A typical progression of thyrotoxic manifestations while awaiting laboratory confirmation

An ill-nourished man, whose hyperthyroid state was unmasked by respiratory infection, had more than one attack of thyroid storm and rapidly went through several unusual complications which included thyrotoxic periodic paralysis, upper and lower motor neuron manifestations, neuropsychiatric and metabolic disturbances. Diagnosis of hyperthyroidism was established after 14 days with the arrival of thyroid function test which was drawn on admission. Though his symptoms improved after initiating treatment, he continued to suffer from thyroid associated ophthalmopathy and myasthenia gravis. Although these manifestations of hyperthyroidism are well known, their occurrence in a single patient is unusual. This report highlights the need for the physicians to be alert regarding these rare manifestations of thyrotoxicosis in their patients and initiate treatment as it is difficulttoobtain rapid laboratory confirmation in emergency department

Clinical and neurophysiological pattern of Guillain-Barre syndrome in Kuwait

To study the clinical and neurophysiological pattern of Guillain-Barre syndrome [GBS] in Kuwait. The clinical records of consecutive GBS patients admitted to Ibn Sina Hospital, Kuwait, during a 7-year period between 1997 and 2003 were analyzed. Of the 41 cases, 77% were male. The majority of the cases presented during the winter months and a preceding infection was reported in two thirds of them. Proximal lower limb [LL] weakness was the predominant clinical presentation. Nerve conduction studies [NCS] demonstrated a demyelinating pattern in 70%, an axonal pattern in 15%, mixed type in 5% and no abnormality in the remaining 5%. The majority of the patients [73%] improved with one course of intravenous immunoglobulin [IV IG]. Mean recovery time [MRT] was 4.4 weeks. Delayed recovery [MRT =/>6 weeks] was noted in patients with predominant distal weakness in the LL [MRT 7.8 weeks; p = 0.001], proximal weakness in the upper limb [UL] [MRT 6 weeks; p = 0.005], autonomic disturbance [MRT 6.5 weeks; p = 0.05], and axonal type GBS [MRT 6 weeks; p = 0.001]. The presence of predominant distal weakness in LL, proximal weakness in UL, autonomic disturbance and axonal pattern in NCS predict a poor outcome. Hence we recommend early immunomodulatory therapy in patients presenting with these features