The classic subdural hematoma develops after trauma, but in one series 20% did not have a history of trauma. In that same series, 60% of patients were alcoholics, 30% of patients had no lateralizing signs, and one third of the patients had multiple hematomas (with 21% having bilateral subdural hematomas and 14% having additional hematomas […]
In primary cerebral cortex brain tumor, the CSF usually is clear and colorless, although xanthochromia may be present. Spinal fluid pressure is elevated in 70% of patients. Seventy percent show increased protein levels, with about one half of these more than 100 mg/100 ml (1.0 g/L). CSF glucose levels are normal. The majority (70%) of […]
Brain abscess is most commonly due to direct extension of infection from infected middle ear, mastoid sinus, or paranasal sinuses; traumatic injuries, or infected prostheses. There can also be more distant spread from the lungs or from infected emboli. There is increased incidence in immunosuppressed patients. The most frequent organisms cultured are various streptococci, Bacteroides, […]
As noted in Chapter 17, the HIV-1 (AIDS) virus may produce a mild aseptic meningitis lasting 2-3 weeks as the first clinical manifestation of infection. The exact incidence is unknown, but it is probably greater than the 2%-5% estimated in one report. The majority of patients do not manifest this stage but develop more advanced […]
Viral meningitis is one component of a syndrome known as aseptic meningitis. The aseptic meningitis syndrome is now usually defined as meningitis with normal CSF glucose levels, normal or elevated protein levels, and elevated cell count with a majority of the cells being lymphocytes. A less common definition is nonbacterial meningitis; a definition no longer […]
Candida is said to be the most common fungal infection of the CNS. About one half of the patients with Candida CNS infection have a lymphocytic pleocytosis and about one half show a predominance of neutrophilis. Some reports have indicated a surprisingly high rate of CNS involvement in the systemic mycoses (blastomycosis, 3%-10%; histoplasmosis, up […]
Cryptococcus neoformans is the most common fungus producing CNS infection and is an important, although not numerically frequent, etiology of meningitis. The organism is discussed in detail in Chapter 16. About 70% of cryptococcal meningitis cases are male, and the majority are of middle age. About one-half are associated with malignancy or other severe diseases […]
Mycobacterial meningitis is most common in children between the ages of 6 months and 5 years and in the elderly. Chest x-ray film is reported to show hilar adenopathy in 50%-90% of children, but normal chest findings are more common in adults (in one series, about 50% of adults had normal chest x-ray findings). Purified […]
Syphilis is discussed in Chapter 15. CNS syphilis can be diagnosed clinically but is much more accurately diagnosed through tests on CSF. In two studies, cell counts were normal (<5 cells) in 19%-62%, between 5 and 10 cells in 24%-69%, and more than 10 cells in 12%-14%. The majority of the cells were mononuclear in […]
Pressure Reference values for cerebrospinal fluid (CSF) pressure are 100-200 mm H2O. Elevations are due to increased intracranial pressure. The two most common causes of elevated CSF pressure are meningitis and subarachnoid hemorrhage. Brain tumor and brain abscess will cause increased intracranial pressure in most cases but only after a variable period of days or […]
