LANDES BIOSCIENCE V m U. K. Misra J. Kalita R. A. Shakir a d e m e c u V LANDES BIOSCIENCE a d e m e c u m Table of contents (excerpt) 1. Tuberculosis Meningitis 2. Spinal Tuberculosis 3. Pyogenic Infections of the Central Nervous System 4. Brucellosis 5. Tetanus 6. Leprosy 7. Acute Viral Encephalitis 8. Poliomyelitis 9. Human Rabies: Pathogenesis, Clinical Aspects and Current Recommendations for Prophylaxis The Vademecum series includes subjects generally not covered in other handbook series, especially many technology-driven topics that reflect the increasing influence of technology in clinical medicine. The name chosen for this comprehensive medical handbook series is Vademecum, a Latin word that roughly means “to carry along”. In the Middle Ages, traveling clerics carried pocket-sized books, excerpts of the carefully transcribed canons, known as Vademecum. In the 19th century a medical publisher in Germany, Samuel Karger, called a series of portable medical books Vademecum. The Vademecum books are intended to be used both in the training of physicians and the care of patients, by medical students, medical house staff and practicing physicians. We hope you will find them a valuable resource. Tropical Neurology ad em e c u m V Misra Kalita Shakir LANDES BIOSCIENCE Tropical Neurology 10. Subacute Sclerosing Panencephalitis 11. HTLV-I-Associated Myelopathy 12. Neurological Manifestations of HIV 13. Parainfectious Demyelinating Diseases of the Nervous System 14. Fungal Infections of the Central Nervous System 15. Neurocysticercosis 16. Cerebral Malaria 17. Neuroschistomiasis 18. Human African Trypanosomiasis Sleeping Sickness All titles available at www.landesbioscience.com ISBN 1- 57059- 637- 9 9781570 596377 U. K. Misra, M.D., D.M., F.A.M.S. Professor and Head Department of Neurology Sanjay Gandhi Post-Graduate Institute of Medical Sciences Lucknow, India J. Kalita, M.D., D.M. Associate Professor Department of Neurology Sanjay Gandhi Post-Graduate Institute of Medical Sciences Lucknow, India R. A. Shakir, F.R.C.P. Consultant Neurologist Charing Cross Hospital London, U.K. Tr opical Neurology G EORGETOWN , T EXAS U.S.A. vademecum L A N D E S B I O S C I E N C E VADEMECUM Tr opical Neurology LANDES BIOSCIENCE Georgetown, Texas U.S.A. Copyright ©2003 Landes Bioscience All rights reserved. No part of this book may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopy, recording, or any information storage and retrieval system, without permission in writing from the publisher. Printed in the U.S.A. Please address all inquiries to the Publisher: Landes Bioscience, 810 S. Church Street, Georgetown, Texas, U.S.A. 78626 Phone: 512/ 863 7762; FAX: 512/ 863 0081 ISBN: 1-57059-637-9 Library of Congress Cataloging-in-Publication Data Tropical neurology/[edited by] U. K. Misra, J. Kalita, R. A. Shakir p. ; cm. (Vademecum) Includes bibliographical references and index. ISBN 1-57059-637-9 1. Nervous system Diseases. 2. Tropical medicine. 3. Nervous system Infections. 4. Neurological manifestations of general diseases. I. Misra, U. K. II. Series. [DNLM: 1. Nervous System Diseases. 2. Tropical Medicine. WL 140 T8561 2001] RC346. T755 2001 616.8'00913 dc21 00-061996 While the authors, editors, sponsor and publisher believe that drug selection and dosage and the specifications and usage of equipment and devices, as set forth in this book, are in accord with current recommendations and practice at the time of publication, they make no warranty, expressed or implied, with respect to material described in this book. In view of the ongoing research, equipment development, changes in governmental regulations and the rapid accumulation of information relating to the biomedical sciences, the reader is urged to carefully review and evaluate the information provided herein. Dedication We dedicate this book to our parents and teachers. Contents Preface xi 1. Tuberculous Meningitis 1 U. K. Misra and J. Kalita 2. Spinal Tuberculosis 28 Satyajit B. Naique and V. J. Laheri 3. Pyogenic Infections of the Central Nervous System 50 Kameshwar Prasad, Sumit Singh, Shailesh Gaekwad and Chitra Sarkar 4. Brucellosis 75 R. A. Shakir 5. Tetanus 85 S. Prabhakar and P. Syal 6. Leprosy 96 K. V. Desikan 7. Acute Viral Encephalitis 115 J. Kalita and U. K. Misra 8. Poliomyelitis 139 P. M. Jeena 9. Human Rabies: Pathogenesis, Clinical Aspects and Current Recommendations for Prophylaxis 154 Te r apong Tantawichien and Visith Sitprija 10. Subacute Sclerosing Panencephalitis 175 U. K. Misra and J. Kalita 11. HTLV-I-Associated Myelopathy 185 Masanori Nakagawa and Mitsuhiro Osame 12. Neurological Manifestations of HIV 200 Shri Kant Mishra, J. Kalita and Indu Subramanian 13. Parainfectious Demyelinating Diseases of the Nervous System 217 J. Kalita and U. K. Misra 14. Fungal Infections of the Central Nervous System 238 David Saffer and Raymond A. Smego, Jr. 15. Neurocysticercosis 255 Oscar H. Del Brutto 16. Cerebral Malaria 284 J. E. Touze, L. Fourcade, P. Heno, P. Riviere and P. Paule 17. Neuroschistosomiasis 300 José Eymard Homem Pittella 18. Human African Trypanosomiasis, Sleeping Sickness 325 Bernard Bouteille and Michel Dumas 19. Environmental Neurotoxins in the Tropics 344 U. K. Misra and J. Kalita 20. Insecticides and Industrial Poisons 370 Nimal Senanayake 21. Poisoning and Envenoming by Animal Neurotoxins in the Tropics 391 Sérgio de A. Nishioka, Paulo Vitor P. Silveira and A. Cherian 22. Heat Stroke 406 Basim A. Yaqub and Saleh M. Al Deeb 23. Epilepsy in the Tropics 422 J. M. K. Murthy 24. Stroke in the Tropics 434 D. Nagaraja and M. Veerendrakumar 25. Mental Retardation 456 Veena Kalra and K. S. Rana 26. Nutritional Deficiency Disorders of the Nervous System 470 N. H. Wadia, U. K. Misra and J. Kalita 27. Neuroepidemiology in the Tropics 491 K. Radhakrishnan and P. N. Sylaja 28. Craniovertebral Anomalies 512 R. Shukla Index 533 Editors U. K. Misra Professor and Head Department of Neurology Sanjay Gandhi Post-Graduate Institute of Medical Sciences Lucknow, India Chapters 1, 7, 10, 13, 19, 26 J. Kalita Associate Professor Department of Neurology Sanjay Gandhi Post-Graduate Institute of Medical Sciences Lucknow, India Chapters 1, 7, 10, 12, 13, 19, 26 R. A. Shakir Consultant Neurologist Charing Cross Hospital London, U.K. Chapter 4 Saleh M. Al Deeb Department of Neurosciences Riyadh Armed Forces Hospital Riyadh, Saudi Arabia Chapter 22 B. Bouteille Institute of Tropical Neurology University of Limoges Limoges, France Chapter 18 A. Cherian Christian Medical College & Hospital Vellore, India Chapter 21 Oscar H. Del Brutto Department of Neurology Luis Vernaza Hospital Guayaquil, Ecuador Chapter 15 K. V. Desikan Mahatma Gandhi Institute of Medical Sciences Sevagram, India Chapter 6 M. Dumas Institute of Tropical Neurology University of Limoges Limoges, France Chapter 18 L. Fourcade Tr opical Medical Institute for French Army Marseille, France Chapter 16 S. Gaekwad Department of Neuroradiology All India Institute of Medical Sciences New Delhi, India Chapter 3 Contributors P. H eno Tr opical Medical Institute for the French Army Marseille, France Chapter 16 P. M. Jeena Department of Pediatrics & Child Health University of Natal Congella, South Africa Chapter 8 Veena Kalra Department of Pediatrics All India Institute of Medical Sciences New Delhi, India Chapter 25 V. J. Laheri Department of Orthopedics The Seth G. S. Medical College & King Edward VII Memorial Hospital Mumbai, India Chapter 2 S. K. Mishra Department of Neurology University of Southern California School of Medicine Los Angeles, California, U.S.A. Chapter 12 J. M. K. Murthy The Institute of Neurological Sciences CARE Hospital Hyderabad, India Chapter 23 D. Nagaraja Department of Neurology National Institute of Mental Health and Neurosciences Bangalore, India Chapter 24 Satyajit B. Naique Department of Orthopedics The Seth G. S. Medical College and King Edward VII Memorial Hospital Mumbai, India Chapter 2 M. Nakagawa Third Department of Internal Medicine Kagoshima University School of Medicine Kagoshima, Japan Chapter 11 S. de A. Nishioka Centro de Ciências Biomédicas Universidade Federal de Uberlândia, Uberlândia, Brazil Chapter 21 M. Osame Third Department of Internal Medicine Kagoshima University School of Medicine Kagoshima, Japan Chapter 11 P. Paule Tr opical Medical Institute for the French Army Marseille, France Chapter 16 J. E. H. Pittella Department of Pathology and Legal Medicine School of Medicine Federal University of Minas Gerai Belo Horizonte, Brazil Chapter 17 S. Prabhakar Department of Neurology Postgraduate Institute of Medical Education and Research Chandigarh, India Chapter 5 K. Prasad Department of Neurology All India Institute of Medical Sciences New Delhi, India Chapter 3 K. Radhakrishnan Department of Neurology Sree Chitra Tirunal Institute for Medical Sciences and Technology Thiruvananthapuram, India Chapter 27 K. S. Rana Department of Pediatrics All India Institute of Medical Sciences New Delhi, India Chapter 25 P. R i viere Tr opical Medical Institute for the French Army Marseille, France Chapter 16 David Saffer Department of Neurology Chris Hani Baragwanath Hospital University of the Witwatersrand Johannesburg, South Africa Chapter 14 Chitra Sarkar Department of Pathology All India Institute of Medical Sciences New Delhi, India Chapter 3 Nimal Senanayake Department of Medicine University of Peradeniya Peradeniya, Sri Lanka Chapter 20 R. Shukla King George’s Medical College Lucknow, India Chapter 28 P. Paulo Victor Silveira Centro de Ciências Biomédicas Universidade Federal de Uberlândia Uberlândia, Brazil Chapter 21 Sumit Singh Department of Neurology All India Institute of Medical Sciences New Delhi, India Chapter 3 Visith Sitprija Queen Saovabha Memorial Institute Bangkok, Thailand Chapter 9 R. A. Smego, Jr. Department of Infectious Diseases and Clinical Microbiology University of Witwatersrand South African Institute for Medical Research Johannesburg, South Africa Chapter 12 Indu Subramanian Department of Neurology UCLA School of Medicine Los Angeles, California, U.S.A. Chapter 14 P. S yal Department of Neurology Postgraduate Institute of Medical Education and Research Chandigarh, India Chapter 5 P. N . Sylaja Department of Neurology Sree Chitra Tirunal Institute for Medical Sciences and Technology Thiruvananthapuram, India Chapter 27 Terapong Tantawichien Division of Infectious Diseases Department of Medicine Chulalongkorn University and Queen Saovabha Memorial Institute Bangkok, Thailand Chapter 9 J. E. Touze Tr opical Medical Institute for the French Army Marseille, France Chapter 16 M. Veerendrakumar Department of Neurology National Institute of Mental Health and Neurosciences Bangalore, India Chapter 24 N. H. Wadia Department of Neurology Jaslok Hospital and Research Center Mumbai, India Chapter 26 Basim A. Yaqub Department of Neurosciences Riyadh Armed Forces Hospital Riyadh, Saudi Arabia Chapter 22 [...]... tuberculosis 8 Tropical Neurology Table 1. 2 Clinical presentation of tuberculous meningitis15 1 Parameters Symptoms: Headache Nausea/Vomiting Apathy/behavioral change Seizures Prior history of tuberculosis Signs: Fever Meningismus Cranial nerve palsy Coma Children Adults 2 0-5 0% 5 0-7 5% 3 0-7 0% 1 0-2 0% 55% 5 0-6 0% 8-4 0% 3 0-7 0% 0 -1 3% 8 -1 2% 5 0 -1 00% 7 0 -1 00% 1 5-3 0% 3 0-4 5% 6 0 -1 00% 6 0-7 0% 1 5-4 0% 2 0-3 0% 15 Modified... Inflamed meninges Isoniazid Rifampicin Ethambutol Pyrazinamide Streptomycin 5. 0 -1 0 1 0-2 0 1 5-2 5 2 5-3 0 1 5-4 0 3. 0-5 .0 0. 4 -1 2 1. 0-7 .7 3 5-5 0 2 5-5 0 0. 6 -1 .6 0 0 30 trace 2. 0-3 .2 0. 4 -1 .0 0. 5-2 .5 3 0-5 0 2. 0-9 .0 15 Modified from Zugar A, Lowy F In: Scheld WN et al, eds Infections of Central Nervous System Philadelphia: Lippincott, 19 94: 41 7-4 44 concentration in the presence of meningitis and drug levels remain in... probability of drug resistance INH 300 Rifampicin 600 Pyrazinamide 1 5-3 0/kg Streptomycin 10 00 Ethionamide 15 /kg Frequency Duration (mo) daily daily daily 6/ 9 -1 8 6/ 9 -1 8 2/ 9 -1 8 daily daily daily daily daily 9 -1 8 9 -1 8 9 -1 8 2 2 -1 8 15 Modified from Zuger A, Lowy F In: Scheld WN et al, eds Infections of Central Nervous System Philadelphia: Lippincott, 19 94: 41 7-4 44 months for children Streptomycin or ethambutol may... Specificity Time required 9 0-9 4% 8 8-9 6% 48 hours 7 3 -1 00% 7 1- 9 9% . 8-4 0% Apathy/behavioral change 3 0-7 0% 3 0-7 0% Seizures 1 0-2 0% 0 -1 3% Prior history of tuberculosis 55% 8 -1 2% Signs: Fever 5 0 -1 00% 6 0 -1 00% Meningismus 7 0 -1 00% 6 0-7 0% Cranial nerve palsy 1 5-3 0% 1 5-4 0% Coma. India Chapters 1, 7, 10 , 13 , 19 , 26 J. Kalita Associate Professor Department of Neurology Sanjay Gandhi Post-Graduate Institute of Medical Sciences Lucknow, India Chapters 1, 7, 10 , 12 , 13 , 19 , 26 R Bioscience, 810 S. Church Street, Georgetown, Texas, U.S.A. 78626 Phone: 512 / 863 7762; FAX: 512 / 863 00 81 ISBN: 1- 5 705 9-6 3 7-9 Library of Congress Cataloging-in-Publication Data Tropical neurology/ [edited