Bickerstaff's brainstem encephalitis associated with IgM antibodies to GM1b and GalNAc-GD1a.

This is the first report of a case of Bickerstaff's brainstem encephalitis (BBE) associated with IgM antibodies to GM1b and GalNAc-GD1a. Subsequent to Campylobacter jejuni enteritis, the patient rapidly developed consciousness disturbance and hyperreflexia in addition to external ophthalmoplegia and cerebellar-like ataxia. EEG showed transient 7 Hz monorhythmic theta activities, predominantly in the front-central area. He received high doses of immunoglobulin intravenously and had completely recovered 3 months later. High anti-GM1b and anti-GalNAc-GD1a IgM antibody titers present during the acute phase decreased with his clinical improvement. An absorption study showed the anti-GM1b and anti-GalNAc-GD1a IgM antibodies to be cross-reactive. Anti-GM1b and anti-GalNAc-GD1a antibodies have been detected in some patients who developed Guillain-Barré syndrome after C. jejuni enteritis, whereas the anti-GQ1b IgG antibody is associated with BBE. Infection by C. jejuni bearing a GM1b-like or GalNAc-GD1a-like lipooligosaccharide may trigger the production of anti-GalNAc-GD1a and anti-GM1b IgM antibodies. It is not clear why our patient developed BBE rather than Guillain-Barré syndrome. These antibodies may, however, prove useful serological markers for identifying BBE patients who do not have the anti-GQ1b IgG antibody.

Neurologic outcome of acute measles encephalitis according to the MRI patterns.

The aim of this prospective study was to clarify the ramifications of neuroimaging patterns associated with neurologic outcomes of acute measles encephalitis. Twelve patients with neurologic complications stemming from a measles outbreak were diagnosed based on characteristic clinical features, the presence of measles-specific antibodies, and abnormal cerebrospinal fluid findings. Neuroimaging studies were then performed during the acute phase of the disease. Our subject group consisted of four males and eight females (mean age: 9.9 years). Main neurologic findings were loss of consciousness, seizures, and paralysis. Serum tests for measles-specific Ig G and M antibodies were positive in eleven patients. Neuroimages of the group revealed the following three abnormalities: (1). demyelination of white matter with hypoperfusion on interictal single-photon-emission computed tomography, (2). high signal intensity of gray matter with hypoperfusion on interictal single-photon-emission computed tomography, and (3). normal MRI with hypoperfusion on single-photon-emission computed tomography. We identified a new pattern of acute measles encephalitis that involved cortical and/or deep gray matter, and this finding suggests a variant in the pathogenesis of acute measles encephalitis. Patients that demonstrated a gray matter abnormality had a higher rate of complications and required longer periods of hospitalization.

Epidemiological and serological aspects in canine toxoplasmosis in animals with nervous symptoms.

The presence of anti-Toxoplasma gondii IgM and IgG antibodies was studied in samples of blood serum taken from eighty dogs with nervous symptoms at the Serviço de Enfermidades Infecciosas dos Animais, Faculdade de Medicina Veterinária e Zootecnia, Unesp, Botucatu, São Paulo, Brazil. The frequency of IgG titers were 16 (13.7%), 64 (13.7%), and 256 (5%), and for IgM titers were 16 (7.5%), 64 (15%), and 256 (8.7%). Positive reactions were more frequent in the older animals, males, from a rural environment, in constant contact with small animals, principally birds and rodents. There was a higher frequency of a positive reaction in dogs fed with kitchen food, especially in those fed with raw ingredients. The most common neurological pictures were alterations in consciousness, in movement, and in the hand-cart test. The percentage of reagents with specific IgM antibodies was high, indicating active infections, but the possibility of co-infection with the distemper virus can not be discarded, and this may be a predisposing factor for toxoplasmosis infection, once the distemper virus has a potent immunosuppressive action.

[Changes in peripheral lymphocytes count in unconscious patients treated at home with Japanese herbal medicines (Hozai)].

We investigated changes in peripheral white blood cells count, lymphocytes count, and serum albumin level in five unconscious patients administered Japanese herbal medicines (Hozai). The causes of unconsciousness were intracerebral hemorrhage in 3, cerebral infarction in 1, and craniopharyngioma in 1. The administered Hozai were Hotyu-ekki-to in 4 and Jyuzen-taiho-to in 1. To assess the effect of Hozai on the immune system of unconscious patients, we investigated these parameters before and after treatment. We observed normalization of WBC counts, increase of lymphocytes count, and unchanged levels of serum albumin after Hozai treatment. These findings suggest that Hozai may improve the immunological competence of unconscious patients. One of the problems affecting unconscious patients treated at home is infectious diseases, especially respiratory infections. It is considered that improvement of their immunological competence would contribute to prevent infections. These results suggest that Hozai treatment might be useful adjuvants to support the general condition of the patients treated at home.