ABSTRACT
A previously healthy young man presented with an acute stroke syndrome and was found to have cryptococcal organisms in the CSF. Though an initial CSF examination for an infectious etiology was negative, a second lumbar puncture was performed because of hypoglycorrhachia, which established the diagnosis. An uneventful recovery followed the administration of Amphotericin B and 5-Flucytosine. A literature search revealed only one previously reported case of cryptococcal meningoencephalitis presenting as a stroke. The need for performing a CSF examination on young patients presenting with a cerebrovascular event, and the aggressive investigation of unexplained hypoglycorrhachia are emphasized.
Subject(s)
Cryptococcosis/complications , Hemiplegia/etiology , Meningoencephalitis/complications , Adult , Cryptococcosis/diagnosis , Cryptococcosis/drug therapy , Humans , Male , Meningoencephalitis/chemically induced , Meningoencephalitis/drug therapyABSTRACT
Generalized weakness, intermittent dysphagia, and a 40-pound weight loss developed in an elderly man over a six-month period. Examination revealed weakness, atrophy and fasciculations of extremity musculature, pseudobulbar speech, hyperactive upper extremity reflexes, and extensor toe signs without sensory loss. Results of electrodiagnostic studies were consistent with an axonal polyneuropathy. Endocrinologic results were compatible with hyperthyroidism. Radioiodine therapy resulted in resolution of clinical neurologic symptoms and signs within seven months. This case illustrates a previously undescribed concurrence of hyperthyroid associated polyneuropathy and pyramidal tract dysfunction that led to an initial clinical diagnosis of amyotrophic lateral sclerosis.
Subject(s)
Amyotrophic Lateral Sclerosis/diagnosis , Hyperthyroidism/diagnosis , Peripheral Nervous System Diseases/complications , Pyramidal Tracts , Aged , Diagnosis, Differential , Humans , Hyperthyroidism/complications , Hyperthyroidism/physiopathology , Male , Pyramidal Tracts/physiopathology , Spinal Cord Diseases/complicationsABSTRACT
The abuse of ipecac syrup for three years resulted in painless, nonfatigable, chiefly proximal weakness in a 27-year-old woman. Electromyography (EMG) and a muscle biopsy revealed features of a myopathy similar to those previously reported in experimental emetine myopathy. Clinical weakness and EMG abnormalities improved after discontinuation of ipecac administration. A direct toxic action of ipecac (acting through its active alkaloid, emetine hydrochloride) on muscle fibers seemed to be responsible for the weakness in this patient.
Subject(s)
Ipecac/adverse effects , Muscular Diseases/chemically induced , Adult , Female , Humans , Muscular Diseases/pathology , Substance-Related Disorders/diagnosisABSTRACT
Facial or limb myokymia was present in 8 patients (17%) of 48 consecutive cases of Guillain-Barré syndrome. It occurred early in the course of the illness and persisted 5 to 40 days as the patients recovered. Facial myokymia usually occurred in clinically weak muscles, was most often bilateral, and was more common in women. Bilaterality and transient nature differed from the facial myokymia seen in pontine tumors and demyelinating disease.
