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1.
Ir J Med Sci ; 187(3): 777-780, 2018 Aug.
Article in English | MEDLINE | ID: mdl-29307101

ABSTRACT

BACKGROUND: Patients with 'suspected viral encephalitis' are frequently empirically treated with intravenous aciclovir. Increasing urea and creatinine are 'common', but rapidly progressive renal failure is reported to be 'very rare'. AIMS: To describe the clinical course and outcome of cases of aciclovir-induced acute kidney injury (AKI) encountered by the Liaison Neurology Service at AMNCH and to highlight the importance of surveillance and urgent treatment of this iatrogenic complication. METHODS: Retrospectively and prospectively collected data from the Liaison Neurology Service at AMNCH on patients who received IV aciclovir for suspected viral encephalitis and developed AKI were analysed. Aciclovir-induced AKI was defined by a consultant nephrologist in all cases as a rise in serum creatinine of > 26 µmol/L in 48 h or by ≥ 1.5 times the baseline value. Renal function, haematocrit, and fluid balance were monitored following AKI onset. RESULTS: Data from 10 patients were analysed. Median time to AKI onset was 3.5 days (range: 1-6 days). Aciclovir was stopped or the dose adjusted. All patients recovered with IV normal saline, aiming for a urine output > 100-150 ml/h. The interval between first rise in creatinine and return to normal levels varied between 5 and 19 days. CONCLUSIONS: Liaison neurologists and general physicians need to be aware that aciclovir may cause AKI attributed to distal intra-tubular crystal nephropathy. Daily fluid balance and renal function monitoring are essential because AKI may arise even with intensive pre-hydration. Prognosis is good if identified early and actively treated.


Subject(s)
Acute Kidney Injury/chemically induced , Acyclovir/adverse effects , Acyclovir/therapeutic use , Antiviral Agents/adverse effects , Antiviral Agents/therapeutic use , Encephalitis, Viral/drug therapy , Acute Kidney Injury/pathology , Acute Kidney Injury/virology , Adolescent , Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Prognosis , Retrospective Studies , Young Adult
2.
Neurology ; 81(21): e154-8, 2013 Nov 19.
Article in English | MEDLINE | ID: mdl-24249794

ABSTRACT

A 50-year-old right-handed retired family business manager developed progressive left-sided weakness over 5 days after a mechanical fall. She remembered catching her foot on the carpet and falling down a flight of stairs, followed by severe neck pain over C4-C5 and inability to get up for nearly an hour. Over the subsequent month her symptoms progressed and she presented to hospital with an asymmetric spastic paraparesis, loss of pinprick sensation in her arms and legs, loss of vibration sense to both hips, and double incontinence.


Subject(s)
Amyotrophic Lateral Sclerosis/diagnosis , Frontotemporal Dementia/diagnosis , Amyotrophic Lateral Sclerosis/complications , Amyotrophic Lateral Sclerosis/genetics , Diagnosis, Differential , Fatal Outcome , Female , Frontotemporal Dementia/complications , Frontotemporal Dementia/genetics , Humans , Memory Disorders/diagnosis , Memory Disorders/etiology , Middle Aged , Quadriplegia/diagnosis , Quadriplegia/etiology
4.
J Neurol Neurosurg Psychiatry ; 78(9): 980-3, 2007 Sep.
Article in English | MEDLINE | ID: mdl-17702779

ABSTRACT

BACKGROUND: Most patients with adult onset primary torsion dystonia (AOPTD) have the sporadic form of the disease. They may however be the only manifesting family members of a poorly penetrant genetic disorder. Sensory changes, including structural abnormalities of the primary sensory cortex, are found in AOPTD. Spatial discrimination threshold (SDT), a measure of sensory cortical organisation, is abnormal in AOPTD and in unaffected relatives of patients with familial AOPTD. Our hypothesis was that abnormal SDTs might be found in unaffected relatives of patients with sporadic AOPTD. METHODS: SDTs were assessed at the index finger bilaterally by a grating orientation task. Normal age related SDTs were derived from 141 control subjects aged 20-64 years. SDTs were considered abnormal when greater than 2.5 SD above the control mean. In total, 105 of 171 (61%) eligible unaffected siblings and offspring of patients with cervical dystonia had SDT examined. RESULTS: Fourteen of 48 siblings (29%) and 10 of 57 (18%) offspring were found to have an abnormal SDT. Only five of the 20 patients examined had abnormal SDTs. In 11 of the 25 families, no abnormality was found in an unaffected relative. In the 14 families where at least one unaffected relative had an abnormal SDT, 14 of 37 siblings (38%) and 10 of 33 offspring (30%) had abnormal SDTs. CONCLUSION: Sensory abnormalities found in unaffected relatives of patients with apparently sporadic AOPTD may be a surrogate marker for the carriage of an abnormal gene.


Subject(s)
Dystonic Disorders/genetics , Dystonic Disorders/physiopathology , Sensation/physiology , Space Perception/physiology , Adult , Case-Control Studies , Female , Heterozygote , Humans , Male , Middle Aged , Phenotype
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