unusual presentation of Lemierre syndrome

Lemierre syndrome is an entity defined by septic thrombophlebitis of the internal jugular vein following an oropharyngeal infection, which is usually acute and complicated by metastatic infection in different organs. The usual causative organism is Fusobacterium necrophorum. On looking back at the case reports of Lemierre syndrome, we have found different sites of primary infection and also different presentations depending on the primary site and the site of involvement resulting from metastatic septic embolization. However, chronic otitis media as the primary site of infection and bloody diarrhea as the presenting symptom were very rarely presented. The case presented here was referred to Faghihi hospital of our academic medical center with bloody diarrhea. After work ups, the patient was diagnosed as a case of Lemierre syndrome on the base of chronic otitis media

Epilepsy in patients 60 years and above

To evaluate the clinical characteristics and etiology of epilepsy at age 60 years and above in the Western Region of Saudi Arabia [KSA], as epilepsy is now considered to be the third most frequent neurological problem in the elderly population. We retrospectively reviewed the medical records of patients 60 years and above at King Khalid National Guard Hospital, Jeddah, KSA between 1999 and 2007 with new onset of seizures and diagnosed as suffering from epilepsy. We excluded patients 60 and above with provoked seizures. Seventy-five patients of late onset epilepsy were studied. Partial seizure [focal] was found in 40 patients [53.3%]; generalized tonic clonic seizures in 18 patients [24%]; unclassified seizure in 13 patients [17.5%]; and status epilepticus in 4 patients [5.3%]. Stroke was the underlying etiology in 52 patients [69.3%]; brain tumor was found in 8 patients [10.7%], trauma in 3 patients [4%], and infection in 3 patients [4%]. None of the patients had a family history of epilepsy. No cause [idiopathic] was found in 9 [12%] patients. The most common type of epilepsy at age 60 and above in our study is symptomatic epilepsy with stroke as the leading cause. Modifying risk factors for stroke such as: hypertension, diabetes mellitus, and high cholesterol may reduce the incidence of epilepsy in this age group

Central pontine myelinolysis due to rapid correction of hyponatremia induced by excessive water intake

We report a 25-year-old female with a recent diagnosis of gastric B-cell lymphoma based on imaging and pathological findings. She was discharged against medical advice after it was recommended to her, by an "alternative medicine practitioner," to restrict her diet to excessive ingestion of the "Holy water Zamzam" [natural well water in Makkah]. She presented back with altered level of awareness and severe, new-onset hyponatremia. The hyponatremia was corrected rapidly and her condition improved. Six days later, she developed the classical pyramidal and extrapyramidal features of central pontine myelinolysis, documented by MRI. The patient succumbed to her original disease 3 months later