Neurologic Injury After Sacral Neuromodulation.

OBJECTIVE: Neurologic injury after sacral nerve stimulation (SNS) is rare, but the incidence is unknown. Infection is a potential mechanism for neurologic damage. This report illustrates the presentation, pathophysiology, diagnostic considerations, and treatment of epidural infection causing neurologic deficits after SNS. CASE REPORT: We present a case of a woman with severe fecal incontinence due to Crohn's disease who underwent SNS implantation and subsequently developed a wound infection requiring complete device explantation. A few days later, she presented with leg pain and weakness. Urgent evaluation and treatment of epidural infection were performed. She had persistent neurologic deficits 6 months later. CONCLUSIONS: Neurologic sequelae from an infection after SNS are a rare event and should be considered in patients with fevers, leg pain, and neurologic deficits.

Hip pain and cauda equina syndrome.

Acute cauda equina syndrome secondary to a spinal epidural abscess as a result of a psoas abscess is very uncommon. We report the case of a 64-year old with a 6-day history of left hip pain, which progressively worsened until she presented to the emergency department with systemic infective symptoms and classical acute cauda equina syndrome. A good clinical outcome was achieved by urgent posterior decompression, followed by CT-guided drainage of the psoas abscess and appropriate antibiotic treatment.

[Differential diagnostics of neuroinfections: Lyme disease].

In the article the clinical case of development of arthritis is examined for a patient with Laymborreliozom, exposed on territory of Kyrgyzstan. It is well-proven that a chronic flow can flow continuously and with relapses. The compatible clinical and serum criteria of diagnosis of illness are not developed. It is needed to take into account at interpretation of results of tests, that level of antiborrelioznykh antibodies, and frequency of exposure depend on the terms of inspection, beginning of therapy and stage of illness. Along with antibiotikoterapiey nosotropic treatment which consists in setting of nesteroidnykh protivovospalitel'nykh facilities and at a necessity glyukokortikoidov is used. Choice of preparations and dose depend on clinical displays and weight of flow.

[Neurological involvement in brucellosis; clinical classification, treatment and results]. / Brusellozda sinir sistemi tutulumu; klinik siniflama, tedavi ve sonuçlar.

The aim of this retrospective study was to describe and to categorize different clinical pictures of patients with neurobrucellosis in our clinic, and present demographical and laboratory data about the patients. Hospital records of 430 patients with brucellosis between 2003 and 2009, were retrospectively reviewed. Out of 430 patients, 19 (4.4%) had neurobrucellosis. These patients were classified into four groups: Meningitis group (n= 14, 13 cases of subacute/chronic meningitis, one case of acute meningitis), encephalomyelitis group (n= 3, one case of meningoencephalomyelitis, one case of cerebellar abscess and one case of transverse myelitis), polyradicular group (n= 1, Miller-Fisher Syndrome), and others (n= 1, one case of intradural abscess). Ten patients (52.6%) were female, and the mean age of the patients was 48.8 years. About 47.4% of the patients had fever, 26% of the patients had neck stiffness and 5% of the patients were in an unconscious state. Out of 19 patients, 18 underwent lumbar puncture and they had positive brucella antibody test in cerebrospinal fluid (CSF) by standard tube agglutination method. Brucella spp. Were grown in four patient's blood culture and one patient's CSF culture. There were cranial nerve involvement in five cases, the most frequent being the sixth cranial nerve. Out of 19 patients, three recovered with sequela (paraparesis, hearing loss, dementia and sphincter disfunction) and 16 patients recovered completely. Although neurobrucellosis is most frequently presented as subacute/chronic meningitis, it may be associated with different clinical pictures. The classical triad of meningitis (fever, neck stiffness, unconsciousness) is rarely seen in brucellosis-related meningitis. Brucellosis should be kept in mind in patients with unexplained neurological findings particularly in areas where brucellosis is endemic. In addition, a current classification of neurobrucellosis, related to involved location of nervous system, clinical picture and pathogenesis, is needed.

Acute spinal cord compression caused by disseminated Nocardia infection involving the conus medullaris.

Distinguishing between an infective and malignant process provides a diagnostic challenge for clinicians. This case highlights an example of an acute spinal cord compression that could fall into either of these two categories. The diagnosis in this case of disseminated Nocardiosis is an extremely rare cause of acute spinal cord compression and to our knowledge intrinsic conus medullaris infection from Nocardia has not previously been reported in the literature. Nocardia cyriacigeorgica is an emerging strain of Nocardia species recently identified which was previously categorised as Nocardia asteroides type VI infection. The challenge of eliciting the diagnosis and the need to have an index of suspicion of Nocardia as a possible aetiology agent is shown in the report. The case shows this is especially important in evaluation of a multi-system infection in an immunosuppressed individual. The case described highlights an interesting diagnostic case with the resultant causative organism an emerging strain of Nocardia species with no previous reported cases of conus medullaris involvement.

Neurobrucellosis: report of a rare disease in 20 Iranian patients referred to a tertiary hospital.

We reviewed the clinical manifestations and outcome of 20 cases of neurobrocellosis out of 1375 patients with brucellosis admitted to the infectious diseases ward of a tertiary hospital in Hamedan, Islamic Republic of Iran. Of the 20 cases, 12 had meningitis (acute and subacute), 4 had meningoencephalitis, 2 had myelopathy, 1 had polyradiculopathy and 1 had meningovascular complications manifested by stroke. The most prevalent symptoms were headache (75%), vomiting and fever (50%) and unconsciousness (35%). Among 20 neurobrucellosis patients, 1 died and the other 19 recovered; 14 fully recovered and 5 patients had residual neurological deficits. In endemic areas, the disease should be ruled out in all patients who develop unexplained neurological symptoms.

[Pasteurella dagmatis: an unusual cause of vertebral osteomyelitis]. / Pasteurella dagmatis: une cause inhabituelle de spondylodiscite.

Vertebral osteomyelitis is a quite rare but severe cause of back pain in adults. Various causative organisms have been reported. Pasteurella species have rarely been isolated. We report here a case of vertebral osteomyelitis and consecutive cauda equina syndrome due to Pasteurella dagmatis in a 60-year-old diabetic man.

Easy drainage of presacral abscess.

Presacral region is one of the difficult regions for drainage of abscess as the approaches described for this carry a lot of morbidities. Transpedicular approach is described for the drainage of presacral abscess. Further, tuberculous abscess as a cause of cauda equina syndrome is reported. Patient had complete neurological recovery within weeks of drainage of abscess. Transpedicular drainage of presacral abscess is a safer option for recently developed neurological deficit. Late presentation may need anterior approach, which is associated with increased morbidity.

Early syphilis presenting as a painful polyradiculopathy in an HIV positive individual.

Neurosyphilis and neurological complications from syphilis may be commoner in HIV disease. With outbreaks of early syphilis in HIV positive individuals being observed over recent years, rare neurological manifestations of secondary syphilis will be observed more commonly. We describe a case of an HIV positive individual whose first presenting feature of early syphilis was a polyradiculopathy.

[Extrapulmonary complications of Mycoplasma pneumoniae infections]. / Ekstrapulmonale komplikationer ved mycoplasma pneumoniae-infektioner.

INTRODUCTION: Mycoplasma pneumoniae is a common cause of atypical pneumonia in children and young adults. The infection is generally mild and only a very few patients are admitted to hospital. However, extrapulmonary complications are well recognised--mostly as manifestations from the central nervous system (CNS). MATERIAL AND METHODS: We describe 21 patients with M. pneumoniae infection seen at Rigshospitalet, Copenhagen, from 1994 to 2000. RESULTS: The patients had fever, headache, myalgia, and cough. Biochemically, they were characterised by leucocytosis, an increased level of C-reactive protein, and infiltrations on the chest x-ray. A total of seven patients developed extrapulmonary complications to the infection in the form of encephalitis (3), polyradiculitis (1), transversel myelitis (1), erythema multiforme (3), cardial arrhythmia (1), and haemolytic anaemia (2). Three patients had more than one complication at the same time. DISCUSSION: The incidence of patients with complications to M. pneumoniae infection was higher than that reported in the literature, probably because these patients are typically submitted to the Department of Infectious Diseases, Rigshospitalet. The pathogenesis of extrapulmonary complications to M. pneumoniae infection is unknown.

Stages and syndromes of neuroborreliosis.

To ascertain the varieties of neuroborreliosis, 330 patients were identified at the Departments of Neurology in Würzburg and Giessen from 1979 to 1994. Patients who fullfilled at least one of three strict case definitions based on clinical and laboratory criteria were included in the study. Ninety-one per cent of the patients had second-stage neuroborreliosis (duration of symptoms < or = 6 months). The most common syndrome was a painful spinal meningoradiculitis, alone (37%) or in combination with a cranial radiculitis (29%). Meningoradiculitis cranialis (9%), isolated meningitis (4%) and erythema chronica migrans-associated mono/polyneuritis (3%) were further stage II features. Central nervous system involvement occurred either as an acute meningomyelitis or meningomyeloradiculitis (5%) and meningoencephalitis or meningenocephaloradiculitis (4%). Less than 9% of the patients ran a chronic course (stage III) with a disease duration between 6 months and 9 years, either as acrodermatitis chronica atrophicans associated mono- or polyneuritis (2%) or a chronic progressive encephalomyelitis (6%). Cerebrovascular neuroborreliosis (1%) occurred in both stages; however, the primary nature of the course was a chronic one. Involvement of other organs except the skin was rare (joints 3%, heart 1%) but elevated hepatic enzymes were frequent. Our study demonstrates that neuroborreliosis has to be considered in the differential diagnosis of a wide variety of neurological conditions. Cerebrospinal fluid analysis and the search for specific intrathecal antibody production are important diagnostic procedures.

Poliradiculomielopatia causada por citomegalovirus en pacientes con SIDA / Cytomegalovirus polyradiculomyelopathy in AIDS

Se presenta una serie de 7 pacientes con SIDA en quienes se diagnosticó poliradiculomielopatía causada por Citomegalovirus (CMV-PRAM), con el objetivo de evaluar la eficacia del tratamiento con ganciclovir, foscarnet, o la combinación de ambos agentes. Se realizaron evaluaciones clínicas y neurológicas al momento de presentación y durante el tratamiento para el CMV. La fuerza muscular fue establecida de acuerdo a la escala del Medical Research Council (MRC). Se clasificó la respuesta al tratamiento de acuerdo al grado de mejoría en la fuerza muscular. En 6 de los 7 pacientes se observó una mejoría en la fuerza muscular con tratamiento anti-CMV alcanzando grado 4, o una mejoría de por lo menos 3 grados de acuerdo a la escala MRC. El paciente restante tuvo una respuesta intermedia. CMV-PRAM puede ser tratada con ganciclovir o la combinación de ganciclovir y foscarnet con buenos resultados.

Poliradiculomielopatia causada por citomegalovirus en pacientes con SIDA / Cytomegalovirus polyradiculomyelopathy in AIDS

Se presenta una serie de 7 pacientes con SIDA en quienes se diagnosticó poliradiculomielopatía causada por Citomegalovirus (CMV-PRAM), con el objetivo de evaluar la eficacia del tratamiento con ganciclovir, foscarnet, o la combinación de ambos agentes. Se realizaron evaluaciones clínicas y neurológicas al momento de presentación y durante el tratamiento para el CMV. La fuerza muscular fue establecida de acuerdo a la escala del Medical Research Council (MRC). Se clasificó la respuesta al tratamiento de acuerdo al grado de mejoría en la fuerza muscular. En 6 de los 7 pacientes se observó una mejoría en la fuerza muscular con tratamiento anti-CMV alcanzando grado 4, o una mejoría de por lo menos 3 grados de acuerdo a la escala MRC. El paciente restante tuvo una respuesta intermedia. CMV-PRAM puede ser tratada con ganciclovir o la combinación de ganciclovir y foscarnet con buenos resultados. (AU)