Rinshō shinkeigaku = Clinical neurology
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Case Reports
[Idiopathic intracranial hypertension without headache detected during a routine health check].
A 47-year-old woman was admitted to our hospital with an optic disc edema detected during a routine health check. On admission, she exhibited bilateral optic disc edema without headache and no visual disturbance. ⋯ Treatment with acetazolamide reduced the cerebrospinal pressure. We suggest that examination of the optic fundi is sufficient to diagnose both IIH without headache and IIH with atypical symptoms.
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Review Case Reports
[Case of antiamphiphysin antibody-positive stiff-person syndrome with breast cancer diagnosed by FDG-PET].
We report a case of antiamphiphysin antiboddy-positive stiff-person syndrome associated with breast cancer, which was detected only by FDG-PET. A 46-year-old woman was admitted to our hospital because of painful muscle cramp and stiffness of both legs. Laboratory results were negative for anti-GAD antibody, but highly positive for antiamphiphysin antibody (1: 61,440). ⋯ Then, the left axillary lymph nodes were resected and immunohistochemically diagnosed as breast adenocarcinoma. Treatment of stiff-person syndrome was initiated with corticosteroids followed by chemotherapy against breast cancer, which led to a remarkable improvement of her neurological symptoms. If there is possibility of paraneoplastic syndromes like stiff-person syndrome, FDG-PET is very useful for detecting the occult carcinoma.
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Case Reports
[A case of reversible cerebral vasoconstriction syndrome (RCVS) triggered by a Chinese herbal medicine].
A 51-year-old woman started taking Chinese medicine containing ephedara herba as a nasal decongestant. One week later, she had three episodes of thunderclap headache, one during defecation and the others while taking a bath. She then had a convulsive seizure upon resolution of the second headache. ⋯ She has had no symptoms and signs since the third attack of headache. RCVS is an important disease in the differential diagnosis of thunderclap headache without neurological deficit. This is the first report of RCVS triggered by Chinese herbal medicine.
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Case Reports
[Acute meningoencephalitis caused by Streptococcus pneumoniae, mimicking acute disseminated encephalomyelitis].
A 57-year old woman had a five-day history of cough and high fever followed by abnormal behavior and headache with signs of meningeal irritation. A cerebrospinal fluid (CSF) exam revealed polymorphonuclear pleocytosis. Streptococcus pneumoniae was cultured from the patient's CSF and serum. ⋯ The patient responded to pulse therapy with intravenous methylprednisolone (1 g/day), carried out over three days: she recovered neurological function and her MRI lesions resolved. We report a case of acute meningoencephalitis caused by Streptococcus pneumoniae, mimicking acute disseminated encephalomyelitis (ADEM). We suggest that pneumococcal infection is one of the pathogenetic factors in ADEM.
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Case Reports
[Orolingual angioedema as complication after rt-PA in stroke patient treated with ACE inhibitor].
A 75-year-old right-handed woman was admitted to our hospital because of sudden onset of consciousness disturbance. She had taken angiotensin converting enzyme (ACE) inhibitor for hypertension. A neurological examination showed consciousness disturbance, total aphasia, right central facial palsy and right hemiparesis. ⋯ Sixty minutes after alteplase infusion, she developed orolingual angioedema. Immediately she was treated with methylprednisolone intravenously, and the angioedema improved. Orolingual angioedema should be considered as a complication associated with alteplase in a patient who has taking ACE inhibitor.