Polymyositis Associated with Bronchiolitis Obliterans Organizing Pneumonia

Bronchiolitis obliterans organizing pneumonia (BOOP) is a clinicopathologic syndrome of pulmonary inflammatory responses which has become increasingly recognized and has been described in association with a variety of disorders. We present a case of polymyositis associated with BOOP that responded to a corticosteroid therapy. The patient had a nonproductive cough, increasing dyspnea, fatigue, mild proximal limb weakness, and bilateral basal interstitial infiltrates on chest X-ray. This case will add further strength to the association of BOOP with polymyositis. (J Korean Neurol Assoc 19(5):547~549, 2001)

A Case of Germinoma Presenting with Pupil-involving Isolated Oculomotor Nerve Palsy

In patients with pupil-involving isolated oculomotor nerve palsy (IOP), compressive lesions, meningitis, and midbrain infarction can usually be excluded if the responsible lesions are not verified on a brain MRI, catheter angiography, and cerebrospinal fluid examination. However, we experienced a 11-year-old boy with pupil-involving IOP whose initial investigations had been normal and whose symptoms had been stationary over 3 months but was eventually confirmed to have germinoma. This case suggests that a patient with IOP without improvement for a prolonged period needs re-evaluation regardless of normal initial investigations. (J Korean Neurol Assoc 19(4):423~426, 2001)

A Case of Hashimoto's Encephalopathy

Hashimoto's encephalopathy (HE) is a steroid-responsive disorder of persistent or relapsing neurological or neu-ropsychological deficits associated with elevated serum concentrations of antithyroid antibody that frequently presents with myoclonus, seizures, and stroke-like episodes. We report a 55-year-old woman who presented with an altered men-tality associated with generalized tonic-clonic seizure. She was diagnosed with Hashimoto's thyroiditis 3 years prior. Serum antithyroglobulin antibody and antimicrosomal antibody were elevated. Electroencephalography (EEG) showed generalized slowing. Brain magnetic resonance imaging (MRI) with T2-weighted sequence and fluid-attenuated inver-sion- recovery (FLAIR) image revealed a high signal intensity in both mesial temporal areas. Single photon emission computed tomography (SPECT) demonstrated decreased perfusion in multiple areas. With the impression of HE, she was placed on high dose steroid and thyroid hormone replacement therapy which ameliorated her neurological symp-toms. We suggest that HE should be included in the differential diagnosis of decreased mentality, especially when patients with Hashimoto's thyroiditis show altered consciousness, seizure disorder, or cognitive decline.

H-reflex Studies in Patients with Subclinical Diabetic Polyneuropathy

BACKGROUND: The H-reflex has been used to assess the proximal nerve conduction in radiculopathy or peripheral neuropathy. The purpose of this study was to evaluate the clinical usefulness of the H-reflex in the diagnosis of subclinical diabetic polyneuropathy. METHOD: Thirty-four diabetic patients (17 women and 17 men) who had neither motor nor sensory symptoms were selected (mean age 57.6 +/- 12.9 years). The duration of diabetes varied from 0.5 to 24 years (mean 6.2 +/- 5.1 years). None of the patients had any known cause of peripheral neuropathy other than diabetes. Twenty-seven healthy subjects (16 women and 11 men) were evaluated as an age-matched control group. H-reflex studies were performed using Braddom and Johnson's methods. The presence and latencies of the H-reflexes were examined in both legs. RESULTS: Twenty-four of the 34 patients (70.6%) had abnormal H-reflex responses (absent H-reflex in 17, prolonged latency in 7). However, only three out of the 27 control subjects (11.1%) had abnormal H-reflex responses (absent H-reflex in 1, prolonged latency in 2). CONCLUSIONS: Abnormalities in H-reflex studies have often been seen in diabetic subjects without overt neurological symptoms. This study suggests that the H-reflex study may be a useful screening tool in the diagnosis of subclinical diabetic polyneuropathy.