Transient electromyographic findings in serotonergic toxicity due to combination of essitalopram and isoniazid

Here, we report a case of serotonergic toxicity due to combination of essitalopram and isoniazid, which was rarely reported before. Moreover, we observed transient neurogenic denervation potentials in needle electromyography, which disappeared with the treatment of serotonergic toxicity. As to our best knowledge, this is the first case, reporting transient electromyographic changes probably due to serotonergic toxicity

Acute transverse myelitis at the conus medullaris level after rabies vaccination in a patient with Behçet's disease

Case report: A 25-year-old man with Behçet's disease was admitted because of weakness of the lower limbs and difficulty in urination. He had received a rabies vaccination 2 months previous because he had been bitten by a dog. Findings: Clinical and laboratory findings supported acute transverse myelitis. A hyperintense lesion and expansion at the level of conus medullaris was detected on spinal magnetic resonance imaging. Conclusion: Although neurologic involvement is one of the main causes of mortality and morbidity in Behçet's disease, the factors that aggravate the involvement of the nervous system are still unclear. Vaccination may have been the factor that had activated autoimmune mechanisms in this case. To our knowledge, involvement of the conus medullaris in Behçet's disease after rabies vaccination has not been reported.Indications:For prevention of rabies in a patient who was bitten by a dog. Coexisting diseases: Behcet's disease, relapsing aphthous stomatitis and genital ulcerations.Patients:One 25-year-old male patient.TypeofStudy:A case report describing acute transverse myelitis at the conus medullaris level after Rabipur vaccination in a patient with Behcet's disease.AdverseEffects:1 patient developed acute transverse myelitis at the conus medullaris characterized by weakness of lower limbs, urinary retention, severe backache, difficulty with urination and defecation, hypoesthesia below the level of L1, absence of lower extremities vibratory and position senses, absence of deep tendon reflexes in the lower extremities, detrusor atony, and atrophy and fasciculations of the left leg muscles.AuthorsConclusions:Involvement of the conus medullaris in Behcet's disease after rabies vaccination has not been reported previously in the literature. The possibility of an activating factor (eg, vaccination) other than infection has never been mentioned in Neuro-Behcet syndrome. Understanding the activating factors may be helpful for the prevention of neurological involvement and is important for planning follow up and understanding the prognosis. Further reports and investigations are needed.FreeText:Tests: cerebrospinal fluid (CSF) leukocyte and protein level; muscle strength using Medical Research Council grade scoring; spine magnetic resonance imaging (MRI); vibratory and position senses; and deep tendon reflexes. The active substance of the rabies vaccine was an inactivated rabies virus.Results:Two months after the administration of the rabies vaccine, the patient experienced weakness of lower limbs which was preceded by severe backache for 12 hours and urinary retention. The weakness progressively worsened, and he began experiencing difficulty with urination and defecation. Muscle strength score was 2/5 at proximal left lower limb, 1/5 at distal left lower limb, 3/-5 at proximal right lower limb, and 1/5 at distal right lower limb. Atrophy and fasciculations of the left leg muscles were noted. There was hypoesthesia below the level of lumbar 1 (L1), and lower extremities demonstrated absence of vibratory and position senses. Absence of deep tendon reflexes was noted in the lower extremities, and plantar responses were extensor bilaterally. CSF examination revealed 110 leukocytes/mm3 with no microorganisms and elevated protein level (114 mg/dL). Spine MRI showed hyperintense lesion and expansion at the level of the conus medullaris. The patient was treated with methylprednisolone, azathioprine, and physiotherapy. He also required intermittent catheterization for urinary retention. After a year, a complete resolution of symptoms was observed and spinal MRI became normal.DosageDuration:Dosage not stated; given on the day of the bite and on the 3rd and 7th days thereafter

Unilateral thalamodiencephalic syndrome presenting with severe hypersomnia

Thalamic and brainstem strokes can cause organic hypersomnia. Paramedian thalamus is believed to play an important role in the regulation of sleep, and disturbances of sleep regulation are known to occur in paramedian thalamic stroke (PTS). In patients with PTS, slight sleepiness is reported with unilateral and limited lesions. In this paper we report on a patient presenting with severe hypersomnia who has a limited, unilateral thalamodiencephalic ischemic lesion on magnetic resonance imaging (MRI). A 54 year-old man referred to our hospital with the complaint of excessive day time sleepiness. His cranial MRI revealed a unilateral ischaemic lesion beginning at the level of left thalamus and extending to nucleus Ruber and Edinger Westpall. His total day time sleep was about 23-24 hours in the first week. He had been put on dopamine agonist therapy (bromocriptine 2.5mg/day up to dose 7.5mg/day). During this medication his total day time sleep decreased gradually and after two months he returned to his normal vigilance. Lesions affecting thalamus and mesencephalic or pontine tegmental reticular formation are a cause of hypersomnia but clinical presentation and degree of hypersomnia can be various due to the affected region of the brain. We think that regulation of sleep and wakefulness by different brain structures are still elusive and new case reports and clinical trials would be helpful about clarification of this condition

Effect of hyperglycemia on conduction parameters of tibial nerve′s fibers to different muscles: A rat model

Introduction: Routine conduction studies reflect the summation of all nerve fibers in a peripheral nerve. Nerve fiber groups to distal, small muscles have smaller diameters than the ones to large proximal muscles. There may be minimal differences between the diameters of nerve fiber groups innervating different muscles; even they are all same type of fibers. So, in neuropathic processes some nerve fiber groups may be more seriously affected. Materials and Methods: 14 rats ( 7 diabetic, 7 control) were studied. Tibial nerve was stimulated from two points and while recorded from a distal (foot intrinsic muscles) and a proximal (gastrocnemius) muscle. Results: There was a significant difference between the proximal and distal recorded conduction velocities. Both proximal and distal recorded conduction velocities decreased during the hyperglycemic process. Discussion: Our method successfully demonstrated different nerve fiber groups; but, the neuropathic process seemed to be homogeneous in both fiber groups

ASCO classification in clinical practice

ASCO (Atherosclerosis, Small vessel disease, Cardiac source. Other cause) is a new of classification of ischemic cerebrovascular diseases. This classification categorizes the data of the patients according to all underlying diseases and allows the clinician to grade the severity of cause (Each of the four phenotypes can be graded 1, 2, or 3). It is suggested to use ASCO classification in large epidemiologic studies but this classification may be used in daily practice. In this study we aimed to analyze the clinical features of patients with ischemic stroke and to investigate results of ASCO classification of these patients and data of 35 patients with ischemic stroke is analyzed. Use of ASCO classification is discussed with the special example cases. Patients' etiology of stroke was classified according to ASCO as known, unknown, completely unknown and unclassifiable group. Percentile of the patients classified as "known" was 71.4% (n=25), "unknown" was 1 7.1% (n=6), "completely unknown" was 5.7% (n=2) and "unclassifiable group" was 5.7% (n=2). We think that the ASCO classification which is thought to be more useful in large epidemiologic studies may be used in clinical follow-up period of the stroke patients. Further studies, from different neurology centers and stroke units, are needed to expand our experiences about use of ASCO classification in clinical practice

Wallenberg Syndrome following neck cracking: A case report

Cracking the neck is an age-old practice in contravention of its dangerous affects. One of these affects is Brain stem strokes and in this report we describe a patient with Wallenberg syndrome due to neck cracking who is the one of the rare cases in the literature

Wallenberg Syndrome following neck cracking: A case report

Cracking the neck is an age-old practice in contravention of its dangerous affects. One of these affects is Brain stem strokes and in this report we describe a patient with Wallenberg syndrome due to neck cracking who is the one of the rare cases in the literature