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A 24-year-old immune-competent woman was admitted to hospital with a three-day history of fever and headache. On examination bilateral facial nerve palsy, lumbosacral radicular pain, reduced sacral sensibility and urinary retention were found. Open perianal lesions were suspect for genital herpes. The symptoms were compatible with a meningoradiculitis including a sacral polyradiculitis. On testing, cerebrospinal fluid was found to be abnormal with a lymphocytic cell reaction. Polymerase chain reaction (PCR) of cerebrospinal fluid and of the perianal lesions was positive for herpes simplex virus type 2 (HSV-2). An MRI scan showed colouration of part of the cauda equina. The patient was treated by intravenous injections of acyclovir 10 mg/kg t.i.d. for 21 days, after which she completely recovered. HSV-2 infection of the nervous system can cause lymphocytic, and sometimes recurrent meningitis as well as sacral polyradiculitis. It may also occur without any symptomatic genital herpes infection. A positive result from a PCR test of the cerebrospinal fluid confirms this diagnosis. Treatment with acyclovir should be started as soon as possible.

A 63-year-old healthy man developed acute meningitis. A Gram-stain of the cerebrospinal fluid showed Gram-negative rods, which grew slowly. They were identified by 16S ribosomal RNA sequence-analysis as Capnocytophaga canimorsus, an oral commensal found in various animal species including dogs. Upon further questioning, the patient mentioned a superficial dog bite. Using fluorescence-in situ-hybridisation with specific DNA probes, C. canimorsus cells were detected in a gingiva swab from his dog. The strains isolated from the patient and his dog were identical. The patient made a quick recovery following therapy with cefotaxime. Infections with C. canimorsus are associated with immune suppression (especially splenectomy or alcohol abuse), yet 40% of the patients have no predisposing conditions. Documented infections concern mainly sepsis or meningitis, with a mortality of approximately 30%. Due to its fastidious growth, C. canimorsus may be missed in standard culture methods. Therefore, in each case of unexplained sepsis or meningitis contact with animals should be enquired about.

Two patients, men aged 42 and 40 years, developed new neurological symptoms 3 months and 22 years, respectively, after a traumatic high thoracic spinal cord injury. The MRI scan showed a cavity in the central part of the spinal cord, on which the diagnosis of 'posttraumatic syringomyelia' could be based. In one of the patients a syringo-subarachnoidal shunt was created, the other was treated conservatively because of a severe concomitant thoracic kyphosis. Posttraumatic syringomyelia is a potentially life-threathening late complication of spinal cord injury and is characterized by development of new neurological symptoms after a variable time interval. The most typical symptom of non-traumatic syringomyelia, viz. diminution of vital sensitivity without loss of gnostic sensitivity, is not necessarily present in posttraumatic syringomyelia. Surgical treatment of posttraumatic syringomyelia is advocated if there is progressive neurological deterioration, and consists of drainage of the syrinx.