A 57-year-old man underwent lumbar selective nerve root block (SNRB) for low back pain and lower radiating pain caused by left-sided L4 disc herniation. He presented to the emergency department with fever, headache and aggravated low back pain approximately 3 hours after the procedure. Infection was suspected; hence, blood tests, cerebrospinal fluid (CSF) tests, lumbar magnetic resonance imaging, and brain computed tomography were performed. Imaging findings were not suggestive of infection. The CSF was turbid and yellowish with pleiocytosis; however, the CSF culture was negative. Based on these findings, the patient was diagnosed with acute meningitis. Broad-spectrum antibiotics and steroid therapy were initiated considering the patient's age and general condition. From hospital day (HD) 2, fever and headache were reduced and disappeared completely by HD 5. At the last follow-up, 1 month after discharge, the patient had no symptoms. Acute meningitis is associated with a high mortality and neurologic deficits. Hence, timely tests, diagnosis, and treatment are critical for positive outcomes. Symptoms of meningitis following a nerve block generally occur within 24-48 hours after the procedure. This case is notable, as it involved a quicker and more sudden onset of symptoms; meningitis occurred only a few hours after lumbar selective nerve root block.
The functional specialization of CD4 T lymphocytes into various subtypes, including T1 and T cells, is crucial for effective immune responses. T cells facilitate B cell differentiation within germinal centers, while T1 cells are vital for cell-mediated immunity against intracellular pathogens. Integrin α4, a cell surface adhesion molecule, plays significant roles in cell migration and co-stimulatory signaling.
Introduction: A scoring system to characterize the efficacy of middle meningeal artery (MMA) embolization is lacking and would help predict the likelihood of subdural hematoma resolution.
Methods: We developed a simple angiographic classification system ranging from 0 to 3 for quantifying MMA Patency After Coil Embolization (PACE) based residual flow distal to the embolization. MMA embolizations using coils at our institution were used to validate the PACE score system using procedural angiograms.
Pneumococcal meningitis is the most severe bacterial meningitis rarely complicated by acute myelitis. We report a case of a 54-year-old female who presented with pneumococcal meningoencephalitis. After eight days of hospitalization, the patient presented a sudden onset of bilateral lower leg weakness and bladder and bowel sphincter dysfunction.
Invasive meningococcal disease (IMD) is a life-threatening yet vaccine-preventable disease, with vaccines approved and recommended in the United States by the Centers for Disease Control and Prevention. This study assessed complications, mortality, healthcare resource utilization (HCRU), and healthcare costs among a sample of commercially-insured individuals living in the United States who experienced IMD. We used retrospective data from large claims databases limited to individuals with IMD covered by commercial health plans between January 2010-March 2022.
