Metronidazole-Induced Encephalopathy With Probable Crohn Encephalitis: A Case Report.

OBJECTIVES: Metronidazole central nervous system toxicity is a rare finding in patients receiving the medication. We report a peculiar case of metronidazole central nervous system toxicity in which both the underlying condition (Crohn disease) and the drugs used to treat it are potential causes of encephalopathy. METHODS: A 26-year-old female with 6-year history of Crohn's disease for 6 years presented acute-onset encephalopathy. We provide bibliographic evidence to support metronidazole toxicity and potential Crohn disease-associated neurologic involvement. RESULTS: The patient presented dystonia, cerebellar ataxia, and altered mental status. Magnetic resonance imaging of the brain revealed typical findings of metronidazole toxicity and white matter involvement of the centrum semiovale. Immunoelectrophoresis and immunofixation of serum and cerebrospinal fluid proteins were consistent with a systemic inflammatory process. We concluded on an association between drug toxicity and probable Crohn-associated neurologic involvement. Metronidazole was stopped and the patient was placed on vitamin therapy and diazepam to control dystonia. She deteriorated and was transferred to the intensive care unit where she expired. CONCLUSIONS: Acute behavioral changes in a young patient constitute an emergency and differential diagnoses should include infective, inflammatory, metabolic, and toxic causes. Metronidazole is a potential toxic etiology.

Sternal Puncture-Induced Acute Spinal Cord Syndrome in a Myeloma-Remissive Patient Revealing Pott Disease: A Case Report.

Cord compression is not a known complication of sternal puncture. We report the case of a patient with a history of multiple myeloma who presented acute onset paraplegia brought on during sternal puncture. Neuroimaging revealed focal spondylodiscitis and cord compression by an abscess. Neurosurgical decompression was not carried out on the patient because of her fragile general state of health and tardy consultation. Workup revealed the patient in remission from her multiple myeloma thus making decompressive radiotherapy unnecessary. The diagnosis of Pott disease was made by taking into account the clinical presentation, spine imaging and extra neurological imaging findings. Empiric anti-tuberculosis treatment was initiated which resulted in spectacular outcomes with a patient being able to walk with little aid by the end of her nine-month treatment course.

Chronic Cephalalgia-Parkinsonism Complex Revealing a Meningioma in a Young Patient: A Case Report.

The emergence of parkinsonism in a patient with an intracranial meningioma is indeed an uncommon occurrence. Here, we detail the case of a patient experiencing parkinsonian syndrome for four years without any observable clinical improvement following medical treatment. A magnetic resonance imaging (MRI) of the brain revealed a left intracranial meningioma. The successful complete surgical removal of the tumor led to the resolution of parkinsonian syndrome. The extent of the neoplasm and the surrounding peritumoral edema could potentially exert significant pressure, thereby compromising perfusion in the basal ganglia region. This clinical case serves as an exemplar, emphasizing the criticality of identifying specific red flags that necessitate further clinical investigations in the context of parkinsonian syndrome.

Stroke in young adults: about 128 cases.

UNLABELLED: Ischemic stroke is rare in young adults, but it is genuinely a serious situation giving the fact that it touch a very active part of our society. We report a series of 128 cases. The purpose is to analyze the risk factors, etiologies and outcomes of ischemic stroke in young adults in Marrakesh. Retrospective study performed at the Neurology department Mohammed VI universitary hospital in Marrakesh interesting 128 patients. The diagnosis of ischemic stroke was assessed through clinical and radiological confrontation. RESULTS: The age of our patients varied from 18 to 45 years old, 76 males and 52 females giving a male: female ratio of 1:46. Hypertension was the first risk factor involved with 63 (49.2%) cases, followed by smoking with 52 (40.6%) patients. The causes of ischemic stroke were characterized by the predominance of the cardio embolic origin with 43 (33.5%) cases, the existence of 14 (11%) cases of syphilitic arthritis, and the 52 (40.6%) cases of unknown etiologies. The authors stress the difficulties faced on supporting ischemic stroke in southern Morocco in particular when concerned by the etiological finding and the rehabilitation after the acute phase of the stroke. Our study points out the high incidence of embolic heart disease in our context. The lack of neurologists, low coverage of the population and the underestimation by physicians are factors that can explain why ischemic stroke remain undiagnosed.