Zoster paresis.

Herpes zoster (HZ) is essentially a viral disease of the posterior root ganglia and sensory nerve fibers, which presents clinically with vesicular eruption of the skin, radicular pain and sensory changes in the distribution of the affected ganglion. However, motor involvement can be seen as well. If classic cutaneous lesions are present, HZ-related motor paresis is easily diagnosed. Otherwise, the diagnosis may be suspicious, especially if the weakness occurs before the cutaneous lesions have appeared, or weeks after they have subsided. We present a patient with HZ-related motor paresis due to radiculopathy in the cervical segments whose motor symptoms and signs appear as major clinical features.

Antioxidant status in cerebrovascular accident.

Ischemia is associated with the pathological changes caused by the accumulation of reactive oxygen metabolites (ROM) in cerebrovascular accident (CVA). The aim of this study was to determine red cell copper/zinc-superoxide dismutase (Cu/Zn-SOD) and catalase activities and copper and zinc concentrations both in plasma and in red cells in CVA. Cu/Zn-SOD and catalase activities of 16 patients, with an average age of 64 yr, were measured spectrophotometrically; copper and zinc concentrations were determined by atomic absorption spectrophotometer. The results showed that Cu/Zn-SOD activity was increased markedly in patients compared to the young controls and reached a peak on the d 5 of the disease, whereas the catalase activity of the patients on d 3 and d 5 were in the normal range, but higher on d 10. The enzyme activities of the elderly group were generally increased compared to the young controls. Copper and zinc concentrations showed corresponding alterations. These findings suggested that the effects of oxidative stress in CVA might be reflected in red cell and plasma parameters.

Effect of sodium valproate on somatosensory evoked potentials in juvenile myoclonic epilepsy.

We analysed somatosensory evoked potentials (SEPs) in the patients with juvenile myoclonic epilepsy (JME) in order to find out if sodium valproate (VPA) affects SEP latencies and amplitudes. SEPs were studied in 23 patients with JME receiving VPA monotherapy, eight patients with JME not receiving VPA, and a control group consisting of 20 healthy subjects. The N20, P24, and N34 latencies bilaterally were significantly prolonged in the JME group receiving VPA as compared with the control group. In the untreated patients the P24, and N34 latencies bilaterally and the N20-P24 interpeak latency on the right, were significantly prolonged as compared with the control group. In addition, in the patient group without treatment, the N20-P24 amplitudes bilaterally and the P24-N34 amplitudes from left sided median nerve stimulation, were greater as compared with the control group. In the SEP latencies, no significant differences were observed between the patients treated and untreated with VPA. Regarding SEP amplitudes, in the untreated group, while the N20-P24 amplitudes from right sided median nerve stimulation were significantly enhanced, all the other amplitudes also showed increase, even insignificant, as compared with the patients treated by VPA. These findings suggest that the SEPs latencies are prolonged, and the amplitudes are enhanced in JME. The changes of the SEPs latency in JME could be due to abnormal synaptic transmission and not influenced by VPA. On the other hand, the increase of the amplitude tends to be lowered by VPA.

Wernicke's encephalopathy due to hyperemesis gravidarum: an under-recognised condition.

We present a case of a 25-year-old woman with drowsiness, nystagmus, severe ataxia and areflexia, which developed six weeks after admission to an obstetric clinic for hyperemesis gravidarum. She had been treated with intravenous dextrose and electrolyte solutions and antiemetics. Magnetic resonance imaging (MRI) performed on the fifth day of her neurologic symptoms showed increased intensity in both thalami, periaqueductal grey matter, the floor of the fourth ventricle and superior cerebellar vermis in T2 weighted and FLAIR images. Clinical signs and MRI findings were consistent with the diagnosis of Wernicke's encephalopathy. On the third day of thiamine replacement, neurologic signs improved dramatically In addition to our case, we review 29 previously reported cases of Wernicke's encephalopathy associated with hyperemesis gravidarum, and emphasize the importance of thiamine supplementation to women with prolonged vomiting in pregnancy especially if they are given intravenous or parenteral nutrition.

EMG needle causes severer pain in the end-plate region compared to the silent site of the muscle.

We investigated the severity and the quality of pain in the end-plate and the electrically silent site during electromyography by self-assessment. In 42 muscles of 30 patients, the mean pain score was 52.0 +/- 5.3 of 100 for the end-plate region, and it was 27.7 +/- 4.8 for the silent site. The commonest type of pain was pricking both in the end-plate region and the silent site (19 and 31%, respectively). We suggest two hypotheses for the difference. The pain fibers may be more densely situated in the end-plate, or muscle fiber contraction precipitated by needle irritation may also cause irritation of pain fibers.

In-111 platelets used in evaluation of emboli and thrombi in patients with cerebrovascular accident.

Studies with In-111 platelets were conducted to evaluate pulmonary embolus, deep vein thrombus and cardiac thrombus. This study aimed to evaluate active thrombi and possible new emboli in patients with cerebrovascular accident (CVA) in the first 24 hours by using autologous In-111 platelets. Twenty-five patients were included in the study. Carotid artery thrombi observed in 10 patients with this technique were confirmed by Doppler ultrasonography. Intracranial thrombi appearing in 3 cases were verified by X-ray computed tomography (CT). Scintigraphy of 8 patients who showed findings suggesting CVA in CT revealed no abnormal accumulation. This was attributed to the possibility that they were small in size, deep in location and/or were also quite aged. Abnormal accumulations observed in the lungs of 3 patients and in the mediastinum and pelvis in one patient were verified by other radiological methods. In-111 platelet study was found to be useful in patients with CVA to evaluate the active thrombi and possible emboli in the early period before clinical symptoms appeared.

Hemidystonia secondary to cervical demyelinating lesions.

Hemidystonia is usually associated with a structural lesion in the contralateral basal ganglia. We report a patient with definite multiple sclerosis, according to Poser's criteria, presenting with an acute-onset sustained left hemidystonia. Cranial T2-weighted magnetic resonance imaging (MRI) showed several hyperintense lesions in the centri semiovali and in the periventricular area without basal ganglia involvement. Moreover cervical spinal cord T2-weighted MRI showed two hyperintense lesions in the left posterolateral spine at C2 and C3, and one lesion in the right posterolateral spine at C4 levels. The hemidystonia improved completely after daily treatment with 1000 mg of methylprednisolone, and cervical MRI was performed after the improvement which showed that the lesions had become smaller and less intense. Finally we consider that the hemidystonia may be caused by the cervical spinal cord lesions of multiple sclerosis.

Influence of disease duration on visual evoked potentials in migraineurs.

OBJECTIVE: To determine the possible influence of the duration of migraine on pattern-reversal visual evoked potentials. METHODS: An investigation was conducted in 49 patients with migraine without aura according to the International Headache Society criteria. Twenty-two of these patients had had migraine for 2 years or less (group 1), and the other 27 patients had had the disease for 10 years or more (group 2). The control group consisted of 17 healthy subjects. RESULTS: Comparison of the mean P100 latency and amplitude showed no significant difference among the groups. There was, however, a good negative correlation between age and latency (r = -0.59, P =.003) in group 1, but no such correlation was observed for group 2 or the control group. CONCLUSIONS: It was concluded that the duration of migraine has no influence on pattern-reversal visual evoked potentials and that the pathogenesis of early- and late-onset migraine may be different.

Difference of disability between electrophysiologic subgroups of essential tremor.

OBJECTIVE: The aim of the study was to test the validity of the controversial subdivision of essential tremor (ET) patients into electrophysiological subgroups. METHODS: We evaluated a hundred patients with ET using surface electromyographic (EMG) recordings of antagonists forearm muscles and distinguished three groups: the first group showed synchronous activity of antagonistic muscles, the second showed alternating activity of antagonist muscles; and the third group consisted of patients whose EMG recordings were not compatible with the other two groups. We compared patients with synchronous and alternating activity in terms of sex, age at onset, duration of illness, family history of tremor, symmetry and frequency of tremor, and the scores of a disability scale. RESULTS: The only significant difference between the patients with synchronous and alternating activity was that the patients with synchronous activity were more disabled. CONCLUSION: This result adds to the evidence for distinct electrophysiological subgroups of ET with distinct clinical properties.

Isolated nuclear oculomotor nerve syndrome due to mesencephalic hematoma.

Unilateral third nerve palsy with bilateral superior rectus paresis and bilateral ptosis is a typical condition for nuclear oculomotor nerve syndrome. We report a case of nuclear oculomotor nerve syndrome due to midbrain hemorrhage, as a rare cause. A 73-year-old man presented with an abrupt onset of double vision and difficulty opening his eyes. He had uncontrolled hypertension in his history. Neurological examination revealed right oculomotor palsy with impairment of bilateral upward gaze and bilateral ptosis. MRI showed a mesencephalic area of increased T1 signal and decreased T2 signal consistent with a subacute hematoma. It is emphasized that isolated mesencephalic hemorrhage may be the cause of the nuclear oculomotor nerve syndrome without associated neurological signs.

Functional imaging in reading epilepsy: a case report.

Reading epilepsy is an uncommon epileptic syndrome preferentially related to the temporoparietal region of the language dominant hemisphere. We report ictal and interictal brain perfusion SPECT images in a 28-year-old woman who was reading epilepsy.

The one-and-a-half syndrome in systemic lupus erythematosus.

We report a case of one-and-a-half syndrome occurring as the first manifestation of central nervous system (CNS) involvement in systemic lupus erythematosus (SLE). The lesion in the pons was documented with magnetic resonance imaging (MRI). The patient responded quite satisfactorily to high-dose i.v. methyl-prednisolone therapy.

Antioxidant defence system in a patient with cerebrovascular accident.

The increased production of reactive oxygen metabolites in the central nervous system may result in cellular damage and vascular-parenchymal injury. Vascular injury is also a cause of the vasoregulation deficiency. In this case report, a 60-year-old woman was admitted to the department of neurology, with a diagnosis of cerebrovascular accident. During 18 days of follow-up, the status of the antioxidant system was determined by measuring red cell superoxide dismutase and catalase activity. Red cell and plasma copper, zinc and magnesium concentrations were also measured. Red cell superoxide dismutase activity increased markedly by Day 2, reached a peak on Day 6 before decreasing to normal 18 days after the injury. Red cell catalase activity was below normal values during the whole of the 18-day study period and was at its lowest between days 6 and 7. Plasma copper, zinc and magnesium concentrations showed corresponding alterations.

Sneddon's syndrome associated with anticardiolipin antibody: a case report.

We report the case of a young man suffering from the rare combination of livedo reticularis and recurrent ischemic cerebrovascular disease (Sneddon's syndrome). He also had a circulating anticardiolipin antibody. in the absence of systemic lupus erythematosus, we suggest the likelihood of a primary antiphospholipid syndrome.