Subject(s)
Methotrexate/adverse effects , Methylenetetrahydrofolate Reductase (NADPH2)/genetics , Polymorphism, Single Nucleotide/genetics , Spinal Cord Diseases/chemically induced , Spinal Cord Diseases/genetics , Antimetabolites, Antineoplastic/adverse effects , Female , Humans , Male , Middle Aged , Risk Factors , Spinal Cord Diseases/diagnostic imagingABSTRACT
A woman aged 77 years was transferred to our neurocritical care unit for evaluation and treatment of rapidly progressive motor weakness and encephalopathy. Examination revealed an ability to follow simple commands only and abnormal movements, including myoclonus, tongue and orofacial dyskinesias, and opsoclonus. Imaging study findings were initially unremarkable, but when repeated, they demonstrated enhancement of the cauda equina nerve roots, trigeminal nerve, and pachymeninges. Cerebrospinal fluid examination revealed mildly elevated white blood cell count and protein levels. Serial electrodiagnostic testing demonstrated a rapidly progressive diffuse sensory motor axonopathy, and electroencephalogram findings progressed from generalized slowing to bilateral periodic lateralized epileptiform discharges. Critical details of her recent history prompted a diagnostic biopsy. Over time, the patient became completely unresponsive with no further abnormal movements and ultimately died. The differential diagnosis, pathological findings, and diagnosis are discussed with a brief review of a well-known yet rare diagnosis.
Subject(s)
Bites and Stings/diagnosis , Brain Diseases/diagnosis , Chiroptera , Quadriplegia/diagnosis , Rabies/diagnosis , Aged , Animals , Bites and Stings/complications , Brain Diseases/etiology , Fatal Outcome , Female , Humans , Quadriplegia/etiology , Rabies/complicationsABSTRACT
Diabetes has become one of the largest global health-care problems of the 21 (st) century. According to the Centers for Disease Control and Prevention, the population prevalence of diabetes in the US is approaching 10% and is increasing by 5% each year. Diabetic neuropathy is the most common complication associated with diabetes mellitus. Diabetes causes a broad spectrum of neuropathic complications, including acute and chronic forms affecting each level of the peripheral nerve, from the root to the distal axon. This review will focus on the most common form, distal symmetric diabetic polyneuropathy. There has been an evolution in our understanding of the pathophysiology and the management of diabetic polyneuropathy over the past decade. We highlight these new perspectives and provide updates from the past decade of research.
