We report 31 cases of herpes zoster (HZ) with neurological complications: 14 with cranial nerve deficits, 1 with cranial nerve deficit associated with segmental motor disorder, 3 with segmental motor deficits, 2 with meningoencephalitis, 2 with meningoencephalitis associated with cranial neuropathy or myelitis, 2 with meningitis, 2 with hemiplegia contralateral to the ophthalmic HZ. 1 with hemiplegia and motor deficit and finally 1 with hemiplegia and a cranial neuropathy. Smoking was the putative risk factor in 53% of our patients together with diabetes, which has already been mentioned in the literature. We frequently observed more than one complication in succession (19.3%) that could not easily be related to the cutaneous distribution. Acyclovir had no demonstrable positive effects on neurological complication in our patients.

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Purpose To prospectively evaluate the prevalence of the embolization of the spleen in patients with definite leftsided infective endocarditis (IE) using a contrast-enhanced ultrasound (CEUS). Methods From March 2012 through September 2013, 18 consecutive patients (9 females and 9 males, aged 21-83 years) evaluated at our hospital and with definite left-sided IE according to the revised Duke criteria were enrolled. All of the patients gave informed written consent and the study was performed in conformity with the ethical guidelines of the Declaration of Helsinki. All of the patients were submitted to a CEUS of the spleen within 10 days after the definite diagnosis of IE. For the CEUS, a blood pool second-generation contrast agent and an ultrasound machine with a contrast harmonic imaging technology were used. Results The splenic CEUS showed infarctions in 11 patients (61 %) and resulted positive in the 2 patients with negative echocardiography. Conclusions In this study, CEUS of the spleen, a repeatable and low-cost imaging technique, easily allowed the bedside detection of asymptomatic and even tiny infarctions and showed a high rate of embolization in patients with definite left-sided IE. Therefore, in the setting of IE (possible or definite), CEUS of the spleen has the potential to better define or accelerate the diagnosis itself.Keywords Spleen Á Endocarditis Á Ultrasound Á Contrast Á Embolization Riassunto Scopo valutare prospetticamente la prevalenza di embolizzazione splenica in pazienti con endocardite infettiva (EI) certa del cuore sinistro con l'utilizzo dell'ecografia con mezzo di contrasto (CEUS). Metodi lo studio è stato effettuato presso il nostro Ospedale dal marzo 2012 al settembre 2013; sono stati arruolati 18 pazienti consecutivi (9 femmine e 9 maschi, con età compresa tra 21 e 83 anni) con diagnosi di EI certa del cuore sinistro secondo i criteri Duke rivisti. Tutti i pazienti hanno dato il loro consenso informato scritto e lo studio è stato condotto in conformità con le linee guida etiche della Dichiarazione di Helsinki. Tutti i pazienti sono stati sottoposti ad una CEUS della milza entro 10 giorni dalla diagnosi di EI certa del cuore sinistro. Per la CEUS è stato utilizzato un mezzo di contrasto di seconda generazione ed un ecografo dotato di imaging armonico.Electronic supplementary material The online version of this article (doi:10.1007/s40477-014-0131-4) contains supplementary material, which is available to authorized users. Ultrasound (2015) 18:223-227 DOI 10.1007 Risultati la CEUS ha mostrato la presenza di infarto della milza in 11 pazienti (61%) ed è risultata positiva nei 2 pazienti con indagine ecocardiografica negativa. Conclusioni in questo studio la CEUS della milza, una tecnica di imaging ripetibile e a basso costo, ha permesso facilmente la identificazione al letto del paziente di infarti asintomatici, anche di piccole dimensioni; ha dimostrato che nei pazienti con EI del cuore sinistro c'è una elevata frequenza di embolizzazione splenica. Pertanto, nel contesto di ...

Contrast-enhanced ultrasound (CEUS) examination is based on the use of a second-generation, blood-pool contrast agent and contrast harmonic imaging technology. It is widely used for the study of parenchymal microvascularization and is an accurate and very sensitive method for the detection of ischemic lesions of the kidneys [3]. Pathologic studies have clearly demonstrated that gross kidney infarction is common in patients with infective endocarditis [1]. We recently observed a case of this type in a 63-yearold male with aortic valve stenosis, who was admitted to our hospital for fever. Blood cultures obtained prior to the initiation of empiric antibiotic therapy were positive for Streptococcus anginosus. Transthoracic echocardiography was negative, but a subsequent transesophageal echocardiogram revealed vegetations on the native aortic valve.Infective endocarditis was definitively diagnosed in accordance with the revised Duke criteria [2], and a course of antibiotic therapy was initiated. Four weeks later, the patient developed acute left flank pain. The gray-scale ultrasound examination showed no abnormalities involving the left kidney. A CEUS study of the left kidney was then performed with the patient's written, informed consent. SonoVue Ò (Bracco, Milan, Italy) was used as the contrast agent. During the venous phase of the examination (an interval of 4 min, beginning approximately 1 min after the intravenous injection of Sonovue), a single, wedged-shaped area of hypovascularity, 30 mm long, was observed in the inferior portion of the kidney (Fig. 1), findings that were consistent with kidney infarction.In the presence of left-sided infective endocarditis, peripheral embolization at any site may represent either a complication or a diagnostic clue; in either case, they are often difficult to detect. There are currently no bedside methods for identifying kidney embolization, but our

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