Serial magnetic resonance imaging changes in hypoglycemic encephalopathy.

PURPOSE: Reports of serial magnetic resonance imaging (MRI) in hypoglycemic encephalopathy were limited because MRI is not routinely performed in these patients. Here we present one patient with a history of hypoglycemic encephalopathy and discuss sequential neuroimaging findings. CASE REPORT: A 53-year-old male mistakenly took oral hypoglycemic agents developed hypoglycemic encephalopathy. Immediate brain diffusion-weighted image (DWI) demonstrated extensive symmetrical hyperintensive lesions over bilateral subcortical white matter. 14 days later, new hyperintensive lesions involving bilateral cerebral cortex were found on DWI, while previous subcortical white matter lesions disappeared. On day 86, diffusion-weighted images abnormalities vanished and diffuse brain atrophy was noted. CONCLUSION: Although subcortical white matter involvement in hypoglycemic encephalopathy was occasionally reported in the literature, few report revealed similar serial MRI changes as our case. Although its mechanism is still unknown, it is important to follow sequential images in hypoglycemic encephalopathy. The brain tissue which was normal in early DWI may not necessarily guarantee undamaged.

Cervical spinal epidural hematoma mimics acute ischemic stroke.

Spinal epidural hematoma is an accumulation of blood in the epidural space that can mechanically compress the spinal cord. It is an uncommon condition, and most cases occur spontaneously. Detailed evaluation of neurologic deficit and detailed history taking are important tools for early diagnosis, and magnetic resonance imaging is currently the diagnostic method of choice. Prompt surgical intervention is important in achieving positive clinical outcomes. Spinal epidural hematoma usually comes with acute, severe pain with radiation to the extremities and may be accompanied with severe neurologic deficit. Common neurologic signs include paraparesis and quadriparesis. Here, we report 2 cases of cervical spinal epidural hematoma with sudden onset of neck pain, followed by the development of unilateral limbs weakness and respiratory distress. Both patients were initially suspected to have acute ischemic stroke and were considered using intravenous thrombolytic therapy with recombinant tissue plasminogen activator as treatment. Cervical spinal epidural hematoma was confirmed after obtaining magnetic resonance imaging. Patients with this uncommon presentation must be carefully distinguished from acute stroke. This article aimed to highlight the potential pitfalls in diagnosing acute hemiparesis with no cranial nerves deficits and the importance of clinical suspicion.

Wernicke encephalopathy with atypical magnetic resonance imaging.

Wernicke encephalopathy (WE) is a medical emergency caused by thiamine (vitamin B1) deficiency. Typical clinical manifestations are mental change, ataxia, and ocular abnormalities. Wernicke encephalopathy is an important differential diagnosis in all patients with acute mental change. However, the disorder is greatly underdiagnosed. Clinical suspicion, detailed history taking, and neurologic evaluations are important for early diagnosis. Magnetic resonance imaging (MRI) is currently considered the diagnostic method of choice. Typical MRI findings of WE are symmetrical involvement of medial thalamus, mammillary body, and periaqueductal gray matter. Prompt thiamine supplement is important in avoiding unfavorable outcomes. Here, we report a case of alcoholic WE with typical clinical presentation but with atypical MRI. Axial fluid-attenuated inversion recovery images showing symmetrical hyperintensity lesions in dentate nuclei of cerebellum, olivary bodies, and dorsal pons. Although atypical MRI findings are more common in nonalcoholic WE, it can also occur in alcoholic WE. This article is aimed to highlight the potential pitfalls in diagnosing acute mental change, the importance of clinical suspicion, and early treatment in WE.

Risk factors and prevalence rate of restless legs syndrome among pregnant women in Taiwan.

BACKGROUND: The goal of this study was to assess the prevalence and clinical correlates of restless legs syndrome (RLS) among pregnant Taiwanese women. METHODS: We enrolled 461 pregnant women (18-45 years) admitted at Mackay Memorial Hospital for delivery from September 2010 to May 2011. The face-to-face questionnaire used to gather data included assessment of RLS diagnostic criteria, and questions related to RLS. RESULTS: The overall prevalence rate of RLS among the study participants was 10.4%; 2.8% were categorized as having chronic RLS. Participants without RLS reported higher folate and iron supplement consumption than those with RLS. Multivariate analysis revealed significant associations of RLS with anemia and peptic ulcer disease. Participants with transient RLS during pregnancy reported more regular coffee consumption before pregnancy, and better sleep latency, duration, and efficiency, than those with chronic RLS. Overall, 81.2% of RLS sufferers reported sleep disturbances. CONCLUSIONS: Our study revealed highly prevalent but poorly recognized RLS among Taiwanese pregnant women. The identification of predictors such as medical comorbidities, and protectors such as folate and iron supplements, is warranted for obstetric RLS. In most cases, symptoms began during the second or third trimester and resolved within a week after delivery. Restricted coffee consumption before pregnancy is encouraged, but further evidence is needed to support this recommendation.