IgLON 5 Antibody Syndrome: Isolated Case of a Patient With Indolent Disease Progression and Unusual MRI Findings.

IgLON-5 antibody syndrome has a myriad of clinical presentations, including gait instability, movement disorders, abnormal eye movements, bulbar symptoms, sleep disorders, neuropsychiatric symptoms, dysautonomia, and peripheral neuropathy. Abnormal magnetic resonance imaging (MRI) findings have also been reported such as leukoariotic changes and cerebral and cerebellar atrophy. We present a case of IgLON-5 antibody syndrome with a unique MRI finding of persistent leptomeningeal enhancement. A close follow-up would be warranted as the progression of the disease may be indolent.

A Rare, Unreported Cognitive Side Effect of Topiramate: Do We Know It All Yet?

This report describes a unique, dose dependent side effect of a commonly used drug, topiramate. Although cognitive side effects of this drug have previously been reported in literature, we present a case of drug-induced amnesia, with support from Naranjo Nomogram, as a hitherto unreported side effect of topiramate. Here, we highlight the importance of being cognizant of such rare cognitive side effects, with the aim of improving patient outcome by timely recognition, and discontinuation of the offending drug, as the side effect was fortunately found to be reversible.

Risk Factors Associated With Hyperammonemia Following Unprovoked Convulsive Seizures.

This report describes a unique case of recurrent transient hyperammonemia (THA) following a first-time occurrence of generalized tonic-clonic seizure in a young adult, who went on to develop post-stroke epilepsy. Although this phenomenon has been described in recent literature, we report not only the highest initial ammonia level to date, 549 µmol/L, but we also document serial trends of the ammonia levels at multiple admissions for the same patient for the management of breakthrough seizures. Interestingly enough, persistence of the elevation of the ammonia levels was accompanied by no other significant metabolic derangements, unlike reported in similar cases. Of prior studies, high ammonia levels have been reported in the context of alcohol-induced seizures, with resolution of ammonia levels within eight hours. Here, we highlight the importance of medication compliance, as well as the need for serial ammonia levels for improving patient outcomes, with the knowledge that ammonia accumulation leads to potential irreversible neurotoxicity. Additionally, we completed a systematic literature review on data pertaining to the risk factors associated with hyperammonemia following unprovoked convulsive seizures in an effort to analyze our case in the context of the existing literature. Our objective is to ultimately understand the utility of serial ammonia levels for unprovoked convulsive seizures in the context of the patient's initial presentation, and whether treatment of these episodes of hyperammonemia can significantly alter outcomes.

ADHD presenting as recurrent epistaxis: a case report.

Epistaxis is an important otorhinolaryngological emergency, which usually has an apparent etiology, frequently local trauma in children. Here we present a case report wherein the epistaxis was recalcitrant, and proved to have a psychiatric disorder as an underlying basis. The child was diagnosed with Attention Deficit/Hyperactivity Disorder, hyperactive type, which led to trauma to nasal mucosa due to frequent and uncontrolled nose picking. Treatment with atomoxetine controlled the patient's symptoms and led to a remission of epistaxis.