fatal complication of bronchiectasis. brain abscess with intraventricular rupture

The classic clinical manifestations of bronchiectasis are cough and daily production of purulent sputum for months to years. The most common complications are hemoptysis and respiratory failure. Brain abscess has become rare in the recent antibiotic era. In this report, we present a case of bronchiectasis complicated by brain abscesses. Despite the early diagnosis and appropriate management, and while the condition of the patient was improving, an intraventricular abscess rupture led to rapid coma then death. Presentation and management of this potentially fatal complication of bronchiectasis are discussed

Neuromuscular paralysis in the intensive care unit

To determine the features, causes, risk factors and outcome of acquired neuromuscular paralysis in critically ill patients. Retrospective review of all confirmed cases of acquired polyneuropathy and myopathy examined by our Neurology service in the Intensive Care Unit [ICU], at King Fahad National Guard Hospital, Riyadh, Kingdom of Saudi Arabia over a period of 5 years. All patients had comprehensive electrophysiological studies and one third had muscle and nerve biopsies. Thirty cases were included, 8 cases of polyneuropathy, 15 cases of myopathy and 7 cases of mixed neuropathy and myopathy. Absent deep tendon reflexes and absent sensory potential on nerve conduction studies were significantly suggestive of neuropathy. The level of creatine phosphokinase was not of great diagnostic value. Most polyneuropathy and myopathy cases had passed through a stormy ICU course with sepsis and multiorgan failure. The use of high doses of steroids was more associated with myopathy. Seven patients died in ICU, the others were discharged to the wards after a mean ventilation period of 40 days. One patient became chronic ventilator dependent. From this series and available literature, it seems that symptomatic myopathy is more frequent than polyneuropathy and some risk factors are common for both [sepsis and multiorgan failure] while the use of steroids is more associated with ICU myopathy. Treating sepsis and stopping corticosteroids results in the improvement of most of the cases

Application of DNA-based tests for diagnosis of spinal muscular atrophy in Saudi Arabia

We examined the deletion of the survival motor neuron [SMN] and neuronal apoptosis inhibitory protein [NAIP] genes in patients with spinal muscular atrophy [SMA] using polymerase chain reaction followed by restriction site assay methods. The study included 16 Saudi patients [9 SMA type I and 7 SMA type II] and 6 healthy Saudi volunteers. The homozygous deletions of exons 7 and 8 of the telomeric SMN gene, and exon 5 of the NAIP gene were found in all SMA type I patients. Exons 7 and 8 of telomeric SMN were deleted in all SMA type II patients. However, exon 5 of NAIP was deleted in three of the seven cases. All control volunteers and all family members of the patients had normal SMN and NAIP. The incidence of NAIP deletion was higher in the more severe SMA cases and the dual deletion of the SMN and NAIP genes was more common in Saudi SMA type I patients compared with patients of other ethnic groups

Bell's palsy in the eastern province of Saudi Arabia

During a 6-year period at the Neurology Clinic of King Fahd University Hospital, AI-Khobar in the eastern province of Saudi Arabia, 123 patients [72 males, 51 females] with idiopathic facial paralysis [Bell's palsy] were seen. The peak frequency was in the third decade [32%]; 67% of the cases occurred during October to March [cold season]; 110 patients had single unilateral episodes, eight had an ipsilateral and one a contralateral recurrence. Recurrent episodes on both sides and simultaneous bilateral lesions were each observed in two cases. Although infrequent, the main identified associated clinical disorders or presumed predisposing factors were diabetes mellitus, hypertension, pregnancy and a preceding history of an upper respiratory tract infection. The prognosis was relatively good and only 15% had a severe deficit 3 months after the onset of symptoms