RESUMO
A 36-year-old woman with severe postural headaches caused by spontaneous intracranial hypotension developed bilateral hearing loss. Her hearing loss varied in severity and also at times affected one ear more than the other. She noticed her hearing returned to normal on lying flat, and this was confirmed on audiometry. Her hearing fully recovered after treatment with blood patches. Audiovestibular symptoms affect up to 70% of people with spontaneous intracranial hypotension but are probably under-reported. Cerebrospinal fluid and inner ear fluids are related in two separate channels: the vestibular and the cochlear aqueducts. We discuss their role in the postural hearing loss of spontaneous intracranial hypotension.
Assuntos
Autoanticorpos/sangue , Moléculas de Adesão Celular/sangue , Leucemia Linfocítica Crônica de Células B/sangue , Doença dos Neurônios Motores/sangue , Fatores de Crescimento Neural/sangue , Condução Nervosa/fisiologia , Idoso , Humanos , Leucemia Linfocítica Crônica de Células B/complicações , Leucemia Linfocítica Crônica de Células B/diagnóstico por imagem , Masculino , Doença dos Neurônios Motores/complicações , Doença dos Neurônios Motores/diagnóstico por imagemRESUMO
We present two cases of cryptococcal meningitis in people subsequently diagnosed with idiopathic CD4+ lymphopenia. Both presented with new onset headaches without sinister features and were sent home on multiple occasions from emergency departments. Cryptococcal meningitis in HIV-negative patients poses major diagnostic and management problems; the associated mortality is 9%-27%. We suggest performing blood and cerebrospinal fluid cryptococcal antigen tests in all people with lymphocytic meningitis.
Assuntos
Linfócitos T CD4-Positivos/imunologia , Linfopenia/complicações , Meningite Criptocócica/complicações , Adulto , Feminino , Humanos , Linfopenia/imunologia , Masculino , Meningite Criptocócica/imunologia , Pessoa de Meia-IdadeAssuntos
Aquaporina 4/sangue , Encefalite Viral/sangue , Encefalite Viral/diagnóstico , Infecções por HTLV-I/sangue , Infecções por HTLV-I/diagnóstico , Vírus Linfotrópico T Tipo 1 Humano/metabolismo , Encefalite Viral/complicações , Feminino , Infecções por HTLV-I/complicações , Humanos , Adulto JovemRESUMO
In a recent study, administration of granulocyte colony stimulating factor (G-CSF) increased neuromyelitis optica (NMO) lesions in mice. Here we report a patient whose first episode of NMO may have been exacerbated by inadvertent administration of G-CSF. Histological examination of brain and spinal cord samples from three other NMO patients revealed markedly increased expression of G-CSF in neurons located in and around the lesions, with little or no expression in multiple sclerosis lesions or normal white matter. Taken together, these cases support a detrimental role for G-CSF in NMO pathogenesis.
