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0851 A histopathologically proven case of cerebral toxoplasmosis in a patient with AIDS
Poster Abstracts regions in Europe. The neurological examination demonstrated lesions of the right 2na and 5tt~, left 1T h and both 7m cranial nerves. Results: Lyme serology was positive. Neuroimaging showed marked enhancement of multiple cranial nerves with a normal brain parenchyma. Cerebrospinal fluid (CSF) analysis demonstrated 178 lymphocytes, a raised protein of 2.24g/1 and positive oligoclonal bands. Serum anti-mxonal antibodies were detected. Following a four-week course of intravenous ceftrimxone, there was complete resolution of the patients" symptoms, abnormalities in the CSF and changes on brain imaging. Discussion: Lyme disease can present with bilateral facial weakness. Tiffs case illustrates both the neuroradiological and CSF features of cranial neuritis in neuroborreliosis, demonstrating that resolution of reported abnormalities can occur rapidly following treatment matching clinical recovery.
0851 A Histopathologically Proven Case of Cerebral Toxoplasmosis in a Patient with AIDS Vehrde, M l, Corral, E 1, C.ollantes, E 1. 1University of the Philippines-
Philippine General Hospital Synopsis: We documented a histopathologically proven case of cerebral toxoplasmosis in an inmmnocompromised patient Clinical Presentation: A 41 year old male, married, an overseas contract worker who was admitted due to loss of consciousness. Physical Findings: The physical examination revealed the presence of lichenified rashes on face and extremities. He had significant weight loss and anorexia. On neurologic examination, he had severe cognitive impairment There was presence of bilateral papilledema but there were no motor nor sensory deficits. There were no pathologic reflexes. Diagnostic Work-up: Cranial Magnetic Resonance Imaging with gadolinium revealed presence of multiple irregular, contrast-enhancing nodules on the cortical-subcortical areas. The initial diagnosis was multiple space-occupying lesions probably metastases with unkD.own primary. He underwent craniectomy with excision of the right frontal nodule when he presented with impending herniation. Nodule biopsy revealed necrotizing encephalitis consistent with toxoplasmosis. Serological toxoplasma test such as IgG was positive. Due to above finding, he underwent HIV testing which was also positive and was confirmed with Western blot. Treatment: The patient was started on pyrimethanffne/sulfadoxine and clindamycin. Treatment response was monitored clinically and radiographically after 14 days of treatment. He was advised continuation of medications for 6 weeks. Significance: There is no locally published case report on cerebral toxoplasmosis. The diagnosis was confirmed through serological testing and with surgical biopsy. 0852 Clinical and epidemiological peculiarities of Mixt Infection (Nil) of Lyme Disease (LD) and Tick-Borne Encephalitis (TBE). VoLkova, L 1, Ankudinova, M 1, Prasdnichkova, E 1. 1Sverdlovsk
Regional Hospitall, Regional Centre of Tick Infections. Sverdlovsk region is higly endemic for tick infections. During 7 years (1998-2004) we registered 6973 patients with tick infections. Of this amount 3599 (151.6"/0) suffered from TBE, 3073 (144.1%) suffered from LD, 301 (4,3%) suffered from ML Epidemiology o f MIis similar to that of monoforms of TBE and LD. Men suffer more frequent (58.3%), then women, able-bodied population predominates (72?,'8). We registered more patients with M[ (131.1%) and LD (118.7) of older age (161 yrs and >). This differs from TBE patients, when younger and older patients suffer equally (121.3% and 19.3%). The main way of M[ transfer was transmissive (77%). In MI patients the duration of a bite was less then 1 day. The bite duration of 2 days and more was more typical for MI patients (8.8%), and LD patients (18.1%), titan for TBE patients (2.6"/0).
Wednesday, November 9, 2005
$317
The clinical picture of MI showed combination of different TBE and LD forms. More frequently (151.5%) we registered combination of LD tick migrating erytema and meningeal form of TBE. In 13.5% of patients we mentioned combination of erytemic LD form and meningeal TBE form. More rare we noted combination of LD with locomotive system impairment and fever (8.6%) or meningeal (6.7%) form of TBE. Thus, we didn't reveal any specific epidemiological peculiarities of ML Also we didn't mention any significant change in clinical picture of TBE and LD. Though some increase of TBE severity was mentioned and also erytemic and generalized disseminated fotllts of LD were registered more frequently.
0853 Oxidative stress in central nervous system infections; a non-randonfised study Wasay, M, Usman, U, Mushtaq, S, Kheleani, B, Zulfiqar Naqvi, S, Siddiqi, A. Department of Neurology, The Aga Khan University,
Karaehi; Department of Biological and Biomedical Sciences, The Aga IOzan University, Karaehi Background: Routine cerebrospinal analysis findings in various central nervous system infections do not correlate with outcome. Recent studies have shown that CSF markers of oxidative stress in CNS infections may have a correlation with clinical outcome. Objective: To analyze the CSF levels of anti-oxidant Ascorbic A d d and Uric A d d in patients with CNS infections and other noninfectious CNS diseases. Methods: Patients with CNS infections were included in study over a four month period at The Aga Khan University. A group of patients with acute, non-infectious CNS diseases was included as control. CSF concentrations of Ascorbic A d d and Uric Acid were determined by high-pressure liquid chromatography. Results: A total of 15 patients were included in the study. There were seven men and eight women. Age range was 17-86 years (mean 43). Patients were divided into two groups based on presence of CNS infections. There were five patients in C.NS infections group (bacterial meningitis; 3 patients, tuberculous meningitis; 2 patients) while noinfections group (control group) had ten patients 0nfarction; 2 patients, Depression; 1 patient, Gullian Barre syndrome; 2 patients, Seizures; 3 patients, Acute disseminated encephalomyelitis; 1 patient, Neuroleptic malignant syndrome; 1 patient). Mean Uric Acid level in infections group was 5.99 microgram per milliliter (Range: 0.58-20.70) as compared to control group (11.24 ug/mL , range: 0.58-1.40). Mean Ascorbic Acid level in infection group was 0.581ug.mL(range: 0.0801.200 ug/mL) as compared to control group (Mean: 0.775 u g / m L range: 0.337-1.180). Conclusion: Our study suggests that elevated CSF Uric Acid level and lower CSF Ascorbic A d d level in patients with C.NS infections are indicative of increased oxidative stress in these patients. Further studies with larger number of patients may extend our findings. 0854 Cryptococcus metdngilis presenting with leueoeneephalopathy Wilcox, R, Thyagarajan, D, Kempster, P. Neurology Department,
Flinders Medical Centre, Adelaide, Australia; Monash Neurology, Monash Medical Centre, Melbourne, Australia Background: Cryptococcal meningitis is one of the most conmton fungal infections of the CNS. Itusually presents subacutely and follows a chronic fluctuating course over months or years. There is no pathognomic radiological picture; brain MRI may be normal; show meningeal enhancment after gadolinium; or crytococcomas. Case Report: Here we report two patients with confirmed cryptococcal meningitis, both with combined inmmnodeficiency, who had unusual MRI findings of a gadolinium-enhancing white matter lesions quite distinct from cryptococcomas, occurring before treatment with
0851 A Histopathologically Proven Case of Cerebral Toxoplasmosis in a Patient with AIDS Vehrde, M l, Corral, E 1, C.ollantes, E 1. 1University of the Philippines-
Philippine General Hospital Synopsis: We documented a histopathologically proven case of cerebral toxoplasmosis in an inmmnocompromised patient Clinical Presentation: A 41 year old male, married, an overseas contract worker who was admitted due to loss of consciousness. Physical Findings: The physical examination revealed the presence of lichenified rashes on face and extremities. He had significant weight loss and anorexia. On neurologic examination, he had severe cognitive impairment There was presence of bilateral papilledema but there were no motor nor sensory deficits. There were no pathologic reflexes. Diagnostic Work-up: Cranial Magnetic Resonance Imaging with gadolinium revealed presence of multiple irregular, contrast-enhancing nodules on the cortical-subcortical areas. The initial diagnosis was multiple space-occupying lesions probably metastases with unkD.own primary. He underwent craniectomy with excision of the right frontal nodule when he presented with impending herniation. Nodule biopsy revealed necrotizing encephalitis consistent with toxoplasmosis. Serological toxoplasma test such as IgG was positive. Due to above finding, he underwent HIV testing which was also positive and was confirmed with Western blot. Treatment: The patient was started on pyrimethanffne/sulfadoxine and clindamycin. Treatment response was monitored clinically and radiographically after 14 days of treatment. He was advised continuation of medications for 6 weeks. Significance: There is no locally published case report on cerebral toxoplasmosis. The diagnosis was confirmed through serological testing and with surgical biopsy. 0852 Clinical and epidemiological peculiarities of Mixt Infection (Nil) of Lyme Disease (LD) and Tick-Borne Encephalitis (TBE). VoLkova, L 1, Ankudinova, M 1, Prasdnichkova, E 1. 1Sverdlovsk
Regional Hospitall, Regional Centre of Tick Infections. Sverdlovsk region is higly endemic for tick infections. During 7 years (1998-2004) we registered 6973 patients with tick infections. Of this amount 3599 (151.6"/0) suffered from TBE, 3073 (144.1%) suffered from LD, 301 (4,3%) suffered from ML Epidemiology o f MIis similar to that of monoforms of TBE and LD. Men suffer more frequent (58.3%), then women, able-bodied population predominates (72?,'8). We registered more patients with M[ (131.1%) and LD (118.7) of older age (161 yrs and >). This differs from TBE patients, when younger and older patients suffer equally (121.3% and 19.3%). The main way of M[ transfer was transmissive (77%). In MI patients the duration of a bite was less then 1 day. The bite duration of 2 days and more was more typical for MI patients (8.8%), and LD patients (18.1%), titan for TBE patients (2.6"/0).
Wednesday, November 9, 2005
$317
The clinical picture of MI showed combination of different TBE and LD forms. More frequently (151.5%) we registered combination of LD tick migrating erytema and meningeal form of TBE. In 13.5% of patients we mentioned combination of erytemic LD form and meningeal TBE form. More rare we noted combination of LD with locomotive system impairment and fever (8.6%) or meningeal (6.7%) form of TBE. Thus, we didn't reveal any specific epidemiological peculiarities of ML Also we didn't mention any significant change in clinical picture of TBE and LD. Though some increase of TBE severity was mentioned and also erytemic and generalized disseminated fotllts of LD were registered more frequently.
0853 Oxidative stress in central nervous system infections; a non-randonfised study Wasay, M, Usman, U, Mushtaq, S, Kheleani, B, Zulfiqar Naqvi, S, Siddiqi, A. Department of Neurology, The Aga Khan University,
Karaehi; Department of Biological and Biomedical Sciences, The Aga IOzan University, Karaehi Background: Routine cerebrospinal analysis findings in various central nervous system infections do not correlate with outcome. Recent studies have shown that CSF markers of oxidative stress in CNS infections may have a correlation with clinical outcome. Objective: To analyze the CSF levels of anti-oxidant Ascorbic A d d and Uric A d d in patients with CNS infections and other noninfectious CNS diseases. Methods: Patients with CNS infections were included in study over a four month period at The Aga Khan University. A group of patients with acute, non-infectious CNS diseases was included as control. CSF concentrations of Ascorbic A d d and Uric Acid were determined by high-pressure liquid chromatography. Results: A total of 15 patients were included in the study. There were seven men and eight women. Age range was 17-86 years (mean 43). Patients were divided into two groups based on presence of CNS infections. There were five patients in C.NS infections group (bacterial meningitis; 3 patients, tuberculous meningitis; 2 patients) while noinfections group (control group) had ten patients 0nfarction; 2 patients, Depression; 1 patient, Gullian Barre syndrome; 2 patients, Seizures; 3 patients, Acute disseminated encephalomyelitis; 1 patient, Neuroleptic malignant syndrome; 1 patient). Mean Uric Acid level in infections group was 5.99 microgram per milliliter (Range: 0.58-20.70) as compared to control group (11.24 ug/mL , range: 0.58-1.40). Mean Ascorbic Acid level in infection group was 0.581ug.mL(range: 0.0801.200 ug/mL) as compared to control group (Mean: 0.775 u g / m L range: 0.337-1.180). Conclusion: Our study suggests that elevated CSF Uric Acid level and lower CSF Ascorbic A d d level in patients with C.NS infections are indicative of increased oxidative stress in these patients. Further studies with larger number of patients may extend our findings. 0854 Cryptococcus metdngilis presenting with leueoeneephalopathy Wilcox, R, Thyagarajan, D, Kempster, P. Neurology Department,
Flinders Medical Centre, Adelaide, Australia; Monash Neurology, Monash Medical Centre, Melbourne, Australia Background: Cryptococcal meningitis is one of the most conmton fungal infections of the CNS. Itusually presents subacutely and follows a chronic fluctuating course over months or years. There is no pathognomic radiological picture; brain MRI may be normal; show meningeal enhancment after gadolinium; or crytococcomas. Case Report: Here we report two patients with confirmed cryptococcal meningitis, both with combined inmmnodeficiency, who had unusual MRI findings of a gadolinium-enhancing white matter lesions quite distinct from cryptococcomas, occurring before treatment with