Wernicke's Encephalopathy and Peripheral Polyneuropathy Developed during Long Term Metronidazole Therapy in a Patient with a Brain Abscess: A Case Report

Metronidazole can induce serious neurologic problems including peripheral neuropathy, seizures, and encephalopathy. We examined a patient with acute Wernicke's encephalopathy and peripheral polyneuropathy that had developed after prolonged metronidazole therapy without a history of chronic alcoholism or poor nutritional intake. The 68-year-old man had been hospitalized for a brain abscess and was treated for 10 weeks with metronidazole (2 grams per day). This patient, who showed symptoms of numbness and tingling in the legs, was referred for electromyography (EMG) and was diagnosed with peripheral polyneuropathy. A few days later, he developed sudden ataxia, dizziness, and diplopia. The neurologic examination revealed nystagmus and ophthalmoplegia, and the FLAIR brain MRI showed symmetrical high signal intensity lesions in the cerebellar dentate nucleus, midbrain, tegmentum around the periaqueductal gray matter, and tectum. After administering intravenous thiamine and stopping the metronidazole therapy, he recovered from the ophthalmoplegia and ataxia. Brain MR showed complete recovery within 3 weeks; however the EMG remained abnormal for a further 6 months, although the symptoms were almost completely resolved by this time.

The Influence of Depressive Symptoms on Cognitive and Functional Recovery in Chronic Stroke Patients

OBJECTIVE: To investigate the influence of depressive symptoms on cognitive and functional recovery in chronic stroke patients. METHOD: Seventy-four chronic stroke patients were included. They had inpatient rehabilitation program for 2 months. Depressive symptoms were evaluated with the Beck depression inventory (BDI), cognitive functions by the Korean mini-mental status examination (MMSE-K) and functional status by the modified Barthel index (MBI) before and after the rehabilitation. We investigated whether the improvement of depressive symptoms after rehabilitation had influenced the cognitive and functional recovery, by comparing the changes of MMSE-K and MBI in patients with depressive symptoms. RESULTS: Before inpatient rehabilitation program, patients with depressive symptoms had low scores of MMSE-K and MBI compared to those without. While patients with depressive symptoms had significant improvement of MMSE-K after rehabilitation (p<0.05), those without did not. Both groups with and without depressive symptoms had significant improvement of MBI after rehabilitation, but the changes of MBI were not different significantly. Among patients with depressive symptoms at admission, those who showed improved depression after rehabilitation had the significant improvement of MMSE-K after rehabilitation (p<0.05), but those with sustained depressive symptoms did not. CONCLUSION: Post-stroke depressive symptoms may influence on cognitive function. However, post-stroke depressive symptoms did not have any effect on functional recovery.

Ulnar Neuropathy within Guyon's Tunnel in a Golf Player : A case report

One of common injury sites in golfers is the wrist, but ulnar neuropathies at wrist in golfers have been rarely reported. We report a case of ulnar neuropathy within the Guyon's tunnel occurred in a single golfer diagnosed with electrodiagnosis and ultrasound. A 59-year old man suffered from difficulty with extension of left 4th and 5th finger joints and weakness of hand grasping, which had occurred 2 weeks ago and aggravated slowly. He had no sensory disturbance. During recent two months, he had practiced golf for three to four hours daily. Electrodiagnostic study showed that the deep branch of left ulnar nerve was compromised at the wrist (type IIA). Ultrasound study revealed a ganglion cyst within the Guyon's tunnel. Therefore we diagnosed the patient as having ulnar neuropathy (only deep branch involvement) associated with a ganglion cyst within the Guyon's tunnel.