A Cerebellar Conundrum
|
|
|
- Norman Lane
- 5 years ago
- Views:
Transcription
1 BHIVA AUTUMN CONFERENCE 2011 Including CHIVA Parallel Sessions Dr Lavanya Raman Chelsea and Westminster Hospital, London November 2011, Queen Elizabeth II Conference Centre, London A Cerebellar Conundrum Lavanya Raman 1
2 Miss R 33 year-old Brazilian lady Presented to GP in Nov 2010: Headache Vertigo Watchful waiting advised Symptoms persisted; February 2011 Worsening headaches Vertigo Nausea Left ear heaviness Prescribed Betahistine and referred to ENT 2
3 Back in Brazil... Returned to Brazil for further medical advice Feb 2011 Diagnosed with HIV- Efavirenz/Combivir started MRI LP Brain biopsy CSF Lymphocytic Toxoplasma PCR +ve TB PCR ve Results Virology, culture and syphilis serology ve Biopsy CaseatingGranulomata 3
4 MRI Brazil Leptomeningeal enhancement with left cerebellar lesion What are the top differentials? 4
5 Treatment in Brazil March 2011: Quadruple therapy for CNS TB 6/52 Toxo Rx Follow up in England Returned in May 2011 Switched to Efavirenz/Atripla Headaches improving CD4 210 cells/ul VL 65 copies/ml LP : Unremarkable MRI repeated 5
6 MRI JUNE 2011 No significant change from imaging in Brazil MRI report June 2011 Discussed at radiology MDT Changes consistent with TB Management Ongoing outpatient TB treatment 6
7 July 2011 Worsening occipital headaches Unsteadiness Slurred speech Good compliance with meds; ARVs and TB therapy TB Elispot negative MRI JULY 2011 Compare to previous 7
8 Radiological findings CT/MRI head: Worsening oedema cerebellar vermisextending into cerebellar hemispheres More prominent ring enhancement of left cerebellar lesion Number and size of cerebellar lesions unchanged More prominent leptomeningeal enhancement CSF analysis July 2011 Opening pressure 19mmH2O Glucose 3.8, Protein 1.39 WCC 58 AFB & TB culture negative CSF gram stain & culture negative Toxo PCR positive TPPA & syphilis IgG/IgM EIA positive but VDRL negative EBV 4450 copies/ml All other virology negative CRAG negative 8
9 Has our differential changed? IRIS? Neurosyphilis? Toxoplasmosis?...But treatment completed Progression of TB?...But on treatment and blood/csf -ve Is the CSF virology relevant? Lymphoma? DIAGNOSIS? TB IRIS Commenced on 4mg Dexamethasone QDS Symptoms improved; discharged 9
10 One Week later...august 2011 Worsening headaches Worsening balance impairment New right facial weakness Slurred speech Nystagmus Dysdiadochokinesis Ataxic gait CD4 252 cells/ul VL <40 Repeat MRI August 2011 Where is the new abnormality? New focal high signal area R thalamus consistent with new inflammatory lesion. Otherwise stable appearances. Consistent with IRIS 10
11 Repeat CSF analysis August 2011 Opening pressure 28mmH2O Glucose 5.2, protein 1.63 WCC 7, RCC 12 VL<47 CSF culture, AFB/TB culture negative Syphilis TPPA/VDRL negative, IgG/IgMEIA equivocal CRAG negative EBV copies/ml Other virology negative How would you proceed? 11
12 Ongoing Treatment Steroids; diagnosis still considered most likely IRIS Sulfadiazine and Pyrimethaminein light of positive T.GondiiPCR in CSF July days Benzylpenicillinin light of previous CSF STS results and compatible MRI features Ongoing TB treatment (to complete total 1 year) Repeat MRI end August: stable appearances Had we really coined the diagnosis? 12
13 The final straw...a trip to Brazil Biopsies from Feb 2011 collected from Brazil Re-analysed at St Thomas Hospital Biopsy of cerebellum 13
14 Encephalitis Vasculitis 14
15 CD8 T-cells EBER in situ hybridisation. EBV+ cells in and around the vessel 15
16 BIOPSY OUTCOMES Negative IHC: Toxo JC HIVp24 HSV CMV Treponema pallidum Positive EBV- In situ hybridisation CSF PCR VZV Our working diagnosis EBV-associated encephalitis/vasculitis Valganciclovir commenced Steroids continued with an aim to wean Miss R improved Scans objectively improved Interval LP Oct 2011: EBV 225 copies/ml 16
17 BUT...Represented 28/10/11 Worsening R leg weakness Worsening slurred speech New headaches Still on Valganciclovir BUT Steroid dose weaned to 1mg Latest CD4 205, VL <60 O/E L Reflexes brisk NOVEMBER 11 ANY SIMILARITY? JUNE/JULY 17
18 MRI Spine Nov 2011 Appearances consistent with acute myelitis at C6-7 Aetiology presumably the same as underlying cerebral vasculitis BUT...cannot exclude lymphoma Where is the abnormality? What would you do next? 18
19 Repeat LP EBV undetectable PET Scan Normal Steroids increased Miss R discharged What we did Where do we go from here? Continue higher dose of steroids Review in 1 month with interval scans brain/spine Aim to wean steroids in 1 month If reduced steroid dose not tolerated consider Rituximab 19
20 WHY RITUXIMAB? Dr M. Nelson Professor S. Lucas Dr A. Pozniak Dr S. Papineni Dr E. Page Dr J. Roe Dr S. Jacoub Dr P. Holmes Dr K. Wheatley Dr I. Kooner Dr S. Dhoot Dr S. Portsmore Acknowledgements 20
Dr Keerti Gedela. Chelsea and Westminster Hospital NHS Foundation Trust, London. 19 th Annual Conference of the British HIV Association (BHIVA)
19 th Annual Conference of the British HIV Association (BHIVA) Dr Keerti Gedela Chelsea and Westminster Hospital NHS Foundation Trust, London 16-19 April 2013, Manchester Central Convention Complex Value
A Child with Cross Eye. Nia Kurniati
A Child with Cross Eye Nia Kurniati Background When dealing with new case with potential social problem, complication related to ARV treatment may pose difficulties Restricted resource to address potential
FOCAL NEUROLOGICAL DEFICIT in HIV PATIENTS -a case based approach. Dr Jency Maria Koshy, CMC, Ludhiana
FOCAL NEUROLOGICAL DEFICIT in HIV PATIENTS -a case based approach Dr Jency Maria Koshy, CMC, Ludhiana Case 1 Middle aged gentleman Diagnosed to have HIV 5 months prior to admission CD4 at the time of detection-132
Cerebral Toxoplasmosis in HIV-Infected Patients. Ahmed Saad,MD,FACP
Cerebral Toxoplasmosis in HIV-Infected Patients Ahmed Saad,MD,FACP Introduction Toxoplasmosis: Caused by the intracellular protozoan, Toxoplasma gondii. Immunocompetent persons with primary infection
Dr Paul Holmes Guy s and St Thomas NHS Foundation Trust, London
Dr Paul Holmes Guy s and St Thomas NHS Foundation Trust, London HIV and Lumbar punctures in 2018 Paul Holmes Consultant Neurologist Guy s and St Thomas Hospitals I have no competing interests Summary of
Cryptococcal Meningitis
Cryptococcal Meningitis Dr N Thumbiran Infectious Diseases Department UKZN Index patient 27 year old female Presented to King Edward Hospital on 17/07/2005 with: Severe headaches Vomiting Photophobia X
HIV and Dementia. London Dementia Clinical Network 14 June Dr Patricia McNamara MB BCh BAO MRCP PhD. Locum Consultant Neurologist, NHNN
HIV and Dementia London Dementia Clinical Network 14 June 2018 Dr Patricia McNamara MB BCh BAO MRCP PhD Locum Consultant Neurologist, NHNN Patricia.mcnamara2@nhs.net History of HIV Infection HIV 36 million
Opportunistic infections in the era of cart, still a problem in resource-limited settings
Opportunistic infections in the era of cart, still a problem in resource-limited settings Cristiana Oprea Victor Babes Clinical Hospital for Infectious and Tropical Diseases, Bucharest, Romania Assessment
The Neurology of HIV Infection. Carolyn Barley Britton, MD, MS Associate Professor of Clinical Neurology Columbia University
The Neurology of HIV Infection Carolyn Barley Britton, MD, MS Associate Professor of Clinical Neurology Columbia University HIV/AIDS Epidemiology World-wide pandemic, 40 million affected U.S.- Disproportionate
Meningi&s in HIV NORTHWEST AIDS EDUCATION AND TRAINING CENTER
NORTHWEST AIDS EDUCATION AND TRAINING CENTER Meningi&s in HIV Christina M. Marra, MD Neurology and Medicine University of Washington School of Medicine Susceptibility to CNS Opportunistic Infections CD4+
Dr Ria Daly. Birmingham Heartlands Hospital. 18 th Annual Conference of the British HIV Association (BHIVA)
18 th Annual Conference of the British HIV Association (BHIVA) Dr Ria Daly Birmingham Heartlands Hospital 18-20 April 2012, The International Convention Centre, Birmingham 18 th Annual Conference of the
Case Report Chronic Lymphocytic Inflammation with Pontine Perivascular Enhancement Responsive to Steroids, with Cranial and Caudal Extension
Hindawi Case Reports in Neurological Medicine Volume 2017, Article ID 2593096, 4 pages https://doi.org/10.1155/2017/2593096 Case Report Chronic Lymphocytic Inflammation with Pontine Perivascular Enhancement
Managing meningitis not just antibiotics. Helena White December 2013
Managing meningitis not just antibiotics Helena White December 2013 Case history 43 year old British-born Asian lady Legal advisor Married with a three year old child (on Amoxicillin for recent ear infection)
Reasons why we will never forget. Andrea Antinori INMI L. Spallanzani IRCCS, Roma
Reasons why we will never forget Andrea Antinori INMI L. Spallanzani IRCCS, Roma SMRs according to time spent with CD4 count >500/mm3 after cart initiation in MSM 80,642 HIV-infected individuals eligible
Initial Management of Suspected Encephalitis. Dr Ruth Palmer Consultant Microbiologist
Initial Management of Suspected Encephalitis Dr Ruth Palmer Consultant Microbiologist CNS infections are urgent and important Mortality is significant recovery is slow and and post infection deficits occur
Primary Angiitis of the Central Nervous System. Dr Laura Ross Rheumatology Registrar St Vincent s Hospital
Primary Angiitis of the Central Nervous System Dr Laura Ross Rheumatology Registrar St Vincent s Hospital CASE PRESENTATION Case presentation Mr RH 47 year old man PMHx: Hypertension Diagnosed age 44 years
May He Rest in Peace
May He Rest in Peace Neurologic Complications of AIDS Medical Knowledge Fiesta 2012 Paul K. King MD pkingmd@yahoo.com Objectives definition of HIV/AIDS what are the neurologic complications of AIDS how
GUIDELINE FOR THE MANAGEMENT OF MENINGITIS. All children with suspected or confirmed meningitis
GUIDELINE FOR THE MANAGEMENT OF MENINGITIS Reference: Mennigitis Version No: 1 Applicable to All children with suspected or confirmed meningitis Classification of document: Area for Circulation: Author:
GUIDELINE FOR THE MANAGEMENT OF TOXOPLASMOSIS ENCEPHALITIS
GUIDELINE FOR THE MANAGEMENT OF TOXOPLASMOSIS ENCEPHALITIS Full title of guideline Guideline for the management of toxoplasmosis encephalitis Author Dr P Venkatesan (ID consultant) Division and specialty
5/15/2017. What Does HIV/AIDS Look Like in DC in Potpourri of Challenges With Opportunistic Infections
Potpourri of Challenges With Opportunistic Infections Henry Masur, MD Clinical Professor of Medicine George Washington University Washington, DC FORMATTED: 4/28/217 Learning Objectives After attending
A challenging neurological complication in a young HIV-infected woman
A challenging neurological complication in a young HIV-infected woman Ianache Irina-Cristiana Vi tor Ba es Clini al Hospital for Infectious and Tropical Diseases Bucharest - HIV/AIDS department Assessment
ANTIBIOTIC GUIDELINES FOR THE MANAGEMENT OF COMMUNITY-ACQUIRED MENINGITIS AND ENCEPHALITIS IN ADULTS
ANTIBIOTIC GUIDELINES FOR THE MANAGEMENT OF COMMUNITY-ACQUIRED MENINGITIS AND ENCEPHALITIS IN ADULTS Version 4.0 Date ratified February 2009 Review date February 2011 Ratified by Authors Consultation Evidence
Dilemmas in the Management of Meningitis & Encephalitis HEADACHE AND FEVER. What is the best initial approach for fever, headache, meningisums?
Dilemmas in the Management of Meningitis & Encephalitis Paul D. Holtom, MD Professor of Medicine and Orthopaedics USC Keck School of Medicine HEADACHE AND FEVER What is the best initial approach for fever,
Dr Michael Rayment Chelsea and Westminster Hospital, London
17 TH ANNUAL CONFERENCE OF THE BRITISH HIV ASSOCIATION (BHIVA) Dr Michael Rayment Chelsea and Westminster Hospital, London 6-8 April 2011, Bournemouth International Centre A decade of renal biopsies in
Coversheet for Network Site Specific Group Agreed Documentation. Diagnosis and Staging Protocol
Coversheet for Network Site Specific Group Agreed Documentation Document Title Diagnosis and Staging Protocol Document Date July 2010 Consultation Process Consultation was by the West Midlands Children
Neuroradiology of AIDS
Neuroradiology of AIDS Frank Minja,, HMS IV Gillian Lieberman MD September 2002 AIDS 90% of HIV patients have CNS involvement 1 10% of AIDS patients present first with neurological symptoms 2 73-80% of
VIRAL ENCEPHALITIS EASY TO MISS
TAMORISH KOLE MBBS MRCS(EDIN) FRSM(UK) SENIOR CONSULTANT & HEAD, EMERGENCY MEDICINE, MAX HEALTHCARE, NEW DELHI, INDIA ADJUNCT ASSISTANT PROFESSOR, EMERGENCY MEDICINE, GEORGE WASHINGTON UNIVERSITY, WASHINGTON
Advanced HIV and seriously ill: challenges in low resource settings Rosie Burton, Southern African Medical Unit, MSF
Advanced HIV and seriously ill: challenges in low resource settings Rosie Burton, Southern African Medical Unit, MSF Mozambique Mozambique Mozambique Mozambique Preventing mortality MSF hospital, Kinshasa,
When the drugs don t work- a case of HSV encephalitis.
When the drugs don t work- a case of HSV encephalitis. Nicky Price Consultant Virologist Public Health Wales 67 year old Caucasian Female Presenting complaint 2 day history of: Confusion Shivering Headache
34-year-old female Presented with an 18-month history of headaches.
J. Nel April 2016 34-year-old female Presented with an 18-month history of headaches. Bilateral, frontoparietal Refractory to simple analgesia Occur daily no respite over past 18 months Headaches had gradually
1st interactive course in MS advanced managment
6-7 December - Toronto, Canada 1st interactive course in MS advanced managment IMPROVING THE PATIENT S LIFE THROUGH MEDICAL EDUCATION www.excemed.org Liesly Lee Sunnybrook Health Sciences Centre. Department
CNS Infections. Philip Gothard Consultant in Infectious Diseases Hospital for Tropical Diseases, London. Hammersmith Acute Medicine 2011
CNS Infections Philip Gothard Consultant in Infectious Diseases Hospital for Tropical Diseases, London Hammersmith Acute Medicine 2011 Case 1 HISTORY 27y man Unwell 3 days Fever Headache Photophobia Previously
3/16/2018. Disclosures. Learning objectives. Neurosyphilis CNS INFECTIONS: PEARLS AND PERILS. I have no disclosures.
Disclosures CNS INFECTIONS: PEARLS AND PERILS Felicia Chow, MD, MAS Assistant Professor of Neurology March 16, 2018 I have no disclosures. https://www.intechopen.com/books/novel-aspects-on-cysticercosis-andneurocysticercosis/epilepsy-and-neurocysticercosis-in-sub-saharan-africa
HIV and CNS Stereotactic Biopsy in the diagnosis of brain lesions in AIDS patients
HIV and CNS Stereotactic Biopsy in the diagnosis of brain lesions in AIDS patients Department of Neurosurgery Infectious Diseases Hospital, University of Buenos Aires, Argentina Definition AIDS Patients
A 39 years old HIV-positive black African woman with previously treated cerebral
1 Abstract A 39 years old HIV-positive black African woman with previously treated cerebral toxoplasmosis experienced a foetal intra-uterine death due to congenital toxoplasmosis. This case demonstrates
BHIVA Best Practice Management Session
BHIVA Best Practice Management Session CNS (The brain) - I keep forgetting things DEMENTIA DIAGNOSIS, CLASSIFICATION AND INVESTIGATIONS Paul Holmes Consultant Neurologist Guy s and St Thomas Hospitals
21 st BHIVA Brighton th April Dr Christopher Wood North Middlesex University Hospital
21 st BHIVA Brighton 21-24 th April 2015 Dr Christopher Wood North Middlesex University Hospital Mortality by cause of death and sex: E&W, 1997-2012 2 Mortality and causes of death among women living with
Professor Mark Bower
BHIVA AUTUMN CONFERENCE 2012 Including CHIVA Parallel Sessions Professor Mark Bower Chelsea and Westminster Hospital, London COMPETING INTEREST OF FINANCIAL VALUE > 1,000: Speaker Name Statement Mark Bower
Meningitis. Matthew Grant MD
Meningitis Matthew Grant MD Objectives Understand the diagnostic accuracy of clinical findings Appreciate the differential diagnosis of aseptic meningitis syndrome, and indications for hospitalization
2017 CST-Astellas Canadian Transplant Fellows Symposium. EBV Post Transplantation Implications and Approach to Management
2017 CST-Astellas Canadian Transplant Fellows Symposium EBV Post Transplantation Implications and Approach to Management Atul Humar, MD Atul Humar is a Professor in the Department of Medicine, University
UK Meningitis Study CRF
History Date of onset of symptoms Route of admission A and E GP Other Date of admission to hospital* / / Time of admission (24 hour clock) : *record time and date of admission to A and E if admitted ia
Division of Dermatology Dr A Motau
Division of Dermatology Dr A Motau CASE 1 Histopathology H&E H&E H&E Wartin Starry Immunohistochemical stain for T. pallidum Investigations FBC, U&E, LFT Normal T. pallidum Abs Reactive RPR screen
Opportunistic Infections BHIVA Guidelines
Opportunistic Infections BHIVA Guidelines Mark Nelson David Dockrell Simon Edwards I have.. 1. Read all of the BHIVA guidelines 12% 2. Read some of the BHIVA guidelines in their entirety 3. Browsed some
Marchiafava Bignami Disease (MBD) and Diffusion Tensor Image (DTI) Tractography. Priscilla Chukwueke, MD, MPH
Marchiafava Bignami Disease (MBD) and Diffusion Tensor Image (DTI) Tractography Priscilla Chukwueke, MD, MPH INTRODUCTION Definition: A rare CNS disease characterized by demyelination of the Corpus Callosum.
Overview on Opportunistic Infections of the Central Nervous System
Second HIV Infection and the Central Nervous System: Developed and Resource-Limited Settings Venice, Italy April 14 16, 2007 Overview on Opportunistic Infections of the Central Nervous System Adriana Ammassari
Neuropathology Inflammation, Infection, Demyelination in the CNS
Neuropathology Inflammation, Infection, Demyelination in the CNS PathoBasic 2016-09-20 Jürgen Hench Inflammation in the CNS inflammation generally as a reaction against pathogen, substance, necrotic, or
Mycobacterial Infections and HIV
HIV Pediatrics 2017 Paris, France Mycobacterial Infections and HIV Complex cases from Imperial College Healthcare NHS Trust, St. Mary s Hospital, London, UK Presented by Gareth Tudor-Williams, with thanks
Deborah J. Nicolls. 2 ND YEAR RESEARCH ELECTIVE RESIDENT S JOURNAL Volume VI, A. Study Purpose and Rationale
Combined Diagnostic Approach to AIDS-Related Primary CNS Lymphoma Using EBV-DNA Polymerase Chain Reaction in CSF, Thallium-201 Single-Photon Emission Computed Tomography, and Toxoplasma gondii Serologies.
Brain abscess rupturing into the lateral ventricle causing meningitis: a case report
Brain abscess rupturing into the lateral ventricle causing meningitis: a case report Endry Martinez, and Judith Berger SBH Health System, 4422 Third Ave, Bronx, NY 10457 Key words: brain abscess, rupture
Analysis. Answers. Action. Saturday Night Fever. Shaka Brown Capital Congress
Saturday Night Fever Shaka Brown Capital Congress Shaka Zulu October 31, 2012 SICK SUCKS How my illness started October 2013 August to October 2013 Symptoms: Severe fatigue Night sweats Low grade fever
A Neurologist s Approach to Altered Mental Status
A Neurologist s Approach to Altered Mental Status S. Andrew Josephson, MD Department of Neurology University of California San Francisco October 23, 2008 The speaker has no disclosures Case 1 A 71 year-old
Recurring and Emerging Questions Related to Management of HIV-Related Opportunistic Infections. Objectives. Henry Masur MD
Recurring and Emerging Questions Related to Management of HIV-Related Opportunistic Infections Henry Masur MD Clinical Professor of Medicine George Washington University School of Medicine Objectives To
Safety of switching raltegravir 400mg twice daily to raltegravir 800mg once daily in virologically suppressed patients
Safety of switching raltegravir 400mg twice daily to raltegravir 800mg once daily in virologically suppressed patients Amy Moore, Sonali Sonecha, Tristan Barber, Anton Pozniak, David Asboe, Marta Boffito
MANAGEMENT OF SUSPECTED VIRAL ENCEPHALITIS IN CHILDREN
MANAGEMENT OF SUSPECTED VIRAL ENCEPHALITIS IN CHILDREN OVERVIEW 1980s: dramatically improved by aciclovir HSV encephalitis in adults Delays treatment(> 48h after hospital admission): associated with a
A Case of Metastatic Lung Adenocarcinoma EGFR ve, ALK +
ESMO Preceptorship Programme Dr Najihah Abu Bakar University Malaya Medical Centre, Kuala Lumpur, Malaysia A Case of Metastatic Lung Adenocarcinoma EGFR ve, ALK + HISTORY Mr TT/ 65yo/ Male/ Non smoker/no
Virology Serology Diagnostics Infection Training Dr Alison Watt
Virology Serology Diagnostics Infection Training 2016 Dr Alison Watt Total testing Pathway Lundberg (1981): Brain to Brain loop concept for laboratory testing: Pre-Analytical Pre Post Post Post Analytical
Central Nervous System Immune Reconstitution Disease: Pathology
Central Nervous System Immune Reconstitution Disease: Pathology F.Gray, H.Adle-Biassette, F.Héran, G. Pialoux, A.Moulignier, APHP Hôpital Lariboisière Université Paris VII Introduction of HAART, which
Dr Marta Boffito. Chelsea and Westminster Hospital, London COMPETING INTEREST OF FINANCIAL VALUE > 1,000:
BHIVA AUTUMN CONFERENCE 2013 Including CHIVA Parallel Sessions Dr Marta Boffito Chelsea and Westminster Hospital, London COMPETING INTEREST OF FINANCIAL VALUE > 1,000: Speaker Name Dr Marta Boffito Statement
Case discussion: How do drugs/patients impact need and type of monitoring CASE 2
Case discussion: How do drugs/patients impact need and type of monitoring CASE 2 Marta Boffito Head of Clinical Trials, St. Stephen s Centre (SSAT) Consultant Physician, Chelsea and Westminster Foundation
Clinical-Radiological-Pathological Correlation. Lymphomatoid Granulomatosis. Michael Leffler-McCabe, MD; H. Brent Clark, MD, PhD*
1 Clinical-Radiological-Pathological Correlation Lymphomatoid Granulomatosis Michael, MD; H. Brent Clark, MD, PhD* Department of Neurology and *Department of Laboratory Medicine and Pathology, University
Dr Manisha Yapa. Chelsea and Westminster Hospital, London. 19 th Annual Conference of the British HIV Association (BHIVA)
19 th Annual Conference of the British HIV Association (BHIVA) Dr Manisha Yapa Chelsea and Westminster Hospital, London 16-19 April 2013, Manchester Central Convention Complex The impact of switching to
CD20-positive high-grade non-hodgkin Lymphoma in patients in which R-CHOP is not indicated
INDICATION CD20-positive high-grade non-hodgkin Lymphoma in patients in which R-CHOP is not indicated TREATMENT INTENT Curative or Disease Modification. PRE-ASSESSMENT 1. Ensure histology is confirmed
Problems of Neurological Function. Unit 10
Problems of Neurological Function Unit 10 Independent Student Review Brain Anatomy and physiology of cerebral hemispheres, diencephalon, brain stem, and cerebellum Meninges, ventricles, flow of CSF Blood
2/17/2011. Two months after symptom onset, she began experiencing episodic vertigo and unsteadiness that was provoked by riding in the car.
A young woman with blurry vision and an abnormal brain MRI Ellen M. Mowry, MD, MCR UCSF Multiple Sclerosis Center Recent Advances in Neurology February 16, 2011 History of Presenting Illness A 27-year-old,
Helpful Information for evaluation of new neurological symptoms in patients receiving TYSABRI
Helpful Information for evaluation of new neurological symptoms in patients receiving TYSABRI This information is provided as an educational resource for healthcare providers and should be considered current
MR neuroimaging of HIV infected patients : A pictorial review
MR neuroimaging of HIV infected patients : A pictorial review Poster No.: R-0198 Congress: 2014 CSM Type: Scientific Exhibit Authors: P. F. Kwan, R. Thomas, A. Dixon; SOUTH YARRA/AU Keywords: Neuroradiology
Case Presentation. Rafid Asfar, MD
Case Presentation Rafid Asfar, MD Introduction ANCA associated vasculitis may be localized or systemic, and can involve the eyes Ocular manifestations can occur in the absence of systemic disease in persons
New Insights on Optic Neuritis in Young People
Cronicon OPEN ACCESS EC OPHTHALMOLOGY Case Study New Insights on Optic Neuritis in Young People Sergio Carmona 1, Sandra Barbosa 1 and Maria Laura Ortube 2 * 1 Department of Neuro-ophthalmology, Hospital
Neurosyphilis SYPHILIS OF THE CENTRAL NERVOUS SYSTEM AS A CAUSE OF COGNITIVE IMPAIRMENT AT YOUNGER AGE, DIAGNOSTIC DIFFICULTIES
29 SYPHILIS OF THE CENTRAL NERVOUS SYSTEM AS A CAUSE OF COGNITIVE IMPAIRMENT AT YOUNGER AGE, DIAGNOSTIC DIFFICULTIES Nesteruk M 1 *, Nesteruk T 2, Mandecka M 3, Dorobek M 1 1. Neurology Clinic, MSW Hospital,
Re-emerging infections: Syphilis & Tuberculosis
Re-emerging infections: Syphilis & Tuberculosis Nicholas Jones Manchester Royal Eye Hospital Syphilis and TB - historical plagues? Syphilis incidence over 40yrs Manchester: Manchester: The Syphilis Capital
R-GDP: Rituximab, Gemcitabine, Dexamethasone &Cisplatin
: Rituximab, Gemcitabine, Dexamethasone &Cisplatin INDICATION Relapsed or refractory Hodgkin and non-hodgkin lymphoma. Omit Rituximab for patients with Hodgkin Lymphoma or high grade T cell non-hodgkin
Nuclear Medicine in HIV Update with FDG PET
Nuclear Medicine in HIV Update with FDG PET Mike Sathekge, MB ChB, M Med (Nucl Med), PhD HOD: University of Pretoria Introduction Outline Brief about general nuclear medicine FDG in HIV: Update & Potential
Clinical presentation Opportunistic infections
Clinical presentation Opportunistic infections Assoc Prof. Thanyawee Puthanakit Division of Infectious Diseases, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University,Bangkok, Thailand
Disclosures. Learning objectives. Neurosyphilis NEUROINFECTIOUS DISEASES: PRACTICAL TIPS FOR COMMON DISORDERS. I have no disclosures.
Disclosures NEUROINFECTIOUS DISEASES: PRACTICAL TIPS FOR COMMON DISORDERS Felicia Chow, MD, MAS Assistant Professor of Neurology and Medicine (ID) February 8, 2017 I have no disclosures. Learning objectives
Revisions to the Syphilis Surveillance Case Definitions, 2018
National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention Revisions to the Syphilis Surveillance Case Definitions, 2018 Sarah Kidd, MD, MPH Medical Epidemiologist Division of STD Prevention
A common case definition for PML
A common case definition for PML Transatlantic workshop: Drug-related Progressive Multifocal Leukoencephalopathy (PML) 25.-26.7.2011, EMA, London Paul-Ehrlich-Institut Dr. Dirk Mentzer, MD Paul-Ehrlich-Str.
a mimicker of Wegener s Granulomatosis
a mimicker of Wegener s Granulomatosis Combined Meeting October 2009 a story of 2 ladies Madam JA 56 year-old Madam RH 36 year-old Madam JA 56 year-old Apr 2008 May Jun Jul Aug Sept Oct Nov 2008 Madam
SYPHILIS (Treponema pallidum) IMMEDIATE NOTIFICATION STD PROGRAM
SYPHILIS (Treponema pallidum) IMMEDIATE NOTIFICATION STD PROGRAM Event Name: Event Time Period: Clinical Description (CDC 2014) Syphilis 180 days Syphilis is a complex sexually transmitted disease that
How Do We Future Proof HIV Nursing
How Do We Future Proof HIV Nursing How Do We Future Proof HIV Nursing BHIVA monitoring guideline s Audit 123 services took part in the audit Data was collected on 8258 people living with HIV. All patients
DEPARTMENT OF MICROBIOLOGY IMPORTANT NOTICE TO USERS Turnaround Times (TATs) for Microbiology Investigations
Dear User, ISSUE: M008 DEPARTMENT OF MICROBIOLOGY IMPORTANT NOTICE TO USERS Turnaround Times (TATs) for Microbiology Investigations In order to comply with national quality guidance and as part of our
Dr Andrew Ustianowski
BHIVA AUTUMN CONFERENCE 2014 Including CHIVA Parallel Sessions Dr Andrew Ustianowski North Manchester General Hospital 9-10 October 2014, Queen Elizabeth II Conference Centre, London BHIVA AUTUMN CONFERENCE
Hemiparetic multiple sclerosis
Journal of Neurology, Neurosurgery, and Psychiatry 1990;53:675-680 The National Hospital for Nervous Diseases, Queen Square, London J Cowan I E C Ormerod P Rudge Correspondence to: Dr Ormerod, The National
Stroke: clinical presentations, symptoms and signs
Stroke: clinical presentations, symptoms and signs Professor Peter Sandercock University of Edinburgh EAN teaching course Burkina Faso 8 th November 2017 Clinical diagnosis is important to Ensure stroke
Lisa Villarroel, MD MPH Medical Director, Division of Public Health Preparedness Arizona Department of Health Services.
Lisa Villarroel, MD MPH Medical Director, Division of Public Health Preparedness Arizona Department of Health Services Disclosures: None 1 PRIMARY Fitzgerald TJ, Cleveland P, Johnson RC et al: Scanning
Professor Rob Miller
BHIVA AUTUMN CONFERENCE 2013 Including CHIVA Parallel Sessions Professor Rob Miller University College London Medical School COMPETING INTEREST OF FINANCIAL VALUE > 1,000: Speaker Name Prof Rob Miller
Schedule of Accreditation issued by United Kingdom Accreditation Service 2 Pine Trees, Chertsey Lane, Staines-upon-Thames, TW18 3HR, UK
2 Pine Trees, Chertsey Lane, Staines-upon-Thames, TW18 3HR, UK Royal Liverpool & Broadgreen University Hospitals NHS Trust Department of Virology Liverpool Clinical Laboratories Royal Liverpool and Broadgreen
The Neurology of Immunosuppression
The Neurology of Immunosuppression The Neurology of Systemic Disease Monday 13 th November 2017 Royal College of Physicians of London Dr Nicholas Davies Consultant Neurologist Chelsea & Westminster and
Reflex Test Protocols
UCH Clinical Laboratory Reflex Test Protocols Blood Bank Prepare RBCs for Transfusion (aka Crossmatch) N/A No Antibody Screen ordered Antibody Screen Direct Antiglobulin Test (DAT) Polyspecific DAT Positive
R-GDP: Rituximab, Gemcitabine, Dexamethasone &Cisplatin
: Rituximab, &Cisplatin INDICATION Relapsed or refractory Hodgkin and non-hodgkin lymphoma. Omit Rituximab for patients with Hodgkin Lymphoma. TREATMENT INTENT Palliative or curative depending on context.
Didactic Series. STD Screening & Management: Syphilis. Christian B. Ramers, MD, MPH
Didactic Series STD Screening & Management: Syphilis Christian B. Ramers, MD, MPH Assistant Medical Director Family Health Centers of San Diego Ciaccio Memorial Clinic 3/26/15 ACCREDITATION STATEMENT:
5/1/2017. Sexually Transmitted Diseases Burning Questions
Sexually Transmitted Diseases Burning Questions Jeffrey D. Klausner, MD, MPH Professor of Medicine and Public Health University of California Los Angeles Los Angeles, California FORMATTED: 04-03-17 Financial
The gold standard? A 4-year-old boy with somnolence and focal weakness
The gold standard? A 4-year-old boy with somnolence and focal weakness Alex Florence, MD, PGY-3, UNC Children s Hospital Disclosures I have no conflicts of interest or financial obligations to disclose.
Schedule of Accreditation issued by United Kingdom Accreditation Service 2 Pine Trees, Chertsey Lane, Staines-upon-Thames, TW18 3HR, UK
Schedule of Accreditation 2 Pine Trees, Chertsey Lane, Staines-upon-Thames, TW18 3HR, UK National Infection Service, Public Health England Colindale 61 Colindale Avenue London NW9 5EQ Contact: Dr Sanjiv
Syphilis Treatment Protocol
STD, HIV, AND TB SECTION Syphilis Treatment Protocol CLINICAL GUIDANCE FOR PRIMARY AND SECONDARY SYPHILIS AND LATENT SYPHILIS www.lekarzol.com (4/2016) Page 1 of 8 Table of Contents Description... 3 Stages
Dr Sophia Davies. Birmingham Heartlands Hospital. 18 th Annual Conference of the British HIV Association (BHIVA)
18 th Annual Conference of the British HIV Association (BHIVA) Dr Sophia Davies Birmingham Heartlands Hospital 18-20 April 2012, The International Convention Centre, Birmingham 18 th Annual Conference
A Hypothesis Driven Approach to the Neurological Exam
A Hypothesis Driven Approach to the Neurological Exam Vanja Douglas, MD Assistant Clinical Professor UCSF Department of Neurology Disclosures None 1 Purpose of Neuro Exam Screen asymptomatic patients Screen
Introduction: About the Author:
Introduction: Welcome to CUGH s bi-weekly clinical case-series, Reasoning without Resources, by Prof. Gerald Paccione of the Albert Einstein College of Medicine. These teaching cases are based on Prof.
They are updated regularly as new NICE guidance is published. To view the latest version of this NICE Pathway see:
bring together everything NICE says on a topic in an interactive flowchart. are interactive and designed to be used online. They are updated regularly as new NICE guidance is published. To view the latest
Delivering stratified follow-up in primary care for Prostate Cancer Patients - The NCL Approach. Dr Elizabeth Babatunde Macmillan GP
Delivering stratified follow-up in primary care for Prostate Cancer Patients - The NCL Approach Dr Elizabeth Babatunde Macmillan GP Background 2 Objectives Enhance patient experience and outcomes by providing