Zoster myelitis in sickle cell anemia.

A 17-year-old female patient, known case of sickle cell anemia was admitted to our hospital with 10 days history of fever, vomiting, and epigastric pain. On examination, her temperature was 38°C. There was a vesicular type of rash below the nipple and over the left chest involving the back. She was diagnosed as herpes zoster and was started on acyclovir with good hydration and analgesia. Three days later, she developed weakness and decreased sensation of the right leg. On the fifth day, examination revealed power of 1/5 on the right leg, and 4/5 on the left leg, there was proximal and distal increased tone and brisk reflexes and up going toe on the right side with sensory level at T4-T6. An MRI of the thoracolumbar spine showed high signal intensity at T4-T6. The CSF analysis revealed positive polymerase chain reaction for varicella zoster. She was treated with intravenous (IV) dexamethasone 4 mg, 4 times per day. After 3 days she developed left leg weakness, urine incontinence, and power in the left leg was 3/5. Reflex plantar was up going bilaterally with sensory level at the nipple, T4-T6. She was then stared on IV methylprednisolone one gm for 3 days followed by a tapering dose of prednisolone 50 mg for 2 weeks, after a week of starting medication she was able to walk. This case of transverse myelitis is related to varicella zoster infection, with sickle cell anemia, and was successfully treated with high dose IV methylprednisolone, IV acyclovir, and physiotherapy.

Epilepsy in patients 60 years and above.

OBJECTIVE: To evaluate the clinical characteristics and etiology of epilepsy at age 60 years and above in the Western Region of Saudi Arabia (KSA), as epilepsy is now considered to be the third most frequent neurological problem in the elderly population. METHODS: We retrospectively reviewed the medical records of patients 60 years and above at King Khalid National Guard Hospital, Jeddah, KSA between 1999 and 2007 with new onset of seizures and diagnosed as suffering from epilepsy. We excluded patients 60 and above with provoked seizures. RESULTS: Seventy-five patients of late onset epilepsy were studied. Partial seizure (focal) was found in 40 patients (53.3%); generalized tonic clonic seizures in 18 patients (24%); unclassified seizure in 13 patients (17.5%); and status epilepticus in 4 patients (5.3%). Stroke was the underlying etiology in 52 patients (69.3%); brain tumor was found in 8 patients (10.7%), trauma in 3 patients (4%), and infection in 3 patients (4%). None of the patients had a family history of epilepsy. No cause (idiopathic) was found in 9 (12%) patients. CONCLUSION: The most common type of epilepsy at age 60 and above in our study is symptomatic epilepsy with stroke as the leading cause. Modifying risk factors for stroke such as: hypertension, diabetes mellitus, and high cholesterol may reduce the incidence of epilepsy in this age group.

Cerebellar syndromes as a late presentation of Langerhans cell histiocytosis.

We report a patient with late onset ataxia who was initially labeled as idiopathic diabetes insipidus for many years. Pathological and radiological investigations revealed Langerhans cell histiocytosis. This case report aims to draw the attention of physicians to this delayed and rare presentation.