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
A 5-year retrospective review of airway management by flight nurses was conducted to evaluate airway care and to determine the frequency of surgical cricothyrotomy. Intubation was attempted in 51% of patients, with a success rate of 80%. Oral intubations were attempted in the remaining patients and in those patients in whom initial attempts at nasal intubation failed, with a success rate of 81%. The success rate for intubations was 72% in 1985, 95 % in 1986, 92% in 1987, 97% in 1988, and 76% in 1989. Overall, 87% of patients were successfully intubated and surgical cricothyrotomy was required in only one patient. A greater success rate was achieved when intubations were performed before takeoff than during flight.
