ro13-9904 and Intracranial-Hypertension

Topics: Adolescent; Anti-Bacterial Agents; Anti-Inflammatory Agents, Non-Steroidal; Brucellosis; Ceftriaxone; Doxycycline; Histiocytic Necrotizing Lymphadenitis; Humans; Intracranial Hypertension; Lymph Nodes; Lymphopenia; Male

Lyme disease (LD) is a tick-borne infection that is endemic to multiple areas of the United States. Patients with LD may present with sign and symptoms of intracranial hypertension (IH). The objective of this study is to evaluate the history, clinical findings, CSF analysis, and brain imaging results in pediatric patients with increased intracranial pressure secondary to LD. A retrospective database search was performed using the International Classification of Diseases (ICD) 9/10 codes to identify patients diagnosed with LD and IH between 2004 and 2014 at a tertiary referral pediatric hospital. Clinical, laboratory and neuroimaging data for each patient were reviewed. Seven patients met inclusion criteria; mean age was 9.6 years (standard deviation 4.0 years); 4/7 patients were male. Average body mass index was 18.8 kg/m(2) (standard deviation 3.0 kg/m(2)). Fever was present in four patients. Four had a history of LD related erythema migrans. All had elevated CSF opening pressure with leukocytosis and lymphocytic predominance. MRI obtained in six patients showed contrast enhancement of various cranial nerves. Tentorial enhancement was noted in all patients. In addition, patients had widening of the optic nerve sheath (ONS), optic nerve protrusion, and flattening of the posterior globe consistent with increased intracranial pressure. All patients had resolution of their symptoms after initiation of antibiotic therapy. In endemic areas, LD should be included in the differential of IH. MRI can help distinguish IH due to LD from its idiopathic form due to the presence of tentorial and cranial nerve enhancement in the former in addition to abnormal CSF showing leukocytosis with lymphocyte predominance.

Topics: Adolescent; Anti-Bacterial Agents; Ceftriaxone; Child; Child, Preschool; Cohort Studies; Doxycycline; Female; Humans; Image Processing, Computer-Assisted; Intracranial Hypertension; Lyme Disease; Magnetic Resonance Imaging; Male; Optic Nerve; Severity of Illness Index

Topics: Abducens Nerve Diseases; Anti-Bacterial Agents; Antibodies, Bacterial; Borrelia burgdorferi; Brain Neoplasms; Ceftriaxone; Child; Diagnosis, Differential; Diplopia; Erythema Chronicum Migrans; France; Humans; Intracranial Hypertension; Lyme Neuroborreliosis; Male; Scotland; Travel

* Young infants who have meningitis may present with nonspecific clinical manifestations. * S. pneumoniae and N. meningitidis remain the most common causes of bacterial meningitis in the infant and child, and GBS continues to be the most common neonatal pathogen. * Empiric therapy for suspected bacterial meningitis in a non-neonate includes a combination of parenteral vancomycin and either cefotaxime or ceftriaxone. * Children whose GCS scores are less than 8, show signs of shock or respiratory compromise, and have focal neurologic findings or clinical signs of elevated intracranial pressure should be admitted to a pediatric intensive care unit. * Sensorineural hearing loss occurs in 30% of children who have pneumococcal and 10% of those who have meningococcal meningitis.

Topics: Anti-Bacterial Agents; Cefotaxime; Ceftriaxone; Drug Therapy, Combination; Hearing Loss; Humans; Incidence; Infant; Intracranial Hypertension; Meningitis; Meningitis, Bacterial; Meningitis, Meningococcal; Vancomycin

In neurosurgery, ceftriaxone is a widely used, third generation cephalosporin for the treatment of CNS infections and perioperational prophylaxis. Recent studies have demonstrated that ceftriaxone induces reversible precipitates in the gallbladder. This complication is referred to as "biliary pseudolithiasis", and it has symptoms similar to the raised intracranial pressure (ICP) symptoms of the perioperative period. Symptomatic biliary pseudolithiasis should be kept in mind in all pediatric neurosurgery cases under ceftriaxone therapy in order to prevent unnecessary postoperative investigations and surgery.

Topics: Adolescent; Ceftriaxone; Cephalosporins; Cerebral Ventricle Neoplasms; Child; Cholelithiasis; Diagnosis, Differential; Encephalocele; Humans; Intracranial Hypertension; Intracranial Pressure; Magnetic Resonance Imaging; Male; Neurosurgical Procedures; Tomography, X-Ray Computed; Ultrasonography

A 22 year old female presented with sudden onset of uncrossed diplopia at distance, intracranial hypertension, esotropia and was evaluated. Microbiological tests of CSF and sera showed for brucellosis and the patient received therapy for this and her intracranial hypertension. The papilledema, headache, esotropia and diplopia all disappeared after therapy.. Diagnostic tests for brucella must be considered for patients who have divergence palsy and papilledema, especially those living in endemic areas.

Topics: Acetazolamide; Adult; Antibiotics, Antitubercular; Brucella melitensis; Brucellosis; Ceftriaxone; Central Nervous System Bacterial Infections; Cephalosporins; Cerebrospinal Fluid; Diplopia; Diuretics; Drug Therapy, Combination; Esotropia; Female; Humans; Intracranial Hypertension; Papilledema; Rifampin