Devastating Delayed Leukoencephalopathy Associated with Bath Salt Inhalation.

BACKGROUND: "Bath salts" or synthetic cathinone toxicity remains a potentially deadly clinical condition. We report a delayed leukoencephalopathy with persistent minimally conscious state. METHODS: Case report. RESULTS: A 36-year-old man presents with delayed encephalopathy, dysautonomia, fulminant hepatic failure, and renal failure from severe rhabdomyolysis after consuming bath salts. MRI showed diffusion restriction in the splenium of the corpus callosum and subcortical white matter. CONCLUSIONS: The combination of acute leukoencephalopathy, rhabdomyolysis and fulminant hepatic failure may point to bath salt inhalation and should be known to neurointensivists.

Hemorrhage or Ischemia? The Importance of 'Spotting' it Right.

BACKGROUND: A 78-year-old woman was transferred directly to an ICU because of intracerebral hemorrhage. However, on careful review of the initial imaging, the likely diagnosis was ischemic stroke and reperfusion hemorrhage. METHODS: Case report was explained. RESULTS: The patient suffered significant reperfusion hemorrhage. A CT angiogram revealed contrast extravasation "spot sign" in the bed of the expanding hemorrhage and an occlusive thromboembolism distal to the initial ischemic insult. CONCLUSION: In this case of embolic ischemic stroke with reperfusion hemorrhage, contrast extravasation "spot sign" was associated with hematoma expansion.

Epidemiology of Wheat Leaf and Stem Rust in the Central Great Plains of the USA.

Wheat (Triticum aestivum L) is grown throughout the grasslands from southern Mexico into the prairie provinces of Canada, a distance of nearly 4200 km. The total area seeded to wheat varies considerably each year; however, from 28 to 32 million ha are planted in the Great Plains of the United States alone. Generally in the central Great Plains, an area from central Texas through central Nebraska, 15 million ha are seeded to winter wheat each year. A wide range of environmental conditions exist throughout this area that may affect the development and final severity of wheat leaf rust (caused by Puccinia triticina L), stripe rust (caused by P. striiformis), and stem rust (caused by P. graminis Pers. f. sp tritici) epidemics and the subsequent reduction in wheat yields. Variation in severity of rust epidemics in this area depends on differences in crop maturity at the time of infection by primary inoculum, host resistance used, and environmental conditions. The interrelationships among time, host, pathogen and environment are complex, and studying the interactions is very difficult. Historically, cultivars with new or different leaf rust resistance genes become ineffective after several years of large-scale production within the Great Plains, and then cultivars carrying new or different resistance genes must be developed and released into production. This is the typical "boom and bust" cycle of the cereal rust resistance genes in the central Great Plains.

Models of Early Spring Survival of Wheat Leaf Rust in the Central Great Plains.

Severe leaf rust epidemics, which result in economic yield reductions in the Great Plains wheat-producing region of the United States, are usually initiated by Puccinia recondita f. sp. tritici inoculum that has survived in the local field from the previous wheat crop until early spring. Models were developed for an epidemic year beginning at physiological maturity of one wheat crop to maturity of the following wheat crop. Meteorological variables for periods prior to final tiller development of the wheat crop during 1980 to 1992 at several sites in the central Great Plains winter-wheat-production area were used to model inoculum survival from one wheat crop until early spring of the next crop. Stepwise multiple regression was used to identify weather variables that explained the most variation in inoculum survival at the final tiller development wheat growth stage. Inoculum survival was recorded on a 0 to 9 scale with 0 indicating no survival and 9 indicating inoculum on all wheat plants in the field. Independent variables used in development of models were daily deviations from the 10-year average of maximum and minimum temperature, fungal temperature equivalence function, cumulative fungal temperature function, precipitation, cumulative precipitation, and snow cover averaged for 10-day periods prior to dates inoculum forecasts were desired. Models were constructed to forecast inoculum survival from data collected prior to fall wheat planting, the beginning of winter dormancy of the wheat, and the final tiller development wheat growth stage. Of the observed occurrences of leaf rust overwintering, 70% were forecast by models constructed using weather data prior to wheat planting decision time. Overwintering could be forecast by models constructed with data prior to the wheat entering winter dormancy 80% of the time. Models constructed with data collected prior to final tiller development in the spring forecast overwintering of leaf rust inoculum 95% of the time. Results from these models will be used to develop forecasts of leaf rust epidemics and resulting yield reductions.