Hypertensive encephalopathy after successful treatment of eclampsia.

The association between acute rise of blood pressure and encephalopathy with early recognition, and therapy reversibility has been reported. We reported a case of a young lady in postnatal period, presented with acute rise of blood pressure, encephalopathy, quadriparesis, and apraxia. Magnetic resonance imaging of the brain showed hyperintense lesions in occipital, parietal and right temporal areas. Cerebral angio showed multiple segmental vasoconstriction and narrowing of intracerebral vessels. Immediate control of blood pressure enhanced recovery but it is incomplete.

New features in the Saudi Medical Journal.

Full text is available as a scanned copy of the original print version.

New features in the Saudi Medical Journal.

Full text is available as a scanned copy of the original print version.

Effect of chronic administration of magnesium sulfate on 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine-induced neurotoxicity in mice.

This investigation was aimed to study the effect of magnesium on 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP)-induced neurotoxicity in mice. Four groups of mice were given magnesium sulfate (MgSO4.7H2O) in drinking water at four different concentrations of 0.0 g/l (control), 2.5 g/l (low), 5.0 g/l (medium) and 10.0 g/l (high) respectively for a period of 16 weeks; these animals also received MPTP (30 mg/kg, intraperitoneally daily) during the last five days of Mg treatment. Other four groups of mice were given similar dose regimen of MgSO4 but received injections of saline instead of MPTP. Seventy-two hr after the last dose of MPTP, neurobehavioural studies including locomotor activity, pole climbing test and heart nociception test were performed and striata were collected for the analysis of dopamine. The results of this study show that treatment of mice with MgSO4 or MPTP individually has no effect on their behaviour. Concomitant administration of low dose of MgSO4 (2.5 g/l) along with MPTP produced increase in motor activity and latency to heat stimuli; whereas medium and high doses of MgSO4 in combination with MPTP produced opposite (as compared to low dose) effects resulting in a decrease in motor activity and latency to heat stimuli and increase in pole climbing time. However, MgSO4 dose-dependently exacerbated MPTP-induced depletion of striatal dopamine. The mortality was drastically increased (30-55%) in the animals receiving combined treatments of MPTP and MgSO4 as compared to the mice treated with MPTP alone (12%). This study clearly points towards the ability of MgSO4 to modify MPTP-induced neurotoxicity.

Acute transverse myelitis. A localized form of postinfectious encephalomyelitis.

We analysed the clinical, imaging, electrophysiological, laboratory findings, course and prognostic factors in 31 patients with acute transverse myelitis (20 men and 11 women; mean age, 30 years; range, 18-51 years). All patients were assessed for maximal clinical deficit 'deficit score'; pattern-shift visual, auditory and somatosensory evoked potentials were measured, CSF was examined, and neuroimaging of the spinal cord and brain (MRI or CT myelography) was carried out. The myelitis was preceded by febrile illness in 25 (81%) of the patients. The site of the lesion was cervical in 11 (36%), upper thoracic in two (6%), lower thoracic in 16 (52%). MRI of the spinal cord was abnormal in 10 out of the 20 patients examined (50%); in the remaining 11 patients, only CT was carried out and it was normal in all of them. Somatosensory evoked potentials were abnormal in 19 (61%), while pattern-shift visual and brainstem auditory evoked potentials were normal in all patients. CSF was abnormal in 94% of patients with pleocytosis, increased protein or both. Eighteen patients (58%) had good outcome. All patients had monophasic illness. Three variables have emerged as being associated with significant worsening of the outcome: (i) abnormal somatosensory evoked potentials; (ii) abnormal imaging and (iii) high 'deficit score' at onset. Acute transverse myelitis affects a complete segment of the spinal cord, is monophasic and represents a localized form of postinfectious acute encephalomyelitis.

Neurological complications of infective endocarditis.

We reviewed the files of 80 successive patients with native and prosthetic valve endocarditis admitted to Riyadh Armed Forces Hospital. Neurological complications (NC) occurred in 28 (35%) patients. The valves involved were mitral in 12 (43%), aortic in eight (29%), combined mitral and aortic lesions in six (21%), and others in two (7%). The common causative organisms were Stretococci in 12 (43%), Staphylococcus aureus and Staphylococcus epidermides, both occuring in four (14%). Compared to the 52 infective endocarditis patients with no neurological complications (NNC), the NC occurred more frequently in male patients, those with aortic valve lesion, those with atrial fibrillation, those with delayed therapy and those with causative organisms being Streptococci or Staphylococci. Eleven patients died (39%), 12 (43%) recovered with motor sequelae, six (21%) had seizure disorder, and five (18%) had full recovery. The frequency of neurological complications and mortality is comparable to those reported in the literaturel; however, the frequency of strokes was higher in our patients.

The effect of nimodipine on essential tremor.

We investigated the effect of nimodipine (30 mg qid) in 16 de novo patients with essential tremor in a double-blind placebo-controlled study in which we assessed tremor by clinical scorings, tremorgraphic recordings, and patient self-evaluation. Of the 15 patients who completed the study, eight improved. We conclude that nimodipine is effective in some patients with essential tremor.

Multiphasic disseminated encephalomyelitis presenting as alternating hemiplegia.

Two cases of alternating hemiparesis are reported, one in a black Sudanese woman, the other in a Saudi man, who had two episodes of alternating hemiparesis separated in time by six and three years respectively. Based on the typical appearance of the MRI and the results of brain biopsy, the diagnosis of multiphasic disseminated encephalomyelitis was made rather than that of multiple sclerosis. This entity is also differentiated from recurrent disseminated encephalomyelitis, where the relapses are symptomatically stereotyped although the appearance of the MRI is similar and in which new lesions do not occur. Because of the unusual appearance of these MRI lesions, brain biopsy is often performed but recognising their relevance should obviate that need.

Non-progressive familial congenital cerebellar hypoplasia.

A syndrome is reported of congenital non-progressive, gradually slightly improving, ataxia in 3 out of 5 male sibs, issues of a first-order consanguineous mating. Additional characteristic features included: moderate microcephaly, generalised muscle weakness and hypotonia, nystagmus, and moderate mental retardation. A pyramidal syndrome of hyperreflexia and Babinski signs, without any spasticity, became manifest in the 2nd or 3rd year of life. In all three, the caudal part of the vermis was absent, the enlarged IVth ventricle opening up via Magendie's foramen into the cisterna magna. The middle and rostral vermian parts as well as the sagittal paravermian parts of the cerebellar hemispheres were hypoplastic. The differential diagnosis of this syndrome is analysed and the developmental pathogenetic mechanisms likely to produce the typifying distribution of aplasia are indicated.

Long-term therapy of essential tremor with flunarizine.

We investigated the effect of long-term treatment of essential tremor (ET) with flunarizine (Fz) (10 mg/day) in 17 subjects who had a favorable response to 1 month of treatment. Side effects (dystonia, parkinsonism, weight gain and depression) occurred in 29.4% (5/17) of patients, leading to drug discontinuation. Fz was still effective at the end of 30 months of treatment in 41% (7/17) of patients. Loss of efficacy was observed in 29.4% (5/17) of patients. It is concluded that Fz is an alternative for long-term treatment of patients with ET; however, loss of efficacy and side effects are common.

Posttraumatic paroxysmal nocturnal hemidystonia.

The term "nocturnal paroxysmal dystonia" has been used to describe patients who display paroxysmal episodes of dystonic-dyskinetic movements arising during nonrapid eye movement sleep, in particular stages 2-3 (Lugaresi E, Cirignotta F. Hypnogenic paroxysmal dystonia: epileptic seizure or a new syndrome. Sleep 1981;4: 129-138). The pathogenesis of these attacks has remained controversial. We describe a patient with posttraumatic paroxysmal nocturnal hemidystonia. Acetazolamide led to improvement.

Choroido-cerebral calcification syndrome with retardation.

We present a sibship with a rare syndrome characterized by mental retardation, dense calcification of the lateral ventricular choroid plexus, and increased CSF protein. Neurophysiologic studies yielded nonspecific results, and endocrine studies, including parathormone levels, were normal. Simultaneous measurements of CSF and serum calcium, magnesium, and other electrolytes were normal, but the CSF/serum ratio of phosphate was low, suggesting a possible role in the pathogenesis of this syndrome.

Partial seizures presenting as life-threatening apnea.

Apneic episodes, quite common in newborns, are considered rare after age 1 month, when gastroesophageal reflux, cardiac arrhythmias, idiopathic central apnea, and seizures become included in differential diagnosis. Determining the cause of apnea is important as treatment differs significantly and can be harmful; Caffeine given for presumed idiopathic central apnea is reported to have precipitated seizures in 2 patients with apneic seizures. Two cases of partial seizures presenting as apnea in infants were studied. Interictal EEG was normal in 1 and showed focal spikes in the other. Video EEG monitoring (16 channel) showed focal ictal discharge originating from temporal areas clearly preceding onset of apnea in both patients. Because therapeutic options are sometimes diametrically opposite and interictal EEGs are particularly unreliable for diagnosis, we recommend video-EEG monitoring if there is any doubt about the diagnosis before starting treatment in patients with apneic episodes.

A new neurocutaneous syndrome possibly related to Ota's nevus.

The case of a 42-year-old Sudanese man is reported who had developed hyperpigmentation of the left face and rapidly progressive right hemiparesis followed by myoclonus at the age of 30. Blue-grey hyperpigmentation was noted in the territory of the left ophthalmic, maxillary and mandibular trigeminal nerve branches, with alopecia of the right face and axilla. CT of the brain revealed left-sided paraventricular calcifications and MRI showed atrophy of the left cerebral hemisphere and mesencephalon, a calcified haemangioma in the left basal ganglia, an old infarct in the right central pons, and cerebellar atrophy. This case resembles Ota's syndrome; however, atypical distribution of the facial nevus, the epidermal location of hyperpigmentation, and the combination of vascular and degenerative cerebral malformations indicate that this is a new hitherto unreported neurocutaneous vascular syndrome.

Herpes simplex encephalitis mimicking mumps.

A 16-year-old male diabetic patient presented with bilateral salivary gland swellings followed by encephalitis. The EEG did not show the characteristic periodic lateralising epileptic discharges. Neuro-imaging disclosed compromise of temporal and frontal lobes as well as brain stem which correlated well with his clinical deterioration. Serology and frontal brain biopsy were positive for herpes simplex virus while mumps titers were not significant. Despite delayed acyclovir therapy, the patient recovered enough to be discharged home with a permanent pseudobulbar palsy. Herpes simplex encephalitis involving zones other than temporal lobes is exceptional. To our knowledge, there are no reported cases of pseudobulbar palsy as a sequelae of HSV encephalitis.

Idiopathic long QT syndrome: asking the right question.

Infants and young children cannot describe symptoms of cardiogenic syncope accurately. If the attention in such cases is focused on the seizure activity that may follow, the patient will be treated inappropriately with anticonvulsants. We report such a presentation in 4 infants and young children (ages 6 to 48 months) with idiopathic long QT syndrome. All patients presented with recurrent seizures. All patients had a corrected QT interval (QTc) > or = 0.44 s and none had deafness. The diagnosis was suspected by careful history-taking which revealed episodes of loss of consciousness before convulsions in all patients. All patients were treated successfully with propranolol and remained free of symptoms during the follow-up period of 1-2 years. Screening the other family members revealed a prolonged QTc in 9 out of 16, and a history of 3 sudden and unexplained deaths in two families.

Flunarizine in migraine: a double-blind placebo-controlled study (in a Saudi population).

We evaluated the effect of flunarizine (Fz) (10 mg/d) on migraine in a double-blind placebo-controlled design. The attacks' frequency, duration, severity and associated symptoms were compared before and after treatment. Forty-two patients completed a three-month trial period; 21 patients received Fz and 21 placebo. Statistical analysis showed no significant difference between Fz and placebo (p > 0.05). In this study Fz was not more efficient than placebo in migraine.