Bromide intoxication secondary to pyridostigmine bromide therapy.

The diagnosis of bromide intoxication is often aided by the detection of a low or negative anion gap due to the laboratory detection of bromide as chloride. A 59-year-old woman with myasthenia gravis who received a large dose of pyridostigmine bromide developed postoperative psychosis and was diagnosed as having bromide intoxication. The diagnosis was suspected in the setting of a negative anion gap and only later confirmed by direct measurement of the serum bromide level. To our knowledge , this is the first reported case of bromide intoxication due to pyridostigmine bromide administration.

Depression type in Parkinson disease.

Thirty-three patients with Parkinson Disease were evaluated neurologically and neuropsychologically. Seventy percent without a previous psychiatric diagnosis, were depressed. This depression was not related to the presence of dementia, stage of the disease, a general estimate of memory and attention, years of Parkinsonism, age, or indices of frontal cortex-related functioning. Because the depression did not positively relate to factors suggestive of advancing disease, it is proposed that the depression is reactive to the disease rather than an integral part of it.

Hearing loss in myotonic dystrophy.

Seventeen of 25 patients with myotonic dystrophy had moderate to severe hearing loss, usually sensorineural, that was identified by routine audiometric screening and was treatable in some patients. Further testing failed to reveal a single pathophysiological process.

Central nervous system magnetic resonance imaging findings in myotonic dystrophy.

We evaluated findings in 14 patients with myotonic dystrophy (MD) using magnetic resonance imaging of the brain and compared them with those in age-matched controls with headache. There was an increased incidence of ventriculomegaly and a lumpy and/or thick pattern of periventricular hyperintensity in patients with MD as compared with the age-matched controls. These white matter abnormalities do not appear to be etiologically specific, but some possible explanations for these frequent findings in MD are discussed.

Chronic agonist therapy for Parkinson's disease: a 5-year study of bromocriptine and pergolide.

We used pergolide to treat 10 patients with idiopathic Parkinson's disease who had first responded to, and then failed, bromocriptine therapy. At the end of 5 years, patients had improved when compared with study entry. Peak efficacy, equal with both drugs, was seen at 12 months. After a mean treatment of 29 months, bromocriptine was no longer effective, but pergolide was still beneficial.

Elderly inpatients: postural reflex impairment.

We examined postural reflexes in 50 patients in a geriatric care facility. Patients aged 60 years and older who did not have orthostatic hypotension were subjected to a standing postural perturbation, and the degree of postural instability was recorded. Sixteen patients with leg amputations, recent stroke, and leg deformities were excluded. Of the remaining 34 patients, 44% had severe postural reflex impairment, and 24% had moderate impairment. Although the etiology for postural reflex impairment may be multivariant, the high percentage suggests that postural reflex dysfunction may be an important cause of unexplained falls in the elderly.

Contributory etiologic factor for talipes equinovarus in congenital myotonic dystrophy: comparative biopsy study of intrinsic foot musculature and vastus lateralis in two cases.

Biopsy specimens from the feet and proximal thigh musculature of two patients with congenital myotonic dystrophy with talipes equinovarus were compared. The findings were also compared with those reported in muscle biopsy of idiopathic clubfoot. It was concluded that structural change in intrinsic foot muscle can contribute to the force imbalance that produces clubfoot in this disease.

Pergolide mesylate and idiopathic Parkinson disease.

We studied the effects of pergolide mesylate in an open trial of 23 patients with idiopathic Parkinson disease (PD). All had suffered from loss of efficacy or dose-limiting side effects on current antiparkinsonian regimens. On pergolide therapy, improvement, which was maintained for 6 months, was noted in some parkinsonian features in all 23 patients. All patients suffering from on-off phenomenon were helped by pergolide. Significant side effects were not encountered. Pergolide is useful in the treatment of PD.

Meige disease: acute and chronic cholinergic effects.

We studied central cholinergic systems in 13 patients with idiopathic adult-onset blepharospasm/oromandibular dystonia (Meige syndrome). Six patients studied acutely, and 12 of 13 patients studied chronically, improved after administration of centrally acting anticholinergic agents. These data suggest that Meige syndrome is pharmacologically similar to other dystonic disorders, in which central cholinergic antagonism is more consistently of benefit than manipulation of central dopaminergic systems.

Meige syndrome (blepharospasm-oromandibular dystonia) after long-term neuroleptic therapy.

Two patients developed either blepharospasm or blepharospasm-oromandibular dystonia following chronic therapy with chlorpromazine, haloperidol, or thioridazine. In one patient, appearance of the movement disorder was associated with neuroleptic withdrawal, and in the other patient, the movement disorder began while neuroleptic therapy continued. Because of the age of one patient and the severe intermittent psychosis in the other, these Meige-like symptoms were attributed to chronic neuroleptic use rather than to spontaneously occurring Meige syndrome. The symptoms occurring as part of a tardive dyskinesia suggest that dopaminergic mechanisms play a role in idiopathic Meige syndrome.