(Symmetrical neurological signs means that muscle strength, deep tendon reflexes, Babinski reflex, sensation (...) are equal on both sides of the body.  (E.g. paraplegia is "symmetrical" but hemiplegia is not...)

• "NORMAL" BACTERIAL MENINGITIS?  Uncommon but we have to consider it because it is easy to treat.

• Diagnosis: acute+++; stiff neck +++; Kernig's sign +; headache; high fever; +/- petechia (pxx021) (pxxo55); +/-convulsions.
• Treatment: ampicillin IM 1g 4x/day until no signs, then amoxycillin 500mg 1-2tabs 4x/day for 1 week.  (If IV drug addict and/or a few unclear focal signs, add gentamycin 240mg/day)

 

• CRYPTOCOCCOSI?  Common!!!

• Diagnosis: "sub acute"; fever; stiff neck is common (present in nearly all patients); level of consciousness usually good/lucid (more rarely, unconscious (=final stage)); 10% of patients have convulsions; the headache is typically symmetrical, severe in temporal region and does not respond to Paracetamol, diclofenac…
• Treatment: Fluconazole 200mg 1tab 2x/day for 6-10weeks then fluconazole 200mg 1-2tabs per day for life (see "25-Prophylaxis").  For severe cases, we prefer to treat first with fluconazole 200mg 1tab 3x/day for 5 days and after 1tab 2x/day.  Resistance is rare or as we discovered too late there is no cross-resistance between fluconazole and itraconazole but itraconazole is less active on crypto (but still active!).  To know if treatment is active: stop all painkillers on the 7thday to observe the level of pain compared to pre-treatment levels.  Stiff neck can stay longer even if treatment is active.
• If a patient survives a severe infection, alertness may be reduced ("slow brain"), the pronunciation of words can be strange (strong and not fluid), which is similar to after sever toxo infection.

• CEREBRAL TB?  Common!!!  80% of patients have symmetrical neuro signs.  (For the other 20% see "19-§2-Asymmetrical Neuro Protocol")
• Diagnosis: "chronic"; characteristic TB signs such as irregular low fever, loss of weight, typical gray copper skin color... sometimes confusion; +/- convulsion; patients often have a stiff neck...
• Treatment See "31-Tuberculosis"

 

• CMV?  Rare without ophthalmologic problems (decrease of visual acuity)!  Delirium; psy/cogn problems; lethargy; photophobia; stiff neck…  No treatment is available/affordable in a poor hospice.

• HIV DEMENTIA?  No fever.  Can be the first manifestation of HIV!  Often begins similar to Alzheimer's or chronic depression (memory loss, loss of concentration...); confusion/delirium; behavior troubles; aphasia; lack of motor coordination; trembling; etc. and sometimes paraplegia!  No curative treatment is available (but often a TOXO treatment test is indicated before making the diagnosis!)  Symptomatic care as for psychological diseases: haloperidol, diazepam (Attention!!!  Those patients have an increased sensitivity to the side effect of neuroleptic drugs).  Death usually comes in weeks or months...

• TOXOPLASMOSIS? 

  Common, but only 20% of patients have symmetrical neuro exams!  (For the other 80%,
• Diagnosis & treatment: see "19-§2-Toxoplasmosis")

 

• INFLAMMATORY DEMYELINATING POLYNEUROPATHIES, POLYRADICULITIS & VACUOLAR MYELOPATHY?
• Diagnosis: Symmetrical paralysis...bad prognosis...  See "19-§3-Paralysis Protocol"

• Can also be atypical lymphoma or Neurosyphilis… See "19-§2-Asymmetrical Neuro Protocol"