ABSTRACT
Parkinsonism with myoclonus is rarely associated with infectious disease in adults. We present a 55-year-old man experiencing acute onset bilateral limb tremor, rigidity, and myoclonus with small-stepped gait, and skin rash involving the trunk and limbs, after a fever. Serum was positive for anti-Orientia tsutsugamushi immunoglobulin M antibody. Brain MRI revealed no abnormalities. The fever improved with oral doxycycline, and the parkinsonism and myoclonus improved with amantadine and clonazepam. This is a rare case of parkinsonism with myolonus associated with scrub typhus infection.
Subject(s)
Myoclonus/etiology , Parkinsonian Disorders/etiology , Scrub Typhus/complications , Antibodies/blood , Brain/microbiology , Brain/pathology , Humans , Magnetic Resonance Imaging , Male , Middle Aged , Myoclonus/complications , Myoclonus/microbiology , Orientia tsutsugamushi/immunology , Orientia tsutsugamushi/pathogenicity , Parkinsonian Disorders/complications , Parkinsonian Disorders/microbiology , Scrub Typhus/bloodABSTRACT
BACKGROUNDS: The circle of Willis (CoW) is a primary collateral pathway that compensates quickly for a drop in cerebral blood flow. Using the complete CoW as a surrogate marker for good collateral circulation, its prognostic value after intravenous thrombolysis was examined. METHODS: We prospectively studied 64 consecutive patients with acute ischemic stroke treated with tissue plasminogen activator within 3 hours of stroke onset between October 2005 and June 2012 in our hospital. The study protocol was based on standard guidelines for intravenous thrombolysis. On computed tomographic angiography 24 hours after thrombolysis, the CoW was complete in 21 (32.8%) cases and incomplete in 43 (67.2%). RESULTS: Patients with complete CoW were more likely to have early improvement in National Institute of Health Stroke Scale (NIHSS) score (median improvement 2 vs 0 at 2 hours; 4 vs 1 at 24 hours), be independent at 3 months (42% vs 19%). In the incomplete CoW group, the rate of symptomatic intracerebral haemorrhage (SICH) according to the Safe Implementation of Thrombolysis in Stroke-Monitoring Study (SITS-MOST) definition was almost 3 times higher. Complete CoW was one of the strongest predictors of good functional outcome at 3 months (odds ratio 2.32; P = .01). CONCLUSIONS: Complete CoW independently predicted functional independence and survival.
Subject(s)
Cerebral Hemorrhage/pathology , Circle of Willis/pathology , Stroke/drug therapy , Stroke/pathology , Thrombolytic Therapy/methods , Aged , Brain Ischemia/diagnostic imaging , Brain Ischemia/drug therapy , Brain Ischemia/pathology , Cerebrovascular Circulation/physiology , Circle of Willis/diagnostic imaging , Female , Health Status Indicators , Humans , Male , Middle Aged , Prospective Studies , Stroke/mortality , Time Factors , Tissue Plasminogen Activator/administration & dosage , Tomography, X-Ray ComputedABSTRACT
We presented a case of previous healthy postpartum woman suffering from seizure of sudden onset with conscious change and anisocoric pupils. Head magnetic resonance imaging (MRI) revealed multiple high signal-intensity lesions on fluid-attenuated inversion recovery (FLAIR) / T2 weighted image (T2WI) in bilateral subcortical white matters (especially the parieto-occipital areas), brain stem, and bilateral cerebellum, and mild high signal-intensity lesions on diffusion weighted MRI (DWI). These neurological and radiological anomalies recovered completely later. The final diagnosis was the rare presentation of late postpartum eclampsia as reversible posterior encephalopathy syndrome (RPES).
