Treatment Outcomes of Childhood Tuberculous Meningitis in a Real-World Retrospective Cohort,Bandung, Indonesia

We retrospectively evaluated clinical features and outcomes in children treated for tuberculous meningitis (TBM) at Hasan Sadikin Hospital, Bandung, Indonesia, during 2011–2020. Among 283 patients, 153 (54.1%) were <5 years of age, and 226 (79.9%) had stage II or III TBM. Predictors of in-hospital death (n = 44 [15.5%]) were stage III TBM, hydrocephalus, male sex, low-income parents, seizures at admission, and lack of bacillus Calmette-Guérin vaccination. Predictors of postdischarge death (n = 18 [6.4%]) were hydrocephalus, tuberculoma, and lack of bacillus Calmette-Guérin vaccination. At treatment completion, 91 (32.1%) patients were documented to have survived, of whom 33 (36.3%) had severe neurologic sequelae and 118 (41.7%) had unknown outcomes. Predictors of severe neurologic sequelae were baseline temperature >38°C, stage III TBM, and baseline motor deficit. Despite treatment, childhood TBM in Indonesia causes substantial neurologic sequelae and death, highlighting the importance of improved early diagnosis, better tuberculosis prevention, and optimized TBM management strategies.     

神经内镜下三脑室底造瘘术联合脑室腹腔分流术治疗结核性脑膜炎并发脑积水的疗效分析

目的：探讨神经内镜下三脑室底造瘘术联合脑室腹腔分流术对结核性脑膜炎并发脑积水的治疗效果。方法：回顾性分析12例结核性脑积水患者经神经内镜下三脑室底造瘘术联合脑室腹腔分流术的治疗效果。结果：所有患者均随访6个月,12例患者中11例术后脑积水症状均明显改善,1例患者术后2个月死亡。结论：三脑室底造瘘术联合脑室腹腔分流术是治疗结核性脑膜炎并发脑积水的有效方法。     

侧脑室-腹腔分流术后并发症的病因及处理

[目的]总结侧脑室-腹腔分流术(V-P分流术)治疗脑积水的手术经验。[方法]回顾性分析96例V-P分流术的手术方法、结果和并发症情况,并提出改进措施。[结果]并发症13例,占13.5%,分别为感染4例,过度分流4例,分流管梗塞3例,癫痫发作1例,肠梗阻1例。[结论]V-P分流术的并发症与多种因素有关,改进手术方法,个性化设计治疗方案,能有效降低并发症的发生。     

神经内镜的临床应用

目的：探讨神经内镜治疗脑积水、蛛网膜囊肿、脑室出血的临床应用。方法：回顾性分析2009年12月-2012年10月的45例患者,脑积水22例,（其中6例脑积水合并囊肿）,蛛网膜囊肿22例;脑室出血并侧脑室铸型1例,全部病例采用内镜手术治疗：脑积水行三室底造瘘术,脑积水合并囊肿同时行囊肿-脑室造瘘,蛛网膜囊肿行囊肿-脑池或脑室或蛛网膜下腔造瘘术。结果：45例患者术后临床症状消失或明显改善,影像学检查脑室或囊肿不同程度缩小。结论：神经内镜对于脑积水、蛛网膜囊肿、脑室出血并铸型的治疗损伤小,效果好。     

新生儿脊膜脊髓膨出合并脑积水的外科治疗(附6例报告)

目的 探讨新生儿期脊膜脊髓膨出合并脑积水的发病机理和手术时机。方法 头颅CT6例。腰骶部CT2例，腰骶部X线照片6例。1例分二期行脑室腹腔分流和脊膜脊髓膨出修复术，5例一期手术，分流术中测量颅内压。结果 4例颅内压正常，2例颅内高压，1例分二期手术在行脑室腹腔分流术后脊膜脊髓膨出体积明显缩小。6例伤口愈合良好，随访半年至3年无复发，CT未见脑积水，临床症状好转。结论 脑积水可促进腰骶部脊膜脊髓膨出，在新生儿期行脑室腹腔分流和膨出修补手术疗效良好。显微手术能防止术后脊髓栓系发生。     

神经病学、肿瘤学、脊柱生物力学、全身系统情况治疗决策框架指导脊柱转移瘤治疗的临床应用及评价

目的 探讨神经病学、肿瘤学、脊柱生物力学、全身系统情况（NOMS）治疗决策框架在指导脊柱转移瘤治疗决策中的意义和价值.方法 对59例脊柱转移瘤患者应用NOMS治疗决策框架进行术前评估并制定治疗方案.结果 49例获得随访,随访5 ～ 30个月,平均16个月,1例术后20 d死亡,未发现内固定松动及术后再骨折者.脊髓及神经根损害患者术后均得到不同程度缓解,肿瘤患者生存质量评分平均提高18.0分.结论 NOMS治疗决策框架是从NOMS方面综合评估脊柱转移瘤患者情况并指导临床医生制定治疗方案,合理选择手术方式、放射治疗等,可以取得较好的临床效果.     

Recurring infection and "shunt nephritis" in home hyperalimentation.

A patient on home hyperalimentation after a series of infections, developed a "shunt nephritis" not unlike the nephritis reported in patients with hydrocephalus undergoing ventriculoatriostomy. Permanent eradication of infection and reversal of kidney damage required removal of indwelling catheter.     

Laparoscopic Cholecystectomy in a Patient with a Ventriculoperitoneal Shunt

With the advent of ventriculo-peritoneal shunting and improved medical therapies, patients with hydrocephalus are living longer and presenting with unrelated medical problems. It can be disconcerting to discover that the patient who needs a routine laparoscopic procedure also has a ventriculoperitoneal (VP) shunt. Although the literature is limited there is a small body of evidence indicating that it is safe to perform laparoscopic surgery on these patients with routine anesthetic monitoring. The authors report the case of a laparoscopic cholecystectomy in a patient with a VP shunt.     

Multisystem atrophy made worse by lithium treatment in a hospice patient: a case report

Multisystem atrophy is a neurologic condition defined as an adult-onset, progressive, neurodegenerative disease of unknown etiology. It carries a multisystem clinical course, including autonomic, urogenital, cerebellar, and parkinsonian features. Lithium toxicity, classically manifesting as increased thirst, polyuria, gastric distress, weight gain, tremor, fatigue, and mild cognitive impairment, can present in a similar manner.( 1 ) We would like to present a patient diagnosed with progressive neurologic features typical of multisystem atrophy that also had bipolar disorder and had been taking lithium for many years. Despite normal lithium levels, it appeared as though a subclinical lithium toxicity was manifesting in the patient, and once lithium was discontinued, the patient was discharged from hospice with significant improvement in his presenting symptoms.     

Considerations in fluids and electrolytes after traumatic brain injury.

Appropriate fluid management of patients with traumatic brain injury (TBI) presents a challenge for many clinicians. Many of these patients may receive osmotic diuretics for the treatment of increased intracranial pressure or develop sodium disturbances, which act to alter fluid balance. However, establishment of fluid balance is extremely important for improving patient outcomes after neurologic injury. The use of hyperosmolar fluids, such as hypertonic saline, has gained significant interest because they are devoid of dehydrating properties and may have other beneficial properties for patients with TBI. Electrolyte derangements are also common after neurologic injury, with many having neurologic manifestations. In addition, the role of electrolyte abnormalities in the secondary neurologic injury cascade is being delineated and may offer a potential future therapeutic intervention.     

The use of CT scanning in dementia. A systematic review.

While reversible cases of dementia are rare once detected, the patient may benefit from treatment. This paper examines the cost-effectiveness of computerized tomography (CT) scanning as a screening test for potentially reversible dementia. A systematic review was carried out to identify the proportion of patients with dementia above and below the age of 65 years with a theoretically treatable condition and the proportion of these patients who would benefit from neurosurgery. Information was combined with epidemiological and financial data relating to Scotland to model the costs and benefits of implementing a national screening program. Subdural hematoma, normal pressure hydrocephalus, and brain tumours are rare conditions treatable by neurosurgery. A scanning and treatment program for Scotland would cost 4.6 million Pounds per annum. Of 531 reversible cases detected, 136 would benefit from neurosurgery, 369 would not benefit, and 26 would die as a result of surgery. Treating normal pressure hydrocephalus reduces overall quality-adjusted survival. The most cost effective screening strategy is to scan all patients but treat only subdural hematomas, gaining 178 quality-adjusted life-years (QALYs) at a cost of 14,171 Pounds per QALY for patients aged 65 at the time of the scan. The corresponding figures for patients above and below 65 years are 9,000 Pounds and 23,000 Pounds, respectively. CT scanning appears cost-effective in dementia patients under 65 years. It should be undertaken selectively in more elderly patients. Surgical treatment of normal pressure hydrocephalus may reduce quality adjusted survival and should only be undertaken within clinical trials.     

1996至2004年中国围产儿先天性脑积水的发生状况分析

目的探讨1996至2004年期间我国围产儿先天性脑积水的流行病学特征。方法采用中国出生缺陷监测网的资料,调查孕28周到产后7d住院分娩的围产儿中先天性脑积水的发生情况。将脑积水分为单发和综合征2类,分别按年份、围产儿性别、出生地（城／乡）、产妇年龄、南北方计算其发生率,并分析患儿的出生孕周、出生体重、围产期转归以及畸形的产前诊断情况。结果共收集围产儿4282536例,先天性脑积水3012例,总发生率为7．03／万,其中单发和综合征脑积水发生率分别为5．67／万和1．36／万,年度发生率呈逐年上升趋势。围产儿脑积水的发生率男性为7．09／万,女性为6．76／万;城镇为5．49／万,农村为10．10／万;产妇年龄别发生率的差异有统计学意义,〈20岁组最高（11．42／万）;累计和单发脑积水的发生率北方高于南方,综合征脑积水的发生率则北方低于南方;脑积水患儿中未足月分娩者占57．97％,低出生体重者占50．92％;单发和综合征脑积水的围产期病死率分别为88．66％和83．91％,总病死率为87．75％。先天性脑积水畸形的产前诊断率呈上升趋势。结论我国是先天性脑积水的高发地区,城乡和地区差别明显。脑积水发生率的上升趋势可能与监测医院的畸形诊断能力提高有关。先天性脑积水患儿的围产期病死率高,预后差。     

婴儿外部性脑积水62例临床分析

目的：总结小儿外部性脑积水的共性，并对其发病机制及诊断、治疗、预后的有关问题进行探讨。方法：对６２例外部性脑积水患儿的临床及ＣＴ表现、治疗方法、预后等情况给予综合分析。结果：认为外部性脑积水患儿无特异性临床表现，诊断主要是依赖脑ＣＴ的特殊变化，治疗主要是对原发病的治疗，预后一般良好。结论：外部性脑积水不是独立的疾病，而是婴儿早期多种病因导致的脑发育异常。临床应注意与脑萎缩、脑发育不良相鉴别并要定期随访     

Severe ataxia, myelopathy, and peripheral neuropathy due to acquired copper deficiency in a patient with history of gastrectomy

BACKGROUND: In animal studies, copper absorption has been demonstrated to occur in the proximal gut via duodenal enterocytes. Acquired copper deficiency is known as "swayback" in ruminant animals and Menkes' disease in humans. Copper is an essential micronutrient necessary for the hematologic and neurologic systems. Acquired copper deficiency in humans has been described, causing a syndrome similar to the subacute combined degeneration of vitamin B(12) deficiency. METHODS: This is a single case report. Our patient developed a neurologic constellation of ataxia, myelopathy, and peripheral neuropathy similar to vitamin B(12) deficiency many years after gastrectomy for severe peptic ulcer disease. The patient was maintained for decades with enteral feedings via jejunostomy that provided the recommended dietary allowance (RDA) for copper. RESULTS: Copper deficiency was suspected, identified, and treated. Over 3 months of follow-up, serum copper levels increased from 4 microg/dL to 20 microg/dL (70-150 microg/dL), and ceruloplasmin increased from 6 mg/dL to 8 mg/dL (14-58 mg/dL). During this short time of follow-up, the patient has had no further progression of his neurologic symptoms. CONCLUSIONS: Ataxia and myelopathy secondary to acquired copper deficiency are rare complications of major gastric resection. This is quite similar to the syndrome of vitamin B(12) deficiency. Vitamin B(12) repletion does not improve symptoms. Bariatric procedures such as gastric bypass surgery result in a similar functional anatomy of the proximal gut and may place more patients at increased risk. Early recognition and therapy with oral or parenteral copper may lead to a decrease in both neurologic and hematologic consequences.     

From gene to disease; X-linked hydrocephalus and LiCAM

X-linked hydrocephalus (hydrocephalus due to congenital stenosis of aqueduct of Sylvius; MIM number 307000) has a variable clinical expression. About 5% of cases of non-syndromal hydrocephalus are affected by this condition. The severe clinical phenotype is characterized by hydrocephalus and adducted thumbs in a newborn boy, the milder phenotype by mental retardation and spastic paraplegia. Female carriers may show mild features. Mutations in the LiCAM gene have been demonstrated to cause the condition. The gene is located at Xq28 and encodes for a cell surface glycoprotein that consists of an extracellular part with 6 immunoglobulin and 5 fibronectin type III-like domains, a single pass transmembrane domain and a short cytoplasmic domain. Mutations are documented in about 75% of classical cases. Reliable prenatal diagnosis is possible when a mutation has been documented.     

Lésions cérébelleuses réversibles et neuropathie périphérique induites par le métronidazole

Introduction

Metronidazole is a widely prescribed treatment for amoebic and anaerobic germ infections. Its neurologic toxicity is rare but can be serious.

Case report

We report the case of a 27-year-old male patient, treated with metronidazole for a cerebral abscess. He presented with a cerebellar syndrome and peripheral neuropathy at a cumulative metronidazole dose of 60 g. The MRI aspect of the cerebellar lesions in addition to their reversibility after treatment cessation led to the diagnosis of metronidazole induced neurologic toxicity.

Conclusion

The occurrence of neurologic disorders in patients treated with metronidazole must suggest drug toxicity and lead to cessation of treatment.     

The cost of home hospice care for terminal patients in Israel

This study examined and compared the cost of care provided to terminal metastatic cancer patients by home hospices and by conventional health services. The study population included 146 patients with metastatic cancer. Half received home hospice services, and the other half received conventional services. The average overall per-patient cost of care was, respectively, $4761 (operating costs included) and $12 434. On average, the costs were lower for older patients. A multiple regression analysis revealed that treatment units per patient, care framework, and patient age significantly contributed to explaining the cost variance. The findings suggest a financial advantage for home hospice care for terminal patients. This should be investigated further, as should the cost of informal caregivers and patient and caregiver satisfaction with the quality of care in both frameworks.     

Knowledge of caregivers of children with hydrocephalus

Knowledge of caregivers of children with hydrocephalus is not well assessed. This study identifies the fonts of information to assume activities how to care; to verify caregivers' knowledge about hydrocephalus. Fifty-four caregivers answered the interview from november 2007 to august 2008, with absolute predominance of females. Twenty-nine (53.7%) learned to take care by themselves. Only four caregivers (16.0%) received information at the hospital. 29 (53.7%) regarding the definition, 11 (20.4%) the cause of hydrocephalus. It was observed that caregivers with eight years of study had bigger knowledge. The education level of the caregiver had a positive correlation to on increased knowledge about hydrocephalus, but the caregivers have little concerns about important hydrocephalus' aspects.     

Hypermanganesemia in patients receiving total parenteral nutrition

BACKGROUND: Manganese is one of the trace elements that is routinely administered to total parenteral nutrition (TPN) patients. The recommended daily IV dosage ranges from 100 to 800 MICROg. We have used 500 microg daily. Recent reports have suggested neurologic symptoms seen in some patients receiving home parenteral nutrition (HPN) may be due to hypermanganesemia. Therefore, HPN patients and some short-term inpatients receiving TPN were studied to ascertain the relationship between dose and blood levels. METHODS: Red blood cell manganese levels were obtained by atomic absorptiometry. RESULTS: The levels in 36 hospitalized, short-term patients obtained within 48 hours of initiating TPN were all normal. The 30 patients receiving TPN from 3 to 30 days had levels that ranged from 4.8 to 28 microg/L (normal, 11 to 23 microg/L). Two patients had abnormal levels, at days 14 and 18. Fifteen of the 21 patients receiving inpatient TPN or HPN for 36 to 5075 days had elevated Mn levels. Only one patient with hypermanganesemia, an inpatient, had abnormal biochemical liver tests (bilirubin and alkaline phosphatase). One of the patients with a high level had some vestibular symptoms attributed to aminoglycoside use and had increased signal density in the globus pallidus on T1-weighted images on magnetic resonance imaging (MRI). A second patient with Mn levels twice normal had no neurologic symptoms, but had similar MRI findings. A third had some basal ganglia symptoms, confirmed by a neurologic evaluation, seizures, and very high Mn levels. The MRI showed no signal enhancement, but motion artifacts limited the study technically. CONCLUSIONS: Hypermanganesemia is seen in HPN patients receiving 500 microg manganese daily and may have resulted in some neurologic damage in three patients. Hypermanganesemia is sometimes seen after a short course of TPN in inpatients, as early as 14 days. Patients should be monitored for hypermanganesemia if they receive Mn in their TPN for >30 days. A 500 microg/d dose of Mn is probably excessive, and 100 microg/d should probably never be exceeded. Mn should be eliminated from the solution if the Mn level is elevated and should not be readministered unless the level returns to normal or subnormal. Mn should not be supplemented if the patient has liver disease with an elevated bilirubin.     

Rapidly progressive dementia due to Mycobacterium neoaurum meningoencephalitis

Dementia developed in a patient with widespread neurologic manifestations; she died within 5 months. Pathologic findings showed granulomatous inflammation with caseation necrosis, foreign body-type giant cells, and proliferative endarteritis with vascular occlusions. Broad-range polymerase chain reaction identified Mycobacterium neoaurum as the possible pathogen. Central nervous system infection by M. neoaurum may result in rapidly progressive dementia.