Acute memory loss and nominal aphasia caused by phenylpropanolamine

I have reported a case of acute memory loss and nominal aphasia in a 36-year-old woman after the use of Dexatrim Extra Strength. The toxic reaction improved within 36 hours after discontinuation of the drug.

Association between cyclosporin neurotoxicity and hypomagnesaemia

The serum magnesium levels of all 12 allogeneic bone-marrow transplant recipients who experienced the neurotoxic effects of cyclosporin (CyA) were more than two standard deviations below the normal range. The neurological events seemed to segregate into three separate syndromes. 7 patients had grand-mal seizures, which occurred within the first several weeks of CyA therapy (median onset 12 days). At the time of their first seizure all 7 patients had hypomagnesaemia, which had developed rapidly over the preceding 1-3 weeks. 3 patients had four episodes of cerebellar ataxia, tremor, and depression. These subacute episodes developed after prolonged CyA therapy (median onset 67 days). Each episode was associated with hypomagnesaemia. 2 patients had a transient episode of expressive aphasia following a long period of hypomagnesaemia. In all cases symptoms resolved or did not recur with adequate magnesium replacement. These data suggest that CyA neurotoxicity is associated with hypomagnesaemia and may be treated or prevented with magnesium replacement.

Aphasia and right hemiplegia after cervical myelography with metrizamide. A case report

We report a case of aphasia and right hemiplegia, developing after myelography with metrizamide and lasting for an unusually long time. The neurological disorders, manifested 1 h after the examination was completed, were due to accidental passage of contrast medium into the basal cisterns. In the light of analogous case reports in the literature, as well as experimental data concerning the biochemical activity of metrizamide, possible aetiopathogenetic mechanisms responsible for such disturbances are indicated. The authors underline the lack of effective therapeutic measures after the onset of the disorders, and thus the importance of preventing such complications that behave functionally as true ictuses although with no anatomic substratum.

Confusion, dysphasia, and asterixis following metrizamide myelography

A patient exhibited confusion, dysphasia, and striking asterixis 18 hours after metrizamide myelography. The symptoms lasted for a day and a half. While metrizamide is a useful contrast medium, side effects are not unusual and can, on occasion, be quite severe.

[Benign intracranial hypertension and thrombosis of the venous sinuses during contraceptive treatment: anatomo-clinical and neuroradiological observations (author's transl)]

The side-effects of oral contraceptives on the nervous system have been studied in 2 patients. The first case, a young woman who, after several years, of cyclic consumption of 4 mg of norethylsterone acetate and 0.05 mg of ethynilestradiol, died from a transtentorial temporal hernia due to severe intracranial hypertension. Angiography, and later autopsy, showed thrombosis of the dural venous sinuses and also of the majority of the emissary veins with C.S.F. blockage. The second case, a patient who took 1 mg of norethyndrone and 0.05 mg of mestranol for 20 months, developed a focal symptomatology (Grand Mal, global aphasia without lowering of the level of conscionsness) which cleared up rapidly. The CAT performed during the clinical illness showed mild signs of intracranial hypertension while cerebral angiography normal. It seems possible that the hormonal treatment may disturb the mechanisms of C.S.F. production-reabsorbtion and the filtration dynamics of the blood-brain barrier and perhaps, cause alteration of hypothalamic-hypophysial function. This would explain a transitory symptomatology, such as benign intracranial hypertension. However, the thrombosis of the venous sinuses (sometimes, as in our first case, massive) may be due to the venous stasis, that accompanies intracranial hypertension and to the altered blood coagulation.