Post-heatstroke parkinsonism and cerebellar dysfunction.

A case is presented of a 45-year-old woman who developed parkinsonism, cerebellar dysfunction, aphasia and flaccid paralysis secondary to heat stroke. Magnetic resonance imaging revealed irregular patchy areas of increased signal intensity in the white matter of both cerebral hemispheres and the left striatum, remaining unchanged over a follow-up period of two years. Cerebellar atrophy, while not seen on initial examination, was present on the follow-up study done one year later and became more marked after two years.

Brucellar and tuberculous spondylitis: comparative imaging features.

Radiographs, scintigrams, computed tomographic scans, and magnetic resonance (MR) images of 17 patients with brucellar spondylitis and 15 with tuberculous spondylitis were analyzed to identify distinguishing features. Characteristic findings of brucellar spondylitis included predilection for the lower lumbar spine (68% of lesions), bone destruction limited to the end plates, disk collapse (16 of 19 disks), and granulation tissue or localized soft-tissue edema (17 of 19 sites). MR imaging showed diffuse increased signal in vertebrae and disks on long repetition time (TR)/echo time (TE) images in four patients and focal increased signal with normal disks in one. Epidural extension was best seen on short TR/TE images in four. Tuberculous spondylitis was characterized by predilection for the midthoracic spine (73%), vertebral destruction with gibbus deformity (60%), disk collapse, and paraspinal abscesses (14 of 15). On MR images signal intensity of affected vertebrae was similar to but more severe than findings in patients with brucellar spondylitis. Scintigraphy was the least helpful in differentiating the two infections. Lesions of tuberculous spondylitis affecting the lower lumbar spine were difficult to differentiate from those of brucellar spondylitis.

Osteoarticular brucellosis: results of bone scintigraphy in 140 patients.

One hundred forty patients with proved brucellosis and clinical evidence of bone and joint involvement were evaluated prospectively by 99mTc-methylene diphosphonate scintigraphy to assess the frequency of positive findings. To evaluate the radiographic abnormalities associated with positive scintigraphy, all areas of the skeleton that showed abnormal uptake were studied further by plain radiography. High-resolution CT was performed in all patients who had spinal lesions. Ninety-six patients (69%) had abnormal radionuclide uptake in 57 extraspinal and 101 spinal sites. Uptake was increased in 53 joints and three long bones and decreased in one joint. The knee was the most frequently involved site; the second was the sacroiliac joint. Radiographic and high-resolution CT changes were seen in only 12 (21%) of 57 extraspinal sites. In the spine, the abnormal scintigrams showed either focal increased uptake in affected vertebral bodies (detected mostly on the anterior view and seen in 51 lower thoracic and lumbar vertebrae in 24 patients) or diffuse increased uptake in adjacent vertebrae (detected in anterior and posterior views and seen in 50 different disk levels in 38 patients). Radiographic and high-resolution CT changes were seen at all scintigraphically positive sites. We conclude that bone scintigraphy is a useful method for screening patients with osteoarticular brucellosis. It is more sensitive than radiography in assessing involvement of the extraspinal skeleton and in the spine, it allows accurate localization of affected areas.

Alimentary tract presentations of brucellosis.

A retrospective study was conducted to assess alimentary tract involvement in 140 Saudi patients with acute or chronic brucellosis. A brucella standard agglutination titer of 160 or over was considered to be positive evidence of brucella infection. The commonest symptoms were anorexia, weight loss, right hypochondrial pain, and constipation. A history of raw milk ingestion was obtained in 38 patients. Thirty-nine patients had hepatomegaly, 21 had splenomegaly, and six had signs of cholecystitis. Bilirubin was elevated in eight patients; one or more of the liver enzyme activities studied were elevated in 75 patients. Four of the 14 liver biopsies performed revealed Brucella microgranulomata. Abdominal ultrasound studies were abnormal in 29 of 46 patients. Thirty patients had a normal upper or lower gastrointestinal tract endoscopy. Blood cultures from 18 patients were incubated for six to eight weeks, with Brucella melitensis isolated from five. Sixty-seven patients (47.86%) received effective treatment for brucellosis with improvement in the symptoms, signs and liver functions. Brucellosis is relatively common in the Kingdom of Saudi Arabia, and efforts should be taken to control and possibly eradicate this disease.

Transient polyarthritis associated with familial hyperbetalipoproteinaemia.

Forty-one heterozygous patients with familial hyperbetalipoproteinaemia have been studied. Twenty-two of these patients have been observed for four years'. Transient flitting inflammatory joint symptoms were noted in thirteen patients of this group. In six patients clinical, biochemical, radiological and radio-isotope studies have been carried out during the acute episode. These investigations suggest that this syndrome is due to acute inflammatory periarthritis and peritendinitis. Radio-active xenon clearance is not prolonged as occurs in inflammatory synovitis although there is elevation of the ratio-active technetium uptake over the affected joints suggesting that the blood flow to the affected area is increased. This is the largest group of patients with this complication reported to date and the recognition of this may prove to be an important aspect of case finding in this disorder. The treatment of hyperlipidaemia at an early stage may well contribute to a reduction in the morbidity and mortality from vascular disease. No further elucidation of the pathogenesis of the arthropathy has been made but a possible relationship between undue exercise and the onset of joint symptoms was again observed.

Total body and exchangeable potassium in chronic airways obstruction: a controversial area?

Potassium deficiency is an important complication in the treatment of heart disease. However, there is a serious dichotomy in the literature. Severe potassium depletion has been reported in this condition when exchangeable potassium was measured whereas normal levels or marginal depletion were found in measurements of total body potassium. To clarify this situation, simultaneous measurements of total body potassium by whole-body counting, and of exchangeable potassium by isotope dilution using 43K, were made in 10 male subjects with established airways obstruction. Sequential determinations showed that exchangeable potassium increased up to 68 hours after administration, and values obtained at only 24 hours would have been a substantial underestimate. In this group of subjects neither total body nor exchangeable potassium at 48 hours was significantly different from the expected normal value.