Rzadki przypadek ropnia mózgu wywołanego przez Trichosporon, skutecznie leczony wycięciem chirurgicznym i lekami przeciwgrzybiczymi

Trichosporonosis is an acute, sometimes fatal infection with the potential capability of disseminating to multiple deep organs. More than 100 cases of trichosporonosis have been described, particularly in patients with neutropenia or haematological malignancies. In 1970, Watson et al. described the first case of brain trichosporonosis; the patient died 4 weeks after admission. Herein, we describe a 34-year-old man with a history of autoimmune hepatitis, hypothyroidism, and alopecia totalis, treated with corticosteroids, who was admitted with left lower limb weakness. Brain MRI revealed a diffuse brain lesion in the right frontoparietal area mimicking a brain abscess. After resection of the lesion, Trichosporon asahii was isolated from the abscess. Further treatment with antifungal agents resulted in improvement in clinical status. To the best of our knowledge, this is the second case of Trichosporon brain abscess since the first description in 1970 and the first case of successful treatment of Trichosporon brain abscess.Trichosporonoza to ostre, niekiedy śmiertelne w skutkach zakażenie, w przebiegu którego może dochodzić do wielonarządowego rozsiewu. Dotąd opisano ponad 100 przypadków chorych na trichosporonozę, zwłaszcza pacjentów z neutropenią lub nowotworami krwi. W 1970 r. Watson i wsp. opisali po raz pierwszy przypadek ropnia mózgu spowodowanego przez Trichosporon; chory zmarł po 4 tygodniach. W niniejszej pracy przedstawiono przypadek 34-letniego mężczyzny obciążonego autoimmunologicznym zapaleniem wątroby, niedoczynnością tarczycy i łysieniem całkowitym, leczonego kortykosteroidem, który został przyjęty do szpitala z powodu niedowładu lewej kończyny dolnej. W badaniu mózgu za pomocą rezonansu magnetycznego (RM) stwierdzono rozlane ognisko uszkodzenia okolicy czołowo-ciemieniowej prawej, przypominające ropień mózgu. Po chirurgicznym wycięciu zmiany z ropnia wyizolowano Trichosporon asahii. Leczenie przeciwgrzybicze przyniosło poprawę stanu klinicznego. Zgodnie z naszą wiedzą jest to drugi opisany przypadek ropnia mózgu spowodowanego przez Trichosporon i pierwszy, w którym leczenie zakończyło się powodzeniem

Iranian clinical practice guideline for amyotrophic lateral sclerosis

Amyotrophic lateral sclerosis (ALS) is a rapidly progressive neurodegeneration involving motor neurons. The 3–5 years that patients have to live is marked by day-to-day loss of motor and sometimes cognitive abilities. Enormous amounts of healthcare services and resources are necessary to support patients and their caregivers during this relatively short but burdensome journey. Organization and management of these resources need to best meet patients' expectations and health system efficiency mandates. This can only occur in the setting of multidisciplinary ALS clinics which are known as the gold standard of ALS care worldwide. To introduce this standard to the care of Iranian ALS patients, which is an inevitable quality milestone, a national ALS clinical practice guideline is the necessary first step. The National ALS guideline will serve as the knowledge base for the development of local clinical pathways to guide patient journeys in multidisciplinary ALS clinics. To this end, we gathered a team of national neuromuscular experts as well as experts in related specialties necessary for delivering multidisciplinary care to ALS patients to develop the Iranian ALS clinical practice guideline. Clinical questions were prepared in the Patient, Intervention, Comparison, and Outcome (PICO) format to serve as a guide for the literature search. Considering the lack of adequate national/local studies at this time, a consensus-based approach was taken to evaluate the quality of the retrieved evidence and summarize recommendations

Practical approach to electrodiagnosis of the carpal tunnel syndrome: A review

Despite being the most common entrapment neuropathy and the most common reason for referral to the electromyography (EMG) laboratory, the diagnosis of carpal tunnel syndrome (CTS) continues to be challenging due to a large number of electrodiagnostic (EDX) tests available. We present a flowchart and propose a practical approach to the diagnosis of CTS using the available literature and the American Association of Neuromuscular and Electrodiagnostic Medicine (AANEM) guidelines and the Practice Parameter for Electrodiagnostic Studies in Carpal Tunnel Syndrome

Frontotemporal dementia parkinsonism: Clinical findings in a large Iranian family

Frontotemporal dementia (FTD) is a group of neurodegenerative disorders characterized by atrophy of the frontal and temporal lobes. Clinical features suggestive of FTD include pre-senile onset before the age of 65, behavioral changes, social and interpersonal disinhibition, fluent and nonfluent aphasia, and loss of insight. FTD and parkinsonism linked to chromosome 17 (FTDP-17) was defined during the International Consensus Conference in Ann Arbor, Michigan in 1996. FTDP-17 is an autosomally dominant inherited condition. Most genotypic alterations do not correlate with clinical phenotypes. However, mutations affecting exon 10 splicing are associated with parkinsonism. In the present study, a male case with FTDP who presented with insidious onset of speech difficulty at a young age that was associated with signs of parkinsonism and a positive family history of FTD with MAPT gene mutation at exon 13 has been reported

Frequency of myasthenia gravis in multiple sclerosis: Report of five cases from Isfahan, Iran

This study was designed to determine the frequency and clinical characteristics of myasthenia gravis (MG) in a large cohort of Persian patients with multiple sclerosis (MS) living in the province of Isfahan. We reviewed the case records of patients with definite MS (McDonald′s criteria) registered in the Isfahan MS Society (IMSS) for associated MG. Of the 1,718 patients with MS in the registry, six patients were found to have both MS and MG. The prevalence after excluding one patient with insufficient data, was 291 per 100,000 (0.29%), a higher prevalence than the earlier reports. These results may support the hypothesis that MS and MG share some common immunopathogenic mechanisms

′Cuff Sign′ a new maneuver for decision-making in patients with carpal tunnel syndrome

Background: Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy that results from compression of the median nerve within the carpal tunnel. In most patients, the diagnosis can be proposed based on patient history and clinical symptoms, with physical findings being attributed only in more severely affected patients. The purpose of this study is to introduce a reliable and accurate method for the proper selection of patients with mild carpal tunnel syndrome (CTS), for surgery. Materials and Methods: Electerodiagnostic studies are performed before and after placement of the cuff of the sphygmomanometer at the arm (Cuff sign), at a mean arterial pressure, for three minutes. Thirty symptomatic patients with mild findings on electrodiagnostic studies and 49 asymptomatic control hands have been included. Results: Fifteen patients reported good pain relief on the first postoperative day (50%), which increased to 21 on the fouteenth postoperative day (70%). The sensory latency changes were significantly higher in the pain relief group, both on the first and fourteenth postoperative days. Conclusion: Considering the fact that cooperation of the patients is not necessary and the double effects of direct pressure and ischemia over the proximal parts of the median nerve leads to prolonged latencies, this test is a useful method for decision-making in patients with severe symptoms of CTS, despite the mild electrodiagnostic findings

Chronic inflammatory demyelinating polyneuropathy associated with diabetes mellitus

Various forms of neuropathy are seen diabetic patients; chronic inflammatory demyelinating polyneuropathy (CIDP) seems not to be infrequent neuropathy in patients suffering from diabetes and it seems to be more common than in the general population; on the contrary, some authorities do not support pathogenetic association between diabetes mellitus (DM) and CIDP. Also, there are some controversies on the subject of CIDP treatment in diabetic patients. Some studies showed that patients with CIDP-DM considerably had recovered following treatment with immunotherapeutic modalities like (Intravenous immunoglobulin) IVIG and conversely, some else have argued against the prescription of IVIG in this group and recommend treatment with corticosteroids and provided that resistant, rituximab may be beneficial. The main limitation in most studies is the inadequate number of cases and as a result, problematic decision making in treatment. This article represents an inclusive review of diabetic CIDP presentation and treatment

Epidemiology and Clinical Features of Guillain-Barre Syndrome in Isfahan, Iran

Background: Guillain-Barre syndrome (GBS) is an immune-mediated peripheral neuropathy. We compared clinical, laboratory characteristics, and disease course of GBS subtypes in a large group of Iranian patients in Isfahan. Materials and Methods: We collected data from patients who were admitted to Alzahra referral university Hospital, Isfahan, Iran with a diagnosis of GBS. In this population-based cross-sectional research, characteristic of 388 cases with GBS between 2010 and 2015 were studied. Results: The current study recruited 388 patients with GBS including 241 males (62.1%) and 147 females (37.9%) with a mean age of 42.78 ± 21.34. Patients with polyradiculopathy had the highest mean age of 55.12 ± 20.59 years, whereas the least age was seen in acute motor axonal neuropathy (AMAN) with the mean of 36.30 ± 18.71 years. The frequency of GBS witnessed the highest frequency in spring with 113 cases (29.1%) and winter with 101 cases (26%). Patients' electrodiagnostic findings indicated that the highest frequency pertained to AMSAN with 93 cases (24%), whereas the least frequent diagnosis was acute Polyradiculopathy with 8 cases (2.1%). Most of the patients did not have any infections (53.6%) and among patients with infections, AMSAN had the highest frequency (22.9%) and finally, patients with AMSAN and AMAN had a higher length of stay. Conclusion: The study demonstrated incidence, sex distribution, preceding infection, and surgery similar to previous studies. However, our data differs from a study in Tehran that showed acute inflammatory demyelinating polyradiculoneuropathy is more prevalent than other types and we found a seasonal preponderance in cold months, particularly in axonal types

Assessing of plasma levels of iron, zinc and copper in Iranian Parkinson′s disease

Background: Trace elements have long been suspected to be involved in Parkinson's disease (PD) pathogenesis, but their exact roles have been remained controversial. In this study, we assessed the levels of copper (Cu), iron (Fe) and zinc (Zn) in different stage of PD patients. Materials and Methods: Serum concentrations of iron, copper and zinc were measured in 109 patients with PD by colorimetric methods. Staging of the disease was evaluated according to Hoehn and Yahr (H and Y) and Unified PD Rating Scale III (UPDRS). Results: Severity values of PD measured by UPRDSIII and HY stages with mean ± SD were 22.9 ± 1.81 and 1.8 ± 1.1, respectively. Mean ± SD values of iron, zinc and copper are 100.7 ± 289.2, 68.3 ± 5.32, and 196.8 ± 162.1 μg/dl, respectively. Serum iron level in most of the patients was normal (76.6%). Whereas zinc concentration in most participants was below the normal range (64.5%) and serum Cu in the majority of patients had a high normal concentration (42.7%) and did not significantly differ among various PD stages. Conclusion: The result of this study does not confirm strong correlation between PD stages and serum levels of tested trace elements. The actual correlations between these elements and PD and whether modulating of these agents levels could be an effective approach in the treatment of this disease remain to be elucidated