Two cases of urinary retention secondary to aseptic meningitis]

We report two rare cases of urinary retention secondary to aseptic meningitis. Case I was in a 13-year-old boy admitted to the pediatric department due to aseptic meningitis. Eight days after his admission, urinary retention developed and cystometry showed atonic bladder. Case 2 was in a 18-year-old woman consulted the urological department with a chief complaint of urinary retention accompanied with high fever, headache and vomiting. The spinal fluid examination and cystometry revealed aseptic meningitis and atonic bladder, respectively. In both cases, the patients were treated with conservative therapy and bladder dysfunction was resolved after a few weeks. Eleven cases of urinary retention secondary to aseptic meningitis have been reported in the previous literature.     

Foreign body reaction to rubber Torkildsen catheters: a report of two cases

Two patients came to clinical attention because of foreign body reactions to rubber catheters. In one patient, the reaction presented as multiple levels of aseptic meningitis and, in the second patient, the reaction caused an intracranial mass with localized neurological dysfunction.     

Aseptic meningitis after microdiscectomy: description of a case and review of the literature

BACKGROUND CONTEXT: Aseptic meningitis has rarely been described after spinal surgery. No reports of aseptic meningitis exist after microdiscectomy in the literature. PURPOSE: To report on a case of aseptic meningitis in a patient after undergoing laminotomy and microdiscectomy at L4-L5. STUDY DESIGN/SETTING: Case report. METHODS: A case of aseptic meningitis is reported after microdiscectomy at L4-L5 in a 31-year-old man. In this case, a patient underwent L4-L5 laminotomy and microdiscectomy for weakness and pain. He subsequently presented 3 days after with neck pain, photophobia, and fever. RESULTS: Cerebrospinal fluid (CSF) examination subsequently revealed a pattern for aseptic meningitis. CONCLUSIONS: Presentation of aseptic meningitis after microdiscectomy is a rare but important diagnosis to consider. Examination of CSF is an important procedure to rule out the more dangerous diagnosis of bacterial meningitis.     

The simultaneous determination of cerebrospinal fluid and plasma adenosine deaminase activity as a diagnostic aid in tuberculous meningitis

The simultaneous determination of cerebrospinal fluid (CSF) and plasma adenosine deaminase (ADA) activity was evaluated as a diagnostic aid in tuberculous meningitis (TBM). CSF and plasma ADA activity were determined in four groups of patients: (i) a 'no meningitis' group of 174 children investigated for possible meningitis, but found to be uninfected; (ii) an aseptic meningitis group of 40 children; (iii) a bacterial meningitis group of 31 children; and (iv) a TBM group of 27 patients (24 children and 3 adults). CSF ADA alone was determined in a further 23 children with aseptic meningitis, 19 with bacterial meningitis and 13 children and 7 adults with TBM. Both the CSF/plasma ADA ratio and the absolute CSF ADA activity were raised in TBM (mean values 0,24 and 12,61 U/I respectively) and bacterial meningitis (mean values 0,59 and 15,43 U/I respectively), but not in the aseptic meningitis group (mean values 0,06 and 2,00 U/I) or the 'no meningitis' group (mean values 0,04 and 1,51 U/I). Both values will distinguish TBM from aseptic meningitis, but do not appear to hold any marked advantages over conventional CSF criteria in the diagnosis of TBM.     

Leflunomide-induced aseptic meningitis

Drug-induced aseptic meningitis is uncommon and occurs primarily in patients with autoimmune disease. We report the first known case of leflunomide-induced aseptic meningitis, in a patient with rheumatoid arthritis.     

Méningite aseptique médicamenteuse induite par le léflunomide

Drug-induced aseptic meningitis is uncommon and occurs primarily in patients with autoimmune disease. We report the first known case of leflunomide-induced aseptic meningitis, in a patient with rheumatoid arthritis.     

Aseptic meningitis caused by Teflon implantation for microvascular decompression. Case report.

The authors present the case of a 47-year-old man who, after undergoing microvascular decompression for trigeminal neuralgia, experienced symptomatic pain relief but developed prolonged aseptic meningitis. This case is unusual in that the patient remained dependent on steroid medications for nearly 5 months following the initial surgery and the aseptic meningitis did not resolve until after surgical removal of the Teflon used to pad the trigeminal nerve. The pathophysiological characteristics of the body's reaction to implanted Teflon are discussed along with the rationale for removing this substance in cases of prolonged intractable aseptic meningitis.     

Systemic lupus erythematosus with neurologic onset and secondary antiphospholipid syndrome. A Case Study

A 39-years-old woman was admitted to our hospital with musculoskeletal complaints (myalgias and symmetric arthralgias in proximal interphalangeal, metacarpophalangeal joints of the hands and in knees), systemic symptoms like fever, fatigue, malaise and a six months previous history of a transient ischemic attack. The presence of antibodies to double-stranded deoxyribonucleic-acid (DNA) and antiphospholipid antibodies led to the diagnosis of systemic lupus erythematosus with secondary antiphospholipid syndrome. Cerebral infarction develops significantly more often in patients with lupus and antiphospholipid antibodies, but other clinical syndromes are associated with lupus anticoagulant: cognitive dysfunction, seizures, polyneuropathy, aseptic meningitis, myelopathy.     

Acute flaccid paraplegia: a rare complication of meningococcal meningitis

STUDY DESIGN: A case report of spinal cord dysfunction following meningococcal meningitis. OBJECTIVES: To describe a rare complication of meningococcal meningitis. SETTING: Spinal Unit, Armed Forces Institute of Rehabilitation Medicine, Rawalpindi, Pakistan. METHODS: A young healthy male developed meningococcal meningitis followed by acute onset low thoracic flaccid paraplegia with complete motor and sensory loss and sphincter disturbance. He responded well to antibiotics but was not investigated for causes of paraplegia. While at home in a rural area, he developed pressure ulcers, anemia and depression. Magnetic resonance imaging of the whole spine and computed tomography scan of the brain performed after 4 and 10 weeks were normal. RESULTS: The patient had a comprehensive rehabilitation at our institute. Recovery was complicated by ossification in the right thigh, which responded well to radiotherapy. At 1-year follow-up, the motor deficit and neurogenic bladder and bowel persisted and the patient remained wheelchair dependent for mobility. CONCLUSION: Several mechanisms have been proposed to explain spinal cord damage after meningitis. These include spinal cord infarction; autoimmune-mediated inflammatory myelopathy and direct infection of the cord. Most probable cause of spinal cord dysfunction in this case was thoracic myelopathy.     

Infections in neurosurgery: A retrospective study of 1143 patients and 1517 operations

Summary The files of 1143 neurosurgical patients, operated on between November 1, 1979 and June 4, 1981 were examined for records of post-operative infections. Eighty-three patients had developed infections (7%). In addition there were 33 instances of aseptic meningitis. Patients with a shunt were prone to infection (12%). Bone flap infections accounted for more than half of all infections after supratentorial craniotomy. Bacterial meningitis accounted for more than half of all infections after suboccipital craniotomy and translabyrinthine operations. In these patients bacterial meningitis was six times more common, and aseptic meningitis three times more common than in those who had had supratentorial operations. Shunt infection was more common after repeated shunt operations in quick succession. Craniotomy increased the risk of a shunt becoming infected.Antibiotic prophylaxis should be used not only in shunt operations but in all operations performed on patients with a shunt. If bacteria are recovered in a suspected shunt infection, immediate removal of the shunt is the best treatment. However, if the shunt's removal or replacement is exceptionally difficult intraventricular antibiotic treatment may be tried. The age of the patient, the duration of the operation, the individual surgeon and the number of operations did not affect the rate of infection. Clinical signs and conventional laboratory tests, apart from bacterial culture, cannot differentiate between bacterial and aseptic meningitis, but a drop in the level of consciousness suggests bacterial meningitis.     

An unusual presentation of meningitis as a consequence of inadvertent dural puncture

Bacterial meningitis and aseptic meningitis have been reported as a consequence of spinal anaesthesia. The case we report is of an unusual presentation of meningitis, for which no cause was found, in a patient who received epidural anaesthesia, complicated by dural puncture.     

A case of tranilast-induced cystitis with transient ECG changes]

A case of tranilast (Rizaben)-induced cystitis accompanied with possibly hypereosinophilic heart syndrome was described. A 75-year-old male, who had been taking tranilast for allergic dermatitis for two months, was admitted for severe bladder stimulating symptoms which was unresponsive to antibiotic therapies. Clinical examination revealed tenderness of the prostate, aseptic pyuria, eosinophilia, liver dysfunction and electrocardiographic disorders including atrial fibrillation, T-wave inversions and lowered ST segment without any cardiac symptoms. Cystitis symptoms, pyuria, eosinophilia and liver dysfunction improved within several days after discontinuance of tranilast, and ST-T changes on ECG gradually normalized within a few months. Tranilast-induced cystitis has been demonstrated as a type of eosinophilic cystitis. Since pathologic findings of eosinophilic cystitis and hypereosinophilic heart syndrome are markedly similar and all symptoms and signs disappeared after deprivation of tranilast, it appears likely that eosinophilic inflammation was induced to the heart, liver, bladder and prostate of the current patient by tranilast.     

Spinal fluid profile following surgery in the subarachnoid space

Neurotologic and skull base procedures that include dissection within the subarachnoid space carry with them the potential for meningitis. Postoperative aseptic leptomeningitis occurs more frequently than purulent bacterial meningitis. Differentiation between these two conditions early in the postoperative period is important to avoid delay in or unnecessary treatment. The definitive diagnosis is made with cerebral spinal fluid culture. Early differentiation between postoperative aseptic leptomeningitis and purulent bacterial meningitis on the basis of results of cerebral spinal fluid profile before cerebral spinal fluid culture would result in earlier appropriate therapy.     

Meningitis after combined spinal-extradural anaesthesia in obstetrics

We report two cases of meningitis which developed after combinedspinal-extradural procedures for obstetric analgesia. The firstcase was thought to be caused by aseptic or chemical meningitisand the second was a case of bacterial meningitis in a patientwho also received an extradural blood patch. It is importantthat meningitis is considered as a differential diagnosis inpatients who present with headache after spinal anaesthesiaand that antibiotic therapy is selected to cover unusual organisms.     

A case of cerebral salt-wasting syndrome associated with aseptic meningitis in an 8-year-old boy

Cerebral salt-wasting syndrome is a disorder in which excessive natriuresis and subsequent hyponatremic dehydration occur in patients with intracranial diseases. Cerebral salt-wasting syndrome often develops in patients with severe neurosurgical disorders, such as hydrocephalus, cerebral infarction, and tuberculous meningitis. Here, we report on the case of an 8-year-old boy with cerebral salt-wasting syndrome associated with aseptic meningitis. He showed mild developmental retardation and had a history of convulsion. Four days after his admission, cerebral salt-wasting syndrome abruptly started: natriuresis and hyponatremia gradually improved over 10 days. To the best of our knowledge, this is the first report on cerebral salt-wasting syndrome associated with clinically benign aseptic meningitis.     

Aseptic meningitis as a complication caused by an allergic reaction after microvascular decompression: two case reports

We report here two cases of patients complicated with aseptic meningitis after microvascular decompression (MVD). The first case, a 56-year-old female complained of headache with high fever 18 days after the MVD for right trigeminal neuralgia. The amount of cells in cerebrospinal fluid (CSF) had so much increased that bacterial meningitis was suspected. However, there was no improvement after antibiotics therapy, so immune globulin was injected and the meningitis gradually improved. Eosinophilia remained in peripheral blood and the symptoms improved rapidly after the steroid therapy. Because of this, we suspected that meningitis was caused by an abnormal allergic reaction. The second case, a 30-year-old male complained of headache with mild fever 15 days after MVD for left hemifacial spasm. The amount of cells in CSF increased, so bacterial meningitis was suspected. Eosinophilia remained in peripheral blood and the steroid therapy proved very effective for the meningitis. Because of this, we suspected that meningitis was caused by an abnormal allergic reaction. We suspected that the two patients suffered from aseptic meningitis caused by allergic reaction, and the antigen for this abnormal allergic reaction was the foreign materials used for MVD. The materials were Dacron for prostesis, Goatex or Lyodula for dural plasty, fibrin glue for preventing CSF leakage. We ascertained that the abnormal allergic reaction was caused by human fibrinogen in the second case. It is important to be aware of such allergic reaction to fibrin glue in the post-operative stage after MVD.     

Paediatric meningitis in the western Cape. A 3-year hospital-based prospective survey

Between July 1981 and June 1984 1223 cases of meningitis were seen in the Department of Paediatrics, Tygerberg Hospital. The commonest form in each population group was aseptic meningitis. Positive viral cultures were obtained from the CSF in 108 cases. The median age of white children with aseptic meningitis, 64 months, was significantly greater than that of coloured children, 45 months (P greater than 0.0001), and black children, 26 months (P greater than 0.014). The commonest cause of confirmed bacterial meningitis was Neisseria meningitidis (140 cases; 11.5%), which continues to affect mainly young coloured children (median age 16.9 months). Resistance to sulphonamides was found among 21% of 114 N. meningitidis isolates. Among white children Haemophilus influenzae was responsible for 9 of the 18 cases of confirmed bacterial meningitis. Tuberculosis was responsible for 62 cases of meningitis (5%) and was a commoner cause of meningitis than either H. influenzae (47 cases) or Streptococcus pneumoniae (34 cases). Thirty-four confirmed cases of bacterial meningitis were seen in children less than 1 month old. Klebsiella species were responsible for 8 cases (24%), Escherichia coli for 6 cases (12%), group B beta-haemolytic Streptococcus for 5 cases (15%) while 4 cases each were due to N. meningitidis and Strept. pneumoniae.     

脑肿瘤开颅术后脑膜炎的临床特征及腰大池持续引流的应用价值

目的探讨脑肿瘤术后脑膜炎的临床特征及腰大池持续引流的应用价值。方法对2004年1月至2009年11月间41例脑肿瘤术后脑膜炎病例临床资料进行回顾性分析。其中,无菌性脑膜炎28例,细菌性脑膜炎13例。结果两组间发热发生率、意识改变、发热开始时间、脑脊液常规及生化指标无显著性差异。无菌性脑膜炎治愈时间显著低于细菌性脑膜炎（P〈0.05）。脑膜炎后选择腰大池置管持续引流较反复腰穿在治愈时间、治愈率无显著性差异（P〉0.05）。结论脑肿瘤开颅术后脑膜炎无特异临床表现。无菌性脑膜炎治愈时间显著低于细菌性脑膜炎,但腰大池持续引流并不能降低脑肿瘤术后脑膜炎患者的治愈时间及提高治愈率。     

Kystes dermoïdes de la fosse cérébrale postérieure chez l’enfant révélés par des méningites aseptiques récidivantes : à propos de deux cas et revue de la littérature

Introduction

Dermoid cysts of central nervous system are very rare. The usual clinical presentation is dominated by intracranial hypertension, epilepsy and cranial palsy. The revelation mode could be recurrent aseptic meningitis.

Functional recovery of the bladder in patients with spinal cord injury--prognosticating programs of an aseptic intermittent catheterization

Ninety patients with spinal cord injury were managed by aseptic intermittent catheterization program I (preventing the over-distension of the bladder) and program II (allowing overdistension) in which recovery of bladder function and the clinical effects were comparatively investigated. Using program I, cases with positive BCR restored the automaticity of the bladder on average 8 weeks after injury. When urinary incontinence first occurs during aseptic intermittent catheterization, urinary training may be commenced since the bladder has then recovered from spinal shock. Cases with no BCR do not restore automatic bladder contraction. Program II delayed or weakened the recovery of bladder function considerably. Patients with incomplete lesions and sacral sparing, particularly those with urinary sensation, should be managed by program I which does not impair recovery of the bladder. It is possible to prevent urinary incontinence and infection, if paraplegics with complete lesions are managed by program II. The percentage of urinary infection was 22.6 +/- 16.0% (N = 90) during aseptic intermittent catheterization (non-touch technic) among whom no statistically significant difference between those with trigger voiding (22.2 +/- 17.2%, N = 57) and those with self-catheterization (23.2 +/- 14.0%, N = 33) was found.