The Electrophysiological Features in a Patient with Acute Organophosphate Intoxication

Acute organophosphate intoxication has characteristic electrophysiological features, which include repetitive potentials in nerve conduction studies and decrement (or decrement-increment) responses in repetitive nerve stimulation tests. We experienced a patient who presented with abdominal discomfort, followed by cardiac arrest and then showed motor weakness. The electrophysiological studies revealed decrement responses which were characteristic features of acute organophosphate intoxication. We report clinical and electrophysiological features of acute organophosphate intoxication followed with a literature review.

A Case of Rhino-orbito-Cerebral Mucormycosis Presenting with Recurrent Transient Ischemic Attacks(TIAs)

Rhino-orbito-cerebral muconnycosis is an uncommon fatal fringal infection, almost exclusively seen in diabetic or other itnmunocompromised patients. Recurrent transient ischemic attacks(TIAs) as initial presenting sign of rhino-orbito-cerebral mycormycosis has not been reported to our knowledge. We report a patient with muconnycosis unusually presenting with recurrent TIAs, followed by central retinal artery occlusion, multiple cranial nerve palsies, and then cerebral infarction in the territory of middle cerebral artery.

The Combined Peripheral and Central Demyelinating Disease Associated with Pulmonary Tuberculosis

Although there are some reports of neuromyelitis optica or Guillain-Barre syndrome in patients with tuberculosis, the combined peripheral and central demyelination associated with tuberculosis has not yet been reported. We report a 43 year-old man with active pulmonary tuberculosis presenting with Guillain-Barre syndrome, bilateral optic neuritis, and multiple central nervous system white matter lesions on MRI. Our case suggests that tuberculosis may be associated with the combined peripheral and central demyelination.

Blink Reflex in Idiopathic Parkinson's Disease: Reduction of Habituation in Paired Stimulation

The habituation of early (R1) and late response (R2) of blink reflex was investigated in 44 patients with Parkinson's disease (PD) and 19 control subjects. The latency, duration and area of R1 and R2 components of blink reflex in single stimulation, and the percentage recovery of R1 in paired stimulation were not different between patients and control subjects. However, in PD patients, the latency of R2 evoked by test stimuli was shorter than that of conditioning stimuli, and the percentage recovery of R2 habituation was increased as compared to that of control subjects. The degree of early recovery of R2 habituation was slightly more evident in advanced PD patients and nonmedicated patients than that of control subjects. In addition, the early recovery of R2 was present in the test of asymptomatic side of PD patients. Our results suggests that blink reflex may be used as a method of evaluating the clinical status of PD patients.

Transluminal angioplasty and stenting for the intracranial and extracranial cerebral arterial stenosis: Preliminary experiences

PURPOSE: To report the preliminary results of percutaneous transluminal balloon angioplasty (PTA) and stenting for the intracranial or extracranial care bral arterial stenosis. METHODS: In 11 patient% a total of 12 hemodynamically significant arterial stenatic lesions were treated by tramluminal angioplasty with or without the we of stent ; 8 proiml internal carotid arteries (ICA), 2 middle cerebral arteries (MCA), I distal vertebral artery (VA) and I proximal VA. We performed stent placement for 7 ICA lesions, while we did PTA alone for 2 MCA stenoses. PTA for 1 ICA and 2 VA lesions was performed while we attempted intraarterial urokinam (IAUK) therapy. RESULTS: Mean residual stenosis measured immediately after the procedure was 7% (range 0-27%) in 7 ICA lesions (treated by slanting), 13% and 29% in 2 MCA lesions (PTA), and 38% (range 32 41%) in 1 ICA and 2 VA lesions (PTA after IALJK). During and immediately after the procedure, 2 patients with ICA stenwis developed a transient ischemic attack (TIA) and one patient with ICA stenosis showed the infarct progression. Two patients, who were treated by PTA during IAUK therapy, expired. During the follow-up period (range, 4-18 months; mean, 8.6 months), all patients but one with the MCA lesion were free from further ischemic events. CONCLUSIONS: The efficacy and safety of PTA and stenting were not sufficiently verified with the small number of cases in our series. However, our observations suggest that they may be used as an alternative treatment modality to endarterectomy or a new promising therapy for the extracranial or intracranial arterial stenosis.

Transient Conduction Block in Vasculitic Neuropathy Caused by Churg-strauss Syndrome: Transient Conduction Block in Vasculitic Neuropathy

Transient conduction block and its sequential changes have been rarely reported in human vasculitic neuropathy We performed serial nerve conduction studies during initial stage of nerve infarction in a patient with Churg-Strauss syndrome, who had acute ulnar nerve palsy 2 days before admission. At second day after the ulnar nerve palsy, the motor conduction block was detected in the segment between 12.5cm and 15cm above the ulnar groove; the amplitude of the compound muscle action potentials (CMAP) obtained with stimulation at 12 5cm above the ulnar groove was 7.4mV and that at 15cm was 0. 6mV. At fifth day, the motor conduction block disappeared and the amplitude of the CMAP obtained with stimulation at the site just distal to that segment reduced to 0. 6mV. The amplitude of the compound nerve action potentials (CNAP) of the finger-wrist segment was normal at admission but became unevokable at eighth day. The CNAP of the mixed nerve of the wrist-toelbow segment also gradually decreased and became similar with the amplitude of the wrist-to-axilla segment at twelfth day. These findings suggest that transient conduction block may be present in the metal stage of vasculitic neuropathy and that CMAP become unevokable earlier than CNAP.