Persistent chorea triggered by hyperglycemic crisis in diabetics.

Five female patients developed chorea concurrent with, or shortly after a hyperglycemic episode (admission glucose values 500-1,000 mg/dL). In four of these five patients, there was no prior history of diabetes mellitus. The chorea continued despite correction of blood glucose and persisted to the time of last follow-up, 6 months to 5 years later. The chorea developed subacutely over 2 days to 1 month and was generalized in one, unilateral in three, and involved right > left lower extremity in the other; the severity initially reached ballistic proportions in two. Associated clinical features were nil in four of these patients, but cognitive impairment and personality change occurred in one. The histories and laboratory studies identified no predisposing factors other than the hyperglycemia. The chorea was sufficiently troublesome to require administration of neuroleptic medication in all five cases. Four of the five cases had high signal intensity within basal ganglia on T1-weighted magnetic resonance (MR) imaging, as has previously been described; however, this was not seen in one case (who had the most severe clinical condition). Most previously described cases have involved a reversible clinical syndrome, in contrast to our patients. The pathogenic mechanisms remain uncertain.

Acute radicular pain as a presenting symptom in multiple sclerosis.

From December 1973 through November 1988, we cared for 11 patients who presented with acute radicular pain and in whom radicular compression was ruled out by imaging techniques. Eventually, multiple sclerosis was diagnosed and judged to be responsible for the acute radiculopathy. The patients (seven women, aged 18 to 40 years; median, 32 years) and four men (aged 23 to 34 years; median, 29 years) were followed up from 6 months to 15 years (mean, 4 years 11 months). They represent 3.9% of 282 newly diagnosed cases of multiple sclerosis during the same 15 years. A retrospective analysis of the characteristics of their illness and its evolution was conducted. Six had lumbosacral radiculopathies; three, cervical and two, thoracic. In six of the 11 patients, symptoms occurred in close relationship to trauma; seven had recurrent radicular pain; four had other pain syndromes; and three others, paroxysmal symptoms. One patient died of complications from multiple sclerosis 3 years after diagnosis. Three others were rated five or greater in the extended Kurtzke disability status scale during follow-up.

Posttraumatic intention myoclonus.

A patient with long-standing intention myoclonus was treated with oral clonazepam, which resulted in clinical and electrophysiologic improvement as manifested by dramatic reduction in intention myoclonus and diminished amplitude of somatosensory evoked potentials after treatment.

Compressed spectral array patterns following cardiopulmonary arrest. A preliminary report.

Continuous taped EEG recordings were made following resuscitation in 18 survivors of cardiopulmonary arrest. These taped data were processed, using Bickford's method of compressed spectral array, and four distinctive patterns were recognized. These patterns correlated significantly with eventual outcome of these patients, suggesting that processed EEG information can provide important prognostic information for such patients.