Signs Of Meningeal Irritation Research Articles

Subaraknoid Kanamaya Bağlı Parkinson Hastalığının Karanlık Bir Nedeni Olarak Subtalamik Çekirdek Dejenerasyonu: Deneysel Bir Ön Çalışma

Background: Although the subtahalamic nucleus degeneration has been accused of Parkinson’s disease, the obscure roles of subtalamic nucleus degeneration induced by subarachnoid hemorrhages has not been adequately studied. The aim of the study is to examine the histopathological changes in the subthalamic nucleus after subarachnoid hemorrhage.
 Materials and Methods: Twenty-one wild male healthy rabbits were included in this study. The test subjects were divided as: control (GI, n=5); SHAM 1.2 cc of saline injected (GII, n=6) and 1.2 cc of autologous blood injection into cisterna magna (GIII, n=10). They followed up for three weeks and sacrificed under general anesthesia. Vasospasm index (VSI) was estimated by the circle surface estimation method, degenerated neuron densities of the subthalamic nucleus were estimated by Stereological methods and analyzed by Mann Witney U test.
 Results: Two rabbits dead in the study group were represented by meningeal irritation signs and unconsciousness. Prolonged QT intervals, ST depressions, and low voltage QRSs were noticed in GIII animals. Numerical documents of heart-respiratory rates (n/min), VSI values, and degenerated neuron densities of the subthalamic nucleus (n/mm3) as follows: 1.05±0.03/ 219±324/21±4/8±3 in GI; 1.75±0.23/209±14/15±4/16±4 in GII; and 2.03±0.14/175±19/19±5/123±21 GIII. P values between the VSI values and degenerated neuron densities of the subthalamic nucleus were nearly eqund: p

A West Nile Virus infection expressed as unilateral limb paralysis and complicated by Parsonage–Turner syndrome: a case report

BackgroundWest Nile Virus is a single-stranded Ribonucleic Acid arbovirus of the Flaviviridae family that is transmitted to humans by Culex species mosquitoes. West Nile Virus infection is asymptomatic in the majority of affected people. Of those who develop symptoms, the usual manifestation is a febrile syndrome, while only 1% develop neurological symptoms due to a neuroinvasive form of infection, including encephalitis, meningitis, asymmetrical flaccid paralysis, or a combination of all these features. Parsonage–Turner syndrome is a rare disorder characterized by sudden painful symptoms and subsequent paralysis, involving a shoulder or one of the upper limbs due to post-infective brachial plexopathy. The etiology is unknown, although it can be considered a multifactorial process: a predisposing factor, such as viral infection or strenuous upper-extremity exercise, can trigger an immune-mediated process localized in the brachial plexus.Clinical presentationIn late summer, a 79-year-old male Italian patient was admitted to the emergency department for acute right upper limb weakness and high fever, without any mental status impairment, pain, sensory alterations, or signs of meningeal irritation. Laboratory tests confirmed acute West Nile Virus infection, expressed as a unilateral upper limb flaccid paralysis. After a few days, the patient reported an acute pain in the right upper limb scarcely responsive to nonsteroidal anti-inflammatory drug therapy and a subsequent wider distribution of flaccid paralysis. After multiple examinations, Parsonage–Turner syndrome could be suspected. Patient was treated with steroids and reported an improvement of clinical condition after 2 months, with complete pain remission but partial strength recovery in the affected limb.ConclusionsWest Nile Virus disease has a broad spectrum of neurological manifestations, among which the most common are signs of meningeal irritation or cognitive impairment. We report an unusual presentation of neuroinvasive West Nile Virus infection with arm weakness as expression of unilateral viral neuritis, followed by a post-infective brachial plexopathy consistent with Parsonage–Turner syndrome diagnosis. We diagnosed Parsonage–Turner syndrome after excluding the most common causes of atraumatic acute upper limb pain, through a challenging differential diagnosis in a patient with several comorbidities.

Delayed Appearance of Brain Magnetic Resonance Imaging Abnormalities in a Patient with Glial Fibrillary Acidic Protein Astrocytopathy.

Recent studies have reported that autoantibodies against glial fibrillary acidic protein (GFAP), a major cytoskeletal protein expressed in astrocytes, can lead to GFAP astrocytopathy, an autoimmune central nervous system inflammatory disease. We herein report the unique case of a 59-year-old Japanese woman with GFAP astrocytopathy who presented with characteristic symptoms, including signs of meningeal irritation, cerebellar ataxia, and bladder/rectal dysfunction, in the absence of specific findings on initial brain magnetic resonance imaging (MRI). The patient exhibited new abnormal changes mainly in the brainstem on follow-up MRI, illustrating the need to recognize that MRI abnormalities may appear later in GFAP astrocytopathy.

A case of neurosyphilis presenting as sudden onset of limbic encephalitis

A 52-year-old male was carried to hospital by ambulance, because of an abrupt abnormal behavior and impaired consciousness. Soon after the arrival, the patient started a generalized seizure. Although the seizure was stopped by Midazolam, amnesia were observed. With meningeal irritation signs, in addition to the clinical course, the patient was thought to develop limbic encephalitis. The cause of the encephalitis was diagnosed as neurosyphilis because of the positive serum and CSF syphilis reactions, and the patient was treated with penicillin G from the first admission day on. Steroid pulse therapy was also conducted, followed by acyclovir since herpes encephalitis could not be ruled out; the brain MRI showed left-side dominant T2/FLAIR high intensity lesions in the bilateral temporal lobes and left hippocampus. With the treatment progression, the amnestic syndrome improved and the patient returned to work. Although neurosyphilis is a rare cause of acute onset limbic encephalitis, it is important to keep the possibility of this disease in mind in making a treatment plan.

Anti-NMDA Receptor Encephalitis: A Rare but Important Auto-Immune Cause of Encephalitis

Abstract: A previously healthy 30-year old lady presented with 1-day history of high grade fever and drowsiness. Five days prior to presentation, she developed insomnia and visual hallucinations of seeing unknown faces. Three days prior to presentation, she suffered from 5 episodes of generalized tonic colonic fits. On admission, she had a temperature of 102oF and GCS of 10/15 with no signs of meningeal irritation, no focal neurological deficit, normal deep tendon reflexes and down-going plantar reflex bilaterally. Her brain MRI scan showed mild hyper-intense signals in right cerebellum. Her CSF was tested for Anti-NMDA receptor antibodies which were positive. She was diagnosed as having Anti-NMDA Receptor Encephalitis and started on immediate Plasma Exchange with drastic improvement.

A Rare Case of Guillain–Barré Syndrome with Signs of Meningeal Irritation and Treatment-Related Fluctuations/Relapse

Abstract Guillain–Barré Syndrome is an acute inflammatory demyelinating polyradiculoneuropathy that can present at any age. The presentation of Guillain–Barré syndrome may be variable as the classic symptoms of areflexia and flaccid paralysis may or may not be present. Here we reported a case of a 15-year-old male patient who presented with complaints of weakness in bilateral lower limbs with inability to sit along with slurred speech and drooling of saliva with positive meningeal signs like neck stiffness and Kernig's sign. His symptoms improved with immunoglobulin therapy. Five days later, the child again had pain and increased weakness with increased work of breathing for which repeat dose and course of immunoglobulins were given. As patients with signs of meningeal irritation may suggest other diseases such as meningitis, it is important to consider atypical cases of Guillain–Barré syndrome along with treatment-related fluctuations as observed in our patient.

Bone marrow invasion by cryptococcus in HIV infected patients with asymptomatic meningitis: a case report

Cryptococcal infection is one of the common opportunistic fungal infections seen in HIV patients. It is the second leading cause of mortality in Acquired Immuno deficiency Syndrome (AIDS) patients worldwide. The cryptococcal infection occurs in subacute meningitis, patients having CD4+ T Lymphocytes count below 100 cells/micro liter. However, in severe immunosuppressed patients, Cryptococcus neoformans can infect any human organ including the bone marrow. This case presents the disseminated cryptococcosis with bone marrow involvement and asymptomatic meningitis, focusing on the role of bone marrow aspirate and biopsy study in HIV infected patients. A 42 year old HIV infected male patient with a CD4+ T Lymphocyte count of 25 cells/μl was admitted to the emergency department of Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, India. The patient underwent a CSF examination to rule out the infection of meningitis patient had no signs of meningeal irritation and neurological examinations were normal. The CSF culture showed Cryptococcus sp. The patient was given Amphotericine B plus Fluconazole therapy according to IDSA guidelines. However, the patient developed acute kidney injury stage 3 and was given fluconazole monotherapy. The symptoms disappeared and CSF culture for fungi was negative after 2 weeks of treatment. Bone marrow infection caused by Cryptococcus neoformans is a rare presentation of cryptococccosis.

Seropositive Neuromyelitis Optica in a Case of Undiagnosed Ankylosing Spondylitis: A Neuro-Rheumatological Conundrum

Seropositive Neuromyelitis Optica in a Case of Undiagnosed Ankylosing Spondylitis: A Neuro-Rheumatological Conundrum

Characterization of Meningitis and Meningoencephalitis in the Israeli Defense Forces From 2004 to 2015: A Population-Based Study.

BackgroundMeningitis and meningoencephalitis (MME) are potential medical emergencies. Mandatory reporting of all MME cases in the Israel Defense Force (IDF) allows accurate characterization of MME incidence and course. In the present study, we described the epidemiology of MME in soldiers.MethodsMedical charts of 860,000 combat and non-combat soldiers serving during the years 2004–2015, accounting for 2,256,060 patient years, were retrospectively evaluated. The diagnosis of MME was based on signs of meningeal irritation and a count of > 5 white blood cells (WBC) in the cerebrospinal fluid (CSF). Data on the diagnosis of bacterial or aseptic MME, significant sequelae, and associated mortality were collected.ResultsApproximately 273 cases of MME were diagnosed. Overall, MME incidence was 12.1/100,000 patient-years. Bacterial and viral pathogens were identified in 31/273 (11.4%) and 52/273 (19%) cases, respectively. Combat soldiers had higher incidence of bacterial meningitis [14/40 (35%) vs. 31/212 (14.6%); p = 0.002] and meningoencephalitis [13/40 (32.5%) vs. 33/212 (15.6%); p = 0.023] compared to non-combat soldiers. Their clinical presentation was more severe, including confusion [10/40 (25%) vs. 22/212 (10.4%); p = 0.018], focal neurological deficits [12/40 (30%) vs. 11/212 (5.2%); p < 0.0001], and status epilepticus [3/40 (7.5%) vs. 0/212 (0.0%); p < 0.01]. Mortality among combat soldiers was higher [5/40 (15%) vs. 1/212 (0.5%); p < 0.001]. N. meningitidis was the most frequently isolated bacteria, despite universal preventative vaccination.ConclusionThe incidence of bacterial MME in the IDF is higher than in the civilian population. Combat soldiers present with higher incidence of meningoencephalitis and bacterial meningitis.

Gardnerella vaginalis purulent meningitis in an adolescent male: a case report

BackgroundWe report a rare case of Gardnerella vaginalis found in the cerebrospinal fluid of a young boy.Case presentationA 14-year-old boy was admitted to hospital with headache, vomiting, fever, drowsiness and positive meningeal irritation signs on examination. Cerebrospinal fluid (CSF) shows white blood cell and protein were elevated, and glucose was low. Traditional aerobic and anaerobic culture of CSF did not grow any organisms. However, metagenomic next-generation sequencing (mNGS) reveals G. vaginalis in his CSF. The patient was diagnosed with purulent meningitis, and treated with intravenous meropenem and linezolid for a week, followed by oral administration of amoxicillin for two weeks. He recovered without sequelae.ConclusionsPurulent meningitis caused by Gardnerella vaginalis is extremely rare. Metagenomic next-generation sequencing of CSF should be highlighted for early diagnosis. With effective antibiotic treatment, the prognosis was excellent.

ACUTE ENCEPHALITIS SYNDROME IN A TERTIARY CARE SETTING WITH SPECIAL REFERENCE TO JAPANESE ENCEPHALITIS: AN OBSERVATIONAL STUDY IN ASSAM, INDIA

Acute Encephalitis Syndrome (AES) is a major public health problem and Japanese Encephalitis (JE) is one of the most important causes of AES. Therefore, it is crucial to know the etiology of AES for patient management and decision making. The present study aimed to assess the morbidity and mortality prole of AES/JE patients admitted in tertiary care setting. An observational prospective cross-sectional study was conducted among 140 hospitalized AES patients admitted in Pediatric and Medicine ward of Jorhat Medical College and Hospital (JMCH), Jorhat over a period from August, 2017 to July 2018. Blood serum and cerebrospinal uids (CSF) were tested for presence of JE specic IgM antibody by Mac ELISA during acute illness of AES. The data were compiled and analyzed using the IBM SPSS, V23.0. Of the total 140 AES cases, majority (60%) were below 15 years age (p-value 0.180). Signicantly higher proportion of AES cases were from rural areas (94.3%) (p-value &lt;0.0001). The male and female ratio was 1.3:1. The most common presenting symptoms in AES patients were fever (100%), change in mental status (100%), seizure (56.4%) and headache (42.9%). Signs of meningeal irritation were present in 69.3% of cases. Around 22.9% AES patients had GCS ≤ 8. A total 49 (35%) cases were found to be laboratory conrmed JE following detection of JE specic IgM antibody. Among the JE patients, only 4.1% were immunized with SA 14-14-2 vaccine and 14% died before discharge. The complete recoveries were observed in 78% of cases. JE is one of the major causes of AES which is highly prevalent in this part of India. The signicant ndings in the present study calls for policy decision to combat JE.

Traumatic rupture of an intracranial dermoid cyst: A case report

Intracranial dermoid cyst is a very rare primary intracranial tumor accounting for &lt;0.5% of intracranial masses. They are usually congenital and benign. Rupture of intracranial dermoid may occur spontaneously or with trivial trauma. Most cases of rupture are spontaneous. There are very few reported cases of traumatic rupture of intracranial dermoid cysts in world medical literature. The presentation can range from headache to signs of meningeal irritation and focal neurological deficit. Computed tomography (CT) and magnetic resonance imaging (MRI) of the brain is of paramount importance for early diagnosis and prompt treatment planning which can reduce both morbidity and mortality. The following case report gives an account of a 49-year-old female who presented with complaints of headache after an episode of fall. She was examined and no neurological deficit was found. Examination of the neurological system was within normal limits. She underwent a CT and MRI of the brain and was subsequently diagnosed as traumatic rupture of dermoid cyst based on the findings. She was treated with high-dose steroids until resolution of her symptoms and then discharged with the advice of regular follow-up. This case report highlights the role of CT and MRI in early diagnosis and treatment planning of patients with ruptured dermoid cysts which leads to a decrease in mortality and morbidity and also the ability of the same to rule out other more sinister causes of headache in patients.

Efficacy and safety of intravenous high-dose immunoglobulin in treatment of the severe form of Japanese encephalitis

To explore the efficacy and safety of intravenous immunoglobulin (IVIG) in the treatment of severe Japanese encephalitis (JE). A retrospective study of 124 children diagnosed with the severe or very severe form of JE was undertaken. There were 62 cases in the IVIG group and control group. The efficacy, safety, and tolerability of IVIG were evaluated 3days, as well as 1, 2, and 3weeks after IVIG, respectively, and the prognosis was assessed at 6months. Cox regression survival analysis suggested that the IVIG group reached the criteria for efficacious treatment faster than that in the control group. The duration of unconsciousness and the number of days of seizures, a dull response to light, the pyramidal sign, and meningeal-irritation sign in the IVIG group were shorter than those in the control group (p < 0.05). The number of complications occurring in the IVIG group (including gastrointestinal bleeding and pneumonia) was less than that in the control group (p < 0.05). Cox regression survival analysis suggested that age (p = 0.003) and imaging abnormalities (p = 0.042) had an effect on the efficacy of IVIG treatment. The Liverpool Outcome Score at 6months showed that the prognosis of the IVIG group was better than that of the control group (p < 0.05). IVIG treatment was safe and tolerable. IVIG showed good efficacy, safety, and tolerance for treatment of the severe form of JE. The age and imaging abnormalities of patients affect the efficacy of IVIG treatment.

Varicella-zoster virus-associated meningitis, encephalitis, and myelitis with sporadic skin blisters: A case report

BACKGROUNDVaricella-zoster virus (VZV) generally causes chickenpox at first infection in childhood and then establishes latent infection in the dorsal root ganglia of the spinal cord or other nerves. Virus reactivation owing to an impaired immune system causes inflammation along spinal nerves from the affected spinal segment, leading to skin manifestations (herpes zoster). Viremia and subsequent hematogenous transmission and nerve axonal transport of the virus may lead to meningitis, encephalitis, and myelitis. One such case is described in this study.CASE SUMMARYA 64-year-old man presented with dysuria, pyrexia, and progressive disturbance in consciousness. He had signs of meningeal irritation, and cerebrospinal fluid (CSF) analysis revealed marked pleocytosis with mononuclear predominance and a CSF/serum glucose ratio of 0.64. Head magnetic resonance imaging revealed hyperintense areas in the frontal lobes. He had four isolated blisters with papules and halos on his right chest, right lumbar region, and left scapular region. Infected giant cells were detected using the Tzanck test. Degenerated epidermal cells with intranuclear inclusion bodies and ballooning degeneration were present on skin biopsy. Serum VZV antibody titers suggested previous infection, and the CSF tested positive for VZV-DNA. He developed paraplegia, decreased temperature perception in the legs, urinary retention, and fecal incontinence. The patient was diagnosed with meningitis, encephalitis, and myelitis and was treated with acyclovir for 23 days and prednisolone for 14 days. Despite gradual improvement, the urinary retention and gait disturbances persisted as sequelae.CONCLUSIONVZV reactivation should be considered in differential diagnoses of patients with sporadic blisters and unexplained central nervous system symptoms.

Clinicolaboratory Profile and Outcome of Serologically Confirmed Scrub Typhus among Children from Sub Himalayan Tribal District of India: A Hospital-based Cross-sectional Study

Introduction: Scrub typhus is transmitted by the bite of the larva (chigger) of a microscopic trombiculidae mite (Leptotrombidium) found in moist areas and vegetation, which serves as both vector and reservoir. Scrub typhus is an often neglected and misdiagnosed febrile illness; clinical suspicion is the only key to diagnosis. Aim: To study clinicolaboratory profile and outcome of serologically confirmed scrub typhus in children from sub Himalayan tribal district of India. Materials and Methods: This cross-sectional observational study was conducted in Department of Paediatrics at Government District Hospital, Chamba, Himachal Pradesh, India, from May 2019 to April 2020. Children upto 18 years admitted with positive Immunoglobulin M (IgM) antibodies for scrub typhus were enrolled. The observational data including detail history and examination, relevant laboratory investigation and treatment was analysed by Statistical Package for Social Sciences (SPSS) software version 18.0 and Chi-square test with p-value &lt;0.05 was considered statistically significant. Results: There were total 55 patients with scrub typhus, mean age was 9.2 years, most common age group was 7-12 years, 51% were male. Fever was most common complaint, followed by vomiting (27.3%), abdomen pain (25.4%), respiratory (1.8%), and rash (9%). Clinical examination findings were generalised lymphadenopathy in 46 (83.6%) patients and splenomegaly in 29 (52.7%). Eight patients presented with respiratory signs and tachypnea at the time of admission. Eschar was present in only 3 (5.5%) patients. Sign of meningeal irritation was present in 4 (7.3% cases and low GCS score (below 9) observed in 7 (12.7%) patients. Eight patients required mechanical ventilatory support. Nineteen patients were prescribed doxycycline alone; while 34 were given both azithromycin and doxycycline. There were total five deaths; on multivariate logistic regression, respiratory complaint, need for mechanical ventilation, pain abdomen with liver damage, history of seizures and duration of fever more than 4 days before presentation to hospital were associated with adverse outcome. Conclusion: The prevalence of scrub typhus is considerably high during rainy season, and should be considered as a differential diagnosis of fever among children in this period regardless of the presence of an eschar. Immediate medical care, treatment with doxycycline with early defervescence of fever reduce mortality

Unraveling scrub encephalitis: A study on the clinical profile and investigations of scrub encephalitis

Introduction: Scrub encephalitis (SE) is one of the known causes of acute encephalitis syndrome (AES). Although central nervous system involvement is known in scrub typhus, its association with AES is less understood and lesser diagnosed. In the absence of a point of care test for scrub typhus, cases of SE can be easily missed. A clinical approach using detailed history and clinical profiling of SE will help to diagnose SE in our region, using minimum resources, within a reasonable period. Aims: To analyze the clinical spectrum in patients of SE and to evaluate the investigations required to diagnose SE. Methodology: This is a retrospective study that analyzed Scrub typhus patients over 2 years from January 2018 to December 2019. A total of 370 patients were screened and 23 patients who satisfied the study criteria were included in the study and analyzed. Results: Among the cases of scrub typhus admitted in the hospital, the prevalence of SE was 6%. The most common presenting complaint was fever in 21 patients (91%) followed by altered sensorium in 16 (70%) and seizures in 9 patients (39%). An eschar was noted in 66% of the cases. The mean Glasgow Coma scale was 11 among the cases with almost 70% of cases showing signs of meningeal irritation. Organ involvement was noted as thrombocytopenia in 21 patients (91%), 16 patients (69%) with jaundice, and 1 (4%) with acute kidney injury. Conclusion: SE is an AES which, if detected early, is easily treatable with no residual neurological sequelae. Hence, identification of this condition and prompt diagnosis of SE becomes crucial to the management of this complication of scrub typhus.

Vaccination Status and Clinical Spectrum of Children with Pyogenic Meningitis in A Tertiary Care Hospital of Hazara Division, Pakistan

Background: Pyogenic meningitis is one of the serious causes of mortality and morbidity in children. It is more prevalent in third world countries with poor vaccination coverage. This study was done to determine the vaccination status and clinical spectrum of pyogenic meningitis in children presenting to a tertiary care hospital.&#x0D; Methods: This cross-sectional study was carried out from August, 2017 till January, 2020 over 2.5 years. Records of children who got admitted in pediatric B ward, of either gender between ages of 1 month to 14 years diagnosed as case of pyogenic meningitis were included. Records of vaccination status along with signs of meningeal irritation, complications and outcome during hospital stay were documented. Data was analyzed by SPSS 20 and chi square test applied. P value &lt; 0.05 was taken as significant.&#x0D; Results: There were 117 patients, 78 males and 39 females. Age ranged from 1 month to 14 years with mean age of 5.51± 4.19 years. Patients who were vaccinated up to date were 49.6% and 37.6% were not vaccinated at all. Main presenting feature was fever and seizures especially under one year of age. There was significant association between seizures and age group with p value of 0.001. Signs of meningeal irritation (neck stiffness, brudzinski sign, kerning sign) and paradoxical irritability were present in 85 (72.6%) patients mostly above 1 year of age. There was significant association between signs of meningeal irritation and age group (5 years and above) with p value of &lt;0.001. 110 (94%) got discharged and one (0.9%) patient was referred while 6 (5.1%) patients expired. There was significant association between stay duration and vaccination status. (p = 0.018)&#x0D; Conclusion: Fever was the most common presentation and vaccinated children with pyogenic meningitis had shorter stay in hospital.

Clinical study on the diagnosis of porcine streptococcal meningitis with negative blood and cerebrospinal fluid culture by next-generation sequencing

BackgroundStreptococcus suis (Ss) is a Gram-positive and anaerobic zoonotic pathogen that is susceptible to all populations and can cause meningitis, septicemia, endocarditis and arthritis in humans.MethodsIn this study, patients with meningitis who were admitted to our hospital with negative blood and cerebrospinal fluid culture were divided into a next-generation sequencing group and a control group. In the next-generation sequencing group, we used the next-generation sequencing method to detect pathogenic bacteria in the patients’ cerebrospinal fluid. In the control group, we used blood and cerebrospinal fluid bacterial culture method to detect pathogenic bacteria in the patients' cerebrospinal fluid. The detection rates of pathogenic bacteria in the cerebrospinal fluid of the two groups were compared and analyzed.ResultsA total of 18 patients were included in this study, including 8 patients in the next-generation sequencing group and 10 patients in the control group. The mean age (P = 0.613) and mean disease duration (P = 0.294) were similar in both groups. Patients in the next-generation sequencing group had a leukocyte count of 13.13 ± 4.79 × 109, a neutrophil percentage of 83.39 ± 10.36%, and a C-reactive protein level of 134.95 ± 107.69 mg/L. Patients in the control group had a temperature of 38.32 ± 1.07, a leukocyte count of 8.00 ± 2.99 × 109, and a neutrophil percentage of 74.61 ± 8.89%, and C-reactive protein level was 4.75 ± 6.8 mg/L. The statistical results showed that the leukocytes (P = 0.013) and C-reactive protein levels (P = 0.001) were significantly higher in the patients of the next-generation sequencing group than in the control group. No statistically significant differences were seen in body temperature and neutrophil percentage between the two groups (P > 0.05). The incidence of intracranial pressure and meningeal irritation signs were similar in the two groups (P > 0.05). The detection rate of Streptococcus suis in the cerebrospinal fluid of patients in the next-generation sequencing group was 100%, and the detection rate of Streptococcus suis in the cerebrospinal fluid of the control group was 0%.ConclusionThe detection rate of Streptococcus suis infection in cerebrospinal fluid by next-generation sequencing was significantly higher than that by blood and cerebrospinal fluid bacterial culture. Therefore, the diagnosis of porcine streptococcal meningitis by next-generation sequencing method is worthy of clinical promotion and application.

Asymptomatic meningitis diagnosed by positron emission tomography in a patient with syndrome of inappropriate antidiuretic hormone secretion: a case report

BackgroundSyndrome of inappropriate antidiuretic hormone secretion can be caused by arginine-vasopressin-producing tumors or enhanced arginine vasopressin secretion from the posterior pituitary gland due to central nervous system disorders and intrathoracic diseases.Case presentationA 53-year-old Asian man was hospitalized with complaints of tremor and hiccups. Laboratory examination revealed findings suggestive of hypotonic hyponatremia due to syndrome of inappropriate antidiuretic hormone secretion. The patient did not complain of headache or photophobia, and showed no signs of meningeal irritation. Positron emission tomography–computed tomography revealed 18F-fluoro-deoxy-glucose accumulation along the cervical spinal cord, based on which the patient was diagnosed as having aseptic meningitis. The hyponatremia was treated successfully by fluid restriction, and optimum plasma sodium concentration was maintained by tolvaptan administration.ConclusionsThis case underscores the need to consider the possibility of mild meningitis as the cause of syndrome of inappropriate antidiuretic hormone secretion in patients without other identifiable cause.

Epilepsy P-EP001. Status epilepticus and intractable seizure in herpes simplex encephalitis patient: Case series

Introduction . Herpes Simplex Encephalitis (HSE) is a rare disorder caused by infection of the CNS by HSV that could have a potentially fatal outcome particularly with delayed treatment. The early presentation is relatively nonspecific consisting of fever, headaches, seizures and unconsciousness. Seizures have been associated with death in HSE. This case report aims to publish case series of status epilepticus and intractable seizure in HSE patient at Sardjito Hospital Yogyakarta. Results . CASE 1: A 26year-old male was admitted to the ER Sardjito Hospital in 2018 presented with GTCS and behavior changes. GCS of this patient was E4V4M6 and there were no signs of meningeal irritation, no weakness found in extremity but increase of physiological reflex indicating UMN sign. After being transferred to the ward, patient developed to status epilepticus, then patient was referred to ICU; midazolam & propofol were administered to reduce seizures. Laboratory, CSF analysis and MRI were consistent with HSE. After aggressive treatments with anti-edema, antiviral and multiple antiepileptic drug (AED), there was a reduction in seizure but sometimes patient still developed GTCS. He was discharged after 25 days treatments with full consciousness, reduction of seizure frequency but the focal aware seizures were still remained. CASE 2: A 29-year-old female was admitted to the ER Sardjito in 2019 presented with focal to bilateral tonic-clonic seizure and status epilepticus. The complaints begin with acute progressive headache, fever, visual hallucinations and weakness of the left limbs. GCS of this patient was E2VTM2 (on midazolam) and there were no signs of meningeal irritation. Laboratory and CSF analysis were consistent with HSE. CT scan showed cerebral edema. After treatments with anti-edema, antiviral and AED, the patient regained full consciousness and there was a reduction of seizure frequency but focal aware seizures were still remained. Conclusion . Seizures in HSE are reported to be intractable seizures and more likely to develop status epilepticus. The seizures are typically refractory to AED, often requiring combination and aggressive treatments.