Besides meningism, dizziness has also been frequently reported as a neurologic manifestation of Vogt- Koyanagi-Harada(VKH) syndrome. These neurotologic symptoms usually develop just before or after ocular involvement. We report the patient with VKH syndrome who showed recurrent peripheral vertigo. The characteristic opthalmological symptoms developed later in this case.
Dizziness ; Humans ; Meningism ; Neurologic Manifestations ; Uveomeningoencephalitic Syndrome* ; Vertigo*

Vogt-Koyanagi-Harada (VKH) syndrome is an idiopathic autoimmune disease involving melanocytes. The characteristic features are uveitis, meningismus, tinnitus, alopecia, vitiligo and poliosis, dependent upon the site of melanocyte location. Among the skin manifestations, alopecia usually appears as discrete, alopecic patches around the head. We report a case of fifty-year-old woman who presented with typical features of VKH syndrome, plus alopecia universalis and nail dystrophy.
Alopecia* ; Autoimmune Diseases ; Female ; Head ; Humans ; Melanocytes ; Meningism ; Skin Manifestations ; Tinnitus ; Uveitis ; Uveomeningoencephalitic Syndrome* ; Vitiligo

PURPOSE: The headache, one of the symptoms of meningitis, is related to abrupt elevation of intracranial pressure(ICP) or stimulation of intracranial nociceptive structure. However, in cases of mild elevation of ICP or normal findings of cerebrospinal fluid(CSF) analysis, patients sometimes complain of headaches. Therefore, other pathways may contribute to the occurrence of headaches in aseptic meningitis or meningismus. We intend to investigate the role of substance P(SP) and calcitonin gene-related peptide(CGRP) in aseptic meningitis or meningismus. METHODS: We measured leukocyte count, the concentration of protein and glucose in CSF and ICP of patients with meningeal irritation sign. We also measured SP and CGRP levels by using immunoassay. We analyzed the relationship between the presence of headache and the value of SP and CGRP. RESULTS: The concentrations of CGRP(18.8+/-10.5 ng/mL) in CSF and ICP(14.8+/-4.5 cmH2O) in aseptic meningitis group were significantly higher than in those(14.1+/-7.4 ng/mL and 12.0+/-5.1 cmH2O, respectively) of the meningismus group(P<0.05). There was no significant difference in the SP levels between the two groups. In the aseptic meningitis group, the concentrations of SP and CGRP were significantly higher in the normal ICP group than in the elevated ICP group(P<0.05). CONCLUSION: Headaches in children with aseptic meningitis or meningismus is considered to be related to the elevation of the CSF levels of SP and CGRP.
Calcitonin ; Calcitonin Gene-Related Peptide ; Child* ; Glucose ; Headache* ; Humans ; Immunoassay ; Leukocyte Count ; Meningism ; Meningitis ; Meningitis, Aseptic ; Neuropeptides* ; Substance P

PURPOSE: A clinical diagnosis of meningitis is difficult because of the paucity of physical findings in children. Not all of the meningitis patients show nuchal rigidity, Kernig's sign or Brudzinski's sign. Lumbar punctures were done because of unexplained fever, changes in behavioral or mental status, seizures or skin petechiae in febrile patients. But sometimes cerebrospinal fluid(CSF) findings are not compatible with menigitis for those whose clinical symptoms indicate menigitis. Pediatricians are frequently confronted to the problem of a sick child whose CSF has no white blood cells but the child has a meningeal irritation sign. Therefore, the levels of CSF beta2 microglobulin from children with positive meinigeal irritation signs were examined to evaluate the diagnosis of meinigitis. METHODS: From March to August 2002, We examined the levels of CSF beta2 microglobulin from children with positive meningeal irritation signs by competitive radioimmunoassay in 35 suspected meingitis patients and 12 control patients in the Department of Pediatrics of Chungnam National University Hospital. RESULTS: In 35 suspected menigitis patients, 20 patients were diagnosed as meningitis and 15 patients were no evidence of meningitis in their CSF findings. In the WBC counts of the CSF, meinigitis patients had 268/mm3 and meningismus patient had 2.3/ mm3 on average. In the levels of the CSF beta2 microglobulin concentrations, the two groups were not different. For the 20 meningitis patiens, the average value was 0.193+/-0.054 while it was 0.169+/-0.028 for the 15 meningismus patients and 0.102+/-0.021 for the 12 control patients(P<0.05, <0.05, P>0.05) CONCLUSION: These data demonstrate that the meningeal irritation sign is a meaningful sign for meningitis but the initial CSF findings do not always confirm the diagnosis. So, if patients have a meningeal irritation sign, the patient should be carefully examined and additional diagnostic tools such as the CSF beta2 microglobulin concentration can be used.
Cerebrospinal Fluid* ; Child* ; Chungcheongnam-do ; Diagnosis ; Fever ; Humans ; Leukocytes ; Meningism ; Meningitis ; Muscle Rigidity ; Pediatrics ; Purpura ; Radioimmunoassay ; Seizures ; Skin ; Spinal Puncture

Attention has been called to the sudden expansion of a pituitary tumor by hemorrhage within it, causing sudden loss of vision. Management of the pituitary apoplexy should be regarded as a neurological emergency. The outstanding clinical features of acute pituitary apoplexy were sudden headache, depressed consciousness, opthalmoplegia, meningismus and signs of compression of the optic nerve or chiasm. The authors report two cases of pituitary apoplexy, one was chromophobe adenoma and pathological diagnosis was not obtained in the other. The first case was 45-year-old man admitted to the Department of Neurosurgery, Catholic Medical Center on June 20, 1977, with headache, double vision and impared left side visual acuity. On April 26, 1977, he experienced sudden severe headache and diplopia then became drowsy. The headache and impairment of consciousness improved subsequently. He was admitted to a university hospital following the onset. The work up at the hospital revealed an enlarged sella with hazy dorsum sellae on plain skull films. The carotid angiogram revealed an elevation of the A1 segments bilaterally and cisternal pneumogram revealed an evidence of suprasellar extension of the pituitary tumor. He was advised to have immediate surgery. The patient, however, refused the surgery and noticed the impaired visual acuity and diplopia were persisting. The studies in this hospital revealed marked impairment of left side vision and oculomotor nerve palsy of the left eye. The carotid angiogram and cisternal pneumogram revealed the no evidence of sellar mass or suprasellar extension of the tumor. The second case was 59-year-old woman admitted to the neurosurgical ward on September 30, 1977, after a sudden onset of severe bifrontal headache, vomiting, bilateral ocular pain and drowsy mental state. She was drowsy with panopthalmoplegia of the right side, and spinal fluid was xanthochromic. Skull X-ray, carotid angiogram and air study revealed an evidence of pituitary tumor with minimal suprasellar extension. Removal of pituitary tumor through the trans-sphenoidal approach was performed, and the tumor was proved to be chromophobe adenoma. Panopthalmoplegia was progressively improved postoperatively.
Adenoma, Chromophobe ; Consciousness ; Diagnosis ; Diplopia ; Emergencies ; Female ; Headache ; Hemorrhage ; Humans ; Meningism ; Middle Aged ; Neurosurgery ; Oculomotor Nerve Diseases ; Optic Nerve ; Pituitary Apoplexy* ; Pituitary Neoplasms ; Skull ; Visual Acuity ; Vomiting

A thyroid storm is a potentially fatal complication of hyperthyroidism. Early diagnosis and treatment is essential for reducing morbidity and mortality. Older patients with hyperthyroidism tend to have fewer hypermetabolic signs and increased signs of weight loss, depression, lethargy, cardiac arrhythmia, and apathetic mood. Additionally, comorbid diseases and drug history can affect thyroid function and symptoms. Here, we report an older patient with a thyroid storm and accompanied features of Parkinson's disease. She presented with generalized weakness, delirium, and anxiety. Laboratory findings were consistent with hyperthyroidism. She became drowsy with no precipitating factors. High fever, meningism, and atrial fibrilation occurred with no obvious sources. Suspecting a diagnosis of a thyroid storm, she was treated with an antithyroid drug, Lugol's solution, hydrocortisone, and supportive management. After these treatments, her clinical condition recovered and the neurological signs resolved.
Aged ; Anxiety ; Arrhythmias, Cardiac ; Delayed Diagnosis ; Delirium ; Depression ; Early Diagnosis ; Fever ; Humans ; Hydrocortisone ; Hyperthyroidism ; Iodides ; Lethargy ; Meningism ; Parkinson Disease ; Precipitating Factors ; Thyroid Crisis ; Thyroid Gland ; Weight Loss

OBJECTIVE: Pituitary apoplexy (PA) is described as a clinical syndrome characterized by sudden headache, vomiting, visual impairment, and meningismus caused by rapid enlargement of a pituitary adenoma. We retrospectively analyzed the clinical presentation and surgical outcome in PA presenting with cranial neuropathy. METHODS: Twelve cases (3.3%) of PA were retrospectively reviewed among 359 patients diagnosed with pituitary adenoma. The study included 6 males and 6 females. Mean age of patients was 49.0 years, with a range of 16 to 74 years. Follow-up duration ranged from 3 to 20 months, with an average of 12 months. All patients were submitted to surgery, using the transsphenoidal approach (TSA). RESULTS: Symptoms included abrupt headache (11/12), decreased visual acuity (12/12), visual field defect (11/12), and cranial nerve palsy of the third (5/12) and sixth (2/12). Mean height of the mass was 29.0 mm (range 15-46). Duration between the ictus and operation ranged from 1 to 15 days (mean 7.0). The symptom duration before operation and the recovery period of cranial neuropathy correlated significantly (p = 0.0286). TSA resulted in improvement of decreased visual acuity in 91.6%, visual field defect in 54.5%, and cranial neuropathy in 100% at 3 months after surgery. CONCLUSION: PA is a rare event, complicating 3.3% in our series. Even in blindness following pituitary apoplexy cases, improvement of cranial neuropathy is possible if adequate management is initiated in time. Surgical decompression must be considered as soon as possible in cases with severe visual impairment or cranial neuropathy.
Blindness ; Cranial Nerve Diseases ; Decompression, Surgical ; Female ; Follow-Up Studies ; Headache ; Humans ; Male ; Meningism ; Pituitary Apoplexy ; Pituitary Neoplasms ; Retrospective Studies ; Vision Disorders ; Visual Acuity ; Visual Fields ; Vomiting

Pituitary apoplexy is defined as a complex series of clinical events occurring as a consequence of the fulminant expansion of the pituitary tumor by infarction, hemorrhage, or hemorrhagic infarction of the tumor and the adjacent pituitary tissue. It is one of the entities which need neurosurgical emergency care. Its incidence was, however, reported variously in many literatures due to different diagnostic criteria. We reviewed 150 histologically proven pituitary adenoma cases, operated from January 1980 to September 1986, to select 30 cases which showed clinical or operative findings compatible with pitultary apoplexy('pituitary apoplexy in a broad sense'). Authors analyzed their incidence, presidposing factor, clinical feature, diagnosis and treatment, especially in those who showed major attack with evident enurologic deficits('pituitary apoplexy in a strict sense'). The conclusions are as follows; 1) Among the 150 cases of pituitary tumor, 30 cases (20.0%) were diagnosed as pituitary apoplexy in a broad sense. Eleven cases (7.3%) out of them showed major attack. 2) The symptoms and signs of the 11 cases with major attack were sudden headache(11 cases), visual impairment (9 cases), cavernous sinus compression signs (7 cases), nausea and vomiting (6 cases), depressed consciouness (4 cases), and meningismus (3 cases). 3) In the clinical diagnosis of pituitary apoplexy, findings of plain skull radiologic view were very helpful. 4) With the medical treatment and surgery, good results were achieved in all cases except one patient showing visual impairment. 5) As the method of surgical treatment, the transsphenoidal approach is highly recommended.
Cavernous Sinus ; Diagnosis* ; Emergency Medical Services ; Hemorrhage ; Humans ; Incidence ; Infarction ; Meningism ; Nausea ; Pituitary Apoplexy* ; Pituitary Neoplasms ; Skull ; Stroke ; Vision Disorders ; Vomiting

Intracranial subdural empyema is a neurosurgical emergency and an unusual condition which carries a serious incidence of mortality and morbidity if untreated. The subdural empyema developes from varied sources, but paranasal sinus, the ear and the mastoid process are predominantly affected and subtentorial empyema usually originates from otogenic intracranial complication. Its manifestations are variable such as impaired consciousness, headache, hemiparesis, acute fits, pyrexia, meningism, vomiting, papilledema. ophthalmoplegia, hemianopsia and dysphasia. Subtentorial empyema has additional cerebellar dysfunction syndromes. Early accurate diagnosis and surgical drainage are the most important factors affecting the prognosis. Recently, we experienced two cases of subtentorial empyema which were very rare otogenic intracranial complications. These patients were treated with suboccipital craniectomy, but reaccumulations of empyema and subsequent cerebellar abscess in one case occurred. Finally these patients were recovered without neurologic deficits. Reviewing our two cases and the literature, we are going to describe about causes, symptoms and signs, method of diagnosis, treatment and prognosis of subtentorial empyema.
Abscess ; Aphasia ; Cerebellar Diseases ; Consciousness ; Diagnosis ; Drainage ; Ear ; Emergencies ; Empyema* ; Empyema, Subdural ; Fever ; Headache ; Hemianopsia ; Humans ; Incidence ; Mastoid ; Meningism ; Mortality ; Neurologic Manifestations ; Ophthalmoplegia ; Papilledema ; Paresis ; Prognosis ; Vomiting

BACKGROUND: Herpes simplex virus type 2 (HSV-2) is the second most common cause of viral meningitis and the most common cause of recurrent meningitis. Although the incidence of HSV-2 meningitis is high, its clinical characteristics are not well known. The purpose of this study was to review the clinical characteristics and prognosis of HSV-2 meningitis. METHODS: We analyzed patients who were admitted to the Department of Neurology at Severance Hospital with a final diagnosis of HSV-2 meningitis, as confirmed by applying the polymerase chain reaction to the cerebrospinal fluid (CSF) of patients. RESULTS: The study involved 998 patients with aseptic meningitis and 60 patients diagnosed with HSV-2 meningitis. The mean age at meningitis presentation was 32.5 years (range 18-54 years), and 72% of the patients were female. Common clinical symptoms were headache (100%), nausea and/or vomiting (83%), meningismus (57%), and fever (55%). Six patients had a history of genital herpes infection, and 11 had a past history of recurrent meningitis. The CSF study was notable for elevated protein (111.0±53.5 mg/dL, mean±standard deviation) and white cell count (332.0±211.3 cells/µL). The CSF/serum glucose ratio was 0.52±0.90. Various treatments were applied, including conservative care, antiviral agents, empirical antibiotics, and combined treatments. All patients recovered without serious neurologic sequelae. CONCLUSIONS: HSV-2 meningitis is relatively common, as are recurrent episodes. The clinical characteristics of HSV-2 meningitis are similar to those of other types of aseptic meningitis. HSV-2 meningitis is treated using antiviral therapy, and the prognosis is favorable even with conservative treatment.
Anti-Bacterial Agents ; Antiviral Agents ; Cell Count ; Cerebrospinal Fluid ; Diagnosis ; Female ; Fever ; Glucose ; Headache ; Herpes Genitalis ; Herpes Simplex* ; Herpesvirus 2, Human* ; Humans ; Incidence ; Meningism ; Meningitis ; Meningitis, Aseptic ; Meningitis, Viral ; Nausea ; Neurology ; Polymerase Chain Reaction ; Prognosis ; Retrospective Studies* ; Simplexvirus* ; Vomiting