• Clinical and Experimental Pediatrics
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• v.49 no.10
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• pp.1086-1092
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• 2006

Purpose : Refractory status epilepticus(RSE) is a serious neurological emergency in children. The mortality is high and the neurological outcome is not good. This study aimed to evaluate the clinical significance of cerebrospinal fluid(CSF) pleocytosis in refractory status epilepticus in children. Methods : From January 1999 to January 2006, 25 out of 37 children with refractory status epilepticus had spinal tapping. We retrospectively analyzed the data from these children's medical records. We compared the results between groups with and without CSF pleocytosis, and between a group with first seizure and a group with epilepsy. Result : Six out of 25 children had CSF pleocytosis. The group without CSF pleocytosis had a higher mortality rate and required higher doses of antiepileptic drugs as compared with the group with CSF pleocytosis. The group with CSF pleocytosis had much worse neurologic segualae. However, except for the children with CNS infection, the overall prognosis between the group with and without CSF pleocytosis was not significantly different. All children with CSF pleocytosis came in with first seizures. Conclusion : In children with RSE, a CSF study must be perfomed as soon as possible to exclude the possibility of CNS infection. A CSF study is even more important in cases of first seizure or CNS infection suspected. Mild CSF pleocytosis without evidence of infection does not seem to affect the prognosis, so physicians should therefore be more cautious in selecting antibacterial or antiviral agents for it.

• Clinical and Experimental Pediatrics
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• v.58 no.7
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• pp.251-255
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• 2015

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 ${\leq}1$, 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 ${\geq}4$. 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.

• Pediatric Infection and Vaccine
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• v.24 no.1
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• pp.54-59
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• 2017

Purpose: Urinary tract infection (UTI) is the most common serious bacterial infection in infants younger than 3 months of age. Lumbar puncture is routinely performed to evaluate febrile young infants for sepsis. However, there is no clear consensus on the use of routine lumbar puncture to diagnose concomitant meningitis in infants with UTI. We evaluated the prevalence of coexisting bacterial meningitis and sterile cerebrospinal fluid (CSF) pleocytosis in young infants with UTI. Methods: We retrospectively reviewed the medical records of 85 infants with UTI, aged from 29 to 99 days, who were admitted to Daegu Catholic University Medical Center from January 2013 to May 2016. We included 80 patients who had undergone lumbar puncture. Demographic features, clinical features, and laboratory findings were analyzed. Patients were divided into two groups based on the presence of sterile CSF pleocytosis and we compared these groups and assessed the differences between them. Results: Of the 80 UTI patients enrolled, 34 (43%) had sterile CSF pleocytosis. None had bacterial meningitis, and CSF polymerase chain reaction for enterovirus was positive in two patients without CSF pleocytosis. There were no significant differences between the two groups with regards to age, body temperature, peripheral white blood cell count, urinalysis, and duration of hospital stay. Conclusions: Though sterile CSF pleocytosis is common in young UTI patients, coexisting bacterial or viral meningitis is very rare. Indications for lumbar puncture in these patients depend on clinical condition.

• Annals of Clinical Neurophysiology
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• v.17 no.2
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• pp.82-85
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• 2015

A 59-year old man was admitted for drowsiness and stiff neck. CSF examination showed lymphocytic pleocytosis and PCR for herpes simplex virus (HSV)-1 was positive in CSF. Brain MRI revealed enhanced lesions in left temporal lobe. His symptom improved with acyclovir. Follow-up studies showed red blood cells in CSF and a hematoma in the left temporal lobe. There was no additional symptom related to the hematoma. He was discharged after conservative care. Although rare, hematoma can develop in HSV-1 meningoencephalitis.

• Clinical and Experimental Pediatrics
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• v.58 no.3
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• pp.102-107
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• 2015

Purpose: Human parechovirus (HPeV) and enterovirus (EV) are causative agents of a sepsis-like illness in neonates and of infections of the central nervous system in young children. The objectives of this study were to assess the prevalence of HPeV3 and EV infection in young children with a sepsis-like illness or with meningitis in Jinju, Korea. Methods: Cerebrospinal fluid (CSF) samples were collected from 267 patients (age range, 1 day to 5 years) and assessed for HPeV and EV by performing reverse transcription polymerase chain reaction assay. Amplification products of the VP3/VP1 region of HPeV and of the VP1 region of EV were sequenced to identify the virus type. Results: HPeV and EV were detected in 3.4% and 7.5% of the total CSF samples assessed, respectively. The age distribution of EV-positive patients (median age, 1.4 months) had a significantly broader range than that of HPeV-positive patients (median age, 7.8 months). The peak seasons for HPeV and EV infection were spring and summer, respectively. The clinical symptoms for HPeV and EV infection were similar, and fever was the most common symptom. Pleocytosis was detected in 22.2% of HPeV-positive patients and 35.5% of EV-positive patients. The VP3/VP1 gene sequence of the nine Korean strains clustered most closely with the Japanese strain (AB759202). Conclusion: The data indicate that HPeV infection is predominant in young infants (<6 months) and that meningitis without pleocytosis was caused by both HPeV and EV infection in children.

• Annals of Clinical Neurophysiology
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• v.4 no.1
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• pp.56-59
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• 2002

A 28-year-old man presented with headache, fever, and myalgia. Subsequently, rapidly progressive quadriplegia with areflexia developed. CSF examination revealed moderate pleocytosis and protein elevation. MRI of brain and spinal cord showed hyperintense lesions on T2-weighted image at midbrain and ventral horns along the whole spinal cord. Serial serologic examinations of CSF for Epstein-Barr virus and cytomegalovirus were negative. Culture and neutralization tests of stool and CSF for enterovirus were negative. Although the etiologic pathogen was not identified, we diagnosed him as poliomyelitis-like syndrome by clinical features and findings of MRI.

• Journal of Veterinary Clinics
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• v.34 no.5
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• pp.388-391
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• 2017

A 8-month-old, spayed female, Domestic shorthair cat lived in a shelter was presented with pelvic limbs ataxia and dysuria. Serum biochemical profile abnormalities were hyperproteinemia and decreased albumin/globulin (A:G) ratio (0.70). Results of cerebrospinal fluid (CSF) analysis were mixed cells pleocytosis with predominance neutrophils and an increase in protein concentration. In addition, feline coronavirus was detected by realtime RT-PCR in CSF. Magnetic resonance imaging (MRI) findings revealed lesions of the lumbar spinal cord. Based on clinical signs, MR finding, CSF analysis and realtime RT-PCR result in CSF, this case was diagnosed as feline infectious peritonitis (FIP) associated meningomyelitis. Although prednisolone and mycophenolate mofetil were administrated, clinical signs were not resolved and progressed to tetraplegia and coma status. This case presentation describes that feline infectious peritonitis virus could affect the lumbar spinal cord only and cause meningomyelitis with pelvic limbs ataxia without other neurological signs.

• Clinical and Experimental Pediatrics
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• v.59 no.10
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• pp.395-401
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• 2016

Since the outbreak of the enterovirus 71 (EV71) infection in Malaysia in 1997, large epidemics of EV71 have occurred in the Asia-Pacific region. Many children and infants have died from serious neurological complications during these epidemics, and EV71 infection has become a serious public health problem in these areas. EV71 infection causes hand, foot and mouth disease (HFMD) in children, and usually resolves spontaneously. However, EV71 occasionally involves the central nervous system (CNS), and induces diverse neurological complications such as brainstem encephalitis, aseptic meningitis, and acute flaccid paralysis. Among those complications, brainstem encephalitis is the most critical neurological manifestation because it can cause neurogenic pulmonary hemorrhage/edema leading to death. The characteristic clinical symptoms such as myoclonus and ataxia, cerebrospinal fluid (CSF) pleocytosis, and brainstem lesions on magnetic resonance imaging, in conjunction with the skin rash of HFMD and the isolation of EV71 from a stool, throat-swab, or CSF sample are typical findings indicating CNS involvement of EV71 infection. Treatment with intravenous immunoglobulin and milrinone are recommended in cases with severe neurological complications from EV71 infection, such as brainstem encephalitis. Despite the recent discovery of receptors for EV71 in human cells, such as the scavenger receptor B2 and P-selection glycoprotein ligand 1, it is not known why EV71 infection predominantly involves the brainstem. Recently, 3 companies in China have completed phase III clinical trials of EV71 vaccines. However, the promotion and approval of these vaccines in various countries are problems yet to be resolved.

• Korean Journal of Veterinary Research
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• v.46 no.4
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• pp.405-408
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• 2006

A 4-year-old male Miniature Pinscher was referred because of head tilt, nystagmus, and ataxia. The hemogram revealed a moderate neutrophilic leukocytosis. On magnetic resonance imaging, cerebellar inflammation was detected. And cerebrospinal fluid analysis indicated marked neutrophilic pleocytosis. Based on these results, bacterial meningoencephalitis was suspected. The clinical signs were well controlled by a combination antibiotics therapy of the third generation cephalosporins (cefotaxime and cefixime) and metronidazole. We tentatively diagnosed this case as a bacterial meningoencephalitis because clinical signs were improved after only antibiotics therapy and relapsed when stopped antibiotics administrations, even though the result of bacterial culture on communication of cerebrospinal fluid (CSF) was negative.

• The Korean Journal of Pain
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• v.11 no.2
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• pp.338-342
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• 1998

Postural headache due to spontaneous intracranial hypotension occurs without any diagnostic lumbar puncture, myelography, cranial or spinal injury, or spinal anesthesia. The clinical characteristics of the syndrome are disappearance of the headache or a notable decrease in its severity with recumbency, the finding of meningeal enhancement and subdural fluid collection on brain MRI, the pleocytosis and the increased CSF protein concentration. We report a case of a 40-year-old woman who exhibited the signs and symptoms of postural headache due to low CSF pressure. Her headache started suddenly at the occiput and radiated to frontal head. Magnetic resonance imaging (MRI) of her brain showed enhancement of the meninges and subdural fluid collection. Intrathecal radionuclide cisternography showed the delayed appearance of the isotope in the cranium and the minimal CSF leak at the left upper thoracic region. Her headache was relieved completely after a lumbar (L2-L3) epidural injection of 12 ml of autologous blood and remained asymptomatic.