A Case of Combined Acute Disseminated Encephalomyelitis and Acute Flaccid Paralysis associated with Enteroviral Infection

Enterovirus infection is often aggravated and manifests as various neurological complications such as aseptic meningitis, brainstem encephalitis, poliomyelitis-like acute flaccid paralysis, transverse myelitis, and severe systemic diseases. There are a few reports indicating that enterovirus is associated with acute disseminated encephalomyelitis (ADEM), acute flaccid paralysis, or Guillain-Barre syndrome separately. However, none of these report ADEM and acute flaccid paralysis occurring simultaneously. Here, we present a case of combined ADEM and acute flaccid paralysis associated with enteroviral infection in a child and reviewed the relevant literature. A 5-year-old boy was admitted to the hospital for headache and vomiting with evident meningeal irritation signs. Despite of antibiotic therapy, his mental state rapidly declined to coma with abnormal upper motor neuron (UMN) signs. During 5 consecutive days of steroid pulse therapy, his abnormal UMN signs abruptly changed to flaccid paralysis. Suspected acute flaccid paralysis due to enterovirus prompted the addition of intravenous immunoglobulin (IVIG). On hospital day 33, he was discharged with full recovery of muscle tone and strength with an alert mental state.

Impact of Sleep Duration on Emotional Status in Adolescents

PURPOSE: South Korean adolescents have been identified as a chronic partial sleep-deprived population in several previous studies. This study was to identify the current nocturnal sleep duration by age in South Korean adolescents and to analyze the association of emotional status factors such as subjective happiness, depression and suicidal attempts, and health-risk behaviors with the nocturnal sleep duration. METHODS: The findings in this study are based on the data obtained from the 7th Korea Youth Risk Behavior Web-Based Survey (KYRBWS-VII), a cross-sectional, annual survey of the health-risk behaviors in a representative sample of South Korean middle- and high-school students aged 13-18 years, which was conducted in 2011. Out of 75,643 students from 800 schools across the nation, 75,205 students were selected by using the complex sampling design of the survey. We analyzed the relationships between the duration of nocturnal sleep and emotional status (subjective happiness, stress level, depression, and suicidal thoughts), health-risk behaviors (smoking, drinking), and sleep satisfaction. RESULTS: There was a significant relationship between the duration of sleep and the emotional status. In general, happy students had the longest nocturnal sleep duration, regardless of their grades. Self-rated stress levels and depression in adolescents were inversely proportional to nocturnal sleep duration. Health-risk behaviors such as smoking and alcohol consumptions were more common in sleep-deprived students (P<0.001). CONCLUSION: Appropriate nocturnal sleep duration is critical for emotional health as well as prevention of suicide in the adolescent population.

A Case of Cushing Syndrome Diagnosed by Recurrent Pathologic Fractures in a Young Woman

Cushing's syndrome is characterized by central obesity, fatigability, weakness, amenorrhea, hirsutism, edema, hypertension, impaired glucose tolerance, and osteoporosis due to excessive production of steroids. Cushing's syndrome is an important cause of secondary osteoporosis. Patients with Cushing's syndrome have a high incidence of osteoporotic fractures. At least, 30-50% of patients with Cushing's syndrome experience fractures, particularly in the vertebral body. And it is consistent with the 50% prevalence of osteoporosis in patients with Cushing's syndrome. However, reports of multiple pathological fractures in young patients with Cushing's syndrome are rare. Thus, we describe the case of a 26-year-old woman with Cushing's syndrome accompanied with recurrent multiple osteoporotic fractures and being treated by parathyroid hormone. Careful consideration for the possibility of Cushing's syndrome will be necessary in case of young patients with a spontaneous multiple compression fractures in spine.