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.

Seizures in Chronic Alcoholics / 대한간질학회지

PURPOSE: Seizures constitute one of the most frequent medical complications in alcoholics. The purpose of this study is to elucidate clinical characteristics of seizures in chronic alcoholics. METHODS: Subjects were 50 alcoholics with seizure who were admitted to Kang-Dong Sacred Heart Hospital between Jan. 1999 to May. 2002. We classified them into alcohol withdrawal seizure (AWS) and alcohol related seizure (ARS). AWS was defined as 1) seizures occur within 72 hrs after the last alcohol intake and 2) occurring in the patients without focal abnormalities on brain CT and EEG. ARS was defined as 1) seizures occurring more than 72 hrs after the last alcohol intake, 2) occurring regardless of onset-time in the patients who had concomitant focal brain lesions or focal abnormalities on EEG, and 3) occurr in patients who had experienced seizure unrelated with alcohol. Their clinical, electrophysiologic and neuroradiologic features were analyzed. RESULTS: 45 patients (90%) were male. Mean age was 47 years. 48 patients (96%) were presented with generalized tonic-clonic seizure. 28 patients (56%) were classified into AWS and 22 (44%) into ARS. Mean age was 46 years in patients with AWS and 54.9 in ARS (p=0.04). Mean duration of alcohol intake was 17 years in AWS and 26.2 in ARS (p=0.002). Mean amount of alcohol intake (yrs x bottles/day) were 30.3 in AWS and 42.0 in ARS (p=0.061). EEG showed diffuse slowing in 5 of AWS, sharp waves in 4 of ARS, focal slowing in 3 of ARS and PLEDs in one of ARS. Among 28 patients with AWS, only one patient was treated with long term antiepileptic drugs (AED). Among 22 ARS, 14 (64%) patients were treated with long term AED. One patient of each group experienced recurrent seizure during follow up. Delirium tremens was developed in 17 patients (34%). Among them, 13 (76%) had alcoholic liver disease (p=0.036). CONCLUSIONS: Our study suggests that patients with ARS were older and drunk more for a longer period of time than patients with AWS. Long term AED administration may be required to prevent recurrent seizures in patients with ARS. On the other hand, delirium tremens may be significantly associated with alcoholic liver disease.

Diffuse Signal Changes in Corpus Callosum after Decompression Surgery of Hydrocephalus

Wide spread MR signal changes in the corpus callosum can occur after shunt operation in patients with hydrocephalus. Although the mechanism of these signal changes remains unclear, neural compression caused by active hydrocephalus and changes of conditions after shunt operation may contribute to the development of these changes. We present a patient who underwent successful ventriculo-peritoneal shunt operation for hydrocephalus and had diffuse signal changes in the corpus callosum in MR images taken 2 years after the surgery.