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0843 Neurocysticerkosis as a cause of stroke: a case report
Poster Abstracts November 2004 to March 2005. Subsequently all those patients with neurological symptoms were identified and investigated further with electroencephalography (EEG) lunrbar puncture and imaging as required. Results: A total of 9 patients were identified over the stated period. Seven had encephalitis with non-specific EEG changes and serological evidence of a secondary dengue infection. Four of these seven presented with fever and symptoms of encephalitis preceding the onset of rash. At the time of discharge two patients had neurological sequelae. Of the remaining two patients fi'om the total of 9 identified, one suffered a spontaneous intracerebral bleed which resulted in tire need for mechanical ventilation and intensive care while the remaining patient was diagnosed with post-infective adjustment disorder related to his illness and admission to the hospital. Conclusion: Our results show tire most common neurological manifestation of dengue is encephalitis. We also describe dengue presenting as encephalitis which is an uncommon feature of tire disease. 0843 Neurocysticerkos[s as a cause of stroke: a ease report Sarangerel J, Munkhbayar R, Tsagaankhuu G. Department of
Neurology and Psychiatry, Medical University, Ulaanbaatar, Mongolia We describe a case of 55 year-old man, who presented with transient attacks of weakness of the left arm and slightly dysarthria. The symptoms occur during exercizes and disappear in the rest. The investigation with doppler ultrasonography revealed a highgrade stenosis of right internal carotid artery (S/D - 300/150 cm/sec) and a poststenotic reduction of blood flow in the intracratffal part of internal carotid artery (S/D - 30/20 cm/sec). The cranial CT showed hypodense lesions in the borderzone of the right anterior and middle cerebral arteries, which led to the assumption of ischemic borderzone infarct and to the suggestion of carotid endarteriectomia. But the followed cranial MRI detected nmltiple small subcortical cystic lesions in tire fi'onto-temporal part of the right hemisphere and a sharp limited, conus-like, partly calcified lesion in the right frontal lobe. All lesions were located in the area of the right internal carotid artery. The cystic lesions detected in the MRI are corresponding with the intracerebral cysticercosis, which is possibly embolized from the primary focus in tire carotid bulbus. Tiffs case represents an interesting clinical manifestation of tiffs infection and raises a question of possible cause o f stroke. 0844 Visual impairment in tuberculous meningitis
Shukla, Rakesh ~, Abbas, A t, Saxena, S a, Ahuja, RC 3, Gupta, R K 4.
~Department of Neurology, King George's Medical University, Lucknow, India; 2Department of Ophthalmology, King George's Medical University, Lucknow, bzdia.."3Department of Medicine, King George's Medical University, Lucknow, India; 4Department of .Radiodiagnosis, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India Visual impairment is a common problem in tuberculous meningitis (TBM). The present study has been conducted to evaluate tire prevalence of visual impairment at presentation and its course at 3 months follow-up. Twenty seven consecutive HIV negative patients of highly probable/probable TBM were enrolled. Visual acuity was assessed by Snellen's and near vision charts, colour vision by lschihara's chart, field o f vision by Hunrphrey's automated perimetery and visual evoked potentials were recorded. Plain and contrast c r scan and MRI brain were also done. CSF PCR was done in 18 patients. Male: Female ratio was 9-18. Age ranged from 14 to 57 years (Mean ± SD 23 ± 9.9 years). Mean duration of illness was 2.2 ± 2.3 months. Majority of patients were in stage II (117 patients). Visual impairment was present in 12 patients and tire most common cause was optochiasmatic arachnoiditis seen on MRI, followed by secondary
Wednesday, November 9, 2005
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optic atrophy (12 patients), ocdpital infarct (1 patient) and no spedfic cause was found in 3 patients. There was improvement in visual acuity in 3 patients; no improvement in 6 patients and 3 patients expired at 3 months. In 4 patients who had visual improvement optochiasnmtic arachnoiditis was present in 2 patients and no specific cause was present in 2 patients. Two patients developed decrease in visual acuity on treatment. On multivariate analysis the predictors o f visual impairment at presentation were abnormal MMSE, paresis, abnormal CI" and MRI and presence of hydrocephalus; and only fundus abnormality at 3 months. 0845 Pneumococcal Meningoencephalitis with Septicaemia: Case Report
Taba, P, Seeman, S. Tartu University Clinics, Tartu, Estonia
Background: Bacterial meningitis in adults is a disease with a fulminant course, relevant neurologic sequelae, and high mortality rate. Septicaenria that is rare in pneunrococcal meningoencephalitis, may complicate the course of the disease with severe toxic shock syndrome. Methods and Results: A women aged 53 years was hospitalised with fever, vomiting, limb pain, and skin rash in face, trunk and right hand. Patient was conscious, legs were hyperalgesic; there was no meningeal syndrome, CT was normal. Sepsis was diagnosed and antibacterial treatment started. During tire first day of hospitalisation, patient turned disoriented, somnolent, and the meningeal syndrome appeared. Condition worsened during the next day rapidly, the patient was comatous and hemodynamically hypotonic; right hemiparesis occurred, and hemorrhagic skin rash worsened. In cerebrospinal fluid, pleocytosis was 138 (predominantly neutrophilic), and protein 7.8 g/L. In latex test, Streptococcus pneumoniae was identified that was confirmed in microbiological investigation of blood. Antibacterial treatment was changed from imipenem to penicillin. MRT revealed encephalitic lesions. Imaging two weeks later manifested an intraventricular hemorrage. Primary outcome after three weeks was favourable with improvement of consciousness though right hemiparesis remained, but four weeks after tire first symptoms, the purulent endophthalmitis and gangraena of legs was diagnosed. Additionally, ischaemic lesion in right hemisphaer was diagnosed. The eye was removed and feet amputated. Critical condition worsened continuously, and the patient died. Conclusion: Tiffs case demonstrates that rarely pneunrococcal meningoencephalitis may be accompanied by septicaenffa and toxic shock syndrome with haemorrhagic skin rash, that has a very poor prognosis. 0846 A Continuing high inddenee of subaeute sderosing paneneephalifis (SSPE) in the Eastern Highlands of Papua New Guinea
Toshiaki, T, Miki, K, Mizutani, T, Mgone, C, Mgone, J, Alpers, M, Komase, K. Department of Neurology, Nagaokanishi Hospital,
Nagaoka-city, Japan; Department of Neurology, Nihon University School of Medicine, Tokyo, Japan; Division of Molecular Genetics, Papua New Guinea Institute of Medical .Research; Department of Paediatrics, Goroka Base General Hospital, Eastern Highlands Province, Papua New Guinea; Department of Research and Development, Research Center of Biologieals, The Kitamoto Institute, Tokyo, Japan Heading: A continuing high incidence of subacate sclerosing panencephalitis (SSPE) in tire Eastern Highlands of Papua New Guinea. Background: The aim o f this descriptive study were to confirm the high incidence of subacute sclerosing panencephalitis (SSPE) previously reported from Papua New Guinea (PNG) and to relate SSPE to previous measles vaccination and measles illness. Method: From January 1997 to April 1999 we diagnosed a total of 55 patients with SSPE at Goroka Base Hospital in Eastenr Highlands Province (EHP) of PNG. The diagnosis was based on high cerebrospinal fluid and serum measles virus antibody titres with progressive
Neurology and Psychiatry, Medical University, Ulaanbaatar, Mongolia We describe a case of 55 year-old man, who presented with transient attacks of weakness of the left arm and slightly dysarthria. The symptoms occur during exercizes and disappear in the rest. The investigation with doppler ultrasonography revealed a highgrade stenosis of right internal carotid artery (S/D - 300/150 cm/sec) and a poststenotic reduction of blood flow in the intracratffal part of internal carotid artery (S/D - 30/20 cm/sec). The cranial CT showed hypodense lesions in the borderzone of the right anterior and middle cerebral arteries, which led to the assumption of ischemic borderzone infarct and to the suggestion of carotid endarteriectomia. But the followed cranial MRI detected nmltiple small subcortical cystic lesions in tire fi'onto-temporal part of the right hemisphere and a sharp limited, conus-like, partly calcified lesion in the right frontal lobe. All lesions were located in the area of the right internal carotid artery. The cystic lesions detected in the MRI are corresponding with the intracerebral cysticercosis, which is possibly embolized from the primary focus in tire carotid bulbus. Tiffs case represents an interesting clinical manifestation of tiffs infection and raises a question of possible cause o f stroke. 0844 Visual impairment in tuberculous meningitis
Shukla, Rakesh ~, Abbas, A t, Saxena, S a, Ahuja, RC 3, Gupta, R K 4.
~Department of Neurology, King George's Medical University, Lucknow, India; 2Department of Ophthalmology, King George's Medical University, Lucknow, bzdia.."3Department of Medicine, King George's Medical University, Lucknow, India; 4Department of .Radiodiagnosis, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India Visual impairment is a common problem in tuberculous meningitis (TBM). The present study has been conducted to evaluate tire prevalence of visual impairment at presentation and its course at 3 months follow-up. Twenty seven consecutive HIV negative patients of highly probable/probable TBM were enrolled. Visual acuity was assessed by Snellen's and near vision charts, colour vision by lschihara's chart, field o f vision by Hunrphrey's automated perimetery and visual evoked potentials were recorded. Plain and contrast c r scan and MRI brain were also done. CSF PCR was done in 18 patients. Male: Female ratio was 9-18. Age ranged from 14 to 57 years (Mean ± SD 23 ± 9.9 years). Mean duration of illness was 2.2 ± 2.3 months. Majority of patients were in stage II (117 patients). Visual impairment was present in 12 patients and tire most common cause was optochiasmatic arachnoiditis seen on MRI, followed by secondary
Wednesday, November 9, 2005
$315
optic atrophy (12 patients), ocdpital infarct (1 patient) and no spedfic cause was found in 3 patients. There was improvement in visual acuity in 3 patients; no improvement in 6 patients and 3 patients expired at 3 months. In 4 patients who had visual improvement optochiasnmtic arachnoiditis was present in 2 patients and no specific cause was present in 2 patients. Two patients developed decrease in visual acuity on treatment. On multivariate analysis the predictors o f visual impairment at presentation were abnormal MMSE, paresis, abnormal CI" and MRI and presence of hydrocephalus; and only fundus abnormality at 3 months. 0845 Pneumococcal Meningoencephalitis with Septicaemia: Case Report
Taba, P, Seeman, S. Tartu University Clinics, Tartu, Estonia
Background: Bacterial meningitis in adults is a disease with a fulminant course, relevant neurologic sequelae, and high mortality rate. Septicaenria that is rare in pneunrococcal meningoencephalitis, may complicate the course of the disease with severe toxic shock syndrome. Methods and Results: A women aged 53 years was hospitalised with fever, vomiting, limb pain, and skin rash in face, trunk and right hand. Patient was conscious, legs were hyperalgesic; there was no meningeal syndrome, CT was normal. Sepsis was diagnosed and antibacterial treatment started. During tire first day of hospitalisation, patient turned disoriented, somnolent, and the meningeal syndrome appeared. Condition worsened during the next day rapidly, the patient was comatous and hemodynamically hypotonic; right hemiparesis occurred, and hemorrhagic skin rash worsened. In cerebrospinal fluid, pleocytosis was 138 (predominantly neutrophilic), and protein 7.8 g/L. In latex test, Streptococcus pneumoniae was identified that was confirmed in microbiological investigation of blood. Antibacterial treatment was changed from imipenem to penicillin. MRT revealed encephalitic lesions. Imaging two weeks later manifested an intraventricular hemorrage. Primary outcome after three weeks was favourable with improvement of consciousness though right hemiparesis remained, but four weeks after tire first symptoms, the purulent endophthalmitis and gangraena of legs was diagnosed. Additionally, ischaemic lesion in right hemisphaer was diagnosed. The eye was removed and feet amputated. Critical condition worsened continuously, and the patient died. Conclusion: Tiffs case demonstrates that rarely pneunrococcal meningoencephalitis may be accompanied by septicaenffa and toxic shock syndrome with haemorrhagic skin rash, that has a very poor prognosis. 0846 A Continuing high inddenee of subaeute sderosing paneneephalifis (SSPE) in the Eastern Highlands of Papua New Guinea
Toshiaki, T, Miki, K, Mizutani, T, Mgone, C, Mgone, J, Alpers, M, Komase, K. Department of Neurology, Nagaokanishi Hospital,
Nagaoka-city, Japan; Department of Neurology, Nihon University School of Medicine, Tokyo, Japan; Division of Molecular Genetics, Papua New Guinea Institute of Medical .Research; Department of Paediatrics, Goroka Base General Hospital, Eastern Highlands Province, Papua New Guinea; Department of Research and Development, Research Center of Biologieals, The Kitamoto Institute, Tokyo, Japan Heading: A continuing high incidence of subacate sclerosing panencephalitis (SSPE) in tire Eastern Highlands of Papua New Guinea. Background: The aim o f this descriptive study were to confirm the high incidence of subacute sclerosing panencephalitis (SSPE) previously reported from Papua New Guinea (PNG) and to relate SSPE to previous measles vaccination and measles illness. Method: From January 1997 to April 1999 we diagnosed a total of 55 patients with SSPE at Goroka Base Hospital in Eastenr Highlands Province (EHP) of PNG. The diagnosis was based on high cerebrospinal fluid and serum measles virus antibody titres with progressive