Brain tumors are manifest in a limited variety of ways, presenting with symptoms of increased intracranial pressure and of localized destruction or compression of nervous tissue. Two cases of brain tumor were reported, in which clinical manifestations resembled those of the meningitis, that is, clinical signs and symptoms, as well as cerebrospinal fluid pleocytosis, were consistent with the diagnosis of meningitis.
Brain Neoplasms* ; Brain* ; Cerebrospinal Fluid ; Diagnosis ; Intracranial Pressure ; Leukocytosis ; Meningitis*

Brain tumors are manifest in a limited variety of ways, presenting with symptoms of increased intracranial pressure and of localized destruction or compression of nervous tissue. Two cases of brain tumor were reported, in which clinical manifestations resembled those of the meningitis, that is, clinical signs and symptoms, as well as cerebrospinal fluid pleocytosis, were consistent with the diagnosis of meningitis.
Brain Neoplasms* ; Brain* ; Cerebrospinal Fluid ; Diagnosis ; Intracranial Pressure ; Leukocytosis ; Meningitis*

BACKGROUND & PURPOSE: Confirmation of etiology in various types of meningitis is the essential step for the treatment with respect to the underlying organism. Although the definite diagnosis of TBM depends on identifying M. tuberculosis in the CSF, the acid fast bacilli are rarely shown in smears of CSF and are cultured in only some patients. Increased levels of ADA in systemic tuberculous effusion have been observed. This study is to evaluate the diagnositc significance & value as a laboratory index of disease activity of ADA in TBM. METHODS: We assayed the activity of ADA in the CSF of 117 patients with various types of meningitis (tuberculous, viral, and bacterial) from 1995 through 1996 at Chungnam National University Hospital. We established several diagnostic criteria for TBM: characteristic CSF findings, such as lymphocytic pleocytosis, cloudy or ground-glass appearance, increased protein content, and decreased sugar level, positive acid fast bacilli in CSF smear, brain CT or MRI findings compatible with TBM. RESULTS: The mean ADA value in CSF was higher in TBM(15.5+/-4.6 U/liter) than in other meningitis. The sensitivity of the test for diagnosing TBM was 0.80 and specificity, 0.98. Increased CSF protein in TBM(271.23+/-78.2) showed in parallel with ADA activity in CSF(p<.05). A gradual decline in level of this enzyme was observed during the first two weeks of therapy in concordance with the clinical improvement. The mean interval for normalizing ADA activity was 37.6 days from the onset of treatment. CONCLUSION: The quantification of ADA in CSF is a rapid and economic test that is useful for early diagnosis of TBM and sensitive as an indicator for disease activity.
Adenosine* ; Brain ; Cerebrospinal Fluid* ; Chungcheongnam-do ; Diagnosis ; Early Diagnosis ; Humans ; Leukocytosis ; Magnetic Resonance Imaging ; Meningitis ; Sensitivity and Specificity ; Tuberculosis

PURPOSE: The widespread introduction of bacterial conjugate vaccines has decreased the risk of cerebrospinal fluid (CSF) pleocytosis due to bacterial meningitis (BM) in children. However, most patients with CSF pleocytosis are hospitalized and treated with parenteral antibiotics for several days. The bacterial meningitis score (BMS) is a validated multivariate model derived from a pediatric population in the postconjugate vaccine era and has been evaluated in several studies. In the present study, we examined the usefulness of BMS in South Korean patients. METHODS: This study included 1,063 patients with CSF pleocytosis aged between 2 months and 18 years. The BMS was calculated for all patients, and the sensitivity and negative predictive value (NPV) of the test were evaluated. RESULTS: Of 1,063 patients, 1,059 (99.6%) had aseptic meningitis (AM). Only four patients (0.4%) had BM. The majority of patients (98%) had a BMS of < or =1, indicating a diagnosis of AM. The BMS was 0 in 635 patients (60%) and 1 in 405 patients (38%). All four BM patients had a BMS of > or =4. CONCLUSION: To our knowledge, this is the first study to investigate the diagnostic strength of the BMS in South Korea. In our study, the BMS showed 100% sensitivity and 100% NPV. Therefore, we believe that the BMS is a good clinical prediction rule to identify children with CSF pleocytosis who are at a risk of BM.
Anti-Bacterial Agents ; Cerebrospinal Fluid* ; Child* ; Decision Support Techniques ; Diagnosis ; Humans ; Korea ; Leukocytosis* ; Meningitis, Aseptic ; Meningitis, Bacterial* ; Vaccines, Conjugate

PURPOSE: The aim of this study was to evaluate the difference of clinical features among patients with enteroviral mengitis according to the presence of cerebrospinal fluid (CSF) pleocytosis. METHODS: This was a retrospective analysis of the patients' data diagnosed with enteroviral meningitis by CSF reverse transcriptase polymerase chain reaction (RT-PCR). We reviewed the medical records of children younger than 16 years who visited Korea University Ansan Hospital and Guro Hospital for meningitis or encephalitis between March 2013 and August 2013. Clinical and laboratory variables were compared with regard to the presence of CSF pleocytosis. RESULTS: Among 49 patients with enteroviral meningitis, eight of 49 (16.3%) did not have pleocytosis. The enteroviral meningitis patients without pleocytosis had lower CSF protein level than patients with pleocytosis (18.9+/-4.3 vs 34.9+/-18.3 mg/dL; P=0.002). Age, duration of hospital stay, severity of clinical symptom, peripheral white cell blood counts, absolute neutrophil counts and CSF/serum glucose ratio were not different between two groups. CONCLUSION: Enteroviral meningitis could manifest without pleocytosis. We therefore think that CSF RT-PCR is helpful for the diagnosis, especially in suspected cases, which leads to shorter hospital stay and minimal use of antibiotics.
Anti-Bacterial Agents ; Cerebrospinal Fluid ; Child ; Diagnosis ; Encephalitis ; Enterovirus ; Glucose ; Gyeonggi-do ; Humans ; Korea ; Length of Stay ; Leukocytosis* ; Medical Records ; Meningitis* ; Neutrophils ; Retrospective Studies ; Reverse Transcriptase Polymerase Chain Reaction

PURPOSE: To characterize the infants under 3 months of age with urinary tract infections(UTIs), and especially patients with bacteremia or meningitis METHODS: Hospital records of all the infants under 3 months of age discharged from our hospital for 69 consecutive months with the diagnosis of initial episode of UTI were reviewed. UTI was defined when patients had fever with pyuria, and had urine culture results of > or = 10(5) colony forming units/mL from a bag specimen. Patients with previously known urologic abnormality or immunodeficiency were excluded. Nosocomial infections were also excluded from the study. RESULTS: The male:female ratio was 35 : 6. Of the urine cultures, 40(97.6%) yielded single pathogen, one yielded two pathogens. Escherichia coli was the predominant isolate from the urine. Five patients(12%) also had bacteremia. Pathogens isolated from the blood cultures were E. coli(4) and Enterococcus faecalis(1). No patient had culture-positive meningitis or cerebrospinal fluid pleocytosis. Clinical or laboratory findings between patients with and without bacteremia were not different significantly. The rate of vesicoureteral reflux(VUR) was 44%. The sensitivity of ultrasound for detection of VUR was 38%; specificity was 50%. CONCLUSION: Clinical and laboratory data were not helpful for identifying patients with bacteremia at the time of presentation. Consequently, blood cultures need to be obtained from all febrile infants under 3 months of age with UTIs. A large-scale study including the indication of lumbar puncture for infants with a febrile UTI and study of evaluation and treatment of infants under 3 months of age with UTIs are required.
Bacteremia ; Cerebrospinal Fluid ; Cross Infection ; Diagnosis ; Enterococcus ; Escherichia coli ; Fever ; Hospital Records ; Humans ; Infant* ; Leukocytosis ; Meningitis ; Pyuria ; Sensitivity and Specificity ; Spinal Puncture ; Ultrasonography ; Urinary Tract Infections* ; Urinary Tract*

Hemophagocytic lymphohistiocytosis (HLH) is characterized by fever, splenomegaly, jaundice, and pathologic findings of hemophagocytosis in bone marrow or other tissues such as the lymph nodes and liver. Pleocytosis, or the presence of elevated protein levels in cerebrospinal fluid, could be helpful in diagnosing HLH. However, the pathologic diagnosis of the brain is not included in the diagnostic criteria for this condition. In the present report, we describe the case of a patient diagnosed with HLH, in whom the brain pathology, but not the bone marrow pathology, showed hemophagocytosis. As the diagnosis of HLH is difficult in many cases, a high level of suspicion is required. Moreover, the pathologic diagnosis of organs other than the bone marrow, liver, and lymph nodes may be a useful alternative.
Biopsy* ; Bone Marrow ; Brain Diseases ; Brain* ; Central Nervous System ; Cerebrospinal Fluid ; Diagnosis ; Fever ; Humans ; Jaundice ; Leukocytosis ; Liver ; Lymph Nodes ; Lymphohistiocytosis, Hemophagocytic* ; Pathology ; Splenomegaly

BACKGROUND: Acute necrotizing encephalopathy (ANE) is a rare, but potentially life threatening neurological condition in children. This study aimed to investigate its clinical spectrum, diagnostic and therapeutic dilemma, and prognosis. METHODS: Twelve children with ANE were included in the study. The diagnosis was made by clinical and radiological characteristics from January 1999 to December 2017 and their clinical data were retrospectively analyzed. RESULTS: A total of 12 children aged 6 to 93 months at onset (5 male: 7 female) were evaluated. The etiology was found in 4 of them (influenza A, H1N1; coxsackie A 16; herpes simplex virus; and RANBP2 gene/mycoplasma). The most common initial presentations were seizures (67%) and altered mental status (58%). The majority of the subjects showed elevation of aspartate aminotransferase/alanine aminotransferase with normal ammonia and increased cerebrospinal fluid protein without pleocytosis. Magnetic resonance imaging revealed increased T2 signal density in bilateral thalami in all patients, but the majority of the subjects (67%) also had lesions in other areas including tegmentum and white matter. Despite the aggressive immunomodulatory treatments, the long-term outcome was variable. One child and two sisters with genetic predisposition passed away. CONCLUSION: ANE is a distinctive type of acute encephalopathy with diverse clinical spectrum. Even though the diagnostic criteria are available, they might not be watertight. In addition, treatment options are still limited. Further studies for better outcome are needed.
Ammonia ; Aspartic Acid ; Brain Diseases ; Cerebrospinal Fluid ; Child ; Diagnosis ; Genetic Predisposition to Disease ; Humans ; Leukocytosis ; Magnetic Resonance Imaging ; Male ; Prognosis ; Retrospective Studies ; Seizures ; Siblings ; Simplexvirus ; White Matter

PURPOSE: Meningitis is among the most common infections affecting the central nervous system. It can be difficult to determine the exact pathogen responsible for the infection and patients are often treated with empiric antibiotics. This study was conducted to identify the most common clinical characteristics of enteroviral meningitis in children and evaluate the diagnostic efficacy of reverse transcriptase-polymerase chain reaction (RT-PCR) for early detection of an enterovirus. METHODS: We analyzed the medical records of children admitted to Korea University Medical Center and diagnosed with meningitis on the basis of cerebrospinal fluid (CSF) analysis and RT-PCR from CSF and other samples from January 2010 to August 2013. RESULTS: A total of 333 patients were enrolled and classified into four groups based on diagnosis: enteroviral meningitis (n=110), bacterial meningitis (n=23), other viral meningitis (n=36), and unknown etiology (n=164). Patients with bacterial meningitis were younger than those in the other groups (P<0.001). Pleocytosis in CSF was similar across all groups. Of patients in the enteroviral meningitis group, 92.7% were diagnosed based on RT-PCR findings. Mean length of hospital stay for patients with enteroviral meningitis was 6.08 days, which was significantly shorter than that for patients with meningitis of bacterial etiology (19.73 days, P<0.001). CONCLUSION: Diagnosis of enteroviral meningitis before viral culture results are available is possible using RT-PCR. Accurate diagnosis reduces the length of hospital stay and helps to avoid unnecessary empiric antibiotic treatment.
Academic Medical Centers ; Anti-Bacterial Agents ; Central Nervous System ; Cerebrospinal Fluid ; Child ; Diagnosis ; Early Diagnosis* ; Enterovirus ; Humans ; Korea ; Length of Stay ; Leukocytosis ; Medical Records ; Meningitis* ; Meningitis, Bacterial ; Meningitis, Viral ; Reverse Transcriptase Polymerase Chain Reaction

We report a 39-yr-old man with neuro-Behcet's disease (NBD) in remission who developed left-sided ataxia with a sensory deficit about 10 days after tooth extraction. Several years ago, he experienced a similar episode of relapse after tooth extraction. Brain magnetic resonance imaging showed a newly developed right thalamic lesion. In cerebrospinal fluid, lymphocyte-dominant pleocytosis and mild elevation of IgG were found. Immunologic factors may be important in the pathogenesis of NBD because of the time delay between tooth extraction and relapse. Careful observation and prevention are needed before dental procedures in patients with NBD.
Adult ; Behcet Syndrome/*diagnosis/drug therapy ; Brain/radionuclide imaging ; Humans ; Immunoglobulin G/analysis ; Leukocytosis/cerebrospinal fluid/diagnosis ; Magnetic Resonance Imaging ; Male ; Methylprednisolone/therapeutic use ; Neuroprotective Agents/therapeutic use ; Recurrence ; *Tooth Extraction