Guillain-Barre's syndrome associated with Plasmodium falciparum malaria: role of plasma exchange.

Guillain-Barre's syndrome (GBS) associated with malarial infection is a rare condition reported in the literature. We report a case of Plasmodium falciparum (PF) malarial infection with Guillain-Barre's syndrome complicated by respiratory failure and review of the literature. Our patient gradually improved after treatment with plasma exchange. Review of the literature showed 11 cases of GBS associated with malaria. Four of 8 patients with GBS associated with PF had respiratory failure, whereas, none of the patients with GBS associated with Plasmodium vivax (PV) developed respiratory failure. Three of four patients with respiratory failure died and one who survived was treated with intravenous immunoglobulin. Our patient was the second case to survive after treatment with plasma exchange. The role of plasma exchange, the pathogenesis of malaria in GBS and the mechanism that induced more severe GBS in PF than in PV were discussed.

Guillain - Barre' syndrome following recombinant hepatitis B vaccine and literature review.

A 17 year-old woman developed progressive quadriparesis with bilateral facial diplegia after immunization with recombinant hepatitis B vaccine 3 days prior. Cerebrospinal fluid analysis revealed acellular fluid with high protein level. The electrodiagnosis was compatible with demyelinating polyneuropathy. Other potential causes of Guillain-Barre' syndrome (GBS) were ruled out. Her motor power gradually improved and returned to normal later. The temporal relationship between GBS and vaccination was suggestive of a vaccine-induced cause. Mechanisms of this very rare complication are proposed with a literature review.

Simultaneous bilateral painful ophthalmoplegia and exudative retinal detachment in rheumatoid arthritis.

A 47-year-old woman who suffered from chronic rheumatoid arthritis presented with bilateral painful ophthalmoplegia with proptosis and exudativeretinal detachment. The painful ophthalmoplegia with proptosis might have been caused by pachymeningitis involving the cavernous sinus bilaterally, or bilateral posterior scleritis spreading to the extraocular muscles and tendons. The exudative retinal detachment might have been a result of bilateral posterior scleritis which had spread to the choroid. These two unusual complications of rheumatoid arthritis occurred simultaneously in this case. Both complications responded to corticosteroid treatment.

Pentazocine-induced fibrous myopathy and localized neuropathy.

A 47 year-old woman who had a 4-year history of intramuscular pentazocine injections in the lower extremities, developed gradual stiffness and weakness of the lower extremities. The thigh and buttock muscles were "wooden-hard" on palpation. The skin was hard, shiny and hairless. Associated clinical and electrophysiological polyradiculopathy and multiple mononeuropathy of the lower extremities were observed. Imaging studies showed calcification and fibrosis of the involved muscles. Muscle biopsy revealed fibrous myopathy. Caution in longterm usage and early recognition of pentazocine toxicity as a neuromuscular complication are important in order to prevent irreversible drug-induced fibrous myopathy and localized neuropathy.

Colchicine-induced myopathy in renal failure.

A 60 year-old woman with chronic renal failure developed acute proximal muscle weakness after receiving a regular dosage of colchicine. Elevation of muscle enzymes and electromyography were compatible with myopathy. Muscle biopsy revealed variation in muscle fiber size and few vacuolated fibers which were features of colchicine-induced myopathy. The clinical improvement and decreasing in muscle enzyme level occurred after colchicine withdrawal. Other potential causes of myopathy such as chronic renal failure and other drugs were ruled out. We suggested that colchicine should be used with caution in the presence of renal failure especially when other drugs which affect the metabolism of colchicine are also prescribed.

Spontaneous carotid dissection.

Spontaneous internal carotid dissection typically occurs in young or middle-aged patients. It is associated with a high rate of recovery and low mortality. Anticoagulant and antiplatelet drugs fail to demonstrate a significant improvement when compared with placebo. A 38 year-old woman with spontaneous dissection of the internal carotid artery diagnosed by MRI is reported. She had an excellent recovery without treatment and no recurrent attack occurred after one year of follow-up. The clinical manifestations, diagnostic tests and treatment of spontaneous internal carotid disection are briefly reviewed in this communication.

Progressive cerebral occlusive disease after hypothalamic astrocytoma radiation therapy.

An 18 year-old woman received radiation therapy for hypothalamic astrocytoma at the age of 11 years. She developed progressive cerebral occlusive vascular disease with moyamoya vessels formation in both carotid systems. Apart from diabetes mellitus, she had no other risk factors for occlusive cerebrovascular disease. The site of occlusion was confined to the field of radiation and the development of moyamoya vessels strongly suggestive of a radiation-induced cause. Radiation therapy around the sella and parasellar region appears to be the most common risk factor for this vasculopathy. Progressive irradiation-induced cerebral vasculopathy is due to accelerated atherosclerosis.