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BMJ Case Reports Dec 2018A 53-year-old male with rheumatoid arthritis presented with recurrent headaches, seizures and right-sided lower extremity paralysis while on antiepileptic medications....
A 53-year-old male with rheumatoid arthritis presented with recurrent headaches, seizures and right-sided lower extremity paralysis while on antiepileptic medications. Work up revealed pachymeningeal and leptomeningeal enhancement on brain MRI. Differential diagnosis included a variety of infections, neoplasm and vasculitis. Histopathology showed findings consistent with rheumatoid meningitis (RM). Ultimately based on symptoms, MRI findings and tissue pathology, he was diagnosed with RM. Intravenous pulse dose steroids were initiated followed by rituximab every 6 months, resulting in significant improvement of the brain MRI findings. Patient has remained seizure free.
Topics: Anticonvulsants; Antirheumatic Agents; Brain; Headache; Hemiplegia; Humans; Magnetic Resonance Imaging; Male; Meninges; Meningitis; Middle Aged; Rheumatic Diseases; Rituximab; Seizures
PubMed: 30598469
DOI: 10.1136/bcr-2018-226642 -
PLoS Biology Nov 2023The meningeal space is a critical brain structure providing immunosurveillance for the central nervous system (CNS), but the impact of infections on the meningeal immune...
The meningeal space is a critical brain structure providing immunosurveillance for the central nervous system (CNS), but the impact of infections on the meningeal immune landscape is far from being fully understood. The extracellular protozoan parasite Trypanosoma brucei, which causes human African trypanosomiasis (HAT) or sleeping sickness, accumulates in the meningeal spaces, ultimately inducing severe meningitis and resulting in death if left untreated. Thus, sleeping sickness represents an attractive model to study immunological dynamics in the meninges during infection. Here, by combining single-cell transcriptomics and mass cytometry by time-of-flight (CyTOF) with in vivo interventions, we found that chronic T. brucei infection triggers the development of ectopic lymphoid aggregates (ELAs) in the murine meninges. These infection-induced ELAs were defined by the presence of ER-TR7+ fibroblastic reticular cells, CD21/35+ follicular dendritic cells (FDCs), CXCR5+ PD1+ T follicular helper-like phenotype, GL7+ CD95+ GC-like B cells, and plasmablasts/plasma cells. Furthermore, the B cells found in the infected meninges produced high-affinity autoantibodies able to recognise mouse brain antigens, in a process dependent on LTβ signalling. A mid-throughput screening identified several host factors recognised by these autoantibodies, including myelin basic protein (MBP), coinciding with cortical demyelination and brain pathology. In humans, we identified the presence of autoreactive IgG antibodies in the cerebrospinal fluid (CSF) of second stage HAT patients that recognised human brain lysates and MBP, consistent with our findings in experimental infections. Lastly, we found that the pathological B cell responses we observed in the meninges required the presence of T. brucei in the CNS, as suramin treatment before the onset of the CNS stage prevented the accumulation of GL7+ CD95+ GC-like B cells and brain-specific autoantibody deposition. Taken together, our data provide evidence that the meningeal immune response during chronic T. brucei infection results in the acquisition of lymphoid tissue-like properties, broadening our understanding of meningeal immunity in the context of chronic infections. These findings have wider implications for understanding the mechanisms underlying the formation ELAs during chronic inflammation resulting in autoimmunity in mice and humans, as observed in other autoimmune neurodegenerative disorders, including neuropsychiatric lupus and multiple sclerosis.
Topics: Humans; Animals; Mice; Trypanosoma brucei brucei; Persistent Infection; Meninges; Trypanosomiasis, African; Lymphoid Tissue; Autoantibodies
PubMed: 37983289
DOI: 10.1371/journal.pbio.3002389 -
Postgraduate Medical Journal Jul 1948
Topics: Humans; Meningitis; Tuberculosis, Meningeal
PubMed: 18872136
DOI: 10.1136/pgmj.24.273.358 -
Journal of the Royal Society of Medicine Apr 1990
Review
Topics: Arachnoiditis; Humans; Lumbosacral Region; Pia Mater
PubMed: 2094232
DOI: 10.1177/014107689008300418 -
Methods (San Diego, Calif.) Aug 2017A wide range of viral and microbial infections are known to cause meningitis, and there is evidence that the meninges are the gateway to pathogenic invasion of the brain... (Review)
Review
A wide range of viral and microbial infections are known to cause meningitis, and there is evidence that the meninges are the gateway to pathogenic invasion of the brain parenchyma. Hence observation of these regions has wide application to understanding host-pathogen interactions. Interactions between pathogens and cells of the immune response can be modified by changes in their environment, such as suppression of the flow of blood and lymph, and, particularly in the case of the meninges, with their unsupported membranes, invasive dissection can alter the tissue architecture. For these reasons, intravital imaging through the unperforated skull is the method of choice. We give a protocol for a simple method of two-photon microscopy through the thinned cortical skull of the anesthetized mouse to enable real-time imaging with sub-micron resolution through the meninges and into the superficial brain parenchyma. In reporter mice in which selected cell types express fluorescent proteins, imaging after infection with fluorescent pathogens (lymphocytic choriomeningitis virus, Trypanosoma brucei or Plasmodium berghei) has shown strong recruitment to the cortical meninges of immune cells, including neutrophils, T cells, and putative dendritic cells and macrophages. Without special labeling, the boundaries between the dura mater, the leptomeninx, and the parenchyma are not directly visualized in intravital two-photon microscopy, but other landmarks and characteristics, which we illustrate, allow the researcher to identify the compartment being imaged. While most infectious meningitides are localized mainly in the dura mater, others involve recruitment of immune cells to the leptomeninx.
Topics: Animals; Dendritic Cells; Host-Pathogen Interactions; Intravital Microscopy; Lymphocytic choriomeningitis virus; Macrophages; Meninges; Meningitis; Mice; Mice, Transgenic; Microorganisms, Genetically-Modified; Microscopy, Fluorescence, Multiphoton; Neutrophils; Plasmodium berghei; T-Lymphocytes; Trypanosoma brucei brucei
PubMed: 28351758
DOI: 10.1016/j.ymeth.2017.03.020 -
Acta Neurochirurgica Oct 2022IgG4-related hypertrophic pachymeningitis is a rare fibroinflammatory disorder that may cause localized or diffused thickening of the dura mater. Misinterpretations of...
OBJECTIVE
IgG4-related hypertrophic pachymeningitis is a rare fibroinflammatory disorder that may cause localized or diffused thickening of the dura mater. Misinterpretations of the clinical and imaging findings are common. Clinical manifestations depend on the location of the inflammatory lesion and on compression of neural structures leading to functional deficits. A dural biopsy is commonly needed for a definitive diagnosis. Immunomodulatory therapy is considered the therapy of choice.
METHODS
Four patients with IgG4-related hypertrophic pachymeningitis were identified over a 5-year period. Patient-related characteristics including age, preoperative workup, signs and symptoms of patients, and diagnostic procedures were evaluated. Furthermore, the surgical treatment and 5-year follow-up outcomes were analyzed.
RESULTS
There were two adults and two adolescents (mean age 32 years; range 15 to 67 years). Two patients were male, and two were female. No history of disease was known in any of the patients. Clinical symptoms were epilepsy (n = 2), ataxia and nausea (n = 1), and facial nerve palsy (n = 1). MR imaging studies showed contrast enhancing lesions in the temporal region in two patients, and in the cerebellar region in the other two patients. Subtotal resection was performed in two instances and a biopsy via a suboccipital retrosigmoid approach was obtained in the other two patients. Histochemical and immunohistochemical investigations revealed an IgG 4 disease in all of these patients. Immunomodulatorry therapy led to clinical stability during follow-up of 5 years in all four cases.
CONCLUSION
The diagnosis of IgG4-related hypertrophic pachymeningitis is challenging, but is of great relevance as treatment differs significantly from other forms of pachymeningitis and a specific therapeutic approach may avoid long-term neurological complications. Our series contributes to a better clinical characterization of this rare disease.
Topics: Adolescent; Adult; Dura Mater; Female; Humans; Hypertrophy; Immunoglobulin G; Magnetic Resonance Imaging; Male; Meningitis; Neoplasms
PubMed: 35974231
DOI: 10.1007/s00701-022-05340-5 -
Neurology India 2020Mollaret's meningitis refers to the classical description by Pierre Mollaret of recurrent episodes of fever and meningism lasting 2-5 days, followed by spontaneous...
Mollaret's meningitis refers to the classical description by Pierre Mollaret of recurrent episodes of fever and meningism lasting 2-5 days, followed by spontaneous recovery. It remains a rare entity and most often is attributed to reactivation of latent Herpes Simplex virus (HSV)-2 virus. Though considered self-limiting and innocuous, there are exceptional cases in which neurological sequelae have been reported. From a clinician's perspective, narrowing down the diagnosis may not be straightforward and would require judicious use of investigations. Here we report two cases of Mollaret's meningitis, both of whom had negative cerebrospinal fluid (CSF) polymerase chain reaction (PCR) for HSV. These reports also highlight an unusual pattern of presentation of this rare entity and the utility of CSF cytology in clinching the diagnosis.
Topics: Herpesvirus 2, Human; Humans; Meningitis; Meningitis, Aseptic; Polymerase Chain Reaction; Recurrence
PubMed: 33109885
DOI: 10.4103/0028-3886.299162 -
California Medicine Sep 1949Three hundred and forty-nine cases of disease affecting the meninges were observed at the San Bernardino County Charity Hospital in an eight year period.A total of 29...
Three hundred and forty-nine cases of disease affecting the meninges were observed at the San Bernardino County Charity Hospital in an eight year period.A total of 29 patients with meningococcal, H. influenzae and pneumococcal meningitis were treated. There were four deaths, of which three occurred during the first 24 hours in the hospital. Of 22 cases of unclassified meningitis, four probably were tuberculous, four probably were meningococcal and two probably were of virus origin. Under present treatment programs the differentiation between viral and bacterial meningitides is difficult and it is possible, therefore, that the reported incidence of the two groups may not represent the facts. Of 22 cases of unclassified meningitis, 12 had no specific characteristics which would permit a clinical diagnosis. One of the patients died. Of 70 cases of clinical meningitis, the infecting organism was identified in 69 per cent. Meningococcal meningitis made up only 17 per cent of 70 cases of purulent meningitis observed between July 1, 1945, and July 1, 1948.
Topics: Antigens, Bacterial; Cell Differentiation; Charities; Death; Haemophilus influenzae; Hospitals; Humans; Incidence; Meninges; Meningitis; Meningitis, Bacterial; Meningitis, Meningococcal; Meningitis, Pneumococcal; Meningococcal Vaccines; Risk Management
PubMed: 18137216
DOI: No ID Found -
Journal of Neurology, Neurosurgery, and... Sep 1985A case of pachymeningitis cranialis hypertrophica is described and the CT appearances are presented. The likely cause was syphilis, though sarcoidosis and tuberculosis...
A case of pachymeningitis cranialis hypertrophica is described and the CT appearances are presented. The likely cause was syphilis, though sarcoidosis and tuberculosis were not completely excluded.
Topics: Dura Mater; Humans; Hypertrophy; Male; Meningitis; Middle Aged; Syphilis
PubMed: 4045489
DOI: 10.1136/jnnp.48.9.942 -
British Medical Journal May 1973
Topics: Adolescent; Adult; Bacterial Infections; Child; Child, Preschool; Humans; Infant; Infant, Newborn; Injections, Spinal; Meningitis; Meningitis, Haemophilus; Meningitis, Meningococcal; Meningitis, Pneumococcal; Tuberculosis, Meningeal
PubMed: 4739912
DOI: 10.1136/bmj.2.5863.411