/Users/andrea/_magisterarbeit/korpus/clean/trainkorpus/1/file5.html NN ----------------------------------------- : Skip NP to TO content VV . SENT HomeCurrent NP IssueNew NP ArticlesArchiveSubmit NP PaperContent NP Alerts VVZ PLoSPLoS NP Biology NN Order NP Print NP Issues NPS Contact NP Us NP Author NN Info NP Reviewer NN Info NP Journal NP Info NP Ed NP Board NP Help NN Volume NN 1 CD Issue NN 1 CD OCTOBER NP 2004 CD Previous JJ article NN Next JJ article NN SEARCH NN PLoS NP Medicine NP Advanced NP Search NP Learning NP Forum NP The NP Learning NP Forum NP discusses VVZ an DT important JJ clinical JJ problem NN of IN relevance NN to TO a DT general JJ medical JJ audience NN . SENT Fever NN , , Headache NN , , and CC Visual NP Blurring VVG in IN a DT 17 CD Year NN Old NP WomanWilliam NP Lynn NP , , Sue NP LightmanWilliam NP Lynn NP is VBZ a DT consultant NN in IN infectious JJ diseases NNS and CC the DT medical JJ director NN at IN Ealing NP Hospital NP , , London NP , , United NP Kingdom NP . SENT E SYM mail NN . SENT William NP . SENT lynn NP eht NNS . SENT nhs NNS . SENT uk NP . SENT Susan NP Lightman NP is VBZ professor NN of IN Clinical JJ Opthalmology NN and CC is VBZ head NN of IN the DT Department NP of IN Ophthalmology NN at IN Moorfields NP Eye NP Hospital NP , , London NP , , United NP Kingdom NP . SENT E SYM mail NN . SENT s PP . SENT lightman NN ucl NN . SENT ac NNS . SENT uk NP Competing JJ Interests NNS . SENT The DT authors NNS are VBP on IN the DT editorial JJ board NN of IN PLoS NP Medicine NP . SENT Published VVN . SENT October NP 19 CD , , 2004 CD DOI NP . SENT 10 CD . SENT 1371 CD journal NN . SENT pmed JJ . SENT 0010007 CD Copyright NN . SENT 2004 CD Lynn NP and CC Lightman NP . SENT This DT is VBZ an DT open JJ access NN article NN distributed VVN under IN the DT terms NNS of IN the DT Creative JJ Commons NP Attribution NN License NN , , which WDT permits VVZ unrestricted JJ use NN , , distribution NN , , and CC reproduction NN in IN any DT medium NN , , provided VVD the DT original JJ work NN is VBZ properly RB cited VVN . SENT Abbreviations NNS . SENT CSF NP , , cerebrospinal JJ fluid NN . SENT PCR NP , , polymerase NN . SENT RPE NP , , retinal JJ pigment NN epithelium NN . SENT TB NN , , tuberculous JJ . SENT VKH NP , , Vogt NP Koyanagi NP Harada NP . SENT WBC NP , , white JJ blood NN cell NN Citation NP . SENT Lynn NP W NP , , Lightman NP S NP 2004 CD Fever NN , , Headache NN , , and CC Visual NP Blurring VVG in IN a DT 17 CD Year NN Old NP Woman NP . SENT PLoS NP Med NP 1 CD 1 CD . SENT e SYM 7 CD DESCRIPTION NN of IN CASE NN A DT 17 CD year NN old JJ woman NN , , who WP was VBD born VVN in IN Bangladesh NP , , presented VVD to TO an DT accident NN and CC emergency NN department NN in IN the DT United NP Kingdom NP with IN a DT history NN of IN being VBG unwell JJ for IN 24 CD hours NNS . SENT She PP had VHD a DT headache NN and CC fever NN , , and CC was VBD vomiting VVG . SENT On IN questioning VVG , , there EX was VBD no DT photophobia NN or CC neck NN stiffness NN . SENT She PP lives VVZ in IN the DT United NP Kingdom NP and CC had VHD been VBN for IN a DT holiday NN to TO Bangladesh NP 4 CD months NNS previously RB . SENT The DT family NN members NNS were VBD all RB well RB , , and CC none NN had VHD similar JJ symptoms NNS . SENT The DT woman NN had VHD no DT previous JJ medical JJ history NN and CC was VBD on IN no DT medication NN . SENT On IN examination NN , , she PP looked VVD unwell JJ , , with IN a DT temperature NN of IN 38 CD . SENT 5 CD C NP , , pulse NN 96 CD beats NNS per IN minute NN , , blood NN pressure NN 112 CD 52 CD mm NP Hg NP , , and CC a DT respiratory JJ rate NN of IN 16 CD breaths NNS per IN minute NN . SENT She PP had VHD a DT Glasgow NP Coma NP Score NN of IN 14 CD , , there EX was VBD no DT neck NN stiffness NN , , and CC her PP$ ocular JJ fundi NNS were VBD said VVN to TO be VB normal JJ . SENT There EX were VBD no DT other JJ significant JJ findings NNS on IN examination NN . SENT Immediate JJ investigations NNS showed VVD a DT normal JJ blood NN count NN apart RB from IN a DT raised VVN white JJ blood NN cell NN WBC NP count NN of IN 11 CD . SENT 1 CD 109 CD per IN millilitre NN normal JJ range NN , , 4 CD . SENT 3 CD 10 CD . SENT 8 CD 109 CD , , per IN millilitre NN , , with IN 84 CD neutrophils NNS . SENT Her PP$ erythrocyte NN sedimentation NN rate NN was VBD 15 CD mm NNS in IN the DT first JJ hour NN normal JJ range NN , , 1 CD 12 CD mm NNS , , and CC her PP$ C $ reactive JJ protein NN was VBD less JJR than IN 5 CD mg NN l NN normal JJ range NN , , less JJR than IN 10 CD mg NN l NN . SENT A DT malaria NN screen NN was VBD negative JJ , , and CC renal JJ and CC liver NN function NN tests NNS were VBD normal JJ . SENT What WP Clinical JJ Diagnoses NNS Were VBD Being VBG Considered VVN . SENT A DT clinical JJ diagnosis NN of IN probable JJ viral JJ meningitis NN was VBD made VVN pending VVG the DT results NNS of IN further JJR investigations NNS . SENT Chest NN X NN ray NN was VBD normal JJ , , as RB was VBD an DT unenhanced JJ CT NP brain NN scan VV . SENT Lumbar JJ puncture NN showed VVD a DT normal JJ cerebrospinal NN fluid JJ CSF NP opening NN pressure NN , , and CC the DT CSF NP was VBD not RB blood NN stained VVD . SENT Laboratory NP analysis NN showed VVD 1 CD , , 606 CD WBC NP ml NNS normally RB there EX are VBP less JJR than IN 5 CD cells NNS ml NN , , of IN which WDT 60 CD were VBD lymphocytes NNS with IN protein NN of IN 1 CD . SENT 08 CD g NN l NN normally RB less JJR than IN 0 CD . SENT 6 CD g NN l NN and CC glucose NN of IN 2 CD . SENT 9 CD mmol NN l NN normally RB greater JJR than IN 50 CD of IN plasma NN glucose NN , , with IN a DT corresponding JJ plasma NN glucose NN of IN 5 CD . SENT 7 CD mmol NN l NN normal JJ range NN , , 4 CD 9 CD mmol NN l NN . SENT No DT organisms NNS were VBD seen VVN on IN Gram NP stain VV . SENT The DT CSF NP was VBD negative JJ for IN pneumococcal JJ , , meningococcal JJ , , and CC Haemophilus NP antigens NNS , , and CC bacterial JJ culture NN was VBD subsequently RB negative JJ . SENT The DT patient NN was VBD given VVN 2 CD g NN of IN ceftriaxone NN intravenously RB immediately RB , , and CC ceftriaxone NN treatment NN was VBD continued VVN following VVG the DT CSF NP results NNS . SENT Aciclovir NP IV NP , , at IN a DT dose NN of IN 10 CD mg NN kg NN every DT 8 CD hours NNS , , was VBD added VVN to TO cover VV the DT possibility NN of IN herpes NN encephalitis NN . SENT What WP Was VBD the DT Subsequent JJ Differential NN Diagnosis NN . SENT The DT differential JJ diagnosis NN was VBD now RB viral JJ , , bacterial JJ , , tuberculous JJ TB NN , , fungal JJ , , or CC malignant JJ meningitis NN , , or CC sarcoidosis NN . SENT Additional JJ investigations NNS were VBD requested VVN , , including VVG polymerase NN chain NN reaction NN PCR NP on IN CSF NP for IN viruses NNS and CC tuberculosis NN . SENT There EX were VBD no DT risk NN factors NNS for IN HIV NP infection NN HIV NP seroconversion NN can MD present VV with IN meningitis NN . SENT Mollaret VV s PP meningitis NN recurrent JJ aseptic JJ meningitis NN associated VVN with IN herpes NN simplex NN virus NN was VBD a DT possibility NN 1 CD , , though IN this DT condition NN characteristically RB presents VVZ as IN recurrent JJ episodes NNS of IN apparent JJ aseptic JJ meningitis NN . SENT The DT following VVG morning NN the DT patient JJ s NN temperature NN returned VVN to TO normal JJ at IN 37 CD C NP , , and CC she PP felt VVD better JJR . SENT Referral NN was VBD made VVN to TO the DT Infectious JJ Disease NP Service NP . SENT Twenty CD four CD hours NNS after IN admission NN , , she PP was VBD afebrile JJ but CC clinically RB worse JJR , , with IN marked JJ headache NN and CC vomiting NN . SENT A DT day NN later RBR she PP spiked VVN a DT fever NN of IN 39 CD C NP . SENT No DT organisms NNS were VBD cultured VVN from IN the DT CSF NP , , urine NN , , or CC blood NN . SENT CSF NP bacterial JJ antigens NNS , , cryptococcal JJ antigen NN , , and CC CSF NP auramine NN stain VV for IN mycobacteria NNS were VBD also RB all RB negative JJ . SENT The DT following VVG day NN the DT patient NN complained VVD of IN further JJR headache NN , , nausea NN , , blurred VVD vision NN , , and CC photophobia NN . SENT In IN addition NN , , she PP was VBD noted VVN to TO have VH bilateral JJ large JJ pupils NNS , , which WDT did VVD not RB react VV to TO light NN , , and CC very RB pink JJ optic JJ nerves NNS . SENT Papilloedema NP was VBD thought VVN likely RB , , and CC no DT other JJ neurological JJ signs NNS were VBD detected VVN . SENT The DT original JJ CSF NP sample NN was VBD negative JJ on IN PCR NP for IN tuberculosis NN and CC herpes NN simplex NN virus NN , , C NP reactive JJ protein NN remained VVD at IN less JJR than IN 5 CD mg NN l NN , , and CC a DT further RBR head VV CT NP scan VV with IN contrast NN was VBD normal JJ . SENT The DT diagnosis NN was VBD revised VVN to TO meningoencephalitis NN . SENT Other JJ agents NNS such JJ as IN listeria NN , , tuberculosis NN a DT systematic JJ review NN found VVN that IN PCR NP has VHZ a DT sensitivity NN of IN only RB 56 CD 95 CD CI NP , , 46 CD 66 CD for IN detecting VVG TB NN meningitis NN 2 CD , , and CC viruses NNS such JJ as IN others NNS in IN the DT herpes NN group NN , , mumps VVZ , , and CC West NP Nile NP virus NN were VBD considered VVN . SENT The DT aciclovir NN was VBD stopped VVN , , and CC quadruple JJ tuberculosis NN therapy NN was VBD started VVN . SENT What WP Did VVD the DT Eye NP Signs NNS Mean NP . SENT The DT fixed JJ , , dilated VVD pupils NNS were VBD of IN major JJ concern NN , , and CC urgent JJ ophthalmic JJ review NN was VBD requested VVN . SENT Examination NN by IN the DT ophthalmologist NN showed VVD reduced JJ vision NN at IN 6 CD 60 CD right NN eye NN and CC 6 CD 36 CD left JJ eye NN . SENT On IN testing NN with IN Ishihara NP charts NNS , , the DT patient NN had VHD severely RB reduced VVN colour NN vision NN . SENT Her PP$ pupils NNS were VBD large JJ and CC non JJ reactive JJ to TO light NN or CC accommodation NN in IN both DT eyes NNS . SENT The DT eyes NNS were VBD inflamed VVN , , with IN cells NNS present JJ in IN the DT aqueous JJ and CC vitreous JJ humours NNS . SENT The DT optic JJ nerves NNS were VBD swollen JJ and CC very RB pink JJ Figure NP 1 CD , , but CC there EX was VBD normal JJ spontaneous JJ venous JJ pulsation NN present NN demonstrating VVG that IN this DT was VBD not RB papilloedema NN see VVP Video NP 1 CD . SENT Bilateral JJ choroidal JJ infiltrates NNS with IN overlying VVG serous JJ retinal JJ detachments NNS were VBD also RB present JJ . SENT Video NP 1 CD . SENT Spontaneous JJ Venous JJ Pulsation NN of IN the DT Veins NNS at IN the DT Optic JJ Nerve NN HeadFigure NP 1 CD . SENT Fundal JJ Appearance NN of IN the DT Patient's NP EyeThe NP large JJ arrow NN indicates VVZ the DT pink JJ optic JJ nerves NNS . SENT the DT star NN shows NNS localised VVD retinal JJ detachment NN . SENT and CC the DT small JJ arrow NN pointing VVG down RP shows NNS small JJ , , white JJ choroidal JJ granulomas NNS . SENT What WP Was VBD the DT Final JJ Diagnosis NN and CC Treatment NP . SENT The DT combination NN of IN the DT clinical JJ symptoms NNS , , signs NNS , , and CC ocular JJ features NNS was VBD characteristic JJ of IN Vogt NP Koyanagi NP Harada NP VKH NP syndrome NN 3 CD . SENT All DT antibiotics NNS were VBD stopped VVN , , and CC high JJ dose NN corticosteroids NNS were VBD started VVN at IN 100 CD mg NN prednisolone NN daily RB . SENT At IN one CD week NN there RB was VBD no DT significant JJ ocular JJ improvement NN , , although IN the DT patient's JJ headache NN and CC vomiting NN were VBD now RB gone VVN , , and CC she PP felt VVD much RB better RBR . SENT Additional JJ immunosuppressive JJ therapy NN was VBD initiated VVN with IN cyclosporin NN and CC mycophenolate NN , , and CC within IN a DT further JJR week NN the DT patient's NNS vision NN started VVD to TO improve VV , , with IN settling VVG of IN the DT ocular JJ signs NNS . SENT Oral JJ corticosteroids NNS were VBD tapered VVN , , as IN was VBD the DT cyclosporin NN , , and CC by IN one CD month NN the DT patient's NNS vision NN had VHD returned VVN to TO normal JJ , , and CC the DT ocular JJ signs NNS continued VVD to TO settle VV . SENT By IN three CD months NNS the DT cyclosporin NN was VBD discontinued VVN , , the DT steroid NN dose NN was VBD reduced VVN to TO 5 CD mg NN daily JJ , , and CC the DT mycophenolate JJ dose NN was VBD tapered VVN . SENT By IN six CD months NNS all DT therapy NN was VBD discontinued VVN . SENT At IN review NN six CD months NNS later RBR , , the DT patient NN remained VVD well RB , , with IN normal JJ vision NN and CC normal JJ optic JJ nerves NNS . SENT DISCUSSION NN This DT young JJ patient NN presented VVD acutely RB with IN a DT fever NN and CC some DT signs NNS suggestive JJ of IN meningitis NN . SENT She PP was VBD initially RB treated VVN as IN having VHG viral JJ meningitis NN , , but CC the DT CSF NP findings NNS indicated VVD that IN other JJ aetiologies NNS needed VVN to TO be VB considered VVN . SENT In IN particular JJ , , in IN a DT woman NN who WP previously RB lived VVD in IN and CC recently RB visited VVD Bangladesh NP , , with IN a DT lymphocytic JJ meningitis NN and CC borderline JJ CSF NP glucose NN , , tuberculosis NN had VHD to TO be VB considered VVN . SENT Initially RB the DT ocular JJ symptoms NNS and CC signs NNS were VBD not RB a DT prominent JJ feature NN , , but CC the DT signs NNS were VBD likely JJ to TO have VH been VBN present JJ when WRB the DT patient NN was VBD first RB seen VVN . SENT The DT typical JJ CSF NP changes NNS associated VVN with IN meningitis NN of IN different JJ aetiologies NNS are VBP shown VVN in IN Table NN 1 CD . SENT In IN this DT case NN the DT mixed JJ lymphocytes NNS and CC neutrophil JJ leucocytosis NN with IN a DT borderline JJ CSF NP glucose NN on IN the DT patient's NNS initial JJ CSF NP sample NN were VBD consistent JJ with IN bacterial JJ or CC TB NN meningitis NN . SENT Viral JJ infection NN was VBD far RB less RBR likely JJ , , as IN only JJ mumps NN is VBZ consistently RB associated VVN with IN reduced JJ CSF NP glucose NN . SENT Table NN 1 CD . SENT CSF NP Changes NP in IN the DT Most RBS Commonly RB Encountered VVN Types NNS of IN MeningitisInfectious JJ Causes NNS of IN Meningitis NN There EX is VBZ a DT wide JJ range NN of IN infectious JJ causes NNS of IN meningitis NN worldwide RB . SENT The DT likely JJ infecting VVG organism NN will MD be VB determined VVN by IN the DT age NN and CC immune JJ status NN of IN the DT patient NN plus IN the DT situation NN in IN which WDT the DT infection NN was VBD contracted VVN . SENT Thus RB , , in IN an DT immunocompetent JJ adult NN in IN the DT UK NP , , enteroviruses NNS are VBP the DT commonest JJS cause NN of IN viral JJ meningitis NN , , with IN meningococcus NN and CC pneumococcus NN the DT commonest JJS bacterial JJ agents NNS . SENT Tuberculosis NN is VBZ more RBR common JJ in IN people NNS who WP have VHP lived VVN in IN a DT highly RB endemic JJ area NN . SENT In IN other JJ parts NNS of IN the DT world NN , , the DT differential JJ diagnosis NN may MD include VV viral JJ infections NNS such JJ as IN West NP Nile NP virus NN in IN the DT continental JJ United NP States NPS and CC Japanese NP B NP encephalitis NN in IN Asia NP , , or CC other JJ pathogens NNS such JJ as IN rickettsiae NNS , , borrelia NP Lyme NP disease NN , , and CC protozoa NNS . SENT In IN the DT immunocompromised JJ host NN , , listeria NN must MD be VB considered VVN , , and CC there EX is VBZ an DT increased JJ risk NN of IN fungal JJ infection NN and CC tuberculosis NN . SENT Finally RB , , it PP is VBZ important JJ to TO consider VV sexual JJ exposure NN , , as IN both DT secondary JJ syphilis NN and CC HIV NP seroconversion NN may MD present VV with IN meningitis NN . SENT It PP is VBZ important JJ , , therefore RB , , in IN the DT evaluation NN and CC management NN of IN patients NNS presenting VVG with IN a DT meningoencephalitis NN that IN the DT differential JJ diagnosis NN be VB continually RB reviewed VVN if IN the DT patient NN is VBZ not RB responding VVG to TO therapy NN Table NN 2 CD . SENT When WRB appropriate JJ investigations NNS have VHP been VBN performed VVN and CC are VBP negative JJ and CC symptoms NNS persist VVP , , non JJ infective JJ causes NNS of IN CSF NP inflammation NN must MD be VB considered VVN as IN turned VVN out RP to TO be VB the DT case NN here RB Table NN 3 CD . SENT Table NN 2 CD . SENT What WP to TO Do VV When WRB the DT Patient NP Is VBZ Not RB Getting VVG BetterTable NP 3 CD . SENT Non JJ Infectious JJ Causes NNS of IN Abnormal JJ CSF NP VKH NP Syndrome NN VKH NP syndrome NN 4 CD , , 5 CD , , 6 CD is VBZ a DT systemic JJ disease NN involving VVG various JJ melanocyte NN containing VVG organs NNS . SENT It PP is VBZ rare JJ in IN white JJ Northern NP Europeans NPS and CC white JJ Americans NNS but CC much RB more RBR common JJ in IN people NNS with IN darker JJR , , pigmented JJ skin NN . SENT For IN example NN , , among IN patients NNS presenting VVG with IN uveitis NN , , about RB one CD in IN ten CD in IN Japan NP and CC one CD in IN 50 CD in IN India NP have VH VKH NP syndrome NN 6 CD , , 7 CD . SENT It PP presents VVZ acutely RB with IN varying VVG symptoms NNS and CC signs NNS , , which WDT include VVP meningoencephalitis NN , , visual JJ blurring VVG , , and CC deafness NN . SENT The DT eye NN signs NNS are VBP very RB characteristic JJ and CC can MD help VV to TO make VV the DT diagnosis NN . SENT The DT most RBS prominent JJ ocular JJ finding NN is VBZ intensely RB pink JJ optic JJ nerves NNS see VVP Figure NP 1 CD , , with IN severe JJ visual JJ reduction NN and CC loss NN of IN function NN , , which WDT accounts VVZ for IN the DT absent JJ pupillary JJ responses NNS . SENT VKH NN syndrome NN is VBZ usually RB bilateral JJ , , but CC occasionally RB the DT eyes NNS can MD be VB affected VVN asymmetrically RB so RB that IN one PP is VBZ very RB mildly RB involved VVN . SENT The DT syndrome NN is VBZ accompanied VVN by IN marked JJ intraocular JJ inflammation NN , , and CC there EX are VBP choroidal JJ infiltrates NNS Figure NN 2 CD associated VVN with IN serous JJ retinal JJ detachments NNS , , which WDT may MD be VB localised VVN Figure NP 3 CD or CC affect VV the DT whole JJ retina NN Figure NP 4 CD . SENT It PP is VBZ likely JJ that IN these DT detachments NNS are VBP due JJ to TO the DT retinal JJ pigment NN epithelium NN RPE NN being VBG affected VVN by IN the DT underlying JJ inflammatory JJ choroidal JJ granulomas NNS which WDT heal VV leaving VVG scars NNS . SENT see VV Figure NP 5 CD , , and CC fluid NN accumulates VVZ underneath IN the DT retina NN because IN of IN reduced JJ function NN of IN the DT RPE NP when WRB it PP becomes VVZ inflamed VVN . SENT Figure NN 2 CD . SENT White NP Choroidal NP Infiltrates VVZ Arrow NP Seen NP in IN VKH NP Syndrome NN with IN Very JJ Pink NP Optic NN Nerve NN HeadFigure NP 3 CD . SENT Localised VVN Retinal JJ DetachmentFigure NP 4 CD . SENT Total JJ Retinal JJ Detachment NN , , Where WRB Whole JJ Retina NN is VBZ Grey NP in IN ColourFigure NP 5 CD . SENT Scarring VVG When WRB Choroidal JJ Granulomas NNS SubsideThe NP disorder NN is VBZ caused VVN by IN an DT immune JJ response NN to TO melanin NN and CC affects VVZ parts NNS of IN the DT body NN where WRB melanin NN is VBZ found VVN . SENT The DT initiating VVG stimulus NN for IN this DT response NN is VBZ unknown JJ , , but CC T NN cells NNS sensitised VVN to TO melanin NN associated JJ antigens NNS are VBP found VVN in IN the DT peripheral JJ blood NN . SENT In IN the DT ear NN , , the DT melanocytes NNS of IN the DT inner JJ ear NN are VBP the DT target NN , , and CC the DT inflammatory JJ response NN here RB results VVZ in IN hearing NN loss NN and CC balance NN problems NNS . SENT In IN longstanding JJ untreated JJ cases NNS , , depigmentation NN may MD occur VV in IN other JJ sites NNS such JJ as IN skin NN vitiligo NN . SENT Figure NN 6 CD and CC eyelashes NNS poliosis NN . SENT Figure NN 7 CD , , but CC these DT are VBP uncommon JJ when WRB corticosteroids NNS and CC other JJ immunosuppressive JJ agents NNS are VBP used VVN in IN treatment NN . SENT Depigmentation NN of IN the DT RPE NP can MD also RB occur VV , , giving VVG a DT sunset NN appearance NN to TO the DT dark JJ fundus NN . SENT Figure NN 6 CD . SENT Vitiligo NN on IN Skin NN of IN ForearmFigure NP 7 CD . SENT PoliosisNote NP white JJ eyelashes NNS on IN child NN . SENT Treatment NN with IN high JJ dose NN corticosteroids NNS is VBZ essential JJ 3 CD and CC should MD be VB initially RB 1 CD 2 CD mg NN kg NN day NN . SENT This DT treatment NN can MD be VB given VVN orally RB or CC intravenously RB , , depending VVG on IN how WRB unwell JJ the DT patient NN is VBZ . SENT However RB , , patients NNS commonly RB need VVP other JJ immunosuppressive JJ agents NNS as IN well RB , , so RB as RB to TO allow VV the DT dose NN of IN steroids NNS to TO be VB reduced VVN more RBR quickly RB . SENT Both DT cyclosporin NN and CC mycophenolate NN are VBP very RB useful JJ as IN steroid NN sparing VVG agents NNS , , with IN cyclosporin NN having VHG the DT advantage NN of IN a DT variable JJ dose NN regimen NN for IN more JJR rapid JJ onset NN of IN action NN . SENT On IN the DT down JJ side NN , , cyclosporin NN can MD cause VV hirsutism NN , , especially RB in IN combination NN with IN corticosteroids NNS which WDT can MD also RB cause VV this DT side NN effect NN . SENT Unfortunately RB , , the DT costs NNS of IN cyclosporin NN and CC mycophenolate NN may MD preclude VV their PP$ use NN in IN resource NN poor JJ settings NNS , , with IN the DT result NN that IN patients NNS may MD require VV high JJ dose NN corticosteroids NNS for IN much RB longer JJR , , with IN all PDT the DT concomitant JJ side NN effects NNS . SENT Inadequate JJ initial JJ treatment NN may MD increase VV the DT risk NN of IN recurrence NN and CC long JJ term NN complications NNS . SENT Treatment NN is VBZ required VVN until IN the DT disease NN goes VVZ into IN remission NN . SENT The DT meningoence NN phalitic JJ signs NNS and CC retinal JJ and CC choroidal JJ signs NNS settle VV quickly RB , , often RB within IN a DT week NN or CC so RB , , whereas IN the DT optic JJ nerve NN inflammation NN may MD take VV longer RBR to TO settle VV . SENT The DT visual JJ prognosis NN depends VVZ on IN the DT degree NN of IN permanent JJ damage NN to TO the DT optic JJ nerve NN and CC the DT macula NN area NN , , which WDT often RB shows VVZ considerable JJ pigment NN clumping VVG as IN a DT result NN of IN the DT damage NN to TO the DT RPE NP . SENT Relapse VV affecting VVG the DT optic JJ nerve NN , , choroids NNS , , and CC retina NN is VBZ uncommon JJ , , provided VVD that DT treatment NN has VHZ been VBN given VVN for IN long RB enough JJ . SENT However RB , , recurrent JJ anterior JJ uveitis NN requiring VVG steroid NN drops NNS is VBZ common JJ . SENT This DT is VBZ not RB a DT threat NN to TO sight NN if IN adequately RB controlled VVN . SENT As RB with IN any DT other JJ cause NN of IN intraocular JJ inflammation NN particularly RB associated VVN with IN choroidal JJ involvement NN , , VKH NP syndrome NN can MD lead VV to TO reduced JJ vision NN via IN cataracts NNS , , glaucoma NN damaging VVG the DT optic JJ nerve NN , , and CC new JJ vessels NNS growing VVG into IN the DT retina NN through IN the DT damaged JJ RPE NP choroidal JJ neovascular JJ membrane NN . SENT Key JJ Learning NP Points NP Consider VV meningitis NN in IN the DT differential JJ diagnosis NN of IN a DT patient NN presenting VVG with IN fever NN and CC headache NN . SENT CSF NP analysis NN is VBZ essential JJ to TO confirm VV meningitis NN and CC as IN part NN of IN establishing VVG the DT cause NN . SENT Consider VV non JJ infectious JJ causes NNS when WRB a DT patient NN does VVZ not RB respond VV rapidly RB to TO therapy NN . SENT Blurring VVG of IN vision NN must MD be VB investigated VVN and CC may MD help VV in IN determining VVG the DT underlying JJ diagnosis NN or CC the DT presence NN of IN papilloedema NN . SENT Suggested VVD ReadingSutlas NP PN NP , , Unal NP A NP , , Forta NP H NP , , Senol NP S NP , , Kirbas NP D NP 2003 CD Tuberculous JJ meningitis NN in IN adults NNS . SENT Review NN of IN 61 CD cases NNS . SENT Infection NN 31 CD . SENT 387 CD 391 CD Early JJ suspicion NN and CC appropriate JJ long JJ term NN anti NN tuberculosis NN therapy NN together RB with IN corticosteroids NNS may MD reduce VV mortality NN and CC morbidity NN in IN patients NNS with IN TB NN meningitis NN . SENT Redington NP JJ NN , , Tyler NP KL NP 2002 CD Viral JJ infections NNS of IN the DT nervous JJ system NN . SENT Arch NP Neurol NP 59 CD . SENT 712 CD 718 CD This DT review NN is VBZ an DT update NN on IN diagnosis NN and CC treatment NN . SENT Thomson NP RB NP Jr NP , , Bertram NP H NP 2001 CD Laboratory NP diagnosis NN of IN central JJ nervous JJ system NN infections NNS . SENT Infect JJ Dis NP Clin NP North NP Am NP 15 CD . SENT 1047 CD 1071 CD This DT paper NN discusses VVZ conventional JJ tests NNS , , such JJ as IN culture NN , , and CC others NNS such JJ as IN antigen NN testing NN and CC PCR NP . SENT Rotbart NP HA NP 2000 CD Viral JJ meningitis NN . SENT Semin NP Neurol NP 20 CD . SENT 277 CD 292 CD The DT virology NN , , pathogenesis NN , , epidemiology NN , , clinical JJ manifestations NNS , , diagnostic JJ studies NNS , , and CC established JJ and CC potential JJ antiviral JJ therapies NNS for IN viral JJ meningitis NN are VBP discussed VVN . SENT A DT differential JJ diagnosis NN of IN the DT aseptic JJ meningitis NN syndrome NN is VBZ provided VVN . SENT Negrini NP B NP , , Kelleher NP KJ NP , , Wald NP ER NP 2000 CD Cerebrospinal JJ fluid JJ findings NNS in IN aseptic JJ versus CC bacterial JJ meningitis NN . SENT Pediatrics NNS 105 CD . SENT 316 CD 319 CD Polymorphonuclear JJ cell NN predominance NN in IN the DT CSF NP does VVZ not RB discriminate JJ between IN aseptic JJ and CC bacterial JJ meningitis NN . SENT Kamondi NP A NP , , Szegedi NP A NP , , Papp NP A NP , , Seres VVZ A NP , , Szirmai NP I NP 2000 CD Vogt NP Koyanagi NP Harada NP disease NN presenting VVG initially RB as IN aseptic JJ meningoencephalitis NN . SENT Eur NP J NP Neurol NP 7 CD . SENT 719 CD 722 CD This DT paper NN describes VVZ the DT neurological JJ and CC eye NN signs NNS in IN VKH NP syndrome NN . SENT Seehusen NP DA NP , , Reeves NP MM NP , , Fomin NP DA NP 2003 CD Cerebrospinal JJ fluid JJ analysis NN . SENT Am NP Fam NP Physician NN 68 CD . SENT 1103 CD 1108 CD Lumbar JJ puncture NN is VBZ frequently RB performed VVN in IN primary JJ care NN , , and CC this DT review NN outlines VVZ the DT interpretation NN of IN the DT clinical JJ and CC laboratory NN findings NNS . SENT Shah NP KH NP , , Edlow NP JA NP 2002 CD Distinguishing VVG traumatic JJ lumbar JJ puncture NN from IN true JJ subarachnoid JJ hemorrhage NN . SENT J NP Emerg NP Med NP 23 CD . SENT 67 CD 74 CD The DT purpose NN of IN this DT article NN is VBZ to TO assist VV emergency NN physicians NNS in IN distinguishing VVG traumatic JJ lumbar JJ punctures NNS from IN subarachnoid JJ hemorrhage NN . SENT ReferencesTang NP YW NP , , Cleavinger NP PJ NP , , Haijing NP L NP , , Mitchell NP PS NP , , Smith NP TF NP , , et NP al NP . SENT 2000 CD Analysis NN of IN candidate NN host NN immunogenetic JJ determinants NNS in IN herpes NN simplex NN virus NN associated VVN Mollaret NP s NN meningitis NN . SENT Clin NP Infect JJ Dis NP 30 CD . SENT 176 CD 178 CD . SENT Find VV this DT article NN onlinePai NP M NP , , Flores NP LL NP , , Pai NP N NP , , Hubbard NP A NP , , Riley NP LW NP , , et NP al NP . SENT 2003 CD Diagnostic JJ accuracy NN of IN nucleic JJ acid JJ amplification NN tests NNS for IN tuberculous JJ meningitis NN . SENT A DT systematic JJ review NN and CC meta NP analysis NN . SENT Lancet NP Infect JJ Dis NP 3 CD . SENT 633 CD 643 CD . SENT Find VV this DT article NN onlineKamondi NP A NP , , Szegedi NP A NP , , Papp NP A NP , , Seres VVZ A NP , , Szirmai NP I NP 2000 CD Vogt NP Koyanagi NP Harada NP disease NN presenting VVG initially RB as IN aseptic JJ meningoencephalitis NN . SENT Eur NP J NP Neurol NP 7 CD . SENT 719 CD 722 CD . SENT Find VV this DT article NN onlineRead NN RW NP 2002 CD Vogt NP Koyanagi NP Harada NP disease NN . SENT Ophthalmol NP Clin NP North NP Am NP 15 CD . SENT 333 CD 341 CD . SENT Find VV this DT article NN onlineRead NN RW NP , , Holland NP GN NP , , Rao NP NA TO , , Tabbara NP KF NP , , Ohno NP S NP , , et NP al NP . SENT 2001 CD Revised VVN diagnostic JJ criteria NNS for IN Vogt NP Koyanagi NP Harada NP disease NN . SENT Report NN of IN an DT international JJ committee NN on IN nomenclature NN . SENT Am NP J NP Ophthalmol NP 131 CD . SENT 647 CD 652 CD . SENT Find VV this DT article NN onlineMondkar NP SV NP , , Biswas NP J NP , , Ganesh NP SK NP 2000 CD Analysis NN of IN 87 CD cases NNS with IN Vogt NP Koyanagi NP Harada NP disease NN . SENT Jpn NP J NP Ophthalmol NP 44 CD . SENT 296 CD 301 CD . SENT Find VV this DT article NN onlineWakabayashi NN T NN , , Morimura NP Y NP , , Miyamoto NP Y NP , , Okada NP AA NN 2003 CD Changing VVG patterns NNS of IN intraocular JJ inflammatory JJ disease NN in IN Japan NP . SENT Ocul NP Immunol NP Inflamm NP 11 CD . SENT 277 CD 286 CD . SENT Find VV this DT article NN onlineWares NNS DF NP , , Singh NP S NP , , Acharya NP AK NP , , Dangi NP R NP 2003 CD Non JJ adherence NN to TO tuberculosis NN treatment NN in IN the DT eastern JJ Tarai NP of IN Nepal NP . SENT Int NP J NP Tuberc NP Lung NP Dis NP 7 CD . SENT 327 CD 335 CD . SENT Find VV this DT article NN online JJ View NN this DT article NN by IN . SENT FiguresTablesAudio NP VideoPrint NP PDF NP 714 CD K NP Screen NP PDF NP 187 CD K NP Download NP CitationDownload NP XML NP Options NPS . SENT Take VV the DT QuizRead NP Related NP ArticlesSee NP Articles NNS Citing VVG This DT ArticleE NP mail NN this DT ArticleSend NP Us NP an DT eLetterRead JJ Other JJ eLettersSearch NN PubMed VVN for IN . SENT Related NP ArticlesPubMed NP CitationWilliam NP LynnSue NP Lightman NP PLoS NP Medicine NP is VBZ an DT open JJ access NN journal NN published VVN by IN the DT nonprofit JJ organization NN Public JJ Library NN of IN Science NP . SENT All DT journal NN content NN , , except IN where WRB otherwise RB noted VVN , , is VBZ licensed VVN under IN a DT Creative JJ Commons NP Attribution NN License NN . SENT