Myopathy with tubulin-reactive crystalline inclusions.

A 61-year-old man with muscle aches and persistently elevated serum creatine kinase had aggregates of randomly oriented, rhomboidal or rectangular protein crystalline inclusions in the sarcoplasm of type II fibers. Immunochemical studies showed strong reactivity of the inclusions to tubulin antibodies, suggesting that these unique crystalline inclusions may be a consequence of altered synthesis, processing, or degradation of tubulin.

Unilateral pruritus after a stroke.

A patient with unilateral pruritus after a stroke is described. The neural pathways of pruritus and the role of the central nervous system in the initiation and modulation of the itch sensation are discussed. Pathways between the cerebral cortex and the medulla may play important roles in the sensation of pruritus.

Granulomatous angiitis of the nervous system first seen as relapsing myelopathy.

A previously healthy 19-year-old man with a painful, relapsing myelopathy died of a cerebral hemorrhage. At autopsy he was found to have granulomatous angiitis of the nervous system (GANS). This particular case of GANS is distinctive and has been reported on two previous occasions.

Pseudotumor cerebri, empty sella syndrome, and adrenal adenoma.

Benign intracranial hypertension (BIH) and empty sella syndrome occurred in a patient with Cushing syndrome resulting from adrenal adenoma, removal of which was followed by return of cerebrospinal fluid pressure to normal. This case does not clarify the pathophysiology of BIH, but it does raise questions about the treatment of BIH with corticosteroids, which are of unproved efficacy and may sometimes cause the same clinical syndrome.

Increased clearance of phenytoin as the presenting feature of infectious mononucleosis.

A 19-year-old man with posttraumatic seizures under good control with phenytoin, 500 mg/day, presented with three seizures. His blood level of phenytoin, previously in a therapeutic range, was 4.2 microgram/ml. No systemic or laboratory evidence of infectious mononucleosis was found. Ten days later, the blood picture became compatible with infectious mononucleosis, at which time his phenytoin clearance returned to normal.

Myelin basic protein-stimulated rosette-forming T cells in multiple sclerosis.

A subpopulation of T lymphocytes sensitized to human myelin basic protein in peripheral blood of patients with multiple sclerosis, central nervous system (CNS) tumors, and cerebrovascular accidents was demonstrated by the antigen-stimulated, rosette-forming T-cell assay. A significant increase in the percent of active rosette-forming T cells was detected after in vitro exposure of peripheral blood lymphocytes to human myelin basic protein but not to histones. In contrast, peripheral blood lymphocytes from healthy controls and from patients with benign and malignant breast diseases were unresponsive to stimulation by either antigen. These results demonstrate a functionally active T-lymphocyte subpopulation sensitized to myelin basic protein in patients with multiple sclerosis and in patients with certain other CNS diseases.