ABSTRACT
Syndromes from antibodies to voltage-gated potassium channels include neuromyotonia (NMT), limbic encephalitis (LE) and Morvan syndrome (MVS). There are distinct clinical features for NMT (cramps, stiffness, fasciculations, myokymia, hyperhidrosis; afterdischarges and continuous motor activity on electromyogram), LE (encephalopathy with seizures, deficient recent memory; hyponatremia, temporal lobe magnetic resonance imaging and electroencephalographic abnormalities) and MVS (NMT plus hyperhidrosis, dysautonomia, encephalopathy, severe insomnia, and sleep disorders). There may be associated myasthenia gravis or thymoma, and rarely lung cancer (small cell or adenocarcinoma), mandating that chest imaging be part of the evaluation. Most cases respond favorably to immunosuppression with plasma exchange, intravenous immunoglobulin or pulse intravenous methylprednisolone, usually followed by oral steroids.
Subject(s)
Isaacs Syndrome/therapy , Limbic Encephalitis/therapy , Potassium Channels/immunology , Syringomyelia/therapy , Glucocorticoids/therapeutic use , Humans , Immunoglobulins, Intravenous/therapeutic use , Immunosuppression Therapy , Isaacs Syndrome/immunology , Limbic Encephalitis/immunology , Methylprednisolone/therapeutic use , Plasma Exchange , Syringomyelia/immunologyABSTRACT
BACKGROUND: Upper extremity symptoms can develop in restless legs syndrome, but are rarely the initial symptom. OBJECTIVES: To report a case of restless legs syndrome with restless arms as the initial symptom, and to review the literature. DESIGN: Case report and literature review. PATIENT: A 78-year-old man had arm restlessness and sleep disturbance. A polysomnogram demonstrated subclinical periodic leg movements 1 year after the onset of his symptoms. RESULTS: Two years later, he developed lower extremity symptoms that fit the criteria for restless legs syndrome. To our knowledge, this is the first case of restless legs syndrome with arm restlessness as the initial symptom in an otherwise neurologically normal person. CONCLUSION: Restless legs syndrome may initially exhibit upper extremity symptoms.
Subject(s)
Arm/innervation , Psychomotor Agitation/diagnosis , Restless Legs Syndrome/diagnosis , Aged , Diagnosis, Differential , Humans , Male , Polysomnography , Restless Legs Syndrome/physiopathologyABSTRACT
BACKGROUND: The blood-brain barrier may be permeable under the clinical settings of uncontrolled hypertension, renal insufficiency, immunosuppressive drugs, and intravascular radiographic contrast. Some reversible neurological complications after angiography are caused by cortical penetration of contrast media detected on brain computed tomographic (CT) scans. OBJECTIVES: To describe the first report of a transient visuospatial disorder having elements of Balint syndrome, and caused by angiographic contrast penetration of the bilateral parieto-occipital cortex; and to review cases published between 1980 and 2001 of cortical contrast penetration, documented by CT. RESULTS: Simultanagnosia, optic ataxia, and ocular apraxia occurred in a 74-year-old woman who received nonionic contrast media during a failed renal angioplasty. Contrast noted in the bilateral parieto-occipital cortex on the initial CT scan disappeared after 4 days with clinical resolution. CONCLUSIONS: Angiographic contrast tends to breach the blood-brain barrier of the vertebrobasilar circulation, penetrating the occipital cortex and leading to transient, localizable syndromes of cortical blindness or abnormal visuospatial processing.
