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PubMedDate not supplied

[A study of the incidence and a descriptive analysis of adult non-tuberculous primary bacterial meningitis in a population in Argentina].

INTRODUCTION: Adult non tuberculous primary bacterial meningitis (PBM) represents an important cause of morbidity and mortality in hospitals. The shortage of studies based on the population in Latin America provided the motivation for this work. AIMS: To determine the incidence of PBM in the captive population of our hospital and carry out a descriptive analysis of the cases detected. PATIENTS AND METHODS: We performed an epidemiological study of the captive population (CP) of the hospital (an average of 85,200 patients in 11 years) and a retrospective descriptive examination of patients who had been admitted. The clinical histories of all patients over the age of 18 who had been admitted with PBM between 1 January 1988 and 31 December 1998 were studied. RESULTS AND CONCLUSIONS: A total number of 87 cases of primary bacterial meningitis were registered, of which 70 belonged to the CP. The overall gross rate of PBM incidence in the CP was 8.6/100,000 per year. The annual incidence rate, adjusted to the 1991 National Census on the Argentinean Population, was 5.4/100,000 per year, with a greater frequency between the ages of 70 and 79: 21/100,000 per year. Median age: 73 (lower quartile, 66; upper quartile, 78). Clinical manifestations included high temperatures (90%), consciousness disorders (87%), and a stiff neck (81%). The frequency with which it appeared remained constant over the 11 year period, without showing any seasonal variations. The most frequent etiological agent was pneumococcus (50%). No cases of PBM by Listeria were reported. Overall fatality during the stay in hospital was 23%, without any type of modification over the period we studied.

Adult↗
PubMed2002

[Hashimoto's encephalopathy--case report and diagnostic issues in Japan].

We report a patient with Hashimoto's encephalopathy who showed remission and exacerbation 2 times, with a review of previously reported patients in Japan. A 54-year-old woman was admitted to our hospital for various symptoms, such as tremors of the bilateral upper limbs, psychiatric symptoms, consciousness disorder, and convulsion. Steroid pulse therapy and the subsequent oral maintenance therapy resulted in remission. There was no relapse. The patient was positive for anti-thyroid antibody. Electroencephalography showed diffuse slow waves. The responsiveness to steroids suggested Hashimoto's encephalopathy. According to previous studies, clinical symptoms, magnetic resonance imaging (MRI) findings, and the responsiveness to steroids are similar among steroid-reactive encephalopathy, non-herpetic limbic encephalitis, and Hashimoto's encephalopathy. Anti-thyroid antibody levels characteristically increased in patients with Hashimoto's encephalopathy. However, measurement of this parameter in patients with these diseases is rare. In patients with idiopathic encephalopathy/encephalitis, anti-thyroid antibody levels should be measured to facilitate accurate diagnosis.

Autoantibodies↗
PubMed2003

Postinfectious encephalitis (21 cases appended).

OBJECTIVE: To report 21 cases of postinfectious encephatitis according to ICD-NA, postinfectious/parainfectious encephalitis is an independent disease. METHODS: Using the uniform criteria provided by The Council of State and Territorial Epidemiologists (CSTE) and Centers for Disease Control and Prevention (CDC), we diagnosed postinfectious encephalitis among patients admitted to The First Hospital of Harbin Medical University and analyzed the characteristics of these cases. RESULTS: All the patients had histories of preceding infection, and most of them suffered from mental and conscious disorders. Adrenocortical hormone was effective. CONCLUSIONS: Postinfectious encephalitis is an independent disease. According to this article, about 10% patients with encephalitis admitted to our hospital are postinfectious.

Adolescent↗
PubMed1992

[Pneumococcal meningitis from 1974 to 1984].

We examined a group of 22 patients presented with the acute infective meningeal syndrome. Lumbar punction confirmed diagnosed purulent meningitis--meningoencephalitis, and bacteriologic liquor culture identified Streptococcus pneumoniae as a cause of the disease. Patients were mostly aged over 30. Clinical picture revealed signs of general infection and the meningeal syndrome. The severity of the disease was assessed on the basis of apparent signs of general infection, state of consciousness and endotoxic shock symptoms. Severe consciousness disorders were present in 16 (72.72%) patients. In our patients possible pneumococcus infection foci were: sinusitis, otitis media, pneumonia, mastoiditis and adnexitis. Lethal outcome occurred in 5 (22.72%) patients. In the therapy we used penicillin, chloramphenicol and ampicillin along with corticosteroid administration.

Adult↗
PubMed2003

[First ischemic stroke in the very old: etiology, clinical course and outcome].

This study was designed to investigate the prevalence of risk factors, etiology, clinical course and outcome of the first-ever ischemic stroke in patients aged at least 85 when compared with younger patients with ischemic stroke. We studied 802 patients with first-ever ischemic stroke, including 103 patients at the age of 85 and more, and 699 patients at the age of 60-84. We collected data regarding the prevalence of risk factors, etiology of stroke, severity of neurological deficit and the presence of consciousness disturbances. The major complications were registered and the infarction volume was assessed using computed tomography. Mortality and functional status of the survivors were assessed on the 30th and 90th day after stroke using Barthel Index. Very old patients with ischemic stroke were characterized by greater percentage of women and higher frequency of ischemic heart disease; diabetes, obesity and smoking were all noted less frequently in this group. Very elderly subjects presented more frequently with TACI syndrome (24.3% and 14.6%, respectively; p < 0.05). They had greater neurological deficit in all days of assessment and were more likely to have the consciousness disorders on admission (39% and 22.3%, respectively; p < 0.001). Urinary tract infection was the only major complication more frequently seen in very old subjects (53.4% and 35.3%, respectively; p < 0.05). The studied groups did not differ regarding etiology of stroke, the length of hospital stay and the incidence of other complications. 30th and 90th-day mortality was greater among very elderly subjects (28.1% vs 16.4% and 46.6% vs 24.6%, respectively; both p < 0.05). The disability assessed 30 and 90 days after stroke was also much greater in very old patients. Very old patients with first ischemic stroke have greater neurological deficit, worse functional status and greater mortality after stroke. They are more likely to have ischemic heart disease and less likely to have diabetes or obesity. The causes of stroke, incidence of complications (with the exception of urinary tact infections), size of the lesion and length of hospital stay are similar in very old and younger patients with stroke.

Age Distribution↗
PubMedDate not supplied

[Endoscopic treatment of the spontaneous intracerebral hematomas].

BACKGROUND AND PURPOSE: Surgical evacuation of spontaneous intracerebral hematomas (ICH) performed in a traditional way usually increases primary brain tissue damage due to the hemorrhage. On the other hand, symptoms of the intracerebral pressure and secondary brain tissue destruction close to the hematoma are the basis for making a decision about surgical treatment. In order to limit surgical trauma we started research to evaluate the usefulness of endoscopic surgery in the treatment of ICH. MATERIAL AND METHODS: Twenty three cases were included in the study. Patients with consciousness disorders and/or focal neurological deficit and different systemic diseases were qualified for endoscopic evacuation. The diagnosis of hematoma was based on computed tomography (CT). ICHs were lobar and in certain cases they extended to the basal ganglia. All patients were operated on within one week from the onset of symptoms. Neuroendoscope was introduced to the hematoma cavity through the burr hole and the puncture of the cerebral surface over the hematoma. The hematoma was evacuated by fractionated rinsing. Bigger clots were fragmentized but those which were adjacent to the cavity wall were left. Postoperative assessment of the hematoma evacuation was based on CT performed immediately and in the second week after surgery. RESULTS: Total evacuation of the ICH was achieved in 6 patients, and its volume was reduced in 17 cases. Symptoms of brain edema resolved in all patients. A significant trend to reduce focal neurological deficits was observed: 16 patients improved and 3 remained unchanged. Four patients died. CONCLUSIONS: Endoscopic surgery allows a complete hematoma evacuation or reduction of its volume, reduces symptoms of brain edema and accelerates the improvement of focal neurological deficits.

Aged↗
PubMed2005

[Diagnosis and management of imported malaria].

Any fever in a traveller returning from a tropical area has to be considered first as a malaria attack and needs a parasitological diagnosis. Nevertheless, physicians have to be aware of atypical presentations (lack of fever, febrile enteritis, false negative smear...). In non-falciparum malaria, chloroquine remains the drug of choice. In falciparum-malaria, an ambulatory treatment by the association atovaquone-proguanil or oral quinine is possible only if certain criteria are respected. On the opposite, only one sign of severity (including mild consciousness disorders) implies a transfer in an intensive care unit for emergency treatment with IV quinine including a loading dose. A follow-up with clinical and parasitological assessment at D3, D7 and D28-35 is an important aspect in the management of a malaria case.

Antimalarials↗
PubMed1992

[Febrile coma and disseminated intravascular coagulation following heat stroke].

A clinical case that occurred in a 42 years old female and which fulfils the diagnostic criteria for the entity described as Heat Stroke is presented. In this case, besides the usual manifestations of hyperpyrexia without sweating along with consciousness disorders, features of consumptive coagulopathy, rhabdomyolysis and well marked laboratory liver dysfunction have also been found. The severity of this situation and its less common occurrence in temperate climates, together with the uncertainty in establishing the diagnosis, namely when infection is suspected--in the present case the initial diagnosis was Sepsis, which led to patient's admission in an infectious diseases intensive care unit--motivate the authors to make this report. Furthermore, they consider this case to be a good example of the varied clinical and laboratory manifestations and possible severe complications that Heat Stroke may display.

Adult↗
PubMedDate not supplied

Multiple watershed cerebral infarcts.

The case of a 63-year-old female patient affected by arterial hypertension under home therapy, with disordered consciousness and confusion, is discussed. At the emergency department of another hospital she underwent cranial CT which showed mild swelling of right cerebral hemisphere. Based on the clinical suspicion of herpes simplex encephalitis compatible with a first MRI examination of the brain, the patient was admitted to the department of infectious disease of the polyclinic to confirm the diagnosis and plan the therapeutic approach. MRI was repeated and completed with EPI-DWI sequences and PRESS spectroscopy. It did not rule out categorically the infectious/inflammatory pattern but, based on a careful evaluation of the anatomic distribution of acute lesions, the most likely diagnostic hypothesis was the presence of multiple watershed cerebral infarcts on the right side.

Brain↗
PubMedDate not supplied

[The characteristics of closed craniocerebral trauma in older persons].

It is shown that in the recent 2 decades the incidence of craniocerebral trauma increased from 4.8 to 7.2% among old-aged individuals and from 53 to 72% in the group of patients over 60. The dynamics of changes in the clinical course of mild craniocerebral trauma in 21% of old-aged patients were marked by secondary acute cerebral circulatory disorders which often led to a fatal outcome. Mortality rate in craniocerebral trauma at old age was 52.3%.

Aged↗
PubMed2006

[Severe course of tick-borne encephalitis (Encephalomeningomyelitis): a case report].

A 19-year-old male student was admitted to the Department of Infectious Diseases and Neuroinfections with suspected encephalomeningitis. Three weeks before admission the patient was bitten by a tick. The first symptoms were manifested by mild consciousness disorders, headache, vomiting, and fever with the presence of meningeal syndrome. In the course of the disease, the signs of focal lesions in the central nervous system developed: horizontal nystagmus, bilateral ptosis, paresis of cranial nerves: peripheral damage to nerve VII on the right and nerve XI, weakness of proximal muscles of upper and lower extremities. Examination of the cerebrospinal fluid showed lymphocytic pleocytosis with the presence of antibodies against TBE virus. CT and MRI scans did not show any pathology. The applied treatment reduced neurological abnormalities. In the course of the disease, generalized convulsions were twice observed. On the day of discharge, slight nystagmus, bilateral ptosis with normal movement of eyeballs, slight peripheral paresis of nerve VII on the right and nerve XI, massive paresis of the shoulder girdle muscles as a result of their atrophy were found. Mental status was normal. Residual signs of peripheral paresis of peripheral nerve VII, slight nystagmus as well as paresis and atrophy of the shoulder girdle muscles are still present.

Adult↗
PubMed2006

[Analysis by questionnaire survey concerning example such as purulent meningitis and severe infectious diseases--relation among patient background factor, sequelae, and infecting organism].

Concerning major causative organisms of purulent meningitis, i. e., Haemophilus influenzae and Streptococcus pneumoniae, a questionnaire was sent to medical institutions all over Japan with the aim of investigating the patient background factors, sequelae and causal relationship with the causative organisms. Responses from 84 institutions in various parts of Japan were summarized and the following conclusions were drawn. 1. The diagnostic names of 227 patients for whom the questionnaire could be recollected were as follows: Purulent meningitis 138 cases (patient under 15 years old; 134 cases); purulent meningitis and sepsis, 58 cases; sepsis, 28 cases; and others, 3 cases. The causative organisms for the patients with meningitis and meningitis + sepsis were as follows: Haemophilus influenzae, 132 patients; and Streptococcus pneumoniae, 44 patients. 2. With respect to age distribution among the patients with meningitis and those with meningitis + sepsis, the number of the patients of the age younger than 1 year old was more than twice larger than that of one-year-old patients. The percentage of the cases in which sequelae remained was 35.9% among the cases caused by Streptococcus pneumoniae and 13.4% among the cases caused by Haemophilus influenzae. A significant difference was observed between the bacterial strains (p=0.0025). 3. The major initial symptoms observed were high fever, vomiting, consciousness disorder, drowsiness and poor sucking. The percentage of the patients with remaining sequelae was significantly high among the patients who exhibited convulsion in the early stage after the onset. 4. As to the relationship with administration of dexamethasone, sequelae remained in 40.0% (10/25) of the patients who did not receive dexamethasone, and 17.3% (23/133) of the patients who received the drug. The percentage of the patients with remaining sequelae was significantly low among the patients who received dexamethasone (p=0.0043).

Adolescent↗