A previously healthy 16-month-old Korean girl with symptoms of fever, vomiting, and generalized tonic seizure was diagnosed to have Group D non-typhoid Salmonella meningitis. The patient was treated with ceftriaxone (100 mg/kg/day) and amikin (22.5 mg/kg/day) initially and ciprofloxacin (30 mg/kg/day) was added later because of clinical deterioration and disseminated intravascular coagulation. Brain CT performed on the second day showed a well-demarcated low density lesion in the right lentiform nucleus and both caudate nuclei, without evidence of increased intracranial pressure. MRI performed on the 11th day confirmed CT scan findings as well as right subdural fluid collection, brain atrophy, and ventriculomegaly. She underwent subdural drainage and later ventriculo-peritoneal shunt operation. Despite receiving intensive treatment, she still has severe neurologic sequelae. Our case shows that infarctions of basal ganglia and thalami are not specific for tuberculous meningitis and that meningitis complicated by infarction is indicative of grave prognosis.
Basal Ganglia Diseases/radiography ; Basal Ganglia Diseases/pathology ; Basal Ganglia Diseases/complications ; Basal Ganglia Diseases/cerebrospinal fluid ; Brain/radiography ; Brain/pathology ; Case Report ; Cerebral Infarction/radiography ; Cerebral Infarction/pathology ; Cerebral Infarction/complications* ; Cerebral Infarction/cerebrospinal fluid ; Female ; Follow-Up Studies ; Human ; Infant ; Magnetic Resonance Imaging ; Meningitis, Bacterial/radiography ; Meningitis, Bacterial/pathology ; Meningitis, Bacterial/complications* ; Meningitis, Bacterial/cerebrospinal fluid ; Salmonella Infections/complications* ; Tomography, X-Ray Computed/methods

BACKGROUND: Normal pressure hydrocephalus (NPH) is a poorly understood condition, which typically presents with the triad of gait disturbance, urinary incontinence and cognitive decline. Diagnosis of NPH is often challenging due to its varied presentation and overlap with other neurodegenerative diseases including multiple system atrophy (MSA). CASE REPORT: A 68-year-old male developed rapidly progressive gait difficulty, urinary incontinence and memory impairment. Neurologic examination showed parkinsonism affecting the right side and impaired postural reflexes. Brain MRI showed enlargement of the ventricles and narrowing of the high convexity cerebrospinal fluid (CSF) spaces with relative dilated Sylvian fissure, the supporting features of NPH. 18F-fluorinated-N-3-fluoropropyl-2-b-carboxymethoxy-3-b-(4-iodophenyl) nortropane (¹⁸F-FP-CIT) PET showed decreased FP-CIT binding in the left posterior putamen and ¹⁸F-fluorodeoxyglucose PET showed decreased metabolism in the left basal ganglia, consistent with findings of MSA. CSF removal was performed and the symptoms were improved. The patient underwent ventriculo-peritoneal shunt and his gait and cognition improved. CONCLUSIONS: NPH is a potentially treatable neurological disorder. Therefore, it is necessary to consider the possibility of accompanying NPH when hydrocephalus is present in other neurodegenerative diseases.
Aged ; Basal Ganglia ; Brain ; Cerebrospinal Fluid ; Cognition ; Diagnosis ; Gait ; Humans ; Hydrocephalus* ; Hydrocephalus, Normal Pressure ; Magnetic Resonance Imaging ; Male ; Memory ; Metabolism ; Multiple System Atrophy* ; Nervous System Diseases ; Neurodegenerative Diseases ; Neurologic Examination ; Parkinsonian Disorders ; Putamen ; Reflex ; Urinary Incontinence ; Ventriculoperitoneal Shunt

Acute disseminated encephalomyelitis (ADEM) is a monophasic immune-mediated demyelination disorder that can arise following infection or immunization. Typical MRI findings show multifocal demyelinating lesions in the CNS. The presenting features include acute encephalopathy with multifocal neurologic signs, and patients often progress to develop delirium and/or coma, but acute psychosis is rare. In our current report, we describe a case of a 14-year-old boy presenting with parkinsonian features (masked face, bradykinesia, resting tremor, slow strides) as well as aggressive behavior and irritability with persecutory delusions that developed 3 days after an upper respiratory tract infection. T2-weighted/FLAIR brain MRI showed increased signal intensity in the hippocampus and basal ganglia including in the caudate nuclei. Cerebrospinal fluid (CSF) enterovirus PCR was positive. After treatment with high-dose methylprednisolone and antipsychotics, he recovered without permanent disabilities, and the initial lesions found on MRI disappeared on follow-up.
Adolescent ; Antipsychotic Agents ; Basal Ganglia ; Brain ; Cerebrospinal Fluid ; Coma ; Delirium ; Delusions ; Demyelinating Diseases ; Encephalomyelitis, Acute Disseminated* ; Enterovirus ; Follow-Up Studies ; Hippocampus ; Humans ; Hypokinesia ; Immunization ; Magnetic Resonance Imaging ; Male ; Methylprednisolone ; Neurologic Manifestations ; Polymerase Chain Reaction ; Psychotic Disorders ; Respiratory Tract Infections ; Tremor