A Case of Myasthenia Gravis associated with Idiopathic Thrombocytopenic Purpura

Myasthenia gravis has been associated with a variety of autoimmune diseases, but the association of myasthenia gravis with idiopathic thrombocytopenic purpura has been rarely reported. A previously healthy 33-year-old female presented with a 10-month history of easy fatigability, motor weakness, diplopia and menorrhage. Clinical and labora-tory findings supported the diagnosis of myasthenia gravis and idiopathic thrombocytopenic purpura. After a thymecto-my, there were surprising improvements not only in muscle strength, but also of thrombocytopenia. Though this associ ?ation may be incidental, the patient's progress suggests that idiopathic thrombocytopenic purpura may be closely relat-ed to myasthenia gravis immunologically because both diseases developed simultaneously and showed good therapeu-tic responses after a thymectomy.

Two Cases of Respiratory Failure After Recovery of Cholinergic Crisis in Organophosphate Poisoning: The Intermediate Syndrome / 결핵

Respiratory failure is the most serious manifestation and usual cause of death in acute organophosphate poisoning, and is common in acute cholinergic crisis. But the respiratory failure may appear suddenly in a patient who is recovering from the cholinergic crisis, even while receiving conventional therapy. These are case report of 37 years old male and 24 years old female with intermediate syndrome in organophosphate poisoning. The two patients ingested organophosphate(fenthion and mixture of DDVP with chlorpyrifos respectively) incidentally and in a sucide attempt respectively. After apparent recovery from the cholinergic crisis with a conventional therapy but before the expected onset of delayed polyneuropathy , the respiratory failure appeared suddenly with a muscular weakness, affecting predominantly the proximal limb muscles, neck flexors, territories of several motor cranial nerves. The two patients needed mechanical ventilatory support and recovery from the intermediate syndrome was complete in both patients, although one subsequently developed hypoxic encephalopathy. The clinical manifestation and electrophysiologic study support the clinical diagnosis of intermediate syndrome. The syndrome carries a risk of death, because of respiratory paralysis, if not recognized early and treated adequatedly. Prompt endotrachial intubation and mechanical ventilatory support is the cornerstone of treatment of the intermediate syndrome. Therefore, all patient should be observed in a hospital for up to 5 days after poisoning.

Herpes zoster meningoencephalitis with decreased CSF glucose level-A case report and review of literatures

We report a case of decreased cerebrospinal fluid glucose with lymphocytic pleocytoisis in a patient with herpes zoster meningoencephalitis. The finding was likely to be confused with that of tuberculous meningoencephalitis. The concentration of CSF glucose is a critical point in the differential diagosis of various causes of nervous system infection. Although the herpes zoster meningoencephalitis isa well recognized, cases with markedly low, level of CSF glucose has been rare. We reviewed such unusual cases in the literature that were accompanied by hypoglycorrhachia. The duration of hypoglycorrhachia was transient. This suggests a differential point from that of tuberculous meningitis.

A Case of Cerebral Infarction Following Ingestion of Urushiol

Rhus has been known to one of the most frequent plants which produce allergic contact dermatitis. Allergenic component of thus is urushiol which is composed of catechols with a 15-carbon-atom side-chain. Systemic administration can produced hematogenous contact dermatitis and also severe systemic reactions such as drowsiness, convulsion, nausea, vomiting, glomerulonephritis and urticaria. We experienced a case of right anterior and posterior watershed cerebral infarction, generalized urticaria and allergic contact dermatitis following ingestion of urushiol.

A Case of Nonsystemic Vasculitic Neuropathy: Electrophysilogic and Pathologic Findings

In nonsystemic vasculitic neuropathy, clinically only nerves are affected : there are no or few constitutional symptoms or serological abnormalities. The clinical and pathological features are those of an ischemic neuropathy caused by a necrotizing vasculitis of small arterioles. This is a case report of nonsystemic vasculitic neuropathy in a 22-year-old male who has the distal symmetric poIyneuropathy as a symptom of localized vsaculitis. The sural nerve biopsy showed a few myelin digestion chamber suggesting axonal degeneration. The patient was treated with steroid daily with gradual clinical and electorophysiological improvement.

Three Cases of Adrenoleukodystrophy

Adrenoleukodystrophy is an inborn error of metabolism characterized by adrenal insufficiency and progressive demyelmation of brain white matter and peripheral nerves. Authors experienced three cases of adrenoleukodystrophy in a 7 year old boy, a 17 and a 210 year old males that were diagnosed by increased plasma content of very long chain fatty acid(VLCFA). The clinical symptoms include seizure, visual impairment, and hemiparesis. Two cases showed typical radiological findings and sural nerve biopsy was performed in one.