Some aspects of HTLV-1 infection in Natal, South Africa.

Doctoral Degree. University of KwaZulu-Natal, Durban.Abstract available in PDF.Publications listed on page v-vi

Autoimmune encephalitis: a missed diagnostic and therapeutic opportunity

Encephalitis is a common clinical problem affecting 5 cases per 100 000 population annually. After exclusion of the usual infective causes, a number of cases remain unexplained. It has been observed that many such cases have an autoimmune basis resulting in disruption of synaptic and ion channel function. This diagnosis should be suspected based on subacute onset, short term memory loss, altered mental status or psychiatric symptoms in combination with new focal neurological deficits, new onset seizures, CSF pleocytosis or MRI features suggestive of encephalitis. As this is a treatable condition, with a good prognosis if recognised early, it is important not to miss the diagnosis.Keywords: Autoimmune encephaliti

Reversible syndrome of extrapyramidal movement disorders with bilateral basal ganglia lesions in uremia: a case series and review of the literature

Background: The distinct clinicoradiological syndrome of reversible basal ganglia lesions associated with extrapyramidal movement disorders in uremic patients has rarely been described in the literature. There have been no reported cases from Africa.Methods: This study is a retrospective analysis of uremic patients presenting with extrapyramidal movement disorders in Durban, South Africa from 2003 to 2016. A review of all published studies was also undertaken.Results: Seven patients who presented with this syndrome were identified. An additional 41 cases were reported in the literature. Our seven cases showed similar characteristics to those previously reported. All patients were of Asian ethnicity and had dialysis dependent renal failure, 86% (6/7) due to diabetic nephropathy. The most frequent presentation was parkinsonism (5/7) followed by chorea (1/7) and dystonia (1/7). Typical neuroimaging findings included bilateral symmetrical basal ganglia abnormalities that were hypodense on computed tomography scan, and T1 hypointense and T2 hyperintense on magnetic resonance imaging. A key feature of this syndrome is its reversibility with supportive treatment; Clinical improvement was observed in 86% (6/7), which was accompanied by radiological regression of lesions in two patients who underwent follow-up imaging.Conclusions: The syndrome of acute extrapyramidal movement disorders in uremic patients with bilateral basal ganglia lesions presents with typical clinical and radiological findings. Awareness of this syndrome especially in Asian diabetic patients with renal failure is important for early recognition and appropriate supportive management to aid its resolution.Keywords: Basal ganglia, diabetic nephropathy, extrapyramidal, magnetic resonance imaging, renal failur

Clinico-pathological evaluation of two patients presenting with the neuromyelitis optica syndrome

The discovery of the Aquaporin 4 (AQP4) antibody in patients with neuromyelitis optica (NMO) has expanded clinical spectrum of disorders associated with this antibody. It has also become clear that NMO can be a paraneoplastic manifestation of an underlying malignancy. We report on the pathological changes in the spinal cord in an NMO patient who underwent a biopsy for a suspected spinal tumour. We also present the findings in the testicular tumour of a patient who initially presented with NMO. In the first patient we demonstrate the loss of AQP4 staining and in the latter case we demonstrate the expression of AQP4 by tumour cells.Keywords: Aquaporin 4 antibodies, NMO, paraneoplastic disorde

POSSIBLE MYASTHENIA AND LEMS IN THE SAME PATIENT :CASE REPORT AND REVIEW OF THE LITERATURE

ABSTRACT Myasthenia gravis (MG) together with Lambert-Eaton myasthenic syndrome (LEMS) in the same patient is rarely described. This is a case report of a patient who initially presented with myasthenia gravis and later complicated with presumably auto-immune LEMS. The patient was noted to be HIV positive. The interest lies in the behaviour of MG in immunocompromised patients and the electrophysiological changes at the neuromuscular junction in patients with both MG and LEMS. We present a patient who is HIV positive with a long history of MG and a possibly a more recent diagnosis of LEMS. RESUME L'association myasthénie et syndrome de Lambert-Eaton chez un patient est rarement décrit. Nous rapportons le cas d'un patient, VIH positif, s'étant présenté initialement par une myasthénie, complétée ultérieurement par un syndrome de Lambert Eaton vraisemblablement d'origine auto-immune et discutons les liens éventuels, au plan pathogénique. Key words: Myasthenia Gravis, Lambert Eaton myasthenic syndrome, HIV, Myasthénie, syndrome de Lambert-Eaton, virus d'immunodéficience acquise, VIH African Journal of Neurological Sciences Vol.23(2) 200