ABSTRACT
BACKGROUND: Neuromuscular disease is a common manifestation of human immunodeficiency virus infection and acquired immunodeficiency syndrome, but isolated and severe pathology confined to the motor roots or anterior horn cells are not a recognized clinical entity. OBJECTIVE: To describe the novel clinical presentation of human immunodeficiency virus-related polyradiculopathy manifesting as isolated severe motor symptoms confined to the legs. DESIGN: A case series comprising 4 patients identified prospectively during a 6-month period. SETTING: Patients were seen in the Department of Neurology, Groote Schuur Hospital, Cape Town, South Africa. This is an 800-bed teaching hospital, with approximately 5000 patients seen annually in the Department of Neurology. PATIENTS: Patients were identified by their unique presentation with a severe isolated motor neuropathy in the lower limbs. All were Xhosa-speaking African women. RESULT: Early human immunodeficiency virus infection may be associated with pure motor lumbosacral polyradiculopathy. CONCLUSION: It remains unclear whether this clinical syndrome should be regarded as a variant of the Guillain-Barre syndrome or whether it represents a unique disorder associated with early human immunodeficiency virus infection.
Subject(s)
HIV Infections/complications , Polyradiculopathy/diagnosis , Polyradiculopathy/etiology , Adult , Female , HIV Infections/diagnosis , Humans , Leg , Lumbosacral Region , Magnetic Resonance Imaging , Muscle Weakness/etiology , Neurologic Examination , Prospective Studies , Reflex, Abnormal , Remission, Spontaneous , South Africa , Spinal Cord/pathologyABSTRACT
Spasticity may be relieved by both non-surgical and surgical treatment. Neurosurgical techniques endeavour to either increase inhibition or to reduce facilitation of anterior horn cell activity.
Subject(s)
Motor Neurons/surgery , Muscle Spasticity/surgery , Humans , Spinal Nerve Roots/surgeryABSTRACT
Separated lymphoid cells from patients suffering from multiple sclerosis (MS) were co-cultivated with various cell lines. Over 80% of such co-cultivations showed destruction of the tissue-culture monolayers, whereas less than 5% of "normal" blood co-cultivation behaved in the same manner. Because of the possible involvement of virus in the aetiology of MS, many positive co-cultivations were 1) examined electron-microscopically, but no virus particles were seen; and 2) tested for measles and herpes viruses using immunofluorescent techniques, but these also proved negative. Leukocytes from stroke patients showed monolayer destruction in about 50% of cases. Granulocyte contamination was high in the stroke blood samples. Reduction of granulocyte numbers to "normal" levels completely abrogated the effect in the stroke samples, but had no effect on the MS co-cultivations. Monolayer destruction by MS leukocytes also appeared not to be due to lymphotoxin.
Subject(s)
Leukocytes/immunology , Multiple Sclerosis/immunology , Cell Line , Cerebrovascular Disorders/immunology , Fluorescent Antibody Technique , Granulocytes/immunology , Humans , Leukocyte CountABSTRACT
BACKGROUND: Immunosuppressive (IS) therapy is increasingly advocated in the treatment of myasthenia gravis (MG). This study assessed whether early 'high-dose' IS therapy in new patients with generalised MG (GMG) altered the outcome and reduced the morbidity of GMG. METHODS: Patients with GMG were treated with 'high-dose' IS therapy (prednisone < or = 1 mg/kg, azathioprine 2-3 mg/kg) and followed up for 2 years. Prednisone and azathioprine were initiated on diagnosis. Outcome measures were compared with those of controls previously treated at our clinic with 'low-dose' IS therapy. The primary outcome measure was the number of patients in remission at 1 and 2 years. Secondary outcomes included the MG scores (MGS) after 1 and 2 years, as well as the number of plasma exchanges (P/E), hospital and intensive care unit (ICU) admissions required for decompensated MG. FINDINGS: At 1 and 2 years there were significant improvements in the MGS of patients treated with 'high-dose' IS therapy compared with those of controls; 50% of these patients were in remission after 2 years compared with less than 16% of controls. The number of hospital and ICU admissions had also dropped significantly in the first year of patients receiving 'high-dose' IS treatment. CONCLUSION: Early 'high-dose' IS therapy using azathioprine and prednisone in GMG resulted in a significant increase in the number of patients in remission and reduced morbidity at 1 and 2 years.
Subject(s)
Anti-Inflammatory Agents/therapeutic use , Azathioprine/therapeutic use , Immunosuppressive Agents/therapeutic use , Myasthenia Gravis/drug therapy , Prednisone/therapeutic use , Dose-Response Relationship, Drug , Drug Administration Schedule , Female , Humans , Male , Myasthenia Gravis/classification , Prospective Studies , Severity of Illness Index , Treatment OutcomeABSTRACT
A 47-year-old man developed progressive renal impairment after a series of seven generalised tonic-clonic seizures. The patient did not become oliguric and because recovery of renal function was rapid, dialysis was not required. The diagnosis of myoglobin-induced renal failure was made on the basis of markedly elevated muscle enzyme values, and myoglobin in the urine.