A 69-year-old woman presented with 1 month of rapid cognitive decline preceded by 1 year of very mild memory changes. Examination showed impaired attention, logopenic aphasia, anosognosia, simultagnosia, graphesthesia, and apraxia. Neuroimaging demonstrated leptomeningeal enhancement without significant parenchymal lesions or cerebral microbleeds (figure 1). A lymphocytic pleocytosis (15 nuclea...

OBJECTIVE We report data on 11 patients with neurological symptoms and human immunodeficiency virus (HIV) cerebrospinal fluid (CSF) viremia contrasting with suppressed plasma HIV RNA during receipt of combined antiretroviral therapy. DESIGN We retrospectively identified instances of central nervous system (CNS) symptoms in patients who had been receiving stable combination antiretroviral ther...

Neurobrucellosis manifesting as optic neuritis is a rare disease in childhood. We report a case of neurobrucellosis in a 11 year old girl leading to visual impairment and headache. Physical examination revealed mild oedema of right tibiotarsic joint and optic neuritis. Investigations showed CSF pleocytosis and a Brucella serum agglutination titer of 1/640. Complete reversal of the symptoms was ...

Unlike bacterial and fungal meningitis in which imaging abnormalities are not specific for a particular agent, many virus infections of the CNS produce MRI abnormalities not seen by any other infectious agent. The changes caused by the specific virus can also be produced by noninfectious disorders. Imaging changes must always be evaluated in conjunction with the clinical symptoms, signs, and la...

Vogt-Koyanagi-Harada (VKH) disease, also known as uveomeningitic syndrome, is an idiopathic multisystem inflammatory disease with bilateral uveitis. Patients with bilateral anterior uveitis with vitiligo, poliosis, alopecia, and dysacousia were first described by Vogt in 1906 and then Koyanagi in 1929. Harada described a case of posterior uveitis with exudative retinal detachment and pleocytosi...

A 35-year-old woman presented with 2 months of chronic headache. Her history was remarkable for bilateral uveitis. There was no nuchal rigidity or neurologic deficit. CSF revealed a lymphocytic pleocytosis, elevated protein, and hypoglycorrhachia (23 mg/dL). Culture for acid-fast bacilli was negative. Chest x-ray revealed bilateral hilar lymphadenopathy. There was an increased CD4/CD8 ratio in ...

Viral encephalitis causes an altered level of consciousness, which may be associated with fever, seizures, focal deficits, CSF pleocytosis, and abnormal neuroimaging. Potential pathogens include HSV, VZV, enterovirus, and in some regions, arboviruses. Autoimmune (eg, anti-NMDA receptor) and paraneoplastic encephalitis are responsible for some cases where no pathogen is identified. Indications f...

SECTION 1 A 19-year-old man with no significant medical history noted 3 weeks of right facial numbness and slurred speech. On examination, he had decreased sensation in the rightmiddle and lower trigeminal nerve distributions, right tongue deviation, and bilateral facial weakness. A lumbar puncture yielded CSF with a lymphocytic predominant pleocytosis (50 leukocytes/mm, 95% lymphocytes), eleva...

A 45-year-old man presented with progressive Broca aphasia and right hemiparesis. MRI demonstrated a large white matter lesion with multiple rings (figure). These centrifugal rings reflect concentric layers of active demyelination, typical for Baló concentric sclerosis. CSF showed oligoclonal bands and a mild pleocytosis. Partial recovery followed 5 days of treatment with IV methylprednisolone ...

A 32-year-old female with depression on treatment, was presented with acute psychosis, behavioural symptoms, autonomic instability and a prodromal illness. This occurred on a background of a strong family history of schizophrenia. Despite escalating doses of anti-psychotics, she failed to improve. Her CSF showed a lymphocytic pleocytosis and confirmed the presence of anti-NMDAR antibodies. Foll...