-
Categories
-
Pharmaceutical Intermediates
-
Active Pharmaceutical Ingredients
-
Food Additives
- Industrial Coatings
- Agrochemicals
- Dyes and Pigments
- Surfactant
- Flavors and Fragrances
- Chemical Reagents
- Catalyst and Auxiliary
- Natural Products
- Inorganic Chemistry
-
Organic Chemistry
-
Biochemical Engineering
- Analytical Chemistry
-
Cosmetic Ingredient
- Water Treatment Chemical
-
Pharmaceutical Intermediates
Promotion
ECHEMI Mall
Wholesale
Weekly Price
Exhibition
News
-
Trade Service
For medical professionals only, how to diagnose and treat cryptococcal encephalitis with insidious onset and misdiagnosis? 1.
Case analysis Liu Moumou, male, 67 years old, occupational retired worker, from Chenzhou, Hunan
.
Due to dizziness, unsteady walking for 1 month, and double vision for 8 days, he was admitted to the hospital
.
He denied any history of hypertension, coronary heart disease, diabetes, and stroke
.
Denied the history of infectious diseases such as hepatitis B and tuberculosis and the history of close contact
.
2018.
4.
19 Prominent dizziness, unsteady walking (no obvious visual rotation, tinnitus, nausea and vomiting, hearing loss and other accompanying symptoms)
.
The patient went to the emergency department of a local hospital for treatment, and underwent head MRI (unenhanced scan + DWI), and found a right cerebellar lesion (DWI high signal).
Combined with clinical symptoms, acute cerebral infarction was considered, and he was hospitalized
.
Routine cerebrovascular disease risk factors were investigated during hospitalization, and no obvious positive findings were found.
Routine treatments such as antiplatelet and lipid-lowering were given, and the patient's dizziness symptoms gradually eased, and he was discharged at the end of April 2018
.
After discharge, continued oral antiplatelet and lipid-lowering drugs
.
2018.
5.
1 The left limb weakness with protruding episodes lasted for about 30 minutes and relieved
.
The patient went to the outpatient department of the local hospital again, considering transient ischemic attack, and instructed the patient to go home to continue taking antiplatelet and lipid-lowering drugs
.
2018.
5.
24 The protrusions are seen in pairs
.
He went to a local hospital and was given inpatient treatment.
During the hospitalization, he had fever, cough and sputum, and was treated with antibiotics, which was not well controlled
.
Since the onset of the disease, he has lost more than 10 kilograms of weight through diet, sleep, and two
.
Second, the diagnosis process 1.
Physical examination showed that the patient's BP150/75 mmHg, high systolic blood pressure
.
Of note on the specialist examination was the patient's drowsiness and vertical eye movement disturbances
.
The auxiliary examination after admission showed no obvious abnormality except that the high-density lipoprotein was slightly higher at 0.
77mmol/L
.
Brain MRI: There are multiple abnormal signals in the midbrain, pons, thalamus and temporal lobe
.
The left temporal lobe, right thalamus, and midbrain had multiple punctate DWI high signals
.
Cranial MRA: The cranial and cerebral blood vessels were basically normal, and no obvious vascular malformation aneurysm or vascular stenosis was seen
.
Lung CT: The markings of the lower lungs were slightly increased, and inflammation was considered
.
2.
Preliminary diagnosis (1) Unsteady walking and double vision.
① Localization of dizziness and unsteady walking - cerebellum
.
Left limb weakness - pyramidal tract
.
Double vision, vertical eye movement disorder - midbrain
.
Somnolence: Reticular ascending activation system pathway
.
② Qualitative cerebral infarction (large artery atherosclerosis?) Vasculitis? Intravascular lymphoma? (2) Pulmonary infection 3.
Results of lumbar puncture after admission Figure 1: The results of lumbar puncture after admission showed increased leukocytes in cerebrospinal fluid, mainly monocytes, significantly decreased glucose, and significantly increased trace protein, suggesting that the patient had intracranial infection
.
Colloidal gold test was positive, but Gram, acid-fast, and ink stains were negative
.
4.
Diagnosis of intracranial infection (cryptococcal encephalitis)
.
Multiple cerebral infarction (other causes)
.
Lung infection
.
Hypertension grade 2 very high risk group
.
Venous thrombosis of the upper extremity (right venous to subclavian vein)
.
CSF cultures identified Cryptococcus neoformans, further confirming the diagnosis
.
Figure 2: Imaging manifestations of cryptococcal encephalitis associated with cerebral infarction Cerebral infarction
.
(1) Multiple lacunar cerebral infarction Figure 3: Imaging manifestations of cryptococcal encephalitis with multiple lacunar cerebral infarction Mechanism: ① Secretion of VEGF invades the vascular endothelium and destroys the blood-brain barrier
.
②Invasion of perivascular space, endothelial proliferation, vasculitis, thrombosis
.
③ fibrous tissue hyperplasia, venous obstruction
.
(2) Cerebral infarction in the large artery blood supply area Figure 4: Imaging manifestations of cryptococcal encephalitis with large arterial blood supply area cerebral infarction Mechanisms: ① There are three mechanisms that cause lacunar infarction
.
② skull base vasospasm, vascular stenosis
.
③ Thrombosis and shedding, and embolic events occur
.
Therefore, this patient had cryptococcal encephalitis with multiple lacunar infarcts
.
3.
Treatment process First, amphotericin B liposome needle + flucytosine (17 days) was used, and the patient had obvious renal damage after induction therapy
.
So switch to fluconazole sodium oxide injection (7 weeks)
.
He was discharged from the hospital on 2018.
8.
16 and returned to the local hospital to continue fluconazole treatment
.
At follow-up 1 year later, the patient's left limb muscle strength was still slightly poor and he was able to take care of himself
.
4.
Summary 1.
Cryptococcal encephalitis is characterized by stroke as the first clinical manifestation.
In the early stage, there may be no obvious symptoms of poisoning, the onset is insidious, and it is easy to be misdiagnosed
.
2.
For unexplained stroke, repeated attacks after active treatment and secondary prevention, attention should be paid to finding other rare causes of stroke, and be alert to intracranial infections (tuberculosis, fungus, syphilis, etc.
)
.
3.
As a sensitive detection method for Cryptococcus, colloidal gold should pay attention to its significance in clinical diagnosis
.
How can I get the full course? Scan the QR code of the poster below to unlock it for free, and you will receive 10 COURSE ACHIEVEMENT exciting clinical difficult cases Case analysis from the clinical diagnosis and treatment experience of outstanding young teachers in Xiangya Shennei Interesting clinical speeches and sharing skills from the wonderful perspective
Case analysis Liu Moumou, male, 67 years old, occupational retired worker, from Chenzhou, Hunan
.
Due to dizziness, unsteady walking for 1 month, and double vision for 8 days, he was admitted to the hospital
.
He denied any history of hypertension, coronary heart disease, diabetes, and stroke
.
Denied the history of infectious diseases such as hepatitis B and tuberculosis and the history of close contact
.
2018.
4.
19 Prominent dizziness, unsteady walking (no obvious visual rotation, tinnitus, nausea and vomiting, hearing loss and other accompanying symptoms)
.
The patient went to the emergency department of a local hospital for treatment, and underwent head MRI (unenhanced scan + DWI), and found a right cerebellar lesion (DWI high signal).
Combined with clinical symptoms, acute cerebral infarction was considered, and he was hospitalized
.
Routine cerebrovascular disease risk factors were investigated during hospitalization, and no obvious positive findings were found.
Routine treatments such as antiplatelet and lipid-lowering were given, and the patient's dizziness symptoms gradually eased, and he was discharged at the end of April 2018
.
After discharge, continued oral antiplatelet and lipid-lowering drugs
.
2018.
5.
1 The left limb weakness with protruding episodes lasted for about 30 minutes and relieved
.
The patient went to the outpatient department of the local hospital again, considering transient ischemic attack, and instructed the patient to go home to continue taking antiplatelet and lipid-lowering drugs
.
2018.
5.
24 The protrusions are seen in pairs
.
He went to a local hospital and was given inpatient treatment.
During the hospitalization, he had fever, cough and sputum, and was treated with antibiotics, which was not well controlled
.
Since the onset of the disease, he has lost more than 10 kilograms of weight through diet, sleep, and two
.
Second, the diagnosis process 1.
Physical examination showed that the patient's BP150/75 mmHg, high systolic blood pressure
.
Of note on the specialist examination was the patient's drowsiness and vertical eye movement disturbances
.
The auxiliary examination after admission showed no obvious abnormality except that the high-density lipoprotein was slightly higher at 0.
77mmol/L
.
Brain MRI: There are multiple abnormal signals in the midbrain, pons, thalamus and temporal lobe
.
The left temporal lobe, right thalamus, and midbrain had multiple punctate DWI high signals
.
Cranial MRA: The cranial and cerebral blood vessels were basically normal, and no obvious vascular malformation aneurysm or vascular stenosis was seen
.
Lung CT: The markings of the lower lungs were slightly increased, and inflammation was considered
.
2.
Preliminary diagnosis (1) Unsteady walking and double vision.
① Localization of dizziness and unsteady walking - cerebellum
.
Left limb weakness - pyramidal tract
.
Double vision, vertical eye movement disorder - midbrain
.
Somnolence: Reticular ascending activation system pathway
.
② Qualitative cerebral infarction (large artery atherosclerosis?) Vasculitis? Intravascular lymphoma? (2) Pulmonary infection 3.
Results of lumbar puncture after admission Figure 1: The results of lumbar puncture after admission showed increased leukocytes in cerebrospinal fluid, mainly monocytes, significantly decreased glucose, and significantly increased trace protein, suggesting that the patient had intracranial infection
.
Colloidal gold test was positive, but Gram, acid-fast, and ink stains were negative
.
4.
Diagnosis of intracranial infection (cryptococcal encephalitis)
.
Multiple cerebral infarction (other causes)
.
Lung infection
.
Hypertension grade 2 very high risk group
.
Venous thrombosis of the upper extremity (right venous to subclavian vein)
.
CSF cultures identified Cryptococcus neoformans, further confirming the diagnosis
.
Figure 2: Imaging manifestations of cryptococcal encephalitis associated with cerebral infarction Cerebral infarction
.
(1) Multiple lacunar cerebral infarction Figure 3: Imaging manifestations of cryptococcal encephalitis with multiple lacunar cerebral infarction Mechanism: ① Secretion of VEGF invades the vascular endothelium and destroys the blood-brain barrier
.
②Invasion of perivascular space, endothelial proliferation, vasculitis, thrombosis
.
③ fibrous tissue hyperplasia, venous obstruction
.
(2) Cerebral infarction in the large artery blood supply area Figure 4: Imaging manifestations of cryptococcal encephalitis with large arterial blood supply area cerebral infarction Mechanisms: ① There are three mechanisms that cause lacunar infarction
.
② skull base vasospasm, vascular stenosis
.
③ Thrombosis and shedding, and embolic events occur
.
Therefore, this patient had cryptococcal encephalitis with multiple lacunar infarcts
.
3.
Treatment process First, amphotericin B liposome needle + flucytosine (17 days) was used, and the patient had obvious renal damage after induction therapy
.
So switch to fluconazole sodium oxide injection (7 weeks)
.
He was discharged from the hospital on 2018.
8.
16 and returned to the local hospital to continue fluconazole treatment
.
At follow-up 1 year later, the patient's left limb muscle strength was still slightly poor and he was able to take care of himself
.
4.
Summary 1.
Cryptococcal encephalitis is characterized by stroke as the first clinical manifestation.
In the early stage, there may be no obvious symptoms of poisoning, the onset is insidious, and it is easy to be misdiagnosed
.
2.
For unexplained stroke, repeated attacks after active treatment and secondary prevention, attention should be paid to finding other rare causes of stroke, and be alert to intracranial infections (tuberculosis, fungus, syphilis, etc.
)
.
3.
As a sensitive detection method for Cryptococcus, colloidal gold should pay attention to its significance in clinical diagnosis
.
How can I get the full course? Scan the QR code of the poster below to unlock it for free, and you will receive 10 COURSE ACHIEVEMENT exciting clinical difficult cases Case analysis from the clinical diagnosis and treatment experience of outstanding young teachers in Xiangya Shennei Interesting clinical speeches and sharing skills from the wonderful perspective
