Descending paralysis as an atypical presentation of Guillain-Barré Syndrome.

We herein report a case of a 55-year-old man with an unusual case of Guillain-Barré Syndrome. Its presentation is usually a progression of symmetric muscle weakness that is ascending from the lower extremities making its way more proximal and accompanied by absent or depressed tendon reflexes. Here, the patient exhibited a rare presentation of Guillain-Barré syndrome, where the weakness was ascending upper extremity and descending lower extremity paralysis. The objective of this clinical case report is to highlight this extremely rare descending paralysis presentation of Guillain-Barré Syndrome.

A rare neurological complication of ranolazine.

Myoclonus is not a known side effect of ranolazine. We report a case of myoclonus in a 72-year-old female who underwent cardiac catheterization for angina and was started on ranolazine after the procedure. Two days after ranolazine therapy on 1000 mg per day in divided doses, myoclonus developed, which severely impaired her normal activity. Her symptoms resolved 2 days after discontinuation of ranolazine. Ranolazine was resumed after discharge from hospital with recurrent myoclonus after two days of therapy. The causal relationship between ranolazine and myoclonus was suggested by cessation of myoclonus after ranolazine was discontinued.

An evaluation of a novel mask in four patients with obstructive sleep apnea and overlap syndromes.

We present four cases of adults with obstructive sleep apnea in whom positive airway pressure therapy alone failed to provide adequate oxygenation. We have previously reported the use of dual mask for ventilatory support of a patient postoperatively (Porhomayon et al., 2013). Here, we report an evaluation of the dual mask in four patients with overlap syndromes. Application of dual mask provided adequate oxygenation with lower continuous positive airway pressure (CPAP)/bilevel positive airway pressure (BIPAP) pressure levels.