Von Economo's disease and postencephalitic parkinsonism responsive to carbidopa and levodopa.

Postencephalitic parkinsonism (PEP) is currently perceived as having a very close etiologic relationship with encephalitis lethargica (von Economo's disease [EL]), with PEP developing immediately after the acute phase of EL or at some time later. EL was classically described by von Economo and has somnolent-ophthalmoplegic, hyperkinetic, and amyostatic-akinetic forms. Previous cases have reported success with levodopa in PEP. We report a case with PEP showing success after administration of levodopa and carbidopa. This case would support the hypothesis that this syndrome effects dopamine neurotransmission.

Use of ketamine for acute suicidal ideation in a patient with chronic pain on prescribed cannabinoids.

Ketamine is a standard anaesthetic drug that has been studied as a possible treatment for acute suicidal ideation. Aside to the potential psychotropic effects of ketamine, a Cochrane review reported that available studies suggest a modest effect of ketamine for chronic pain months to years after surgical intervention. We present a patient with acute suicidal ideation who required immediate inpatient psychiatric admission in the setting of concurrent chronic pain on cannabinoids which could not be prescribed within our inpatient hospital setting. This presented a clinical dilemma to rapidly reverse the patient's suicidality while substituting the patient's prescribed cannabinoid products with an alternative pain regimen. Since there is emerging support in the use of ketamine in suicidality and chronic pain, we administered ketamine while withholding cannabinoid products and found evidence to support its use in rapid reversal of suicidal ideation and temporary chronic pain relief.

Use of ultrasound in detection and treatment of nerve compromise in a case of humeral lengthening.

The development of iatrogenic nerve lesions during and following limb lengthening procedures present a challenge to orthopedic surgeons. Early treatment of nerve damage is critical in salvaging full function of the nerve. Precise location of damage, however, must be determined in order to appropriately administer treatment. We report a patient with a short humerus caused by a growth arrest undergoing a 7-cm lengthening who developed a neurapraxic injury of the radial nerve. Nerve compromise was noted 1 month into the lengthening program. Nerve conduction studies and electromyography could not be used to determine the precise site of injury. Likewise, magnetic resonance imaging and computed tomography were contraindicated and inconclusive, respectively, due to the presence of a metallic external fixation device. High-resolution ultrasonography (US) findings, however, correlated with our clinical examination of the patient's radial nerve function and permitted identification of the precise site of nerve involvement. Treatment was administered by removing a causative half-pin. Several days following treatment, nerve function returned to normal. There are a limited number of articles in the literature regarding nerve injuries associated with limb lengthening and their corrective treatments. The outcome of this case underscores the usefulness of US over various other diagnostic techniques under certain circumstances.

Comparison of PACS and hard-copy 51-inch radiographs for measuring leg length and deformity.

BACKGROUND: The picture archiving and communication system (PACS) eventually will replace the use of standard hard-copy radiographs. It is unknown whether measurements of limb length discrepancy (LLD) and deformity on PACS compare in accuracy and reproducibility with those from hard-copy radiographs. QUESTIONS/PURPOSES: We compared the reproducibility and reliability of LLD and deformity measurements for each of these two media. METHODS: We retrospectively reviewed 51-inch standing lower extremity images obtained for LLD or deformity analysis from 40 patients to compare the measurements and their reliability on hard-copy film with those performed on soft-copy PACS. Two observers independently performed measurements twice using each system at 1-week intervals to minimize interobserver or intraobserver bias. Intraclass correlation coefficients (ICCs) were determined to test intraobserver and interrater reliability of Rater 1 and Rater 2. RESULTS: Interrater reliability of measurements made on hard copy ranged from 0.69 to 0.99 and PACS-derived measurements ranged from 0.66 to 0.98. Intraobserver reliability for Rater 1 for measurements made on hard copy ranged from 0.853 to 0.999 and PACS-derived measurements ranged from 0.80 to 0.996. Intraobserver reliability for Rater 2 for measurements made on hard copy ranged from 0.931 to 0.999 and PACS-derived measurements ranged from 0.962 to 0.999. CONCLUSIONS: Each system yielded comparable reliability for measurements, therefore, transition to PACS to perform measurements in patients with LLD or deformity can be made with confidence. LEVEL OF EVIDENCE: Level III, diagnostic study. See the Guidelines for Authors for a complete description of levels of evidence.