Chronic hemicorporal prurigo related to a posttraumatic Brown-Séquard syndrome

Focal pruritus may have a neurological cause. According to the underlying mechanism, two categories of central itch have been distinguished, neuropathic and neurogenic pruritus. We here describe a patient with Brown-Séquard syndrome related to unilateral damage of the spinal cord. The patient progressively developed neuropathic pruritus with chronic prurigo lesions showing strictly hemicorporal distribution. The patient was given pregabalin, an analogue of the neurotransmitter gamma-aminobutyric acid,with significant improvement. Our observation of chronic prurigo with hemicorporal involvement is unique. It underscores the importance of a detailed neurological examination in case of persistent localized itch and further supports the idea that chronic prurigo reflects a neurological problem in a subset of affected patients. Antiepileptic drugs should be considered not only for neuropathic pain, but also for neuropathic itch

Myasthenie grave, traitements et remissions. [Myasthenia gravis: treatments and remissions]

Myasthenia gravis (MG) is an autoimmune disease of the neuromuscular junction, due to the binding of autoantibodies to the nicotinic acetylcholine receptor (AChR), or more rarely to a muscle specific kinase (MuSK). It affects most of the time young women and old patients, with a tendency toward increasing incidence and prevalence. Clinical presentation, with fluctuating weakness of ocular, facial and bulbar muscles has a wide range of severity. Evolution is characterized by remissions and exacerbations. The goal of treatment is a complete remission, which implies a sustained collaboration between the general practitioner and the specialized centre and the use of symptomatic treatment (anticholinesterasic) in association with immunomodulators/suppressors (prednisone and azathioprine); although other treatments are available

Mild clinical expression of Lambert–Eaton myasthenic syndrome in a patient with HIV infection

Neuromuscular complications of HIV are related to immunodeficiency, direct cytotoxicity of the virus or side effect of the treatments. Autoimmune disorders involving the nervous system, including Guillain–Barre syndrome, myositis and vasculitis, have been described in association with HIV. Neuromuscular junction autoimmune diseases such as myasthenia gravis have been occasionally reported in patients with HIV, whereas the Lambert–Eaton myasthenic syndrome (LEMS) has never been described. We report an unusual case of paucisymptomatic LEMS in a patient with HIV infection

Is cerebral autoregulation impaired in Parkinson's disease? A transcranial Doppler study

Orthostatic hypotension (OH) is one of the many autonomic disturbances observed in Parkinson's disease (PD). It has been debated whether an additional impairment of cerebral autoregulation (CA) in PD patients may exacerbate the consequences of OH upon brain perfusion. We assessed CA in PD patients and the potential influence of dopaminergic agents. CA was determined by means of transcranial Doppler (TCD) monitoring of the middle cerebral artery (MCA) at rest and during a thigh cuff release test inducing a systemic blood pressure (BP) drop. Fourteen patients were investigated when taking their usual dopaminergic medication and after drug discontinuation for 12 h. A control group was composed of 11 age-matched subjects (CS). In comparison with PD patients, CS presented a significantly higher increase of the mean cerebral blood flow velocities in the MCA after the BP drop. Mean velocities were increased above the initial values in all CS, whereas a flattened curve was observed in PD patients. No significant differences could be further observed between the PD patients regarding the BP, the cerebrovascular resistance, the heart rate and the pulsatility index. These results provide evidence of an impaired cerebral autoregulation in PD patients which appears independent of dopaminergic treatment

Combined antiviral-immunosuppressive treatment in human T-lymphotrophic virus 1-Sjögren-associated myelopathy

In several studies, antiretroviral drugs (principally zidovudine) have been used with success in the treatment of myelopathy associated with human T-lymphotrophic virus 1 (HTLV-1) (tropical spastic paraparesis-HTLV-1-associated myelopathy). The retrovirus HTLV-1 has been implicated as a causative agent of Sjögren syndrome (SS) in clinical reports and murine experiments. Moreover, a recognized complication of primary SS is a myelopathy, which has been shown in case reports to respond to immunosuppressive treatment