A Parkinson's Disease Patient without Corpus Callosum.

The authors report of a patient with Parkinson's disease in whom imaging revealed a complete agenesis of the corpus callosum. Although this co-occurrence is probably coincidental, this finding suggests that the bilateral degenerative changes in Parkinson's disease may occur independent of the interhemispheric connections.

[Headache: consider cavernous sinus thrombophlebitis]. / Hoofdpijn: denk aan sinus-cavernosustromboflebitis.

A 38-year-old woman presented with a 1-week history of progressive headache and acute onset of left-sided hemiparesis. Neurological examination showed bradyphrenia and intermittent left hemiparesis. Brain neuroimaging revealed cavernous sinus thrombosis, subdural empyema, pathological vessel-wall enhancement of the right middle cerebral artery and ischaemia in the right striatum. Cavernous sinus thrombophlebitis with secondary vasculitis and ischaemic stroke was diagnosed. Bacteraemia due to Streptococcus intermedius from a jaw infection was found and she received antibiotic treatment. At six-month follow-up, her symptoms had improved remarkably. Clinical signs such as progressive headache, which does not respond to analgesics, subtle cranial nerve palsy and increased infectious parameters should alert the clinician to conduct appropriate neuroimaging studies. Early initiation of effective antibiotic treatment in these cases is essential and can change the course of the illness and improve prognosis.

Sudden Death: An Uncommon Occurrence in Dementia with Lewy Bodies.

We present a 75-year-old woman with dementia and parkinsonism who developed severe orthostatic hypotension and eventually died. Autopsy revealed extensive Lewy body formation in the midbrain, limbic system, intermediate spinal cord, and medulla oblongata. Furthermore, a vast amount of Lewy bodies was seen in the paravertebral sympathetic ganglia which likely explained the severe autonomic failure. We speculate that this autonomic failure caused sudden death through dysregulation of respiration or heart rhythm, reminiscent of sudden death in multiple system atrophy (MSA). Clinicians should be aware of this complication in patients presenting with parkinsonism and autonomic dysfunction, and that sudden death may occur in dementia with Lewy bodies (DLB) as it does in MSA.

[Sudden unexpected death in epilepsy: SUDEP]. / Plotse onverwachte dood bij epilepsie, ofwel 'SUDEP'.

Sudden unexpected death in epilepsy (SUDEP) is the most important direct epilepsy-related cause of death. Patients with refractory epilepsy are at especially high risk of SUDEP. SUDEP occurs predominantly at night and unwitnessed, and can best be regarded as a fatal tonic-clonic seizure. While its pathophysiology is incompletely understood, SUDEP is most probably triggered by a number of predisposing and precipitating factors, including seizure-induced respiratory depression and cardiac arrhythmia. Achieving seizure freedom is the best way to prevent SUDEP. Nocturnal supervision may be another alternative preventive strategy, but this requires further research.