The neurological manifestations of Nipah virus encephalitis, a novel paramyxovirus.

A novel Hendra-like paramyxovirus named Nipah virus (NiV) was the cause of an outbreak among workers from one abattoir who had contact with pigs. Two patients had only respiratory symptoms, while 9 patients had encephalitis, 7 of whom are described in this report. Neurological involvement was diverse and multifocal, including aseptic meningitis, diffuse encephalitis, and focal brainstem involvement. Cerebellar signs were relatively common. Magnetic resonance imaging scans of the brain showed scattered lesions. IgM antibodies against Hendra virus (HeV) were present in the serum of all patients. Two patients recovered completely. Five had residual deficits 8 weeks later.

Stereotactic microelectrode-guided posteroventral pallidotomy and pallidal deep brain stimulation for Parkinson's disease.

Three patients underwent stereotactic posteroventral pallidotomy, and 1 patient underwent pallidal deep brain stimulation, for medically intractable symptoms of advanced Parkinson's disease, characterized by peak-dose levodopa dyskinesias, wearing-off fluctuations, tremor, rigidity and bradykinesia. Surgery was performed stereotactically under local anaesthesia, with eventual target coordinates derived from a combination of magnetic resonance imaging (MRI), coregistration with an electronic brain atlas, intraoperative microelectrode neuronal recordings and microstimulation before lesioning or placement of a deep brain stimulator was done. Assessment was made at baseline preoperatively and at 3-month intervals postoperatively, with Unified Parkinson's Disease Rating Scale (UPDRS) and Core Assessment Program for Intracerebral Transplantation (CAPIT) scoring. All patients improved in dyskinesia, tremor, rigidity and bradykinesia contralateral to the lesion side, but also on the ipsilateral side to a lesser extent. The improvement was largely seen in the 'off' state: UPDRS by 41%, and CAPIT by 19% on the contralateral side. 'On' freezing was not helped. There were no deaths and no visual complications, but there was one complication of a delayed contralateral upper limb dystonia after pallidotomy. The 1 patient with pallidal deep brain stimulation (DBS) obtained similar improvement as those with pallidotomy. Posteroventral pallidotomy and pallidal stimulation improves all the cardinal features of Parkinson's disease, and effectively ameliorates levodopa dyskinesias.

The profile of hospitalised patients with Parkinson's disease.

The objective of this study was to provide a profile of patients with Parkinson's disease (PD) who required admission to hospital. We reviewed retrospectively all patients with PD who were admitted to our hospital in 1995. In our study, there were 260 admissions involving 173 PD patients. The average age was 74.7 years. Of these patients, 93 were males and 80 were females. There were 150 Chinese, 12 Indians, 9 Malays, and 2 of other races. The average duration of hospitalisation was 11.7 days. The main reasons for admissions were: 1) chest infections (22%), 2) falls (13%), 3) control of PD symptoms (10%), 4) general medical problems (9%) and 5) urinary dysfunction (8%). Nine per cent were classified as Hoehn and Yahr stage 2, 31% as stage 3, 31% as stage 4 and 24% as stage 5. Twenty-one per cent of our patients were first diagnosed with PD during their hospitalisation. Upon discharge, 26% required transfer to either a community hospital or nursing home. The current in-patient load of PD patients is expected to rise with the ageing population. A significant number of people within the community may have undiagnosed PD. These patients suffer multiple medical problems and need a multi-disciplinary team approach to management. Greater resources will be required to support these patients in the community.

Creutzfeldt-Jakob disease presenting with visual blurring, diplopia and visual loss: Heidenhain's variant.

Focal electroencephalographic abnormalities as described in Heidenhain's variant of Creutzfeldt-Jakob disease are uncommon. We report a 73-year-old male presenting with visual symptoms, right hemianopia and rapidly progressive dementia. Myoclonus was synchronous with generalised periodic epileptiform discharges on electroencephalography (EEG). In addition, there were periodic focal sharp waves at the left occipital region. Diffusion-weighted magnetic resonance brain images showed slightly increased signal intensity in the occipital parasagittal area, left more than right. 14-3-3 protein was detected in the cerebrospinal fluid. The patient died within 5 months of presentation.

Sciatic neuropathies--a retrospective review of electrodiagnostic features in 29 patients.

Sciatic neuropathy is an uncommonly diagnosed focal mononeuropathy. We reviewed the aetiology and electrodiagnostic features of 29 patients studied at the Neurodiagnostic Laboratory, Tan Tock Seng Hospital from January 1989 to April 1995. External nerve compression was the most common cause (38%) followed by trauma (21%). Other rare causes in this series included intragluteal injections, hip surgery and diabetic mononeuropathy while 24% had uncertain aetiology. Electrodiagnostic studies showed preferential involvement of the peroneal division in 51%. Axonal loss was found in 97%. We conclude that sciatic neuropathy often mimics distal peroneal nerve dysfunction and neurophysiological studies are essential for diagnosis. Furthermore, these studies are necessary for assessing prognosis in relation to axonal loss.

Nuclear third nerve palsy and somnolence due to stroke--a case report.

We describe a 40 year-old male with a ball-cage mitral valve prosthesis who suddenly developed bilateral ptosis, bilateral dilated and unreactive pupils, right third nerve palsy, bilateral failure of vertical gaze, somnolence and mild ataxia without major motor deficits. Computed Tomography (CT) revealed bilateral thalamic infarcts in the distribution of the rostral basilar artery. Infarction in this case occurred despite adequate anticoagulation. The recognition of the entity of rostral basilar artery occlusion is important as interruption of anticoagulation may be avoided.

Persistent mutism and dysphagia of acute onset due to bilateral internal capsule infarction.

Acute mutism with paralysis of the bulbar and facial muscles following discrete bilateral internal capsular infarction is a rare stroke syndrome. We describe a 62 year-old male who suddenly became unable to speak or swallow. The paucity of facial expression and inability to voluntarily move the facial, lingual and pharyngeal muscles were persistent and contrasted with a relatively mild limb paresis which recovered. High resolution CT scan revealed infarcts in the posterior limbs of both internal capsules. It is important to recognise this stroke syndrome because of the permanence of dysarthria and dysphagia associated with it.

Acute sympathotonic orthostatic hypotension with recovery.

We describe a 30 year-old female who presented with severe orthostatic hypotension despite appropriate compensatory tachycardia on standing, following a viral infection. Clinical assessment and laboratory evaluation failed to detect other causes of her illness besides sympathotonic orthostatic hypotension. She responded to fludrocortisone and recovered completely after 3 months. We postulate that her acute reversible illness was due to a post-viral immunological response selectively affecting the alpha adrenergic receptors subserving the post-ganglionic sympathetic vasomotor fibres.