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Davda N, Buckingham C, Pelluet E, Scobie A, Kyriacou V, Davies G. Lemierre's: a forgotten disease and a rare cause of cranial neuropathy - a case report. Neurol Sci 2024; 45:2395-2398. [PMID: 38150128 DOI: 10.1007/s10072-023-07231-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 11/26/2023] [Indexed: 12/28/2023]
Affiliation(s)
- Nikunj Davda
- Department of Neurology, Royal Free London NHS Foundation Trust, London, UK.
| | | | - Emma Pelluet
- Department of Radiology, Royal Free London NHS Foundation Trust, London, UK
| | - Antonia Scobie
- Department of Infection, Royal Free London NHS Foundation Trust, London, UK
| | - Vera Kyriacou
- Department of Radiology, Royal Free London NHS Foundation Trust, London, UK
| | - Gerard Davies
- Department of Neurology, Royal Free London Foundation TrustRoyal Free London NHS Foundation Trust, London, UK
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Chen YH, Wei YC, Weng WC, Chien YY, Wu CL. Steroid-responsive multifocal motor neuropathy with cranial manifestations - a case report. Acta Neurol Taiwan 2024; 33(1):28-35. [PMID: 37848240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 10/19/2023]
Abstract
The typical presentation of multifocal motor neuropathy (MMN) is progressive asymmetric limb weakness. Cranial neuropathy is rare. We report a 28-year-old woman with cranial and bulbar palsies but with typical electrophysiological features of MMN by multifocal motor conduction blocks and serological markers of anti-ganglioside GM1 antibodies. The previous consensus on the treatment of MMN is intravenous immunoglobulins, but our patient responded to oral steroids and had clinical and electrophysiological improvement under continuous low-dose prednisolone treatment. In summary, MMN is a treatable chronic inflammatory disease of peripheral nerves. Cranial neuropathies can be its initial presentations. Electromyography studies are crucial for MMN diagnosis and helpful in monitoring disease activity and treatment responses. Although the previous guideline did not suggest using steroids for MMN, with careful patient selection, low-dose oral steroids can be an effective treatment in patients with relatively minor symptoms. Keywords: Multifocal motor neuropathy, conduction block, bulbar palsy, cranial nerve, cranial neuropathy.
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Affiliation(s)
- Yi-Hsiang Chen
- Department of Neurology, Chang Gung Memorial Hospital, Keelung, 204, Taiwan
| | - Yi-Chia Wei
- Department of Neurology, Chang Gung Memorial Hospital, Keelung, 204, Taiwan; Collage of Medicine, Chang Gung University, Taoyuan, 333, Taiwan
| | - Wei-Chieh Weng
- Department of Neurology, Chang Gung Memorial Hospital, Keelung, 204, Taiwan; Collage of Medicine, Chang Gung University, Taoyuan, 333, Taiwan
| | - Yu-Yi Chien
- Department of Neurology, Chang Gung Memorial Hospital, Keelung, 204, Taiwan; Collage of Medicine, Chang Gung University, Taoyuan, 333, Taiwan
| | - Chia-Lun Wu
- Department of Neurology, Chang Gung Memorial Hospital, Keelung, 204, Taiwan; Collage of Medicine, Chang Gung University, Taoyuan, 333, Taiwan
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Suzuki D, Koyama S, Takahashi N, Suzuki Y, Igari R, Iseki C, Sato H, Hiraka T, Kanoto M, Ohta Y. A Case with Anti-ganglioside Antibodies Showing Multiple Cranial Nerve Palsies Detected on Gadolinium-enhanced Magnetic Resonance Imaging. Intern Med 2023; 62:3541-3544. [PMID: 37062729 PMCID: PMC10749815 DOI: 10.2169/internalmedicine.1389-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 03/02/2023] [Indexed: 04/18/2023] Open
Abstract
The anti-GQ1b IgG antibody is often accompanied by other anti-ganglioside antibodies, which induces various neurological symptoms. We herein report a patient with anti-ganglioside antibodies, including anti-GQ1b IgG and anti-GT1a IgG antibodies, showing bilateral ophthalmoplegia, facial nerve palsies, dysarthria, dysphagia, dysesthesia in both hands, and enhancement of the bilateral oculomotor, abducens, and facial nerves on gadolinium (Gd)-enhanced T1-weighted brain magnetic resonance imaging (MRI). He was first treated with intravenous immunoglobulin, which improved ophthalmoplegia, bulbar palsies, and dysesthesia of hands, but the facial nerve palsies worsened, and Gd enhancement of the brain nerves persisted. High-dose methylprednisolone therapy subsequently improved the facial nerve palsies and Gd enhancement of the cranial nerves. This is the first case with anti-ganglioside antibodies presenting with multiple cranial nerve palsies that was followed to track the changes in the Gd enhancement of cranial nerves on MRI.
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Affiliation(s)
- Daisuke Suzuki
- Division of Neurology and Clinical Neuroscience, Department of Internal Medicine III, Yamagata University Faculty of Medicine, Japan
| | - Shingo Koyama
- Division of Neurology and Clinical Neuroscience, Department of Internal Medicine III, Yamagata University Faculty of Medicine, Japan
| | - Naomi Takahashi
- Division of Neurology and Clinical Neuroscience, Department of Internal Medicine III, Yamagata University Faculty of Medicine, Japan
| | - Yuya Suzuki
- Division of Neurology and Clinical Neuroscience, Department of Internal Medicine III, Yamagata University Faculty of Medicine, Japan
| | - Ryosuke Igari
- Division of Neurology and Clinical Neuroscience, Department of Internal Medicine III, Yamagata University Faculty of Medicine, Japan
| | - Chifumi Iseki
- Division of Neurology and Clinical Neuroscience, Department of Internal Medicine III, Yamagata University Faculty of Medicine, Japan
| | - Hiroyasu Sato
- Division of Neurology and Clinical Neuroscience, Department of Internal Medicine III, Yamagata University Faculty of Medicine, Japan
| | - Toshitada Hiraka
- Division of Diagnostic Radiology, Department of Radiology, Yamagata University Faculty of Medicine, Japan
| | - Masafumi Kanoto
- Division of Diagnostic Radiology, Department of Radiology, Yamagata University Faculty of Medicine, Japan
| | - Yasuyuki Ohta
- Division of Neurology and Clinical Neuroscience, Department of Internal Medicine III, Yamagata University Faculty of Medicine, Japan
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Zanotelli G, Bresciani L, Anglani M, Miscioscia A, Rinaldi F, Puthenparampil M. Case Report: Para-infectious cranial nerve palsy after bacterial meningitis. Front Immunol 2022; 13:1000912. [PMID: 36275763 PMCID: PMC9582131 DOI: 10.3389/fimmu.2022.1000912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 09/13/2022] [Indexed: 11/13/2022] Open
Abstract
A 27-year-old woman was admitted to our hospital for fever, associated with headache, nausea, and vomiting, and she rapidly developed mild left facial nerve palsy and diplopia. Neurological examination revealed mild meningitis associated with bilateral VI cranial nerve palsy and mild left facial palsy. As central nervous system (CNS) infection was suspected, a diagnostic lumbar puncture was performed, which revealed 1,677 cells/μl, 70% of which were polymorphonuclear leukocytes. Moreover, multiplex PCR immunoassay was positive for Neisseria meningitidis, supporting the diagnosis of bacterial meningitis. Finally, IgG oligoclonal bands (IgGOB) were absent in serum and cerebrospinal fluid (CSF). Therefore, ceftriaxone antibiotic therapy was started, and in the following days, the patient’s signs and symptoms improved, with complete remission of diplopia and meningeal signs within a week. On the contrary, left facial nerve palsy progressively worsened into a severe bilateral deficit. A second lumbar puncture was therefore performed: the CSF analysis revealed a remarkable decrease of pleocytosis with a qualitative modification (only lymphocytes), and oligoclonal IgG bands were present. A new brain MRI was performed, showing a bilateral gadolinium enhancement of the intrameatal VII and VIII cranial nerves bilaterally. Due to suspicion of para-infectious etiology, the patient was treated with oral steroid (prednisolone 1 mg/kg/day), with a progressive and complete regression of the symptoms. We suggest that in this case, after a pathogen-driven immunological response (characterized by relevant CSF mixed pleocytosis and no evidence of IgGOB), a para-infectious adaptive immunity-driven reaction (with mild lymphocyte pleocytosis and pattern III IgGOB) against VII and VIII cranial nerves started. Indeed, steroid administration caused a rapid and complete restoration of cranial nerve function.
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Affiliation(s)
- Giovanni Zanotelli
- Neurology Unit, Azienda Ospedaliera di Padova, Padova, Italy
- Department of Neuroscience, Università degli Studi di Padova, Padova, Italy
- *Correspondence: Giovanni Zanotelli,
| | - Lorenzo Bresciani
- Neurology Unit, Azienda Ospedaliera di Padova, Padova, Italy
- Department of Neuroscience, Università degli Studi di Padova, Padova, Italy
| | | | | | | | - Marco Puthenparampil
- Neurology Unit, Azienda Ospedaliera di Padova, Padova, Italy
- Department of Neuroscience, Università degli Studi di Padova, Padova, Italy
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Carlson KJ, Volsky PG. Remission of Mucosal Melanoma of the Middle Ear and Petrous Temporal Bone and Reversal of Cranial Nerve Paresis Following Radiation and Single Agent Nivolumab: Clinical Capsule and Review of the Literature. Otol Neurotol 2021; 42:e1560-e1564. [PMID: 34282102 DOI: 10.1097/mao.0000000000003293] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE We report disease remission and recovery of fifth and seventh nerve paresis in a case of primary mucosal melanoma of the middle ear and petrous temporal bone. PATIENT A 74-year-old man developed sudden, profound, right sided sensorineural hearing loss, disequilibrium, otalgia, and cranial nerve V and VII dysfunction. Imaging demonstrated an unresectable, osteolytic lesion involving the middle ear and anterior petrous apex. Melanoma was diagnosed via in-office biopsy; whole-body metabolic imaging revealed no other primary site. INTERVENTION Multidisciplinary management included radiation therapy (30 Gy, 10 fractions) followed by induction (five cycles, q2w) and maintenance nivolumab (six cycles, q3w). MAIN OUTCOME MEASURE Complete metabolic response of primary site and metastases on imaging, recovery of cranial neuropathies. RESULTS Following palliative radiation therapy and induction nivolumab, cranial neuropathies resolved. With maintenance-dose nivolumab, primary site and metastases exhibited a complete response. Therapy was stopped at 16 months post-diagnosis. Complete remission was maintained until 22 months after diagnosis. The patient developed a solitary cerebral metastasis which was refractory to radiosurgery and biopsy confirmed melanoma. He expired 2 years, 8 months post-diagnosis. CONCLUSIONS Mucosal melanoma of the middle ear and petrous temporal bone is exceedingly rare. Management is individualized and surgery is undertaken when possible. Key observations in this case are the complete metabolic response and reversal of cranial nerve neuropathies following radiation and anti-programed cell death receptor ligand 1 therapy. Non-surgical treatment is worthy of study as initial management for similar lesions.
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Affiliation(s)
- Kevin J Carlson
- Department of Otolaryngology-Head and Neck Surgery, Eastern Virginia Medical School, Norfolk, Virginia
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Horiuchi K, Oshima Y, Kudo A. Successful Treatment with Rituximab for Granulomatosis with Polyangiitis and Multiple Cranial Neuropathies. Intern Med 2021; 60:1095-1099. [PMID: 33132328 PMCID: PMC8079918 DOI: 10.2169/internalmedicine.4881-20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
We herein report a case of granulomatosis with polyangiitis in a 73-year-old man. He had experienced bilateral ptosis, redness of both eyes, right facial weakness, and hearing loss in the right ear for two months. Myeloperoxidase anti-neutrophil cytoplasmic antibody was positive. Corticosteroids and intravenous cyclophosphamide pulse therapy yielded a response. After the fourth pulse of cyclophosphamide, he developed headache, diplopia, restricted left eye movement, right facial palsy, and hearing loss in the right ear. A one-year remission period was achieved by increasing the steroid and rituximab doses. Rituximab was effective against the relapse of granulomatosis with polyangiitis and cranial neuropathy.
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Affiliation(s)
| | - Yuki Oshima
- Department of Neurology, Hakodate Municipal Hospital, Japan
| | - Akihiko Kudo
- Department of Neurology, Hakodate Municipal Hospital, Japan
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Cao X, Zhang M, Lu Z, Li C, Zeng Y, Fan J, Yu K. Multiple neurological manifestations in a patient with systemic lupus erythematosus and anti-NXP2-positive myositis: A case report. Medicine (Baltimore) 2021; 100:e25063. [PMID: 33725895 PMCID: PMC7969320 DOI: 10.1097/md.0000000000025063] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 02/15/2021] [Indexed: 01/05/2023] Open
Abstract
RATIONALE Systemic lupus erythematosus (SLE) is a complex autoimmune inflammatory disease that frequently affects various organs. Neuropsychiatric manifestations in SLE patients, known as neuropsychiatric SLE, are clinically common. However, the principal manifestation of cranial neuropathy in patients with SLE and comorbidities is relatively rare. PATIENT CONCERNS In this report, we describe a 51-year-old Chinese woman who was admitted with a chief complaint of chronic-onset facial paresthesia, dysphagia, and choking cough when drinking water, accompanied by slurred speech, salivation, and limb weakness. The blood autoantibody test results showed that many SLE-associated antibodies were positive. Meanwhile, anti-nuclear matrix protein 2 (NXP2) antibody was strongly positive in the idiopathic inflammatory myopathy (IIM) spectrum test from the serum. Muscle biopsy indicated inflammatory infiltration of the muscle fiber stroma. DIAGNOSES Taking into account the clinical manifestations and laboratory tests of the present case, the diagnosis of SLE and probable IIM was established. INTERVENTIONS Corticosteroids and additional gamma globulin were administered and the clinical symptoms were relieved during the treatment process. OUTCOMES Unfortunately, the patient experienced sudden cardiac and respiratory arrest. Multiple system dysfunctions exacerbated disease progression, but in the present case, we speculated that myocardial damage resulting from SLE could explain why she suddenly died. LESSONS To our knowledge, multiple neurological manifestations in patients with SLE and anti-NXP2-positive myositis are rare. Note that SLE is still a life-threatening disease that causes multiple system dysfunctions, which requires increasing attention.
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Abstract
PURPOSE OF REVIEW This article provides an overview and update on the neurologic manifestations of sarcoidosis. RECENT FINDINGS The 2018 Neurosarcoidosis Consortium diagnostic criteria emphasize that biopsy is key for diagnosis and determines the level of diagnostic certainty. Thus, definite neurosarcoidosis requires nervous system biopsy and probable neurosarcoidosis requires biopsy from extraneural tissue. Without biopsy, possible neurosarcoidosis can be diagnosed if the clinical, imaging, and laboratory picture is compatible and other causes are ruled out. Recent large retrospective studies from the United States and France established that infliximab appears to be efficacious when other treatments are inadequate. SUMMARY Sarcoidosis is a multisystem noninfectious granulomatous disorder that is immune mediated, reflecting the response to an as-yet unidentified antigen or antigens. Neurosarcoidosis refers to neurologic involvement due to sarcoidosis that clinically manifests in 5% of cases of sarcoidosis, with asymptomatic involvement in as many as another one in five patients with sarcoidosis. Sarcoid granulomas can occur in any anatomic substrate in the nervous system, causing protean manifestations that have earned neurosarcoidosis the sobriquet the great mimic. Nevertheless, central nervous system sarcoidosis occurs in well-defined presentations that can be classified as cranial neuropathies, meningeal disease, brain parenchymal (including pituitary-hypothalamic) disease, and spinal cord disease. In addition, the peripheral nervous system is affected in the form of peripheral neuropathy and myopathy. Glucocorticoids are the cornerstone of treatment, especially in the acute stage, whereas steroid-sparing agents such as methotrexate, mycophenolate mofetil, and azathioprine are used for prolonged therapy to minimize steroid toxicity. Anti-tumor necrosis factor agents may help in refractory cases.
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Park JE, Lee KM, Choi HY, Ahn SE, You MW. Methotrexate-associated primary hepatic lymphoma and cranial neuropathy in a patient with rheumatoid arthritis: A case report with clinical follow-up over a 7-year period. Medicine (Baltimore) 2019; 98:e14997. [PMID: 31027052 PMCID: PMC6831240 DOI: 10.1097/md.0000000000014997] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
RATIONALE Rheumatoid arthritis (RA) shows a variable clinical expression in patients. Articular disease is common manifestation, but patients may rarely present with extra-articular manifestation such as cranial neuropathy. Also, primary hepatic lymphoma (PHL) has rarely been reported in patient treated with immunosuppressive drug such as methotrexate (MTX) for RA. We herein describe a case of cranial neuropathy and MTX-related PHL in a woman receiving MTX for RA. PATIENT CONCERNS A 73-year-old women received MTX treatment for more than 5 years, presented with recurrent cranial neuropathies. During therapy of cranial neuropathies, liver enzyme levels were elevated. DIAGNOSES The patient was diagnosed as RA by laboratory examination. A series of examinations had been launched to evaluate any possible cause of the extra-articular manifestation of the patient including ultrasound, computed tomography, magnetic resonance image (MRI) and positron emission tomography of the liver and MRI of the brain. Finally, the patient diagnosed as MTX-associated PHL and cranial neuropathy. INTERVENTIONS The patient underwent 4-year MTX therapy for RA at first with prednisolone. After that, she had been treated with cyclophosphamide therapy for cranial neuropathy. The liver biopsy was performed for hepatic lesion. OUTCOMES MTX was discontinued, but no improvement of PHL and elevated liver enzyme was observed during the 3 weeks. The patient received 6 cycles of chemotherapy for 3 months and achieved complete remission including PHL and cranial neuronal lesion with symptom. No instances of relapse have occurred in 2 years of follow-up. LESSONS The present case is the extremely rare case in which MTX-related PHL and cranial neuropathy were involved together in the RA patient. It is necessary to examine long-term follow up hepatic and neurologic examinations that patient had a long history of receiving MTX therapy for RA.
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Komamura H, Nakamura T, Kobayashi J, Harada R, Endo K, Ogura M, Higuchi J. Early neurosyphilis presenting with multiple cranial nerve palsies: A case report of management by combined penicillin-corticosteroid treatment. J Infect Chemother 2018; 25:362-364. [PMID: 30538059 DOI: 10.1016/j.jiac.2018.11.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Revised: 08/16/2018] [Accepted: 11/11/2018] [Indexed: 12/27/2022]
Abstract
Early neurosyphilis commonly appears in basilar meninges, and its meningeal inflammation can spread to neighboring cranial nerves, resulting in some cranial nerve palsies. Herein, we report a case of a 51-year-old man who presented with right peripheral facial nerve palsy. His symptoms completely disappeared with prednisolone monotherapy without antibiotics use and were not exacerbated during clinical treatment. However, 2 months after remission of seventh cranial neuropathy, fifth and eighth cranial neuropathies appeared on the right side. Serologic tests for syphilis were revealed to be abnormal. Finally, the patient was diagnosed with early neurosyphilis with multiple cranial palsies. His neurological symptoms were markedly improved by combined penicillin-corticosteroid treatment. Systemic corticosteroids could be effective as adjunctive therapy to ameliorate neurological sequelae in early neurosyphilis.
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Affiliation(s)
- Hiroshi Komamura
- Division of Neurology, Sendai City Hospital, 1-1-1 Asutonagamachi, Taihaku-ku, Sendai 982-8502, Miyagi, Japan
| | - Takaaki Nakamura
- Division of Neurology, Sendai City Hospital, 1-1-1 Asutonagamachi, Taihaku-ku, Sendai 982-8502, Miyagi, Japan.
| | - Junpei Kobayashi
- Department of Neurology, National Hospital Organization Yonezawa Hospital, 26100-1, Misawa, Yonezawa, Yamagata, Japan
| | - Ryuhei Harada
- Division of Neurology, Sendai City Hospital, 1-1-1 Asutonagamachi, Taihaku-ku, Sendai 982-8502, Miyagi, Japan
| | - Kaoru Endo
- Division of Neurology, Sendai City Hospital, 1-1-1 Asutonagamachi, Taihaku-ku, Sendai 982-8502, Miyagi, Japan
| | - Masaki Ogura
- Division of Otolaryngology, Sendai City Hospital, 1-1-1 Asutonagamachi, Taihaku-ku, Sendai, Miyagi, Japan
| | - Jun Higuchi
- Division of Neurology, Sendai City Hospital, 1-1-1 Asutonagamachi, Taihaku-ku, Sendai 982-8502, Miyagi, Japan
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Siegel CH, Finn RS, Ho MG. Multiple Cranial Neuropathies From Nivolumab in a Patient With Metastatic Hepatocellular Carcinoma. Mayo Clin Proc 2018; 93:540-541. [PMID: 29622100 DOI: 10.1016/j.mayocp.2018.01.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Accepted: 01/02/2018] [Indexed: 11/19/2022]
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Nashi S, Preethish-Kumar V, Maji S, Chandrashekar N, Polavarapu K, Kashinkunti C, Bhattacharya K, Saini J, Nalini A. Case Report: Neurobrucellosis with Plastered Spinal Arachnoiditis: A Magnetic Resonance Imaging-Based Report. Am J Trop Med Hyg 2018; 98:800-802. [PMID: 29345223 PMCID: PMC5930921 DOI: 10.4269/ajtmh.17-0828] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Accepted: 12/03/2017] [Indexed: 03/27/2024] Open
Abstract
Diffuse spinal arachnoiditis in neurobrucellosis is a rare manifestation. We report a boy aged 17, presenting with hearing impairment and recurrent vomiting for 18 months, weight loss for 12 months, dysphagia, dysarthria, hypophonia for 6 months, and gait unsteadiness for 5 months. He had bilateral 5th (motor) to 12th cranial nerve palsy, wasting and weakness of limbs, fasciculations, absent tendon reflexes, and positive Babinski's sign. Cerebrospinal fluid (CSF) showed raised protein and pleocytosis. Magnetic resonance imaging (MRI) showed extensive enhancing exudates in cisterns and post-contrast enhancement of bilateral 5th, 6th, 7th, and 8th nerves. Spine showed clumping with contrast enhancement of the cauda equina roots and encasement of the cord with exudates. Serum and CSF were positive for anti-Brucella antibodies. He showed significant improvement with antibiotics. At 4 months follow-up, MRI demonstrated near complete resolution of cranial and spinal arachnoiditis. It is important to recognize such rare atypical presentations of neurobrucellosis.
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Affiliation(s)
- Saraswati Nashi
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Veeramani Preethish-Kumar
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bangalore, India
- Department of Clinical Neurosciences, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Sayani Maji
- Department of Neuromicrobiology, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Nagarathna Chandrashekar
- Department of Neuromicrobiology, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Kiran Polavarapu
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bangalore, India
- Department of Clinical Neurosciences, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Chetan Kashinkunti
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Kajari Bhattacharya
- Department of Neuroimaging and Interventional Neuroradiology, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Jitender Saini
- Department of Neuroimaging and Interventional Neuroradiology, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Atchayaram Nalini
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bangalore, India
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Hosokawa T, Nakajima H, Tsukahara A, Unoda K, Ishida S, Kimura F. [Lower cranial polyneuropathy in zoster sine herpete presenting with pain in the ear and throat: a case report]. Rinsho Shinkeigaku 2016; 56:702-704. [PMID: 27645756 DOI: 10.5692/clinicalneurol.cn-000921] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
A 64-year-old woman developed acute paralysis of glossopharyngeal, vagus, accessory, and hypoglossal nerves on the left side after pain in the head and the left ear and throat. Cerebrospinal fluid examination revealed lymphocytic pleocytosis and elevated protein concentration. Varicella-zoster virus (VZV)-DNA was detected by PCR from cerebrospinal fluid. The diagnosis of lower cranial polyneuropathy due to VZV reactivation was made. After oral administration of an anti-viral agent and steroid, all symptoms and signs dramatically improved. Notably, there was no evidence of cutaneous or mucosal rash during the whole course of the disease. VZV reactivation should be included in the differential diagnosis of acute lower cranial polyneuropathy, especially with pain in the ear and throat, even without cutaneous or mucosal rash.
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Affiliation(s)
- Takafumi Hosokawa
- Division of Neurology, Department of Internal Medicine I, Osaka Medical College
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Park KI, Jung KH, Lee JJ. Delayed cranial neuropathies following zoster oticus: response to immunoglobulin treatment. Acta Neurol Belg 2016; 116:409-11. [PMID: 26404783 DOI: 10.1007/s13760-015-0535-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Accepted: 08/18/2015] [Indexed: 11/26/2022]
Affiliation(s)
- Kyung-Il Park
- Department of Neurology, Seoul Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - Keun-Hwa Jung
- Department of Neurology, Seoul National University Hospital, Seoul, Korea
| | - Jung-Ju Lee
- Department of Neurology, Eulji General Hospital, Eulji University College of Medicine, Hangeulbisek-ro 68, Noweon-gu, Seoul, Korea.
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Affiliation(s)
- S Jacob
- Department of Neurology, Leicester General Hospital, University Hospitals of Leicester, Leicester, UK
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Yasuda K, Sainouchi M, Goto M, Murase N, Ohtani R, Nakamura M. [A case of myeloperoxidase anti-neutrophil cytoplasmic antibody (MPO-ANCA)-associated hypertrophic pachymeningitis presenting with multiple cranial nerve palsies and diabetes insipidus]. Rinsho Shinkeigaku 2016; 56:334-337. [PMID: 27098904 DOI: 10.5692/clinicalneurol.cn-000859] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
A 61-year-old woman developed hearing difficulties and became thirsty after experiencing cold symptoms. A neurological examination revealed a loss of odor sensation, facial palsy, dysphasia, and dysarthria. Vocal cord palsy was observed during pharyngoscopy. Brain magnetic resonance imaging (MRI) showed a thickened pituitary stalk and swelling of the pituitary gland, but no high signal intensity regions were seen in the posterior portion of the pituitary gland. Gadolinium-enhanced MRI demonstrated a thickened dura mater over the anterior cranial fossa. A biopsy specimen of the thickened dura mater showed fibrosis, granulomatous inflammation, and necrotic foci. Blood tests detected myeloperoxidase anti-neutrophil cytoplasmic antibody (MPO-ANCA). The patient's urine osmolarity was low even though she exhibited hypernatremia. We diagnosed her with hypertrophic pachymeningitis associated with MPO-ANCA and diabetes insipidus. The patient received two courses of 5-day high-dose intravenous methylprednisolone (1.0 g/day), and was subsequently administered oral prednisolone, which gradually relieved her symptoms. However, the patient's symptoms recurred despite the high-dose prednisolone treatment. It was difficult to control the patient's symptoms in this case with oral prednisolone monotherapy, but combined treatment with cyclosporine resulted in sustained remission. It is considered that patients with MPO-ANCA-positive hypertrophic pachymeningitis require combination therapy with prednisolone and immunosuppressive agents at an early stage.
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Affiliation(s)
- Ken Yasuda
- Department of Neurology, National Hospital Organization Kyoto Medical Center
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Chernyak VI, Men'shikova IV, Pogromov AP. [NERVOUS SYSTEM LESIONS ASSOCIATED WITH RELAPSING POLYCHONDRITIS: ANALYSIS OF ORIGINAL OBSERVATIONS]. Klin Med (Mosk) 2016; 94:108-113. [PMID: 27459759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Three clinical cases are described including two of relapsing polychondritis with lesions in the central and peripheral nervous system (one of long-standing aseptic lymphocytic meningitis and one of cranial neuropathy of 2, 5, 7, and 8 pairs) and the third case of the optic nerve lesion with amblyopia. The two former cases were successfully treated with high doses of corticosteroids, the third one with moderate doses of the same medications. The data from the current literature concerning variants of clinical manifestations, methods for diagnostics and treatment of neurologic manifestations of relapsing polychondritis are discussed.
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Berenguer-Potenciano M, Villora-Morcillo N, Nunez-Enamorado N, Perez-Alonso V, Camacho-Salas A, Simon-De Las Heras R. [Therapeutic response to pyridoxine and pyridostigmine in a paediatric case of severe peripheral and cranial polyneuropathy due to vincristine]. Rev Neurol 2015; 60:91-92. [PMID: 25583593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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Fytili C, Bournia VK, Korkou C, Pentazos G, Kokkinos A. Multiple cranial nerve palsies in giant cell arteritis and response to cyclophosphamide: a case report and review of the literature. Rheumatol Int 2014; 35:773-6. [PMID: 25194431 DOI: 10.1007/s00296-014-3126-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2014] [Accepted: 08/29/2014] [Indexed: 02/06/2023]
Abstract
Giant cell arteritis (GCA) has been previously associated with cranial mononeuritis (usually optic neuritis). We hereby describe a 68-year-old man who presented due to fever and diplopia of acute onset. Physical examination revealed left abducens nerve palsy and a hearing defect in the right ear. Brain imaging and cerebrospinal fluid analysis were not diagnostic. GCA was suspected, and treatment with high-dose methylprednisolone was initiated, leading to marked improvement. Temporal artery biopsy confirmed the presence of GCA. While considering corticosteroid tapering, the patient experienced hoarseness due to right laryngeal nerve palsy. Addition of cyclophosphamide to the treatment resulted in full response. GCA mainly affects large vessels, but one or more cranial nerve palsies may also occur. Following a review of the literature, this is the first report of three cranial nerve palsies in the setting of histologically proven GCA. The role of cyclophosphamide in this entity is also discussed.
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Affiliation(s)
- Christina Fytili
- First Department of Propaedeutic Internal Medicine, Laiko General Hospital, 17, Agiou Thoma Street, 11527, Goudi, Athens, Greece,
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Caso F, Costa L, Rigante D, Vitale A, Cimaz R, Lucherini OM, Sfriso P, Verrecchia E, Tognon S, Bascherini V, Galeazzi M, Punzi L, Cantarini L. Caveats and truths in genetic, clinical, autoimmune and autoinflammatory issues in Blau syndrome and early onset sarcoidosis. Autoimmun Rev 2014; 13:1220-9. [PMID: 25182201 DOI: 10.1016/j.autrev.2014.08.010] [Citation(s) in RCA: 74] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2014] [Accepted: 07/27/2014] [Indexed: 01/09/2023]
Abstract
Blau syndrome (BS) and early onset sarcoidosis (EOS) are, respectively, the familial and sporadic forms of the pediatric granulomatous autoinflammatory disease, which belong to the group of monogenic autoinflammatory syndromes. Both of these conditions are caused by mutations in the NOD2 gene, which encodes the cytosolic NOD2 protein, one of the pivotal molecules in the regulation of innate immunity, primarily expressed in the antigen-presenting cells. Clinical onset of BS and EOS is usually in the first years of life with noncaseating epithelioid granulomas mainly affecting joints, skin, and uveal tract, variably associated with heterogeneous systemic features. The dividing line between autoinflammatory and autoimmune mechanisms is probably not so clear-cut, and the relationship existing between BS or EOS and autoimmune phenomena remains unclear. There is no established therapy for the management of BS and EOS, and the main treatment aim is to prevent ocular manifestations entailing the risk of potential blindness and to avoid joint deformities. Nonsteroidal anti-inflammatory drugs, corticosteroids and immunosuppressive drugs, such as methotrexate or azathioprine, may be helpful; when patients are unresponsive to the combination of corticosteroids and immunosuppressant agents, the tumor necrosis factor-α inhibitor infliximab should be considered. Data on anti-interleukin-1 inhibition with anakinra and canakinumab is still limited and further corroboration is required. The aim of this paper is to describe BS and EOS, focusing on their genetic, clinical, and therapeutic issues, with the ultimate goal of increasing clinicians' awareness of both of these rare but serious disorders.
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Affiliation(s)
- Francesco Caso
- Research Center of Systemic Autoinflammatory Diseases and Behçet's Disease Clinic, Department of Medical Sciences, Surgery and Neurosciences, University of Siena, Siena, Italy; Rheumatology Unit, Department of Medicine DIMED, University of Padua, Padua, Italy
| | - Luisa Costa
- Rheumatology Unit, Department of Clinical Medicine and Surgery, University Federico II, Naples, Italy
| | - Donato Rigante
- Institute of Pediatrics, Policlinico "A. Gemelli", Università Cattolica Sacro Cuore, Rome, Italy
| | - Antonio Vitale
- Research Center of Systemic Autoinflammatory Diseases and Behçet's Disease Clinic, Department of Medical Sciences, Surgery and Neurosciences, University of Siena, Siena, Italy
| | - Rolando Cimaz
- Department of Pediatrics, Rheumatology Unit, Anna Meyer Children's Hospital and University of Florence, Florence, Italy
| | - Orso Maria Lucherini
- Research Center of Systemic Autoinflammatory Diseases and Behçet's Disease Clinic, Department of Medical Sciences, Surgery and Neurosciences, University of Siena, Siena, Italy
| | - Paolo Sfriso
- Rheumatology Unit, Department of Medicine DIMED, University of Padua, Padua, Italy
| | - Elena Verrecchia
- Periodic Fever Research Center, Department of Internal Medicine, Policlinico "A. Gemelli", Università Cattolica Sacro Cuore, Rome, Italy
| | - Sofia Tognon
- Ophthalmology Unit, Department of Neurosciences, University of Padua, Padua, Italy
| | - Vittoria Bascherini
- Research Center of Systemic Autoinflammatory Diseases and Behçet's Disease Clinic, Department of Medical Sciences, Surgery and Neurosciences, University of Siena, Siena, Italy
| | - Mauro Galeazzi
- Research Center of Systemic Autoinflammatory Diseases and Behçet's Disease Clinic, Department of Medical Sciences, Surgery and Neurosciences, University of Siena, Siena, Italy
| | - Leonardo Punzi
- Rheumatology Unit, Department of Medicine DIMED, University of Padua, Padua, Italy
| | - Luca Cantarini
- Research Center of Systemic Autoinflammatory Diseases and Behçet's Disease Clinic, Department of Medical Sciences, Surgery and Neurosciences, University of Siena, Siena, Italy.
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Tsugawa J, Ouma S, Fukae J, Tsuboi Y, Sakata N, Inoue T. [Multiple cranial neuropathies in a patient with IgG4-related hypertrophic pachymeningitis: a case report]. Brain Nerve 2014; 66:873-878. [PMID: 24998832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
We describe the case of a 75-year-old woman who presented with acute loss of vision. She experienced subacute headache, hearing loss on the left side, hoarseness, and dysphagia during the previous 10 months. On admission, she had bilateral loss of vision, without any ophthalmological abnormalities, and multiple cranial nerve palsies, including left hearing loss and right IX, X, and XI nerve palsies. Head magnetic resonance imaging with contrast enhancement revealed hypertrophic pachymeningitis. Laboratory findings showed no abnormalities except for an increased sedimentation rate and increased C-reactive protein levels. A biopsy of the dura mater was performed, and histopathological analysis revealed inflammatory thickening of the dura mater with plasma cell infiltration; the infiltrating cells were immunoreactive to an anti-IgG4 antibody, thereby indicating an IgG4-related disorder. Furthermore, the histopathological analysis revealed evidence of vasculitis in both veins and arteries. After corticosteroid treatment, her visual acuity dramatically improved. Acute loss of vision with multiple cranial nerve palsies may be an uncommon presentation of IgG4-related hypertrophic pachymeningitis. However, it should be recognized that these conditions might be underdiagnosed. The possibility of central nervous system involvement in IgG4-related disorders should be considered in patients with multiple cranial nerve neuropathies associated with hypertrophic pachymeningitis, even in the absence of systemic sclerosis symptoms. In our case, early treatment with corticosteroids showed immediate effectiveness in correcting the visual symptoms.
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Affiliation(s)
- Jun Tsugawa
- Department of Neurology, Fukuoka University Hospital
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Laukart EB, Selishchev AG. [Cranial neuropathy due to persistent herpes viral infection]. Zh Nevrol Psikhiatr Im S S Korsakova 2014; 114:75-78. [PMID: 24781230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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Abstract
Wegener's granulomatosis (WG) is a systemic vasculitis affecting small and medium-sized vessels with granulomatous formation. Though it is known for respiratory tract and kidney involvement, neurologic manifestation has been also reported. Herein we report a patient who suffered pansinusitis with multiple lower cranial nerve palsies but reached remission by immunosuppressant after the diagnosis of WG. A 54-yr-old female visited with headache, hearing difficulty, and progressive bulbar symptoms. She experienced endoscopic sinus surgeries due to refractory sinusitis. Neurologic examination revealed multiple lower cranial nerve palsies. Vasculitic markers showed no abnormality. Nasal biopsy revealed granulomatous inflammation and vasculitis involving small vessels. Given cyclophosphamide and prednisolone, her symptoms were prominently improved. WG should be considered in the patient with multiple cranial nerve palsies, especially those with paranasal sinus disease. Because WG can be lethal if delayed in treatment, prompt immunosuppressant is warranted after the diagnostic tissue biopsy.
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Affiliation(s)
- Sung-Hee Kim
- Department of Neurology, Ewha Womans University School of Medicine and Ewha Medical Research Institute, Seoul, Korea
| | - Jin Park
- Department of Neurology, Ewha Womans University School of Medicine and Ewha Medical Research Institute, Seoul, Korea
| | - Jung Ho Bae
- Department of Otolaryngology, Ewha Womans University School of Medicine and Ewha Medical Research Institute, Seoul, Korea
| | - Min-Sun Cho
- Department of Pathology, Ewha Womans University School of Medicine and Ewha Medical Research Institute, Seoul, Korea
| | - Kee Duk Park
- Department of Neurology, Ewha Womans University School of Medicine and Ewha Medical Research Institute, Seoul, Korea
| | - Jee Hyang Jeong
- Department of Neurology, Ewha Womans University School of Medicine and Ewha Medical Research Institute, Seoul, Korea
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Dixit G, Dhingra A, Kaushal D. Vincristine induced cranial neuropathy. J Assoc Physicians India 2012; 60:56-58. [PMID: 22799120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Neuropathy is a well known side effect of vincristine, however cranial nerve toxicities are reported less frequently which can involve any cranial nerve in mostly bilateral pattern. As many patients have primary tumors or metastatic lesions in sites that could cause the clinician to overlook this reversible cause of neurologic dysfunction, the potential for misdiagnosis is high. Here, along with review of literature we describe three cases on vincristine who developed cranial neuropathy while on treatment.
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Affiliation(s)
- Gaurav Dixit
- Department of Medicine, Pt. B.D. Sharma PGIMS, Rohtak 124001
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Abstract
A 52-year-old woman was diagnosed with Blau syndrome and rheumatoid arthritis and was treated with prednisolone and methotrexate. Joint pain and skin ulcers were poorly controlled; therefore, mizoribine (MZ; 150 mg/day) was administered once daily from March 2011. In early July 2011, the patient was hospitalized because of acute kidney injury (AKI) and acute pancreatitis. We reasoned that AKI resulted from hyperuricemia during MZ administration because serum concentrations of uric acid (31.6 mg/dL) and MZ (trough level, 5.14 µg/mL) were markedly elevated on admission. MZ should be administered with caution because of the risk of marked hyperuricemia leading to AKI.
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Affiliation(s)
- Tomoya Nishino
- Second Department of Internal Medicine, Nagasaki University of Medicine, Japan
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Abstract
BACKGROUND Recent scientific data support an effect of botulinum neurotoxin (BoNT) on pain and headache. OBJECTIVE We sought to conduct a systematic review of BoNT in the secondary headaches and cranial neuralgias. METHODS MEDLINE, EMBASE, Cochrane, ClinicalTrials.gov and reference lists were searched up to December 2010 to identify all relevant publications. RESULTS Only two papers were rated as highest evidence (Level 1). The absolute majority (30/38, 79%) of identified publications yield only low evidence (Level 4). DISCUSSION No treatment recommendations of Grade A or Grade B can be made based on available research. Grade C treatment recommendations in support of BoNT can be made for chronic headache attributed to whiplash injury, cephalalgic alopecia areata, headache and facial pain in blepharospasm, trigeminal neuralgia, occipital neuralgia and nummular headache. As a result of studies being troublingly inconsistent or inconclusive, only the weakest rank of recommendations (Grade D) can be made for using BoNT in medication overuse headache, cervicogenic headache, headache attributed to craniocervical dystonia, pain in masticatory hyperactivity and headache or facial pain attributed to temporomandibular disorder. CONCLUSION At present, BoNT cannot be firmly recommended as an evidence-based treatment in secondary headaches or cranial neuralgias.
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Affiliation(s)
- M Linde
- Department of Neuroscience, Norwegian University of Science and Technology, Trondheim, Norway.
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Subbarao NT, Jaiswal AK. A case of leprosy with multiple cranial neuropathy mimicking Melkerson Rosenthal syndrome. Indian J Lepr 2011; 83:101-102. [PMID: 21972663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Involvement of cranial nerves is not uncommon in leprosy with trigeminal and facial nerves being commonly affected. Other cranial nerves can also be involved especially in longstanding cases of leprosy towards the lepromatous pole. Herein, we report a case of leprosy with multiple cranial neuropathy mimicking Melkerson Rosenthal syndrome.
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Affiliation(s)
- N T Subbarao
- Department of Dermatology, Venereology and Leprosy, Vydehi Institute of Medical Sciences & Research Center, Whitefield, Bangalore-560066, India
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Sharma SM, Martin TM, Rosé CD, Dick AD, Ramanan AV. Distinguishing between the innate immune response due to ocular inflammation and infection in a child with juvenile systemic granulomatous disease treated with anti-TNFα monoclonal antibodies. Rheumatology (Oxford) 2011; 50:990-2. [PMID: 21278066 DOI: 10.1093/rheumatology/keq431] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Miyazaki K, Fukuzumi M, Aizawa T, Shibata M, Sakai T, Tojima H. [Patient with MPO-ANCA-associated disease with interstitial pneumonia and lower cranial nerves palsy who was previously exposed to asbestos]. Nihon Kokyuki Gakkai Zasshi 2010; 48:876-882. [PMID: 21141070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
A 65-year-old man who was occupationally exposed to asbestos for 40 years was admitted to our hospital with fever and cough. Chest CT revealed paraseptal emphysema, subpleural fibrosis in both lungs, and pleural plaques. On bronchoalveolar lavage fluid contained elevated levels of lymphocytes and neutrophils (15% and 17%, respectively), and asbestos bodies were also found. Because serum MPO-ANCA titer was elevated to 188 EU, we suspected ANCA-associated disease with interstitial pneumonia. Prednisolone was begun at 30 mg/day and his lung opacities partially disappeared. Six weeks later, he complained of headache, dysphagia and hoarseness, and was admitted to the neurology department of the hospital. Under a diagnosis of either hypertrophic pachymeningitis or neuritis due to angiitis of the lower cranial nerves, steroid pulse therapy was performed. Asbestos exposure may have been a contributing factor for ANCA generation in this case. Furthermore, the fact that cranial nerves palsy occurred in spite of steroid therapy may also be important.
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Affiliation(s)
- Kenji Miyazaki
- Department of Respiratory Medicine, Tokyo Rosai Hospital
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Lauridsen AG, Mirz F. [Herpes zoster oticus with cranial nerve affection]. Ugeskr Laeger 2010; 172:2849-2851. [PMID: 20961509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Herpes zoster oticus (HZO) with cranial polyneuropathy is also known as Ramsay Hunt syndrome (RHS). After primary varicella infection, the varicella zoster virus (VZV) remains dormant in the nervous system and can reactivate later in life causing RHS. This case describes a 56-year-old man with HZO and palsy of N. V, VII, VIII, IX, X and XII. Anti-viral agents might be effective in patients with RHS, although the only randomized controlled clinical trial on this subject found no significant benefit. There are no randomized controlled trials to support the use of corticosteroid therapy.
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Selewski D, Mukherji SK, Kershaw D. A unique neurological presentation of Wegener's granulomatosis. Pediatr Nephrol 2010; 25:1567-8. [PMID: 20195642 DOI: 10.1007/s00467-010-1482-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2010] [Revised: 01/19/2010] [Accepted: 01/20/2010] [Indexed: 11/29/2022]
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Abstract
A 77-year-old man showed bilateral abducens palsies and multiple cranial nerve enhancement on magnetic resonance images (MRI) and aseptic meningitis. He had xerophthalmia and xerostomia. Serum anti-SS-A and anti-SS-B antibodies were present. He had Sjögren's syndrome (SjS) and corticosteroid therapy ameliorated the symptoms. The cranial nerve enhancement and the cerebrospinal fluid findings were normalized. In patients with SjS, there have not been any reports of multiple areas of cranial nerve enhancement on MRI. We propose that in this case the aseptic meningitis and subsequent lymphocytic infiltration to the cranial nerves contributed to the multiple cranial neuropathy and multiple cranial nerve enhancement on MRI.
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Affiliation(s)
- Kenji Sakai
- Department of Neurology, Noto General Hospital, Nanao.
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Højberg L, Søndergård E, Pedersen C. A case of Epstein-Barr virus infection complicated with Guillain-Barré syndrome involving several cranial nerves. ACTA ACUST UNITED AC 2009; 37:522-4. [PMID: 16012019 DOI: 10.1080/00365540510038514] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
This report presents a case of infectious mononucleosis with severe neurological complications in a previously healthy young female. Both peripheral and cranial nerves were affected causing paralysis and need for assisted ventilation. There was a clear correlation between the symptoms and the serological findings, indicating that the causative agent was Epstein-Barr virus. The patient was treated with acyclovir, methylprednisolone and immunoglobulins. Two months later she had recovered completely. Epstein-Barr virus infection must be considered among the possible causes in patients with cranial nerve affection or Guillain-Barré syndrome.
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Affiliation(s)
- Lise Højberg
- Department of Infectious Diseases, Odense University Hospital, Odense, Denmark.
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Kodama S, Oribe K, Suzuki M. Superior laryngeal neuralgia associated with deviation of the hyoid bone. Auris Nasus Larynx 2008; 35:429-31. [PMID: 17890033 DOI: 10.1016/j.anl.2007.06.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2007] [Revised: 05/15/2007] [Accepted: 06/13/2007] [Indexed: 11/30/2022]
Abstract
Superior laryngeal neuralgia is a rare condition. We report a case of superior laryngeal neuralgia with deviated hyoid bone. A 50-year-old woman presented with paroxysmal and lancing pain localized to the area around the thyrohyoid membrane. Pain was induced and worsened by swallowing. A three-dimensional image showed deviation of the hyoid bone. General and neurological examinations were normal. After spraying of the larynx with 4% lidocaine, the pain improved. Superior laryngeal neuralgia was diagnosed, and the condition was treated with carbamazepine. Superior laryngeal neuralgia is rare but should be considered, particularly if no other pathologic findings are identified.
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Affiliation(s)
- Satoru Kodama
- Department of Otolaryngology, Oita University Faculty of Medicine, 1-1 Idaigaoka, Hazama-machi, Yufu, Oita, Japan.
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Fujikawa K, Kawakami A, Eguchi K. Recovery from multiple cranial nerve palsy of Wegener's granulomatosis with infliximab. J Rheumatol 2008; 35:1471-1472. [PMID: 18609728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
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Pastre T, Faot F, Westphalen FH, da Rosa RS. Treatment of painful post-traumatic peripheral neuropathy with capsaicin in an edentulous patient with extreme resorption in the mental region: a case report. J Contemp Dent Pract 2008; 9:106-113. [PMID: 18335126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
AIM The aim of this report is to present a clinical case of extensive alveolar resorption in the mental region of the mandible of a complete denture wearer for which capsaicin was used for alleviation and remission of post-traumatic painful peripheral neuropathy. BACKGROUND Resorption of the residual ridge occurs in a chronic and progressive manner, altering the configuration of the ridge and the mucosa covering it and subsequently compromising the stability of the complete denture prosthesis. Individual variability associated with such factors as gender, age, edentulous period, nutrition, excessive load and compression on the ridge, parafunctional habits, occlusal instability, and maladaptation of the prosthesis may have a role in the rate and manner of bone loss. REPORT A 62-year-old woman, edentulous at the age of 30, presented with complaints of pain and spontaneous "electrical shocks" in the mucosa under her mandibular complete denture. The pain increased while chewing approximately two years ago due to the pressure of this denture on her supporting tissues. The patient indicated the level of pain corresponded to a score of ten out of ten on the Visual Analogical Scale (VAS). Treatment included denture replacement and topical application of capsaicin gel using a custom tray technique. SUMMARY The review of the literature and the results obtained from the management of this case have served to emphasize how much neuropathic pain research has demonstrated the complexity of its neurophysiologic mechanism due to the lack of association with any somatic manifestation. During the fabrication of a new lower denture the topical application of capsaicin was shown to be effective in the relief and remission of the painful symptoms of the neuropathy as of this writing.
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Affiliation(s)
- Therezinha Pastre
- Prosthodontics Residency Program at Tuiuti University of Parana in Curitiba, PR, Brazil.
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Abstract
Vincristine is a commonly used antineoplastic drug and frequently causes neurotoxicity. Here the authors report a 4-year-old boy with acute lymphoblastic leukemia in whom vincristine-induced peripheral and cranial neuropathy developed during remission induction therapy. The patient seemed to benefit from pyridoxine and pyridostigmine therapy greatly and this therapy is recommended in patients with severe vincristine-induced neuropathy.
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Affiliation(s)
- Hamit Ozyurek
- Ondokuz Mayis University, Faculty of Medicine, Department of Pediatrics, Section of Neurology, Samsun, Turkey.
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Pavone P, Incorpora G, Romantshika O, Ruggieri M. Polyneuritis cranialis: full recovery after intravenous immunoglobulins. Pediatr Neurol 2007; 37:209-11. [PMID: 17765810 DOI: 10.1016/j.pediatrneurol.2007.05.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2007] [Revised: 04/06/2007] [Accepted: 05/07/2007] [Indexed: 11/21/2022]
Abstract
Polyneuritis cranialis is a rare disorder of multiple cranial nerve palsies without spinal cord involvement. The case reported is of a 10-year-old boy with multiple palsies involving cranial nerves III, IV, V, VI, VII, IX, X, XI, and XII cranial nerves, unilaterally or bilaterally. After initial, unsuccessful treatment, corticosteroids and acyclovir were administered. The patient dramatically improved after two cycles of intravenous immunoglobulins. He was left with a mild residual left VI nerve deficit, which fully remitted after 2 months.
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Affiliation(s)
- Piero Pavone
- Department of Pediatrics, University of Catania, Catania, Italy
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Grahn BH, McRuer DL, Sandmeyer LS. Diagnostic ophthalmology ophtalmologie diagnostique. Can Vet J 2007; 48:755-6. [PMID: 17824165 PMCID: PMC1899856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Affiliation(s)
- Bruce H Grahn
- Department of Small Animal Clinical Sciences, Western College of Veterinary Medicine, University of Saskatchewan, Saskatoon, Saskatchewan
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Abstract
Burning mouth syndrome (BMS) is characterized by oral dysesthesia, xerostomia and dysgeusia without visible alterations of oral mucosa. While secondary BMS results from an underlying general condition such as diabetes or iron deficiency, no causal disorder can be identified in primary BMS. The estimated prevalence is 1 - 2%, postmenopausal women are substantially more frequently affected than men. Current etiologic concepts assume a focal peripheral and central neuropathy. Only few controlled drug trials have yet been conducted. Thioctic acid appears the medical treatment of choice due to its comparatively good evidence for efficacy and low incidence of adverse reaction. Gabapentin and pregabalin are modern GABA-analogue anticonvulsants, which are also efficient in the treatment of peripheral neuropathies. Also conceptually appropriate for BMS treatment, current evidence for efficacy in BMS is insufficient. In two trials, local oral treatment with clonazepam has been beneficial in BMS. The efficacy of antidepressants is equivocal.
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Affiliation(s)
- R Schatton
- Klinik für Hals-Nasen-Ohrenheilkunde, Universitätsklinik Ulm.
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Halperin JJ, Shapiro ED, Logigian E, Belman AL, Dotevall L, Wormser GP, Krupp L, Gronseth G, Bever CT. Practice Parameter: Treatment of nervous system Lyme disease (an evidence-based review): Report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology 2007; 69:91-102. [PMID: 17522387 DOI: 10.1212/01.wnl.0000265517.66976.28] [Citation(s) in RCA: 252] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To provide evidence-based recommendations on the treatment of nervous system Lyme disease and post-Lyme syndrome. Three questions were addressed: 1) Which antimicrobial agents are effective? 2) Are different regimens preferred for different manifestations of nervous system Lyme disease? 3) What duration of therapy is needed? METHODS The authors analyzed published studies (1983-2003) using a structured review process to classify the evidence related to the questions posed. RESULTS The panel reviewed 353 abstracts which yielded 112 potentially relevant articles that were reviewed, from which 37 articles were identified that were included in the analysis. CONCLUSIONS There are sufficient data to conclude that, in both adults and children, this nervous system infection responds well to penicillin, ceftriaxone, cefotaxime, and doxycycline (Level B recommendation). Although most studies have used parenteral regimens for neuroborreliosis, several European studies support use of oral doxycycline in adults with meningitis, cranial neuritis, and radiculitis (Level B), reserving parenteral regimens for patients with parenchymal CNS involvement, other severe neurologic symptomatology, or failure to respond to oral regimens. The number of children (> or =8 years of age) enrolled in rigorous studies of oral vs parenteral regimens has been smaller, making conclusions less statistically compelling. However, all available data indicate results are comparable to those observed in adults. In contrast, there is no compelling evidence that prolonged treatment with antibiotics has any beneficial effect in post-Lyme syndrome (Level A).
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Affiliation(s)
- J J Halperin
- Department of Neurosciences, Overlook Hospital, NYU School of Medicine, Summit, NJ, USA
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Kondziella D, Skagervik I. Malignant external otitis with extensive cranial neuropathy but no facial paralysis. J Neurol 2007; 254:1298-9. [PMID: 17325817 DOI: 10.1007/s00415-006-0516-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2006] [Revised: 11/17/2006] [Accepted: 11/28/2006] [Indexed: 10/23/2022]
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Penas-Prado M, Martínez-Salio A, Porta-Etessam J, Villarejo-Galende A, García-Ramos R, Saiz-Díaz RA, Moreno-Ramos T. [Post-traumatic supraorbital neuralgia: a benign condition]. Rev Neurol 2007; 44:89-91. [PMID: 17236147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
INTRODUCTION Supraorbital neuralgia has only recently been described. Most of the cases reported involve patients suffering from chronic idiopathic neuralgias that are difficult to treat and sometimes require surgery to release the nerve. We present our experience in patients with a variant of this neuralgia which has a known causation, is commonly seen and has a benign prognosis. CASE REPORTS We studied five patients, four females and one male, with a mean age of 55 years (range: 29-69 years). They had all suffered direct banal traumatic injury to the frontal region due to different causes. Four of them developed continuous, piercing or burning-type pain; three of them had paroxysmal pain and one had itching. There were no autonomic manifestations. All of them were found to be abnormally sensitive in the affected area, with tactile hypaesthesia, hyperalgesia or allodynia and a positive Tinel's sign. Neuroimaging tests were normal. Two patients were treated with gabapentin and amitriptyline. One was treated with an anaesthetic blockade, which afforded temporary relief. Three of them received no treatment at all. After one year of follow-up, all of them had improved and three were no longer in pain, although sensory alterations persisted in all cases. CONCLUSIONS Post-traumatic supraorbital neuralgia is a frequent condition, although it is probably underdiagnosed. It has its own characteristic clinical and developmental features that distinguish it from idiopathic supraorbital neuralgia. Progress is usually good and it responds favourably to symptomatic treatment, if needed.
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Affiliation(s)
- M Penas-Prado
- Hospital Universitario 12 de Octubre, 28045 Madrid, España
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Ray S, Pavithran K, Nair PS. Cranial neuropathy and bone involvement in primary systemic amyloidosis. J Assoc Physicians India 2006; 54:577-80. [PMID: 17089910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
Bone involvement in primary systemic amyloidosis is rare. Intracranial involvement in primary amyloidosis has not been reported so far. We report two cases of bone involvement in primary amyloidosis. The first patient also had combined deficiencies of factor IX and XII, while the second patient had associated intracranial involvement and XIIth cranial nerve palsy. Both these cases are unique in that, destructive bone lesions with intracranial involvement and combined factor deficiencies have not been reported in primary amyloidosis previously.
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Affiliation(s)
- S Ray
- Internal Medicine, Amrita Institute of Medical Sciences and Research Centre, Elamakkara, Kerala
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Abstract
We describe a 5-year-old girl showed recovery of vincristine induced cranial polyneuropathy with pyridoxine and pyridostigmine treatment. A 5-year-old girl was diagnosed preB cell Acute Lymphoblastic Leukemia (ALL). She received chemotherapy according to the previously described modified St. Jude total therapy studies XIII. Five days after the fourth dose of vincristine, she presented with bilateral ptosis. Neurological examination revealed bilateral ptosis, and complete external opthalmoplegia with normal pupillary and corneal reflexes. She received 3.8 mg cumulative dose of vincristin before development of ptosis. A neuroprotective and neuroregenerative treatment attempt with pyridoxine and pyridostigmine was initiated. The bilateral ptosis markedly improved after 7 days of pyridoxine and pyridostigmine treatment and completely resolved after two weeks. The both agents were given for 3 weeks and were well tolerated without any side effects. During the follow up period we did not observe residue or recurrence of the ptosis.
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Affiliation(s)
- Ali Bay
- Yuzuncu Yil University Faculty of Medicine, Division of Hematology, Van, Turkey.
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Abstract
PURPOSE This study was designed to assess the efficacy of nerve growth factor in the treatment of neurotrophic corneal ulceration in a child with bilateral congenital corneal anesthesia secondary to trigeminal insufficiency. METHODS A 5-month-old child presented to the casualty department with a 2-week history of red eyes and right corneal ulceration. Slit-lamp examination showed a central defect in the right corneal epithelium with underlying stromal opacification, only mild conjunctival inflammation with slight decreased tear production, and otherwise apparently normal eyes. Initially this was investigated as an infected ulcer and treated for several weeks as herpetic ulceration with no beneficial effect. Further clinical examination demonstrated bilateral decreased corneal sensation along with decreased facial sensation in keeping with congenital trigeminal nerve insufficiency. Investigation with magnetic resonance imaging showed no obvious abnormality. Conservative treatment with lubricants resulted in progressive right corneal stromal loss, and no healing occurred in the left corneal ulcer. Bilateral large lateral tarsorrhaphies were performed. Despite this, the left corneal ulcer demonstrated no improvement and increasing stromal opacification was noted. Topical nerve growth factor (NGF) was then used to treat the left cornea and resulted in epithelial healing within 1 week. Treatment was continued for a further 10 days after epithelial healing. Despite conventional treatment on 3 separate occasions, further epithelial breakdown occurred. Topical NGF treatment resulted in a rapid improvement and healing of the epithelial defect.'At present, the patient is receiving a 6-month continuous treatment plan of NGF. RESULTS Persistent epithelial defects (PED) secondary to neurotrophic ulceration have responded to topical NGF on 3 separate occasions during a 2-year period. The corneal epithelium now remains intact, and the cornea has no vascularization; however, mild anterior stromal opacification has gradually increased despite prolonged NGF treatment. CONCLUSION NGF seems to represent a safe and efficacious treatment option to restore the integrity of corneal epithelium in which there is congenital corneal anesthesia because of trigeminal insufficiency. However, this treatment alone is insufficient to prevent progressive anterior stromal opacification.
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Affiliation(s)
- Mei Hong Tan
- Department of Ophthalmology, Oxford Eye Hospital, Radcliffe Infirmary, Oxford, United Kingdom
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Abstract
The systemic treatment of herpes zoster shortens the healing process, and prevents or alleviates pain and other acute or chronic complications, especially when it is administered in the first 72 hours after symptoms appear. This treatment is especially indicated in patients over the age of 50 and in those who, regardless of age, have head and neck involvement, especially in herpes zoster ophthalmicus. The drugs approved in Europe for the systemic treatment of herpes zoster are aciclovir, valaciclovir, famciclovir and brivudine. Brivudine shows greater effectiveness against the varicella-zoster virus than aciclovir and its derivatives, and can be given just once a day for seven days, compared to multiple doses of the latter. As opposed to the others, brivudine is a non-nephrotoxic drug that should not be administered to immunodepressed patients or to those being treated with 5-fluorouracil. The treatment of herpes zoster to reduce pain should be combined with analgesics and neuroactive agents (amitriptyline, gabapentin, etc). While corticosteroids are of dubious efficacy in the treatment of post-herpes neuralgia, the intensity and duration of the pain can be reduced with some topical treatments (capsaicin, lidocaine patches, etc). Finally, this review discusses treatment guidelines for special locations (cranial nerves) and different subpopulations (children, pregnant women, immunodepressed patients, etc).
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Affiliation(s)
- Agustín España
- Departamento de Dermatología, Clínica Universitaria de Navarra, Facultad de Medicina, Spain
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Chang JTC, Lin CY, Chen TM, Kang CJ, Ng SH, Chen IH, Wang HM, Cheng AJ, Liao CT. Nasopharyngeal carcinoma with cranial nerve palsy: the importance of MRI for radiotherapy. Int J Radiat Oncol Biol Phys 2006; 63:1354-60. [PMID: 16297716 DOI: 10.1016/j.ijrobp.2005.05.042] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2005] [Revised: 05/17/2005] [Accepted: 05/25/2005] [Indexed: 11/21/2022]
Abstract
PURPOSE To evaluate various prognostic factors and the impact of imaging modalities on tumor control in patients with nasopharyngeal cancer (NPC) with cranial nerve (CN) palsy. MATERIAL AND METHODS Between September 1979 and December 2000, 330 NPC patients with CN palsy received radical radiotherapy (RT) by the conventional opposing technique at Chang Gung Memorial Hospital-Linkou. Imaging methods used varied over that period, and included conventional tomography (Tm) for 47 patients, computerized tomography (CT) for 195 patients, and magnetic resonance image (MRI) for 88 patients. Upper CN (II-VI) palsy was found in 268 patients, lower CN (IX-XII) in 13, and 49 patients had both. The most commonly involved CN were V or VI or both (23%, 12%, and 16%, respectively). All patients had good performance status (World Health Organization <2). The median external RT dose was 70.2 Gy (range, 63-77.5 Gy). Brachytherapy was also given to 156 patients in addition to external RT, delivered by the remote after-loading, high-dose-rate technique. A total of 139 patients received cisplatin-based chemotherapy, in 115 received as neoadjuvant or adjuvant chemotherapy and in 24 concomitant with RT. Recovery from CN palsy occurred in 171 patients during or after radiotherapy. Patients who died without a specific cause identified were regarded as having died with persistent disease. RESULTS The 3-year, 5-year, and 10-year overall survival was 47.1%, 34.4%, and 22.2%. The 3-year, 5-year, and 10-year disease-specific survival (DSS) rates were 50.4%, 37.8%, and 25.9%. The 5-year DSS for patients staged with MRI, CT, and Tm were 46.9%, 36.7%, and 21.9%, respectively (p = 0.016). The difference between MRI and CT was significant (p = 0.015). The 3-year and 5-year local control rates were 62% and 53%, respectively. The 5-year local control was 68.2% if excluding patients who died without a specific cause. Patients who had an MRI had a significantly better tumor control rate than those evaluated with CT or Tm, with a 15-30% improvement in local tumor control and survival. Patients with extensive CN palsy had worse survival than those with only lower CN or upper CN involvement (5-year DSS 20.4% vs. 43.2% and 40.4%, respectively; p < 0.001). Patients who recovered from CN palsy had better survival than those who did not (47% vs. 26%, p < 0.001). Brachytherapy was associated with poorer local control, whereas a total external dose of more than 70 Gy improved local tumor control and marginally improved DSS. Subgroup analysis in CT and MRI patients group, either DSS or OS was significantly associated with imaging modality, N stage, or location of or remission of CN palsy. CONCLUSION The use of MRI was associated with improved tumor control and survival of patients with NPC causing CN palsy. Patients recovering from CN palsy had better survival. A higher radiation dose delivered by external beam may achieve better tumor control than brachytherapy.
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Karakurum B, Karatas M, Cagici AC, Uncu H, Yildirim T, Hurcan C, Karaca S, Kizilkilic E, Tan M. Mucormycosis presenting with painful ophthalmoplegia. Acta Neurol Belg 2005; 105:201-5. [PMID: 16482869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
Mucormycosis is a rare fungal infection that can involve the sino-orbito-cerebral region. Sino-orbito-cerebral mucormycosis is most common in patients who are immunocompromised or have diabetes mellitus, severe malnutrition or burns. This condition can be fatal if it is not diagnosed early and treated aggressively. This article presents 4 cases of mucormycosis, including 2 with orbital apex syndrome, 1 with cavernous sinus syndrome, and 1 with multiple cranial nerve involvement. All of the patients were presented with painful ophthalmoplegia. The predisposing factors for mucormycosis included diabetes mellitus (three patients) and chronic leukemia (one patient). In all cases, mucormycosis was diagnosed by examining endoscopic sinus drainage material and was treated with surgical debridement and amphotericin B. Two patients with central nervous system involvement died. The others have survived, but still exhibiting various neurologic abnormalities after aggressive treatment. Patients with mucormycosis rarely present with orbital apex syndrome. The possibility of mucormycosis should be investigated in any patient with painful ophthalmoplegia, and prompt otorhinolaryngologic examination is recommended to ensure rapid diagnosis and treatment.
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Affiliation(s)
- B Karakurum
- Baskent University Faculty of Medicine, Adana Teaching and Medical Research Center, Department of Neurology, Adana, Turkey.
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