Perioperative Stroke in the Brain and Spinal Cord Following an Induced Hypotension

A 49-year-old woman presented with stupor and paraplegia following an induced hypotension. The temporal relationship to the induced hypotension and the absence of a clear embolic source on diagnostic tests support a causal association between the hypotensive episode and the ischemic infarct. However, despite the association, a cause-and-effect relationship could not be automatically inferred.

Levosulpiride-induced Parkinsonim

The present report discusses four cases of chronic renal failure, which developed symptoms of parkinsonism in response to levosulpiride. The temporal relationship between levosulpiride discontinuation and the disappearance of parkinsonism suggests a causal link. In addition, decreased striatal dopamine transporter bindings assessed by [I-123] IPT SPECT were observed in two patients suggesting that a dopamine blocking agent causes the dysfunction of nigrostriatal dopaminergic neurons and that such injury may be involved in the pathogenesis of drug-induced parkinsonism.

A Case of Myasthenia Gravis after Allogeneic Bone Marrow Transplantation

A 38-year-old woman, affected by chronic myeloid leukemia, received a BMT from his HLA identical brother. A mild acute graft-versus-host disease (GVHD) developed during the first month after the BMT. A typical clinical and electrophysiological feature of myasthenia gravis (MG) developed 3 months after the BMT requiring medication with pyridostigmine and steroids. Laboratory findings including acetylcholine receptor antibody and other autoantibodies were negative. MG is a well-characterized autoimmune disease which, on rare occasions, is also diagnosed as chronic GVHD after BMT. We report a first case of MG during an acute GVHD period. Since the patient had a myasthenic symptom during an acute GVHD period and no evidence of antibody mediated autoimmunity, this is likely to be an immune complication of acute GVHD. (J Korean Neurol Assoc 19(1):60~61, 2001