrome. Central nervous system involvement is the most devastating form o…
Tuberculosis is a devastating disease and has shown resurgence in recent years with the advent of acquired immunodeficiency syndrome. Central nervous system involvement is the most devastating form of the disease, comprising 10% of all tuberculosis cases. The causative organism, Mycobacterium tuberculosis, incites a granulomatous inflammatory response in the brain, the effects of which can be appreciated on magnetic resonance imaging (MRI), which can thus be used for diagnosis of the same. Neurotuberculosis can present in various patterns, which can be identified on MRI. The meningeal forms include leptomeningitis and pachymeningitis. Parenchymal forms of neurotuberculosis include tuberculoma in its various stages, tubercular cerebritis and abscess, tubercular rhombencephalitis, and tubercular encephalopathy. Each pattern has characteristic MRI appearances and differential diagnoses on imaging. Complications of neurotuberculosis, usually of tubercular meningitis, include hydrocephalus, vasculitis, and infarcts as well as cranial nerve palsies. Various MRI sequences besides the conventional ones can provide additional insight into the disease, help in quantifying the disease load, and help in differentiation of neurotuberculosis from conditions with similar imaging appearances and presentations. These can enable accurate and timely diagnosis by the radiologist and early institution of treatment in order to reduce the likelihood of permanent neurological sequelae.
- Pathologic, histochemical, and immunohistochemical findings in pulmonary and encephalitic cryptococcosis in a goat. [Case Reports]
- JVJ Vet Diagn Invest 2019; 31(1):69-73
- We describe the pathologic, histochemical, and immunohistochemical findings associated with pulmonary and encephalitic cryptococcosis in a 3-y-old, mixed-breed, nanny goat from central-west Brazil. T…
We describe the pathologic, histochemical, and immunohistochemical findings associated with pulmonary and encephalitic cryptococcosis in a 3-y-old, mixed-breed, nanny goat from central-west Brazil. The goat had progressive neurologic signs over 30 d; cryptococcosis was diagnosed antemortem by cytologic evaluation of cerebrospinal fluid. Treatment was initiated, but the animal died spontaneously shortly thereafter. Grossly, there was a large space-occupying gelatinous mass (cryptococcoma) in the left lung and smaller masses in the cerebral temporal and frontal cortex, thalamus, hippocampus, basal nuclei, and mesencephalon with consequent internal hydrocephalus. Histologic evaluation revealed marked granulomatous cryptococcal pneumonia and meningoencephalitis. Intralesional narrow-necked budding cryptococcal yeasts were identified on special stains (Mayer mucicarmine and Grocott methenamine silver) in sections of lung and brain. Immunohistochemistry utilizing a panel of monoclonal antibodies that selectively label capsules of Cryptococcus spp. was consistent with C. neoformans var. grubii.
- Chronic and Subacute Meningitis: Differentiating Neoplastic From Non-Neoplastic Etiologies. [Journal Article]
- NNeurohospitalist 2018; 8(4):177-182
- CONCLUSIONS: Chronic and subacute meningitis diagnosis is challenging in daily neurological practice. The results we report contribute information from Latin America regarding etiologies of CSM, which can be identified after a comprehensive evaluation in a majority of cases.
- Rheumatoid leptomeningitis presenting with an acute neuropsychiatric disorder. [Case Reports]
- PNPract Neurol 2019; 19(1):68-71
- Leptomeningitis is a rare central nervous system manifestation of rheumatoid arthritis, generally in patients with established chronic rheumatoid disease. We report a 41-year-old man without previous…
Leptomeningitis is a rare central nervous system manifestation of rheumatoid arthritis, generally in patients with established chronic rheumatoid disease. We report a 41-year-old man without previous rheumatoid arthritis or psychiatric disorder who presented with an acute neuropsychiatric disturbance and polyarthralgia. His MR scan of brain showed asymmetric bifrontal leptomeningitis, confirmed on (18F)-fluoro-D-glucose-positron emission tomography. Other investigations showed highly positive serum and cerebrospinal fluid anti-cyclic citrullinated peptide. A leptomeningeal biopsy showed necrotising leptomeningeal inflammation with ill-defined granulomas and lymphoplasmacytic infiltrate without organisms. Prolonged high-dose corticosteroids and then rituximab resulted in recovery. Chronic leptomeningitis can present with an acute neuropsychiatric disorder. We highlight that early rheumatoid disease can, rarely, cause a chronic leptomeningitis, reversible with immunotherapy.
- Sarcoidosis of the central nervous system: clinical features, imaging, and CSF results. [Journal Article]
- JNJ Neurol 2018; 265(8):1906-1915
- CONCLUSIONS: This prospective study of neurosarcoidosis increases our understanding of the pathophysiology of the disease. A reclassification of the clinical and imaging features of the disease allows an understanding of its pathophysiology and correlation with CSF indices allows an early identification of those with a more destructive disease will help to define treatment and may thereby improve outcome.
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- Carotid arteritis causing amaurosis fugax and ischaemic cerebrovascular events in neurosarcoidosis. [Journal Article]
- CNClin Neurol Neurosurg 2018; 169:103-106
- CONCLUSIONS: The imaging features suggest a granulomatous infiltration of the carotid artery wall leading to arteritis followed by disorganisation of the internal elastic lamina and fibrosis. The data provide further insight into the pathogenesis of neurological impairments in neurosarcoidosis. The MRI features of carotid arteritis in neurosarcoidosis have not previously been demonstrated.