ABSTRACT
BACKGROUND: Nonvasculitic autoimmune inflammatory meningoencephalitis and Creutzfeldt-Jakob disease can present as rapidly progressive encephalopathies with similar clinical features. Slowing of background rhythm is an electroencephalographic characteristic shown by both, but persistent periodic sharp waves are more specific for Creutzfeldt-Jakob disease and have not been reported in nonvasculitic autoimmune inflammatory meningoencephalitis or related autoimmune meningoencephalitides. OBJECTIVE: To describe a patient with clinical (rapidly progressive myoclonus, dementia, and Parkinsonism) and electroencephalographic findings (persistent periodic sharp waves) that diagnostically suggest Creutzfeldt-Jakob disease. DESIGN AND SETTING: A case report at the Mayo Clinic Arizona, Scottsdale. RESULTS: The patient made a dramatic recovery with resolution of the periodic sharp wave complexes after treatment with high-dose corticosteroids. Our case is the first reported case of a patient with probable nonvasculitic autoimmune inflammatory meningoencephalitis and electroencephalographic periodic complexes suggestive of Creutzfeldt-Jakob disease. CONCLUSION: Rapidly progressive encephalopathy with periodic sharp wave complexes can be associated with a reversible autoimmune syndrome.
Subject(s)
Autoimmune Diseases/pathology , Creutzfeldt-Jakob Syndrome/diagnosis , Inflammation/pathology , Meningoencephalitis/diagnosis , Adrenal Cortex Hormones/therapeutic use , Aged , Alzheimer Disease/etiology , Creutzfeldt-Jakob Syndrome/complications , Creutzfeldt-Jakob Syndrome/drug therapy , Dementia/drug therapy , Dementia/etiology , Diagnosis, Differential , Electroencephalography , Female , Humans , Meningoencephalitis/drug therapy , Myoclonus/drug therapy , Myoclonus/etiologyABSTRACT
The authors evaluated four patients with schizencephaly who underwent subtraction ictal SPECT coregistered to MRI (SISCOM) prior to epilepsy surgery. Three patients had a SISCOM alteration that was concordant with the epileptic brain tissue. Two of these patients were rendered seizure-free and one individual experienced a significant reduction in seizures. The patient with an indeterminate SISCOM had an unfavorable outcome. SISCOM is useful in evaluating patients with schizencephaly for epilepsy surgery.
Subject(s)
Cerebral Cortex/abnormalities , Epilepsies, Partial/surgery , Tomography, Emission-Computed, Single-Photon , Adolescent , Adult , Cerebral Cortex/blood supply , Cerebral Cortex/diagnostic imaging , Cerebral Cortex/surgery , Cerebrovascular Circulation , Epilepsies, Partial/diagnostic imaging , Epilepsies, Partial/etiology , Humans , Learning Disabilities/diagnostic imaging , Learning Disabilities/etiology , Magnetic Resonance Imaging , Memory Disorders/diagnostic imaging , Memory Disorders/etiology , Paresis/diagnostic imaging , Paresis/etiology , Postoperative Period , Preoperative Care , Treatment OutcomeSubject(s)
Complementary Therapies/statistics & numerical data , Epilepsy/therapy , Adolescent , Adult , Aged , Arizona , Attitude of Health Personnel , Cerebral Hemorrhage/chemically induced , Child , Complementary Therapies/psychology , Ephedra/adverse effects , Female , Humans , Male , Middle Aged , Patient Satisfaction/statistics & numerical data , Physician-Patient Relations , Phytotherapy/psychology , Phytotherapy/statistics & numerical data , Plant Preparations/adverse effects , Plant Preparations/therapeutic use , Religion , Stress, Physiological/therapy , Yoga/psychologySubject(s)
Status Epilepticus/diagnosis , Adult , Disease Progression , Female , Humans , Magnetic Resonance ImagingSubject(s)
Dementia, Vascular/diagnosis , Headache/diagnosis , Vasospasm, Intracranial/diagnosis , Dementia, Vascular/complications , Diagnosis, Differential , Epilepsy, Tonic-Clonic/complications , Epilepsy, Tonic-Clonic/diagnosis , Female , Headache/complications , Humans , Middle Aged , Vasospasm, Intracranial/complicationsABSTRACT
OBJECTIVE: To analyze the frequency of neurologic events during commercial airline flights and to assess whether onboard emergency medical kits are adequate for in-flight neurologic emergencies. METHODS: Collaboration of the Mayo Clinic's Departments of Emergency Medicine and Medical Transportation Service and the Division of Aerospace Medicine to provide real-time in-flight consultation to a major US airline that flies approximately 10% of all US passengers. We analyzed all medical events reported from 1995 to 2000 in a database that catalogs the air-to-ground medical consultations. All cases with potential neurologic symptoms were reviewed and classified into various neurologic symptom categories. The cost of diversion for each neurologic symptom was calculated and then extrapolated to assess the cost of neurologic symptoms to the US airline industry. RESULTS: A total of 2,042 medical incidents led to 312 diversions. Neurologic symptoms were the single largest category of medical incidents, prompting 626 air-to-ground medical calls (31%). They caused 34% of all diversions. Dizziness/vertigo was the most common neurologic symptom followed by seizures, headaches, pain, and cerebrovascular symptoms. Whereas seizures and dizziness/vertigo were the most common reasons for diversion, loss of consciousness/syncope was the complaint most likely to lead to a diversion. The estimated annual cost of diversions due to neurologic events is almost 9,000,000 dollars. CONCLUSION: Neurologic symptoms are the most common medical complaint requiring air-to-ground medical support and are second only to cardiovascular problems for emergency diversions and their resultant costs to the US airline industry. Adding antiepileptic drugs to the onboard medical kit and greater emergency medical training for in-flight personnel could potentially reduce the number of diversions for in-flight neurologic incidents.
Subject(s)
Aircraft , Nervous System Diseases/therapy , Travel/statistics & numerical data , Aircraft/economics , Aircraft/statistics & numerical data , Databases, Factual/statistics & numerical data , Emergency Treatment/economics , Emergency Treatment/methods , Emergency Treatment/statistics & numerical data , Humans , Nervous System Diseases/economics , Nervous System Diseases/epidemiology , Travel/economicsABSTRACT
To determine the prevalence of essential tremor (ET) and Parkinson's disease (PD) in a retirement community, all residents of Carefree, Arizona, aged over 65 years were contacted. All participants completed validated questionnaires for PD and ET, and were examined using the Unified Parkinson's Disease Rating Scale. Of 356 individuals evaluated, 155 (43.5%) had tremor; 73 (20.5%) had ET; 26 (7.3%) had PD; and 56 (15.7%) had postural tremor (PT). Thus, a large percentage of individuals were found to have tremor, in the plurality of whom it could be classified as ET. The number of individuals with Parkinson's disease exceeded our expectations.
