Cerebral vasculopathy after 4-bromo-2,5-dimethoxyphenethylamine ingestion.

BACKGROUND: 4-bromo-2,5-dimethoxyphenethylamine (2C-B) is a designer-drug variant of 3,4-methylenedioxymethamphetamine (ecstasy) whose recreational use has increased significantly over the last 10 years. Neurologic consequences of 2C-B usage are currently unknown. CASE REPORT: A 43-year-old woman experienced severe headaches within 48 hours of taking liquid 2C-B, after which time she developed progressive encephalopathy and quadraparesis, which did not improve over several months. MRA and cerebral angiogram imaging demonstrated profound vascular abnormalities of large, medium, and small-caliber vessels with subsequent watershed infarction. Brain biopsy and cerebrospinal fluid studies ruled out an inflammatory process. CONCLUSIONS: This case demonstrates an idiosyncratic and devastating neurologic response to 2C-B, a recreational drug whose popularity has increased with widespread availability of online guides for its synthesis.

Confronting the growing burden of chronic disease: can the U.S. health care workforce do the job?

The U.S. chronic illness burden is increasing and is felt more strongly in minority and low-income populations: in 2005, 133 million Americans had at least one chronic condition. Prevention and management of chronic disease are best performed by multidisciplinary teams in primary care and public health. However, the future health care work-force is not projected to include an appropriate mix of personnel capable of staffing such teams. To prepare for the growing chronic disease burden, a larger interdisciplinary primary care workforce is needed, and payment for primary care should reward practices that incorporate multidisciplinary teams.

Memory for facial expressions: the power of a smile.

Faces with expressions (happy, surprise, anger, fear) were presented at study. Memory for facial expressions was tested by presenting the same faces with neutral expressions and asking participants to determine the expression that had been displayed at study. In three experiments, happy expressions were remembered better than other expressions. The advantage of a happy face was observed even when faces were inverted (upside down) and even when the salient perceptual feature (broad grin) was controlled across conditions. These findings are couched in terms of source monitoring, in which memory for facial expressions reflects encoding of the dispositional context of a prior event.

Seizures and metabolic disease.

Seizures represent an important clinical manifestation of inborn errors of metabolism. The presence of myoclonic seizures and very early onset are clues to a metabolic disorder. Specific correlations between age of seizure onset and electroencephalogram patterns with inborn errors of metabolism are discussed. The explosion of information in neurogenetics and metabolism mandates increasing awareness of appropriate metabolic diagnostic and therapeutic strategies in the setting of certain epilepsies. Specific laboratory, imaging, and treatment considerations are included to present updated material in a field that continues to expand rapidly.