Two Cases of Cervical Dystonia in Tuberculous Meningitis

Secondary cervical dystonia caused by tuberculous meningitis is extremely rare. Sixteen year-old female and 56 year-old male were admitted with fever, headache and mental change. Several days after admission they presented neck deviation and polygraphic study revealed prolonged muscular contraction of sterocleidomastoid and trapezius muscles without EEG changes. Their MRI revealed bilateral lesions in the basal ganglia. Recognition of dyskinesias associated with meningitis may be helpful in the diagnosis of tuberculous meningitis.

Clincal, MRI and MRA Findings of Cheiro-Oral-Pedal syndrome

BACKGROUND: Cheiro-oral-pedal syndrome is characterized by a unilateral or bilateral sensory disturbance in mouth corner and hand and/or foot, and associated with central nervous system disease. Causative diseases are cerebral infarction, intracranial hemorrhage, brain tumor, migraine, etc. When related with cerebral infarction, it is known to have lacunar type pathology and favorable prognosis. But other pathogenic mechanism and poor prognosis is suggested. METHODS: We retrospectively studied 12 patients presented with cheiro-oral-pedal syndrome, who visited the department of neurology in Chosun University Hospital from September 2000 to August 2002. Cheiro-oral-pedal syndrome was diagnosed according to the clinical manifestations and brain MRI findings. We assessed neurological findings, brain MRI and MRA findings, duplex sonographic findings, risk factors of stroke and outcome of the patients. Followup period was 3-20 (mean 8) months. RESULTS: There were 12 patients (10 men, 2 women) with the age ranged from 45 to 80 (mean 57.8) years. Sensory loss on cheiro-oral area was present in 8 (66.7%) and on cheiro-oral-pedal area in 4 (33.3%). Responsible lesions were found in thalamus, capsulo-striatum, corona radiata, pons, and fronto-parietal cortex. Three patients had a major cerebral vascular abnormality on MRA. One had MCA stenosis, the other PCA stenosis and another distal ICA stenosis. Sensory symptoms had remained in all patient except one. In-hospital mortality and other neurological deficit at discharge were absent in all. CONCLUSIONS: Cheiro-oral syndrome has mixed pathogenic mechanism of small vessel disease and large vessel atherosclerosis and involves various sites. Paresthesia itself has bad prognosis but overall clinical course is benign.

Immunohistochemical Localization of Bcl-2 in the Spinal Cords of Rats with Experimental Autoimmune Encephalomyelitis

We examined the localization of the anti-apoptotic molecule Bcl-2 in the spinal cords of Lewis rats with experimental autoimmune encephalomyelitis (EAE). Western blot analysis showed that Bcl-2 was constitutively expressed in normal spinal cords, and weakly increased in response to complete Freund's adjuvant(CFA) immunization. In EAE, with infiltration of inflammatory cells into spinal cords, Bcl-2 declined during the peak stage and further decreased during the recovery stage. Immunohistochemically, some neurons and glial cells constitutively expressed Bcl-2 in normal rat spinal cords. In the spinal cords of rats with EAE, Bcl-2 was also immunoreacted in some perivascular inflammatory cells while some brain cells, such as neurons and GFAP (+) astrocytes showed less Bcl-2 immunoreaction.These findings suggest that in EAE, Bcl-2 expression in the CNS host cells decreases with CNS inflammation, possibly progressing to cell death in some cases, while the survival of host cells, including neurons, astrocytes, and some inflammatory cells, is associated with activation of the anti-apoptotic molecule Bcl-2. Taking all into considerations, its is postulated that Bcl-2 either beneficially or detrimentally functions in some host cells depending on the activation stage of each cell type.