Calf compartment syndrome and lumbar plexopathy following topical bovine thrombin-induced coagulopathy

We describe a patient with acquired thrombin inhibitor who developed tibial and peroneal neuropathies followed by lumbar plexopathy as a result of large calf and psoas muscle hematomas. Thrombin time, Prothombin time, and partial thromboplastin time were prolonged after repeated exposures to topical bovine thrombin in two orthopedic procedures Specific coagulation tests revealed that the coagulopathy was the result of an inhibitor to bovine thrombin that cross-reacted with human thrombin. We emphasize the risk of spontaneous hematomas that can compromise peripheral nerves as a result of an acquired coagulopathy following bovine thrombin exposure.

Peripheral nerve injury after brief lithotomy for transurethral collagen injection

Two patients with prior prostate surgery sustained peripheral nerve injuries after transurethral collagen injection for the treatment of urinary incontinence. In the first patient, brief lithotomy positioning caused a gluteal compartment syndrome and sciatic neuropathy. In the second patient, obturator neuropathy was due to leakage of collagen along the course of the obturator nerve. This is the first report of peripheral nerve injury in patients undergoing transurethral collagen injection.

Identification of a novel mutation in patients with medium-chain acyl-CoA dehydrogenase deficiency

A novel mutation was identified in two unrelated patients with medium-chain acyl-CoA dehydrogenase deficiency. First, a 19-year-old Caucasian female presented with a devastating illness, resulting in sudden death in adulthood which is unusual. The second patient, now a 3.5-year-old male, presented at 17 months of age with a hypoglycemic seizure and dehydration. Sequence analysis revealed a novel mutation G617T in exon 8 resulting in an arginine to leucine substitution at codon 206 (R206L). Both patients were compound heterozygous for this G617T and the common mutation A985G.

Very late-onset Friedreich ataxia despite large GAA triplet repeat expansions

BACKGROUND

Most patients with Friedreich ataxia (FRDA) have abnormal GAA triplet repeat expansions in both X25 genes. The size of the GAA expansion in the shorter of the 2 expanded alleles correlates significantly with parameters of clinical severity and is inversely related to the age at onset.

OBJECTIVES

To describe the clinical and molecular genetic findings in a patient with very late-onset FRDA and to review the literature.

PATIENT AND METHODS

A 58-year-old white woman with mild progressive gait disturbance of 15 years' duration whose examination revealed mild incoordination was analyzed for mutations in the X25 gene. A combination of long-range polymerase chain reaction and genomic Southern blot analyses were used to identify GAA expansions in intron 1 of the X25 gene. To uncover evidence of somatic variability in triplet repeat length, DNA isolated from several tissue samples was similarly analyzed. Single-strand conformational polymorphism analysis was used to screen for mutations spanning the entire coding sequence of frataxin and all intron-exon junctions of the X25 gene.

RESULTS

DNA isolated from blood leukocytes revealed GAA triplet repeat expansions in both X25 genes, which were estimated to contain 835 and 1200 repeats. Similar expansions were detected in DNA isolated from lymphoblasts, fibroblasts, buccal cells, and sural nerve, with estimated mean (+/- SD) lengths of the shorter and longer expansions being 854 (+/-69) and 1283 (+/-72) triplets, respectively. A review of reported cases of late-onset Friedreich ataxia (25-39 years) and very late-onset Friedreich ataxia (> or =40 years) demonstrated that this is the first instance of a patient presenting with very late-onset FRDA despite carrying more than 800 GAA repeats in both expanded X25 alleles.

CONCLUSIONS

This unique case of very late-onset FRDA highlights a limitation in our ability to accurately predict the phenotype in FRDA based solely on the size of the GAA expansion. Other genetic or environmental factors may significantly modify disease severity in FRDA.

Phenytoin-induced dermatomyositis: case report and literature review

A muscle biopsy done to evaluate for ragged red fibers in a patient with progressive myoclonic epilepsy unexpectedly showed prominent inflammation and perifascicular atrophy. Brain biopsy demonstrated Lafora bodies. Lafora body disease is a progressive, fatal myoclonic epilepsy presenting usually in the first or second decade with mental regression, generalized and myoclonic seizures,1,2 ataxia, spasticity, and involuntary movement. It is an autosomal recessive3 disorder localized to chromosome 6q. Phenytoin is herein implicated in the pathogenesis of dermatomyositis.

Reversible dementia and chorea in a young woman with the lupus anticoagulant

A 22-year-old woman gradually developed depression, dementia, and chorea over an 8-month period. She fulfilled the criteria for the primary antiphospholipid antibody syndrome but not those for systemic lupus erythematosus. Her chorea and neurobehavioral deficits responded favorably to a regimen of prednisone, hydroxychloroquine, and aspirin. This appears to be the first report of a patient with a lupus anticoagulant and reversible dementia. The response to immunosuppressive therapy implies an antibody-mediated condition similar to Sydenham's chorea.