N-hexane induced polyneuropathy: a clinical and electrophysiological follow up.

BACKGROUND: Chronic exposure to relatively high levels of n-hexane either by inhalation or skin contact can result in peripheral nerve lesions. We present the clinical and electrophysiological features of 5 patients who have been exposed to n-hexane at similar industrial occupations in the progressive phase. METHODS: All patients underwent routine laboratory tests, cerebrospinal fluid examination, and sural nerve biopsy. Conventional sensory and motor nerve conduction studies were applied at admission and at the end of the 12 month. RESULTS: The average incubation period of the 5 cases was 10.2 months and the average period of the initial symptoms was 3.8 months. Numbness and weakness of the lower extremities were the initial symptoms that had ascended to the upper extremities in three of the patients. Deep tendon reflexes were either diminished or abolic. There was distal atrophy only in patient 5. All were treated with vitamin B complex and physical therapy and training. They were removed from further exposure to n-hexane after aetiological confirmation, but motor disturbance continued to worsen in the patient 5. The patients were visited every 3 months. Sensory functions were regained earlier than motor functions. All the patients, including one who was severe quadriparetic in the early stages, regained their full motor capabilities within 6 months to 21 months. CONCLUSION: Occupational n-hexane causes subacute neuropathy and the duration of exposure is important for the neurological outcome. We suggest that the prognosis of n-hexane induced neuropathy is well if correct diagnosis is made and further exposure is ceased.

Neuromuscular status of thyroid diseases: a prospective clinical and electrodiagnostic study.

With this study, it has been intended to evaluate the neuromuscular symptoms and findings observed in patients with the diagnoses of hyperthyroidism and hypothyroidism. This study included 21 patients with hyperthyroidism, 19 patients with hypothyroidism and a control group comprised of 29 healthy persons. In the patient group with hypothyroidism, the increase in the median motor distal latency and the median sensorial distal latency (p < 0.0001), the reduction in the median sensory action potential amplitude (p < 0.01) and the slowing in the velocity of nerve conduction (p < 0.01) were found significantly different when compared to the control group. H-reflex latencies were determined to be significantly longer bilaterally (p < 0.01). In the patient group with hyperthyroidism, only the reduction in the median sensory action potential amplitude and the prolongation in the distal latency (p < 0.05) were significant. As for the lower extremities, the slowing in the velocity of the nerve conduction of bilateral peroneal (p < 0.0001), the prolongation in the peroneal F-wave latency (p < 0.01), the slowing in the velocity of the nerve conduction of bilateral tibial nerve (p < 0.05), the prolongation in the tibial F-wave latency (p < 0.01), the prolongation in the sural nerve distal latency (p < 0.0001) and the reduction in the sensory action potential amplitude (p < 0.05) were determined to be significantly different compared to the control group. Among the thyroid patients, 17 (42.5%) patients were diagnosed with mononeuropathy and polyneuropathy. Entrapment neuropathy was observed in 30% and diffuse neuropathy in 10% of the patients. Mypopathy findings were observed in 2 patients.

Median sep and blink reflex in thyroid diseases.

Pathological disturbances of thyroid hormones is associated with central and peripheral nervous system disturbances. The aim of this study is to evaluate median nerve stimulated somatosensory evoked potential (SEP) and blink reflex of thyroid patients (hypo and hyperthyroidism). Median SEP was performed in 40 patients (21 with hyperthyroidism and 19 with hypothyroidism). We evaluated the latencies of N9, N11, N13, P9, P11, P14, N20 and P25 waves and the N9-N20, N9-N13, N13-N20 and P14-N20 interpeak latencies. We compared the results of patients with the control group (26 persons). We found that the N20 latency was longer in patients with hyperthyroidism than in the control group and the difference was statistically significant. There was not any statistically significant difference regarding the N9, N11, N13, P9, P11, P14, N20 and P25 latencies and the N9-N20, N9-N13, N13-N20 and P14-N20 interpeak latencies between hypothyroid patients and controls. We performed the blink reflex study in 28 of 40 patients (14 patients with hyperthyroidism and 14 patients with hypothyroidism). Comparing the R1, R2, CR2 (contralateral R2) latencies and durations of the patients and controls, we found that R2 and CR2 duration was shorter in patients with hyperthyroidism. This difference was statistically significant.

Seizure development after stroke.

Although there have been many studies on seizures following stroke, there is still much we do not know about them. In this study, we evaluated the characteristics of seizures in stroke patients. There were 2267 patients with a first-ever stroke, and after excluding 387 patients, 1880 were available for analysis. Of these 1880 patients, we evaluated 200 patients with seizures and 400 patients without seizures. We investigated the seizures according to age, gender, stroke type, the aetiology of ischaemic stroke and the localisation of the lesion. The seizures were classified as early onset and late onset and the seizure type as partial, generalised or secondarily generalised. Seizures occurred in 200 (10.6%) of 1880 strokes. The number of patients with seizures were 138 (10.6%) in ischaemic stroke group and 62 (10.7%) in haemorrhagic stroke group. Patients with ischaemic strokes had 41 embolic (29.7%) and 97 thrombotic (70.3%) origin, and these were not statistically significant in comparison with controls. Cortical involvement for the development of seizures was the most important risk factor (odds ratios = 4.25, p < 0.01). It was concluded that embolic strokes, being younger than 65 years old, and cortical localisation of stroke were important risks for developing seizures.

Polydactyly and fetal hydantoin syndrome: an additional component of the syndrome?

We report a 3-year-old girl with fetal hydantoin syndrome (FHS) whose mother had received phenytoin 600 mg/day throughout gestation. She had growth retardation, mental deficiency, craniofacial dysmorphism and iris colomobata specific to FHS. However, the patient did not have the distal phalangeal hypoplasia which is associated with FHS; instead, she had polydactyly of the right foot. This seems to be the first FHS case in the literature with polydactyly.