An unusual case of 4-aminopyridine toxicity in a multiple sclerosis patient: epileptic disorder or toxic encephalopathy?

We report the case of a 45-year old female multiple sclerosis patient, who accidentally was overdosed with 4-aminopyridine which resulted in dystonic, choreathetoid type abnormal movements in the four limbs, motoric distress, confusion and opisthotonus. There is little known about 4-aminopyridine toxicity. There are only a few reported cases ranging from mild paresthesias to tonic-clonic seizures. 4-aminopyridine enhances neuronal conduction at neuromuscular synapses and is indicated in the treatment of selected neurological disorders including multiple sclerosis (MS) and myasthenia gravis, among others.

A surgical solution to extrahepatic portal thrombosis and portal cavernoma: the splanchnic-intrahepatic portal bypass.

Three cases of prehepatic portal vein thrombosis, complicated by the clinical manifestations of portal hypertension, were successfully treated by surgically created splanchnic-intrahepatic portal bypass. Two out of three patients had been previously submitted to liver transplantation. No significant morbidity was observed and long-term Doppler evaluations proved the patency of the venous grafts. Together with the technical aspects of the procedures, the possible role of this technique, primarily proposed by De Ville de Goyet in 1992, is discussed in relation to the available therapies for the extrahepatic portal vein thrombosis.