Female-to-female transmission of human immunodeficiency virus.

We describe a case of female-to-female transmission of human immunodeficiency virus (HIV). A 20-year-old African American woman with no obvious risk factors received a diagnosis of HIV infection, and the genotype of the infecting strain closely matched that of the strain infecting her openly bisexual female partner. The route of transmission was probably use of sex toys, used vigorously enough to cause exchange of blood-tinged body fluids.

Immune thrombocytopenia: a rare presenting manifestation of tuberculosis.

We report the case of a 49 year-old male who presented with immune thrombocytopenia (ITP)-induced epistaxis and generalized purpura. During the same hospitalization the patient was also found to have clinical, microbiological, histological, and roentgenographic evidence of disseminated mycobacterial tuberculosis (TB). The hematological and infectious abnormalities, which did not respond to high-dose intravenous corticosteroids and immune globulin (IVIg), resolved after anti-tuberculous treatment. Herein we review the characteristics of this rarely documented association.

Pentagon copying is more impaired in dementia with Lewy bodies than in Alzheimer's disease.

OBJECTIVES: In many cases the clinical differentiation of patients with dementia with Lewy bodies (DLB) from those with Alzheimer's disease (AD) has been difficult. Because many neuropsychological studies have reported greater visuospatial/constructional impairment in DLB than in AD, it was determined whether accuracy in copying the interlocking pentagons item on the mini mental state examination (MMSE) may be helpful in distinguishing patients with DLB from those with AD relatively early in the course of the dementia. METHODS: All cases of neuropathologically proved DLB and AD in the Center for Alzheimer Disease and Related Disorders brain bank were retrospectively reviewed, and the first available MMSE for each was retrieved. Only patients with MMSE scores > or = 13 were included, indicating mild to moderate dementia. The patients' copies of the interlocking pentagons were analyzed and graded as acceptable or unacceptable according to the original instructions for grading the MMSE. RESULTS: Seventeen patients with DLB and 27 patients with AD were identified for whom MMSE with copies of the interlocking pentagons were available. Two patients with DLB (MMSEs 22 and 27) drew the pentagons acceptably, by contrast with 16 of the patients with AD (MMSEs 13-28). An unacceptable copy was associated with DLB with a sensitivity of 88% and a specificity of 59% (p = 0.002). CONCLUSIONS: For patients with MMSE scores > or = 13, an inability to accurately copy the pentagons suggests that the diagnosis is more likely DLB than AD. The results confirm the work of others on visuospatial/constructional impairment in DLB and indicate that this feature may be helpful in its diagnosis.

Onset of neurologic deficits after treatment with dihydroergotamine in a patient with sagittal sinus thrombosis.

A woman with a 7-year history of intermittent migraine had 3 months of gradually worsening headaches. Initial neurologic examination including fundus examination was normal, and initial head computerized tomographic (CT) scan and magnetic resonance imaging (MRI) were thought to be normal. The patient was given dihydroergotamine (DHE-45), 1.0 mg, intravenously for relief of headache. Five hours later, she complained of severe diffuse headache and nausea. Neurologic examination showed left arm weakness and sensory loss, blurring of the left optic disc, and bilateral Babinski signs. Cerebral arteriography demonstrated thrombosis of the sagittal sinus, which in retrospect was present on the initial contrast CT scan and MRI scan. The patient's deficits worsened, and she eventually died 20 days later as a result of cerebral infarctions and increased intracranial pressure, despite attempts at selective thrombolysis of the sagittal sinus. DHE has potent venoconstrictive effects. We suspect that DHE helped precipitate neurologic deterioration in this patient with sagittal sinus thrombosis.

Electroencephalographic activity after brain death.

Fifty-six consecutive patients clinically diagnosed as brain dead were seen at Loyola University Medical Center, Maywood, Ill, from January 1984 through May 1986. Eleven (19.6%) of the 56 patients had electroencephalographic (EEG) activity following the diagnosis of brain death. The mean duration of the observed EEG activity was 36.6 hours (range, two to 168 hours). Three patterns of EEG activity were observed: (1) low-voltage (4 to 20 microV) theta or beta activity was recorded in nine (16.1%) patients as long as 72 hours following brain death. Neuropathologic studies in one patient showed hypoxic-ischemic neuronal changes involving all cell layers of the cerebral cortex, basal ganglia, brain stem, and cerebellum; (2) sleep-like activity (a mixture of synchronous 30 to 40 microV theta and delta activity and 60 to 80 microV, 10 to 12 Hz spindle-like potentials) was noted in two (3.6%) patients for as long as 168 hours following brain death. Pathologic studies in both cases demonstrated ischemic necrosis of the brain stem with relative preservation of the cerebral cortex; and (3) alpha-like activity (monotonous, unreactive, anteriorly predominant, 25 to 40 microV, 9 to 12 Hz activity) was observed in one (1.8%) patient three hours following brain death. Regardless of activity on the EEG, none of the patients recovered. The occurrence of EEG activity following brain death would suggest reliance on the EEG to confirm brain death may be unwarranted. The use of the EEG as a confirmatory test of brain death may be of questionable value.

Intracranial tumors: unexpected uptake of I-123 HIPDM.

I-123 HIPDM is a brain imaging agent thought to reflect cerebral cortical perfusion. Increased uptake of I-123 HIPDM occurred unexpectedly in two cases of intracranial tumors.

Massive retinal gliosis. A reactive proliferation of Müller cells.

Both Müller cells and astrocytes have been implicated in the dispute over the histogenesis of massive retinal gliosis. We studied three cases of massive retinal gliosis by light and electron microscopy and immunocytochemistry. Spindle fibrillary glial cells were joined by zonulae adherentes resembling those of the external limiting membrane of the retina. Furthermore, these cells produced a continuous basement membrane around an extracellular space filled with fine filaments, which was highly suggestive of vitreous cavity. In the proliferating cells, immunoperoxidase technique disclosed the presence of carbonic anhydrase isoenzyme C, characteristically found only in Müller cells. The glial cells in the preretinal membrane away from the gliotic nodule showed similar characteristics. We concluded that both the nodule of massive retinal gliosis and the associated preretinal glial membrane resulted from the proliferation and migration of Müller cells.

Neuron-specific enolase and neurofilament protein as markers of differentiation in medulloblastoma.

Immunocytochemical localization of neuron-specific enolase was performed attempting evaluation for neuronal cell differentiation in medulloblastoma. Twenty-seven cases of human medulloblastomas were stained with anti-neuron-specific enolase and antineurofilament protein serum using the peroxidase-antiperoxidase technique. All medulloblastomas showed neuron-specific enolase immunoreaction but only few had neurofilament protein-positive cells. These results suggest that a practically universal tendency towards neuronal cell differentiation occurs in medulloblastomas and that synthesis of neuron-specific enolase takes place before sufficient amounts of neurofilament protein are produced to become immunocytochemically detectable.