ro13-9904 and Ataxia

BACKGROUND Acute cerebellitis in adults is a rare disease. The etiology is unknown but postulated to be due to primary infection or para-infection. Different presentations have been reported, which complicates the diagnosis process. CASE REPORT We report the case of a young man who presented with headache, vomiting, and vertigo. He was found to have ataxia and cerebellar signs, bradycardia magnetic resonance imaging (MRI) of the brain showed acute cerebellitis, and cerebrospinal fluid (CSF) studies showed lymphocytosis. Further investigations showed the presence of Epstein-Barr virus (EBV) immunoglobulin M (IgM) and IgG. His symptoms resolved completely with corticosteroid and antiviral treatments. CONCLUSIONS Acute cerebellitis can present in various ways. Bradycardia, along with neurological deficits, should raise the suspicion of acute cerebellitis.

Topics: Acute Disease; Acyclovir; Anti-Bacterial Agents; Anti-Inflammatory Agents; Antiviral Agents; Ataxia; Bradycardia; Ceftriaxone; Cerebellar Diseases; Dexamethasone; Epstein-Barr Virus Infections; Glucocorticoids; Humans; Immunoglobulin G; Immunoglobulin M; Lymphocytosis; Male; Young Adult

Although it is an orphan disease, isolated central nervous system Whipple's disease is one of the "must be known" conditions in neurology because it belongs to the list of "treatable disorders". Here, we present two cases which highlight the importance of early diagnosis. Additionally, we provide a discussion on up to date diagnostic approach to this life-threatening disorder.

Topics: Adult; Anti-Bacterial Agents; Ataxia; Ceftriaxone; Central Nervous System Infections; Encephalitis; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Trimethoprim, Sulfamethoxazole Drug Combination; Whipple Disease

Topics: Anti-Bacterial Agents; Ataxia; Ceftriaxone; Child; Humans; Magnetic Resonance Imaging; Male; Meningitis, Meningococcal; Ophthalmoplegia; Photophobia; Rare Diseases; Thalamus; Treatment Outcome

Here, we demonstrate a first case of tick-borne encephalitis (TBE) associated with an isolated reversible splenial corpus callosum lesion (IRSL) and highlight the wide range of different clinical entities in which such alterations have been observed. A 42-year-old man showed fever, cephalgia and mild disturbance of coordination and gait. Diagnosis was ascertained by slight CSF-pleiocytosis and positive TBE-IgG as well as by positive intrathekal specific antibody index on follow-up. MRI demonstrated a single ovoid hyperintensity in T2 and DWI with reduction in ADC in the splenium of corpus callosum which was abrogated in follow-up after 6 weeks. Most entities of IRSL presented with excellent prognosis, including our novel case of TBE. We discuss different possible pathomechanisms and the so far unexplained propensity of the splenium for such alterations. Clinicians should be familiar with this phenomenon to avoid unnecessary diagnostic or therapeutic efforts.

Topics: Acyclovir; Adult; Anti-Bacterial Agents; Antiviral Agents; Ataxia; Ceftriaxone; Corpus Callosum; Diffusion Magnetic Resonance Imaging; Encephalitis, Tick-Borne; Fever; Gait Disorders, Neurologic; Headache; Humans; Image Processing, Computer-Assisted; Immunoglobulin G; Magnetic Resonance Imaging; Male; Neck Pain

A case of childhood enteric fever complicated by transient dysautonomia and cerebellitis is reported. The child was treated with intravenous antibiotics, and the complications were managed conservatively. Dysautonomia and cerebellitis resolved by day 5 and day 8 after admission, respectively. Results of a neurologic examination at the end of 6 months were normal. Dysautonomia complicating the course of childhood enteric fever is previously unreported.

Topics: Anti-Bacterial Agents; Ataxia; Autonomic Nervous System; Ceftriaxone; Cerebellar Diseases; Cerebellum; Child; Gait Disorders, Neurologic; Humans; Hypotension; Male; Ofloxacin; Primary Dysautonomias; Salmonella typhi; Tachycardia; Treatment Outcome; Typhoid Fever

No recent publications are available about pneumococcal meningitis in Hungarian children. The aim of this study was to collect data of epidemiological, clinical and prognostic features of pneumococcal meningitis in children treated at Szent László Hospital, Budapest, Hungary.. We conducted a retrospective review of medical charts and follow-up records of patients aged 1 to 18 years admitted to our Pediatric and Pediatric Intensive Care Units due to pneumococcal meningitis between 1st Jan 1998 and 30th Jun 2007.. 31 children with 34 cases of pneumococcal meningitis were admitted to our hospital in the study period. Two children developed recurrent illness. The mean age was 6 years, 26% were under 1 year of age. The mean duration of hospital stay was 21 days, 97% required intensive care. Frequent clinical symptoms were fever (100%), nuchal rigidity and vomiting (78%), altered mental status (71%), Kernig's and Brudzinski's signs (58%) and seizures (41%). Otitis media, sinusitis, mastoiditis were present in 44%, 58%, 41%, respectively. Subdural effusion, parenchymal cerebral lesion and sinus thrombosis were documented in 5, 3 and 2 cases, respectively. One third of the patients received ceftriaxon, two thirds were administered ceftriaxon and vancomycin. Adjunctive therapy with dexamethasone was given to 91% of the children. 70% of patients required mechanical ventilation. 9 patients (25%) required endoscopic sinus surgery. In 13 cases (38%) mastoidectomy, in 5 children (15%) neurosurgery was performed. The case fatality rate was 23.5%. 8 (23.5%) patients had mild or moderate, 1 child (3%) developed severe neurological sequelae.. Pneumococcal meningitis in children remains a source of substantial morbidity and mortality in childhood. The long hospital stay, the frequent need for intensive care and severe neurologic sequelae emphasize the importance of early diagnosis, early treatment and prevention with pneumococcal conjugate vaccines.

Topics: Adolescent; Anti-Bacterial Agents; Ataxia; Ceftriaxone; Child; Child, Preschool; Female; Follow-Up Studies; Hospital Departments; Humans; Hungary; Infant; Infant, Newborn; Intellectual Disability; Intensive Care Units, Pediatric; Length of Stay; Male; Medical Records; Meningitis, Pneumococcal; Muscle Hypotonia; Pneumococcal Vaccines; Recurrence; Respiration, Artificial; Retrospective Studies; Urinary Bladder, Neurogenic; Vaccines, Conjugate; Vancomycin

Topics: Adult; Anti-Bacterial Agents; Antibodies; Ataxia; Borrelia burgdorferi; Brain; Ceftriaxone; Female; Humans; Lyme Neuroborreliosis; Magnetic Resonance Imaging; Nausea; Neck Pain; Norway; Opsoclonus-Myoclonus Syndrome; Time; Tomography, X-Ray Computed; Treatment Outcome

A 74-year-old woman presented with gait impairment, urinary incontinence, and dementia. She showed lymphocytic CSF pleocytosis and pronounced intrathecal Borrelia burgdorferi antibody production, indicating active Lyme neuroborreliosis. The syndrome of normal-pressure hydrocephalus (NPH) fully remitted after ceftriaxone treatment. Lyme neuroborreliosis may cause NPH by interfering with subarachnoid CSF flow.

Topics: Aged; Ataxia; Ceftriaxone; Cerebrospinal Fluid; Dementia; Female; Humans; Hydrocephalus, Normal Pressure; Leukocyte Count; Lyme Disease; Rheology; Urinary Incontinence