Parafalcine empyema, a tricky infectious cause of headache: a case report.

Headache caused by subdural empyema is usually associated with fever and symptoms and/or clinical signs of meningeal irritation and increased intracranial pressure. We describe a patient with headache with absence of these signs or symptoms of meningeal irritation or intracranial pressure, who turned out to have a parafalcine subduralempyema. A 28-year-old man had headache for 2 weeks, which had started with visual symptoms with duration of 5 minutes. Two days later, he developed fever. During these 2 weeks, he had recurrence of visual symptoms for 4 times, with duration of several minutes.Neurologic examination at presentation on the emergency department showed no meningeal irritation or papilledema. However, on closer examination, a limited homonymous hemianopsia on the left side and a drift of the left leg were found. Magnetic resonance imaging showed parafalcine subdural empyema on the right side of the falx and a small brain abscess right occipitally. Neuronavigated craniotomy was performed, which confirmed the presence of empyema and allowed culture of the specimens. Streptococcus milleri group was cultured,which allowed narrowing of the antibiotic therapy to Benzylpenicillin12 million entities per 24 hours. Headache and subdural empyema diminished during treatment, and at follow-up 12 weeks after start of treatment, patient had no remaining complaints. Parafalcine-located subdural empyema can present without presence of clear localizing symptoms or signs like meningeal irritation and increased intracranial pressure. When headache is accompanied with fever, one should extensively question neurologic symptoms, and a thorough neurologic examination should be done.

Disseminated cryptococcosis with caverno-oesophageal fistula in a case of idiopathic CD4+ T-lymphocytopenia.

Idiopathic CD4+ T-Lymphocytopenia is a rare immunodeficiency disorder characterised by significantly low absolute CD4 lymphocytes in absence of any viral infections. We present a case of Disseminated Cryptococcosis with Caverno- Oesophageal Fistula in a case of Idiopathic CD4+ T-Lymphocytopenia. 29 year old lady was referred to Institute in view of lung mass not responding to anti-TB treatment. Subsequently patient had developed headache. Radiological evaluation showed presence of ring enhancing lesion in the occipital region. On evaluation with Fibre-optic bronchoscopy, there was no evidence of malignancy or tuberculosis. Sputum showed presence and growth of Cryptococcus neoformans. Patient's investigations were negative for virus infection, with normal immunoglobulin levels. Her CD4 counts were 129 cells/mm3. Patient was treated with injectable antifungals. Patient developed a Caverno-oesophageal fistula which was confirmed on endoscopy and radiology. Patient was managed with percutaneous jejunal feeding (PEJ). Patient improved symptomatically with CD4 count of 475 cells/mm3.

[Cerebral actinomycosis pseudotumor: a case report]. / Actinomycose cérébrale d'aspect pseudotumoral: à propos d'un cas.

INTRODUCTION: Cerebral actinomycosis is rare and difficult to diagnose. CASE REPORT: We report a case of a 45-year-old man hospitalized for seizures associated with fever and left hemiparesis. The white cell count and C-reactive protein were elevated. HIV serology was negative. Blood cultures remained sterile. The CT scan revealed hyperdense nodular lesions in the occipital area, with annular contrast uptake and peripheral edema causing a mass effect, suggestive of brain metastasis. The pathology examination of a surgical specimen disclosed cerebral actinomycosis. A dental origin of the infection was suspected. Hemiparesis remained after a 12-month antibiotic regimen associated with dental care and short-term corticosteroid therapy. CONCLUSION: Actinomycosis should be discussed as a possible diagnosis for all cerebral lesions, particularly in patients with a potential dental infection. Histology is required for positive diagnosis. Antibiotic therapy alone is generally sufficient; surgery is often performed for diagnostic purposes.

Cefalea y visión borrosa en una mujer de 26 años / Headache and blurred vision in a 26 years old woman

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Fatal outcome of disseminated invasive aspergillosis in kidney allograft recipients.

Fungal infections in solid organ transplant recipients are of concern due to the related high mortality and morbidity. Aspergillus species are one of the major opportunistic fungal pathogens causing invasive pulmonary infections which rarely involve extrapulmonary organs. The occurrence varies by type of transplantation, with aspergillosis more frequently associated with heart, liver and lung transplantation cases than those involving kidney recipients. Several risk factors have been proposed, with cases occurring early and late after the transplantation. Although pulmonary involvement is the main presentation, invasive extrapulmonary aspergillosis can on rare occasions be observed and is associated with poor prognosis. Herein, we report two cases that presented with extrapulmonary invasive aspergillosis, i.e., one presented with cerebral abscess and the second with soft tissue abscess in the right posterior thigh. While the cerebral abscess was not surgically treated, the soft tissue abscess was surgically drained. When the primary focus was investigated, pulmonary nodulars were found in both cases. Both patients were treated with long-term amphotericin B; however, one patient was lost with functioning graft and the kidney of the second patient failed due to decreased immunosuppression and he died while on maintenance hemodialysis. Invasive extrapulmonary presentation of aspergillosis rarely occurs in kidney transplant recipients and is associated with a high mortality rate.

Primary Nocardia farcinica brain abscess with secondary meningitis and ventriculitis in an immunocompetent patient, successfully treated with moxifloxacin.

We report a rare case of Nocardia farcinica occipital brain abscess in an immunocompetent patient with no underlying risk factors successfully treated with the antibiotic moxifloxacin. The patient underwent craniotomy and abscess drainage. Initial post-operative treatment with co-trimoxazole produced a limited response. Despite the development of skull base meningitis and ventriculitis subsequent addition of moxifloxacin produced an excellent outcome.

Brain abscess and Rendu-Osler-Weber disease. Case report and review of the literature.

The case of a 51-year-old man presented with intermittent diplopia, headache and family history of Rendu-Olser-Weber disease , also defined heredirary hemorrhagic telangiectasia (HHT), is described. Magnetic resonance imaging of the brain revealed an enhancing right occipital mass with surrounding edema. Computerized tomography of the chest identified pulmonary arteriovenous fistlae. The physiopathology of HHT and the treatment of the cerebral lesions are discussed.

Nocardiosis with brain abscess due to an unusual species, Nocardia transvalensis.

The identification of Nocardia transvalensis, an unusual and probably underrecognized cause of nocardial infection, is clinically significant because of this species' resistance to aminoglycosides, a standard antinocardial therapy. Diagnosis requires analytic methods available predominately in reference laboratories. We report a case of disseminated infection with N transvalensis with primary pulmonary involvement and subsequent development of brain abscesses, and review the literature to date. Familiarity with the epidemiology, pathologic findings, and clinical significance of this and other unusual Nocardia species may increase early identification and antibiotic susceptibility testing in cases of nocardial infection.

Respiratory foreign bodies and Eikenella corrodens brain abscess in two children.

We report the coexistence of aspirated foreign bodies and brain abscess in two boys. One child had aspirated a metallic needle, and in the other boy partially embedded sunflower seeds were found in the bronchial wall. Both patients had growth of Eikenella corrodens (oral gram-negative flora) from the abscess. Aspirated foreign body in the respiratory tract should be one of the diagnostic considerations if any of the normal oropharyngeal organisms such as E. corrodens is the causative organism of brain abscess.

[Confluent tuberculomas of the vermis cerebelli associated with an occipital localization. Report of a case and review of the literature]. / Tuberculomes confluents du vermis cérébelleux associés à une autre localisation occipitale. Rapport d'un cas et revue de la littérature.

An unusual case of multiple cerebral tuberculomas is reported. The patient, a 19-year-old woman, presented with a 6-month history of raised intracranial pressure and cerebellar symptoms. CT scan disclosed a conglomerate of several ring-enhancing lesions within the cerebellar vermis and another homogeneously enhancing mass against the right occipital horn. Solid and ring-enhancing lesions are the main mode of presentation of cerebral tuberculomas. Although the patient had no history of systemic tuberculosis, this diagnosis was considered highly probable in this geographic area and was confirmed by pathological examination of the cerebellar mass, the excision of which was considered necessary. Antitubercular medications led to complete regression of the associated occipital lesion, as demonstrated by sequential CT scan examinations.

Eikenella corrodens as a cause of brain abscess.

A case of brain abscess due to Eikenella corrodens in a 67-year-old woman is reported. To our knowledge, this is the first case in which the causative organism has been isolated from the occipital lobe. E. corrodens may be the cause of apparently sterile brain abscesses encountered in neurosurgery and should be considered in the differential etiology of brain abscess.