[Polio-like myelitis due to Coxsackie-Virus B 3: Course under treatment with pleconaril]. / Polio-ähnliche Myelitis durch Coxsackie-Virus B 3: Verlauf unter Pleconaril-Behandlung.

Enteroviruses are common with infections of the CNS, such as encephalitis and myelitis, but they may cause various diseases in different organ systems, particulary with fatal outcome. Pleconaril is a new orally acting antiviral drug with broad anti-picornavirus activity, which provides to treat rhinoviral and enteroviral infections. To explain the importance for clinical use, we report a case of severe enteroviral infections of the CNS, treated by Pleconaril. A 14 year old girl presented with a severe polio- like myelitis including flaccid paraparesis and urinary incontinence due to Coxsackievirus-infection. Because of prolonged course and virus persistence we treated with Pleconaril, after treatment a remarkable improvement could be noticed, continency and the ability to walk without aid were regained within a few weeks. With the development of new antiviral substances we are now given more opportunities to treat infectious conditions of the central nervous system. We suggest to include enteroviruses in diagnostic procedures since there is an effective treatment with the new drug Pleconaril available.

[Evoked potentials in Chiari-malformation type I with syringomyelia--a case history]. / Evozierte Potenziale bei Chiari-Malformation Typ I mit Syringomyelie--ein Fallbericht.

The Chiari-syndrome Type I being a malformation of the posterior cranial fossa often leads to syringomyelia. The disease becomes apparent in adolescence with kyphoscoliosis, headache, vertigo, ataxy, hearing loss, partial paralysis and other neurological disorders. The onset is typically characterized by dissociated anesthesia, due to the frequent localization of the syrinx in the neighborhood of the posterior column of the spinal cord. It is reported a case of an 15-years-old-girl suffering from intensive headache, recurrent left-sided paresthesias and progredient scoliosis. Somatosensory evoked potentials of left ulnar and tibial nerves revealed a complete loss of cortical response. Diagnostic imaging showed an Chiari-malformation I with herniation of cerebellar tonsils and secondary syringomyelia of the cervical spinal cord. After surgical treatment with posterior fossa decompression, C1 laminectomy and partial excision of cerebellar tonsils the patient had a clear improvement in symptoms. Postsurgical the width of cervical syrinx decreases. Now somatosensory evoked potentials of the left ulnar and tibial nerves show amplitude-reduced cortical responses with a normal latency.

[Cavernoma of the medulla oblongata mimicking "Anorexia nervosa" - a case report]. / Kavernom der Medulla oblongata unter dem Bild einer "Anorexia nervosa".

An 11-year-old girl presented with recurrent vomiting, reduced food and fluid intake, weight loss and dizziness. In an external hospital she was diagnosed as having habitual vomiting and a beginning eating disorder. The physical examination revealed a very thin, malnourished child with abdominal pain on palpation but without neurologic deficits. Laboratory findings, X-rays, endoscopy and ultrasound revealed no pathological results either. Since the EEG and the cranial computed tomography (CT) were normal, we also suspected the beginning of an eating disorder especially due to some psychical peculiarities. The MRI which was done for ultimate exclusion of an infratentorial tumor showed a well defined displacing structure in the dorsal medulla oblongata and in the upper cervical spinal cord. A corresponding prolongation of the central conduction time was found in the median nerve SSEP whereas the BAEPs were normal. The tumor was excised in toto and the histological examination confirmed the suspected diagnosis of cavernous hemangioma (cavernoma). The post operative phase was without any complications and the intiated nutrition was well tolerated. Neurological deficits were not observed.

[Suspected vaccination complications or atypical vaccination course. Diagnostic assessment of 58 vaccine recipients]. / Verdacht auf Impfkomplikationen oder atypischer Impfverlauf. Diagnostische Abklärung bei 58 Impflingen.

The "list of recommended vaccinations" of the regional Ministries of Health is the legal basis for routine vaccination programmes in each region of Germany; the recommendations of the Federal Commission on Vaccinations, "STIKO", are not legally binding. These programmes of the different regions provide legal grounds for determining claims for damage against a vaccinating doctor. In cases of damage, the Ministry of Health is liable for the damage to a patient caused by a recommended vaccination. Irrespective of these clear and comprehensive legal provisions, in case of an atypical course the patient is entitled to careful diagnosis of the complaint and appropriate medical treatment. However, later claims by the patient for damage can only be decided correctly if the necessary diagnostic data have been carefully collected at the acute stage of the disease. In our 58 patients suffering from atypical vaccination courses or suspected complications, we were able to show in each case that the symptoms are the result of interference by infectious diseases or that there was some other clear diagnosis; in no case did we find that the vaccination had caused disease or permanent damage.

Pre- and perinatal infections due to human herpesvirus-6 and Epstein-Barr-virus with lethal outcome or severe residual encephalopathy.

The Human Herpesvirus-6 (HHV-6) infection causes exanthem subitum (in typical cases) and a wide range of other symptoms. So far no prenatal or perinatal infections have been reported. For HHV-6 the prenatal infection should be extremely rare, because more than 95% of adults are immune in Germany. Two own cases reported here document that pre- and perinatal HHV-6 infection does occur and can provoke dramatic clinical symptoms of illness with death or cerebral defects like other prenatal herpesvirus infections (HSV, VZV, CMV etc.).