Association of renal function and symptoms with mortality in star fruit (Averrhoa carambola) intoxication.

BACKGROUND: Star fruit (SF) is a commonly available fruit produced and eaten in tropical and subtropical countries. Since 1993, various reports have described neurotoxicity after eating SF, but this clinical condition remains unfamiliar. We aimed to describe this clinical entity, the role of renal dysfunction in this disorder, treatment strategies, and prognosis of patients with SF intoxication. METHODS: We conducted a search of PubMed and Google Scholar databases from 1993 to 2016. We included reports describing patients with a clear history of SF ingestion with acute symptoms. We described the demographic characteristics, reported SF intake, treatments used, and outcomes. RESULTS: We reviewed totally 126 patients (male:female = 1.5:1) from 33 articles with mean age 54.4 ± 11 (range: 30-84). The most common symptom was hiccups (65%), whereas confusion and seizure were the most common symptoms associated with mortality (42% and 61%, respectively). Pre-intoxication renal function also affected mortality. While there was no mortality in patients with normal renal function (NRF), the mortality of patients among reported cases with chronic renal insufficiency and end-stage renal disease undergoing dialysis were 36% and 27%, respectively. With the inclusion of patients reported to have NRF, the overall mortality was 24%. Consistently, the number of SF consumed was substantially higher in the patients with NRF than those with renal functional impairment. The most common treatment strategy was hemodialysis (59%). CONCLUSIONS: Patients with impaired renal function were at higher risks of SF intoxication. Severe neurologic symptoms mandate immediate medical intervention because of the association between their occurrence and high mortalities. Toxin removal through dialysis, rather than symptomatic relief, seems to be beneficial to patient survival. Early and continuous dialysis appears to alleviate severe symptoms and prevent symptom rebounds.

Intracranial Hypotension as A Rare Complication of Vertebroplasty: A Case Report.

BACKGROUND: Vertebral compression fracture is one of the frequent complications of osteoporosis. Percutaneous vertebroplasty (PVP) has been applied in the treatment of osteoporotic vertebral compression fractures, multiple myelomas and vertebral metastatic lesions. Complications of the procedure include bleeding at the puncture site, local infection, cement leakage in the vertebral canal and intervertebral foramen. Cerebrospinal fluid leakage after the procedure was rarely mentioned in the literature. CASE REPORT: A 51-year-old healthy female patient has no neurologic or orthopedic illness before. She suffered from severe low back pain since 10 days ago after some exercise. She has back pain with radiating to bilateral subcostal areas. The pain aggravated by bending forward. X ray of spine showed T12 vertebral body compression fracture. MRI demonstrated compression fracture at T12 with bone marrow edema and increased bone marrow enhancement. Bone mineral density checked by Dualenergy X-ray absorptiometry revealed osteopenia. The symptoms were not relieved by conservative treatments and she received vertebroplasty for pain relief. The operation course was smooth, but she started to suffer from orthostatic headache after the procedure. Spinal MRI revealed fluid accumulation at posterior epidural space of T11-12-L1 and CSF leakage was impressed. Intracranial hypotension related to CSF leakage was diagnosed according to the Diagnostic criteria formulated by Schievink, et al (2008). After hydration and bed-rest, her symptoms improved gradually without epidural blood patch. CONCLUSION: Our report highlights the possibility and importance of intracranial hypotension related to CSF leakage after vertebroplasty. Clinicians should be alert to this complication.

Post-neurosurgical nosocomial bacterial meningitis in adults: microbiology, clinical features, and outcomes.

The clinical data of 62 adult patients who suffered post-neurosurgical nosocomial bacterial meningitis, retrospectively collected over a 16-year period, were studied. Cases were divided into two groups based on the date of presentation, the first period being 1986-1993 and the second 1994-2001. Fever and progressive consciousness disturbance were the most consistent clinical features - signs that may also be attributed to other postoperative neurosurgical problems. The common pathogens included Staphylococcus aureus, coagulase negative Staphylococcus, Pseudomonas aeruginosa, Escherichia coli, and Acinetobacter baumannii. An increase in polymicrobial infections and multi-antibiotic resistance during the second period was identified. In the first half of the study, mortality was 22%, and in the second half 36%. Adult post-neurosurgical nosocomial bacterial meningitis has become an important clinical problem. The choice of appropriate empirical antibiotics is challenging and must be guided by an awareness of the relative frequency of various pathogens and the increasing incidence of resistant strains. Although high mortality rates may, in part, be related to the primary brain pathology, early diagnosis and the timely use of antibiotics based on antimicrobial susceptibility testing are essential for survival.

Seizures complicating infantile and childhood bacterial meningitis.

In this study, 116 patients, at least 1 month of age but younger than 5 years, were identified with culture-proven bacterial meningitis. A comparison was made between the clinical data of the patients with and without seizures during hospitalization. Seizures during acute bacterial meningitis accounted for 47% (55/116) of the episodes. Time interval between the onset of bacterial meningitis and that of seizures was 1 to 20 days (mean, 4 days). Twelve of these 55 patients had one or more afebrile seizures after completing the treatment. At follow-up of at least 1 year after completing treatment, 26 patients had good outcomes, whereas the other 29 patients had poor outcomes. A strong correlation between the findings of abnormalities through neuroimaging and the occurrence of seizures during hospitalization was observed. The long-term outcomes of patients with infantile and childhood bacterial meningitis, who had seizures during the acute phase of bacterial meningitis, were worse than the outcomes of those who did not have such seizures. No child developed late seizures unless there were acute seizures. Factors associated with seizures during acute bacterial meningitis include disturbed consciousness on admission, abnormal neuroimaging findings, and low glucose and high concentration of total proteins in cerebrospinal fluid.