Immune brachial plexus neuropathy: suggestive evidence for an inflammatory-immune pathogenesis.

We report brachial plexus biopsy findings from two Australian and two American patients with brachial plexus neuropathy. There were florid multifocal mononuclear inflammatory cell infiltrates. Present evidence suggests that these brachial neuropathies have an immune basis.

Emetine myopathy in a patient with an eating disorder.

OBJECTIVE: To alert physicians to the dangers of a readily available, non-prescription drug by describing the clinical and pathological features of myopathy due to chronic poisoning with ipecac syrup in a patient with an eating disorder. CLINICAL FEATURES: A 27-year-old woman presented in 1991 with a right foot drop, followed a few months later by progressive severe neck and limb weakness associated with dysphagia, faecal incontinence and diffuse body ache. It emerged that she had been consuming increasing quantities of ipecac syrup (up to 200 mL per week) for three months to induce vomiting and weight loss. The serum creatine kinase activity was slightly elevated and electromyographic examination results were in keeping with a necrotising proximal myopathic process. Muscle biopsy showed vacuolar degeneration with myofibrilolysis and fine cytoplasmic body formation, consistent with a diagnosis of emetine myopathy. INTERVENTION AND OUTCOME: The patient was advised to stop taking ipecac and observed for the next few months. The symptoms resolved gradually and strength returned to normal in four months. CONCLUSION: Chronic emetine toxicity, with its potentially catastrophic consequences, should be remembered in the evaluation of neuromuscular symptoms in young women, in whom eating disorders are common and often unrecognised.

Acute intramedullary spinal cord abscess: case report.

We report the first case of an acute pyogenic intramedullary cervical spinal cord abscess, brain abscesses and meningitis due to an unusual anerobe, Bacteroides disiens. The importance of spinal magnetic resonance imaging for establishing the diagnosis is emphasized.

Spinal cord toxoplasmosis in a patient with human immunodeficiency virus infection.

Spinal cord toxoplasmosis occurs rarely in the acquired immunodeficiency syndrome (AIDS). It usually presents as a space occupying lesion which makes differentiation from a neoplasm difficult. As a result, only 2 of the 5 previously reported cases have been diagnosed antemortem. We have incorporated the clinical details from one further case to describe the clinical features of this condition. The clarification of this clinical entity may allow earlier diagnosis of this rare condition in the future.

Intraventricular infusion of Dopamine in Parkinson's disease.

A patient with severe end-stage Parkinson's disease and troublesome fluctuations in motor function was treated with a long-term intraventricular infusion of dopamine. There was modest improvement in speech and mentation and there was smoother control of motor symptoms that was superior to that achieved by conventional oral medications.

Availability of drug assay results and dosage advice improves antiepileptic care in a specialist neurology outpatient clinic.

The incidence of grand mal seizures, distribution of drug levels relative to the therapeutic range and the incidence of side effects were monitored before and after the provision of same-day preconsultation assay results (phenytoin and carbamazepine) to an epilepsy clinic. A total of 300 patients completed the study. The proportion of patients fitting fell from 23.3% at entry to 10% at review (P less than 0.01) while the incidence of side effects fell from 30.7% to 17.3% (P less than 0.01) and the proportion of phenytoin levels in the therapeutic range rose from 41% to 58% (P less than 0.01). Similar patterns were observed in 111 patients who entered the study during a control observation period. The provision of appropriate support services (assay results and dosage advice) to specialist epilepsy clinics allows improvement in the management of epilepsy.

Absence status: a report of two cases.

Two known epileptics presented with abnormal behaviour. One was inattentive, aggressive and ataxic. The other carried out quite complex, though purposeless activity. EEG's revealed that the patients' behavioural abnormalities were due to uncontrolled seizures. Absence Status is an uncommon condition and its various manifestations can lead to delays in its recognition and treatment. It should be considered as a possible diagnosis in any patient who presents with recurring episodes of confusion.

Primary orthostatic cerebral ischaemia.

four patients with "primary orthostatic cerebral ischaemia" are described. They complained of dizziness, light-headedness or syncope on standing. None had a significant fall in his systemic blood pressure on assuming the erect posture. Each had bruits over the major neck vessels or absent pulses. Angiography showed widespread narrowing or occlusion of the cervical blood vessels which supply the brain. Carotid endarterectomy relieved the patients' symptoms and also reduced the fall in retinal artery pressures on standing noted preoperatively. The clinician who is not aware of the poorly documented syndrome of "primary orthostatic cerebral ischaemia" may fail to recognise that a patient's complaints are due to cerebrovascular disease for they are strikingly different from those of classical transient ischaemic attacks.

Comparison of enteric-coated levodopa with levodopa-carbidopa combination. A double-blind crossover trial.

Twenty-seven patients with idiopathic Parkinson's disease completed a double-blind crossover trial which compared enteric-coated levodopa (Prodopa) with levodopa-carbidopa combination (Sinemet). It was easy to stabilize the patients' condition with either drug, and the dose-sparing effect both of the enteric-coated preparation, and of the levodopa-carbidopa combination was again noted. At the dosages used, the levodopa-carbidopa combination was objectively shown to be more effective in 71% of the patients investigated, although there was no clear personal preference for either preparation when patients compared the two parts of the trial. Both drugs play a valuable role in the treatment of Parkinson's disease.

Bromocriptine in lieu of levodopa for Parkinson's disease.

Thirteen patients with Parkinson's disease, whose disability was increasing and on long-term levodopa therapy (both with and without carbidopa), had the levodopa fully replaced by bromocriptine. At three months, eight of the 13 patients (62%) were less disabled on bromocriptine and none became worse. The present indications for the use of bromocriptine are discussed.