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Stroke
Published in Jahangir Moini, Matthew Adams, Anthony LoGalbo, Complications of Diabetes Mellitus, 2022
Jahangir Moini, Matthew Adams, Anthony LoGalbo
With subarachnoid hemorrhage, the patient’s headache is usually extreme and peaks within a few seconds. He or she may lose consciousness. This is usually immediate, but can occur after several hours. Extreme neurologic deficits may occur, becoming irreversible in minutes to several hours. Sensory function may be impaired. The patient may become very restless, and seizures can occur. Unless there is herniation of the cerebellar tonsils, the patient’s neck is usually not stiff. Even so, aseptic meningitis causes moderate to severe meningismus within 1 day. There is usually vomiting and occasionally bilateral extensor plantar responses. There are often abnormalities of the heart or respiratory rates. During the first 5–10 days, continuing headaches, confusion, and fever are often seen. If there is secondary hydrocephalus, the patient may experience additional headache, motor deficits, and obtundation over weeks. If another bleed occurs, symptoms can recur, or new ones can emerge.
Neuroinfectious Diseases
Published in Philip B. Gorelick, Fernando D. Testai, Graeme J. Hankey, Joanna M. Wardlaw, Hankey's Clinical Neurology, 2020
Jeremy D. Young, Jesica A. Herrick, Scott Borgetti
Aseptic meningitis is most commonly associated with several viral pathogens, described below. Most of these begin by colonizing either the respiratory, genital, or GI epithelium. If host innate and adaptive immune defenses fail to control epithelial infection, viral replication, invasion and viremia, and breaching of the blood–brain barrier can lead to infection of the CNS.
Headache associated with central nervous system infection
Published in Stephen D. Silberstein, Richard B. Upton, Peter J. Goadsby, Headache in Clinical Practice, 2018
Stephen D. Silberstein, Richard B. Upton, Peter J. Goadsby
Aseptic meningitis is characterized by headache, low-grade fever, stiff neck, fatigue, and anorexia. The etiologic organisms that may cause this disorder include the enteroviruses (EVs) (echo, coxsackie, polio), arboviruses (herpes simplex virus (HSV) type 2, herpesvirus type 6 (HHV-6)), fungi, Epstein-Barr virus (EBV), varicella-zoster (VZV), Mycoplasma pneumoniae, Borrelia burgdorferi, and Treponema pallidum.9 Among the viruses, the EVs are the most common causative agents, accounting for 85–95% of all cases.11,12 HSV type 2 is the most common etiologic agent of Mollaret meningitis (recurrent brief episodes of meningitis alternating with symptom-free intervals).13
An Atypical Case of Enterovirus Meningitis Presenting with Unilateral Optic Disc Swelling and Minimal Optical Symptoms
Published in Ocular Immunology and Inflammation, 2023
Efthymios Karmiris, Georgios Vasilakos, Konstantinos Tsiripidis, Evangelia Chalkiadaki
Aseptic meningitis is defined as an acute infectious disease with CSF negative for bacteria and is most frequently due to a viral infection. Viruses are often overlooked as their sequelae are not as severe as bacterial meningitis or viral encephalitis, with the most common clinical symptoms for aseptic meningitis patients being fever, vomiting, headache and nausea. Viruses may reach the meninges from the bloodstream or be reactivated from a dormant state within the nervous system.7 Herpes-, arbo- and enteroviruses are the major etiologic agents of central nervous system infections, however their causative role among adult cases of aseptic meningitis is unclear.8 They preferentially cause harm in the very young9 and children are the primary victims of central nervous system infections due to enteroviruses. Therefore, little is known about the natural history of enterovirus meningitis in adults.6
Neuropsychiatric manifestations in primary Sjogren syndrome
Published in Expert Review of Clinical Immunology, 2022
Simone Appenzeller, Samuel de Oliveira Andrade, Mariana Freschi Bombini, Samara Rosa Sepresse, Fabiano Reis, Marcondes C. França
The prevalence of aseptic meningitis is difficult to establish, because most cases derive from case reports or case series [39]. In the majority of the reports, aseptic meningitis occurred in patients prior to pSS diagnosis [39]. Presenting symptoms were similar to those of idiopathic aseptic meningitis or aseptic meningitis associated with other diseases, with headache, fever, nausea or vomiting, and disturbance of consciousness as predominant features [39]. Of interest is the diagnosis of pSS concomitant with aseptic meningitis. Reports have described the occurrence of xerophthalmia and xerostomia (36%), parotitis (18%), arthritis (15%), and peripheral neuropathy (3%), highlighting the importance of careful clinical investigation [39]. Immunological findings have also been reported, with antinuclear antibodies occurring in 79% of patients, positive anti-Ro/SSA in 79%, and anti-La/SSB in 70% [39]. The majority of the patients (89%) required immunosuppressive treatment and recurrence was observed in 36% of the reports, with a median relapse rate of 2.9 , and an average of 35 month follow-up period [39]. Brain magnetic resonance imaging (MRI) findings are variable. Studies have described findings ranging from normal MRI to the presence of T2 weighted hyperintense inflammatory lesions in the cerebral white matter or cortex and vasculitis [25].
Is it all about age? Clinical characteristics of Kawasaki disease in the extremely young: PeRA research group experience
Published in Postgraduate Medicine, 2022
Figen Çakmak, Ferhat Demir, Mustafa Çakan, Hafize Emine Sonmez, Şengül Çağlayan, Şerife Gül Karadağ, Yusuf Ziya Varlı, Gülçin Otar Yener, Kübra Öztürk, Betül Sözeri, Nuray Aktay Ayaz
There was no significant difference in major clinical manifestations between the two groups except cervical lymphadenopathy. It was the least common manifestation in both groups and the frequency was higher in Group II. Clinical features such as vomiting and aseptic meningitis were more common in Group I. Extreme irritability out of proportion to disease has been observed in children with KD, particularly in young infants, and may be a prominent clinical finding. In this cohort, aseptic meningitis was detected in six patients in Group I who underwent lumbar puncture due to excessive irritability and fever. BCGitis was not statistically different from the two groups, but all patients with erythema in BCG scar were less than 1 year old, and two of these nine patients were from Group I. Kang et al. determined that BCGitis and higher NT-pro-BNP levels may be helpful in the early diagnosis of incomplete KD in infants and may be a good predictor of KD in infants with acute fever when combined with other acute phase reactants [26].