Diabetic muscular infarct: an unusual cause of extremity pain and dysfunction.

Diabetic muscular infarct (DMI) is a rare condition, which begins with acute onset of extremity pain and swelling. Patients usually have long-standing disease and poorly controlled diabetes mellitus (DM). Thigh muscle group is the most commonly involved side, while lower leg involvement is rare. We represent herein a 22-year-old patient with type I DM who admitted to our outpatient clinic due to painful swelling of the left leg. In physical examination, anterior left leg was painful and firm on palpation; there was diffuse swelling extending to the knee and ankle with mild local fever and redness. T2-weighted MRI demonstrated hyperintensity in left leg muscles. A biopsy confirmed the diagnosis of DMI. She was treated with glucose regulation, analgesics, antiplatelet treatment and rest. At her 6 months, recurrence of DMI was observed. DMI should be considered in diabetic patients with extremity pain and swelling. Treatment plan should include the regulation of the blood glucose and evaluation of end-organ complications, analgesia, and bed rest.

POEMS syndrome with peripheral and central nervous system demyelination: case report.

INTRODUCTION: POEMS syndrome is a rare, atypical plasma cell proliferative disorder. Predominantly motor chronic demyelinating polyneuropathy and monoclonal plasma cell disease are the major clinical features of POEMS syndrome. Demyelinating lesions of the central nervous system have been reported only in 2 patients with POEMS syndrome up to now. CASE REPORT: A 71-year-old man was investigated for numbness, burning sensation, and weakness of the lower extremities. He was found to have hypertrichosis, white nails, and multiple hemangiomas in the lower extremities. Neurological examination revealed decreased strength of the proximal and distal muscles of the lower extremities and absence of deep tendon reflexes. There was a marked impairment of temperature, position, and vibration senses in the lower extremities. Romberg test was positive. Nerve conduction was markedly reduced in all extremities and needle electromyography showed denervation pattern. Cerebrospinal fluid was clear, colorless, and had no oligoclonal band. IgM kappa monoclonal gammopathy was identified in serum immunofixation electrophoresis. In bone marrow aspirate plasma cells were counted as being <2%, with normal morphology. Brain magnetic resonance imaging revealed hyperintense lesions in the regions of periventricular and subcortical white matter and thalamus. Normal TSH, T4, and T3 levels and elevated levels of antitiroglobulin antibody and antithyroid peroxydase antibody were found in the laboratory tests. Our patient was diagnosed with POEMS syndrome and treated with intermittent courses of melphalan and prednisone. CONCLUSIONS: POEMS syndrome should also be considered in differential diagnosis of patients with demyelinating brain lesions, accompanied by peripheral neuropathy. Diagnostic evaluation of patients with demyelinating polyneuropathy should include brain magnetic resonance imaging.

Effects of lamotrigine and topiramate on brain maturation and cognitive functions in offspring of pregnant rats - preliminary study.

BACKGROUND: Antiepileptic drugs (AED) which are used to treat seizures in pregnant women, infants, and young children may cause cognitive impairment or other uncertain injury. However, the precise mechanisms responsible for the negative effects of new AEDs like lamotrigine (LTG) and topiramate (TPM) in the developing brain are still unclear. OBJECTIVES: To investigate the GFAP, NCAM and S100B levels in the whole brain of newborn rats on postnatal 1 day and in the hippocampus of adult rats to find out the effect of TPM and LTG on cognitive impairment and brain maturation. MATERIAL AND METHODS: Twenty eight pregnant rats were randomly divided into 7 groups with 4 animals in each group. The first group, receiving no drugs, was assigned as the control group. The study groups received intraperitoneal TPM or LTG injections in each trimester. Western blot analysis of the GFAP, NCAM and S100B was performed in the offspring. Behavioral tests were performed at postnatal day 75. RESULTS: The rats in the TPM-I and TPM-III groups had a significant impairment in escape latency on the 5th day as compared to the control rats in a Morris water maze test. In addition, in the expression of astrocyte derived markers, GFAP was upregulated, whereas S100ß and NCAM were downregulated in the whole brain on postnatal day 1, in offspring exposed to LTG and TPM in utero. CONCLUSIONS: The detrimental effects of TPM and LTG appear to be confined particularly to the early stages of brain development. And TPM seems to have a partial role in the cognitive impairment.