氯氮平合用舒必利致比萨综合征1例

正1病例患者,男性,56岁,因"反复自笑、乱语、行为紊乱间歇出现15年,加重3天"于2017年5月3日收治住院。患者于2002年4月无明显诱因出现精神异常,夜间不眠,自语、毁物,行为紊乱,曾被强行送至海南农垦阳江医院住院多次,诊断为"精神分裂症",曾间歇服用过多种抗精神病药物进行治疗,疗效及具体服药情况不详,出院后在家能按时服药,比较懒散,饮食及睡眠基本正常。2017年2月前开始     

A case of bulimia successfully treated by cue exposure

In the present case-study, a 22-year-old female patient with a 7-year history of bulimia nervosa was treated by cue-exposure. During cue-exposure sessions the relationship between CS (stimuli associated with binge-eating behaviour) and UCS (the sensations related to the intake of binge food) was broken. As predicted, the patients' craving for food decline within as well as between cue exposure sessions and a radical decrease in the frequency of binge-eating persisted for at least nine months. Although during the therapy no explicit attention was paid to the patient's low mood and irrational self-talk, mood was improved and beliefs were less irrational after cue-exposure and at the follow-ups. The data suggest that cue exposure may be an effective part of the treatment of bulimia nervosa.     

A case of orbital apex syndrome caused by localized invasive aspergillosis successfully treated with voriconazole]

A 71-year-old man with left periorbital pain and diplopia was hospitalized for evaluation and treatment. He had a past history of untreated diabetes mellitus. Shortly after admission, the patient experienced rapid onset of visual loss in the left eye. MRI and CT showed a lesion expanding from the left orbital apex to the left pterygopalatine fossa. Invasive aspergillosis was diagnosed by open biopsy of intrasinus mucosa via the left maxillary sinus. The patient was treated with voriconazole, an antifungal agent, and marked improvements in left periorbital pain and eye movement were subsequently obtained, although visual acuity was not recovered. This is the first report documenting the clinical utility of voriconazole for sino-orbital invasive aspergillosis.     

A case of internal carotid artery occlusion successfully treated by encephalo-duro-arterio-synangiosis

In many cases, intracranial occlusive strokes in children are treated symptomatically, with a diagnosis of acute infantile hemiplegia. This is because angiography is more difficult in children and, even if occlusive cerebral arterial disease is diagnosed, there is no definite therapeutic procedure. A case is reported of left internal carotid artery occlusion presenting with acute infantile hemiplegia and followed by repeated transient ischemic attacks. Encephalo-duro-arterio-synangiosis — developed as an operation for moyamoya disease — was performed on this patient, resulting in a marked revascularization of the brain in 8 postoperative months with good improvement in symptoms. This suggests that the operation may be effective in chronic cerebral ischemic diseases other than moyamoya disease.     

Brain-stem abscess successfully treated by microsurgical drainage: A case report

Abstract

Brain-stem abscess is an uncommon condition associated with high mortality. The best method of treatment is not yet defined. It can be managed by medical treatment alone, stereotactic aspiration of the pus and medical treatment, or surgical excision/drainage of the abscess. We present a case of large brain-stem abscess, treated successfully by surgical drainage after the failure of medical treatment. The patient had a large brain-stem abscess extending from the mid-brain down to the lower pons. She was in a poor neurological condition pre-operatively, and was worsening despite intravenous antibiotics. The abscess was coming close to the surface in the lateral aspect of the mid-brain. The presumed source of infection was multiple dental abscesses. The brain-stem abscess was approached by a subtemporal transzygomatic approach and drained completely after making an incision on the lateral surface of the mid-brain. After the operation, the patient showed steady improvement. At six months after the surgery, the patient was fully conscious, talking fluently, and walking with the help of a walker. Her hemiparesis and co-ordination were improving. Surgical drainage of a brain-stem abscess is indicated when medical therapy fails. Proper anatomical knowledge of the brain-stem and the selection of appropriate surgical approach is important for safe drainage of the abscess. [Neurol Res 2001; 23: 855-861]     

A case of myokymia-cramp syndrome successfully treated with gabapentin

We report a case of "myokymia-cramp syndrome", a rare and benign disease consisting of muscular cramps in the upper and lower limbs associated with generalized myokymias. In our patient, cramps had been present since adolescence and had increased in frequency and duration during the last 3 years, occurring about 8 or 9 times a day. Cramps were mainly nocturnal and also precipitated by walking; a previous treatment with carbamazepine did not improve the symptoms. Gabapentin therapy proved to be very satisfactory in relieving muscular cramps with a relatively low dosage (600 mg/day) and without any remarkable side effects. The possible interpretation of the mechanism involved in gabapentin induced relief of cramps is discussed. Gabapentin should be considered as a safe alternative treatment for muscular cramps.     

Transient hemiballism caused by a small lesion of the subthalamic nucleus

Hemiballism is most commonly caused by ischemic stroke and most cases have a favorable prognosis. Lesions directly involving the subthalamic nucleus (STN) are the cause of a minority of cases but are usually associated with poor prognosis. We report two patients with a small STN lesion who presented with transient hemiballism. A small lesion confined to and only focally affecting the STN may cause hemiballism yet may have excellent outcome. Precise evaluation of the affected region with MRI is useful in predicting the prognosis.     

A case of acute thallotoxicosis successfully treated with double-filtration plasmapheresis

The authors report a 48-year-old Chinese woman who presented with acute peripheral neuritis with progressive alopecia. Laboratory examinations disclosed a high blood concentration of thallium (97 microg/L) versus a normal value (0.9 microg/L), and she was diagnosed as having acute thallotoxicosis. After her hospitalization, the cutantest of dimercaptopropansulfonate sodium was positive and the patient refused to take Prussian blue because it caused constipation. She rapidly entered remission after assistance via double-filtration plasmapheresis (DFPP), suggesting the potential efficacy of DFPP for thallotoxicosis.     

A case of brain nocardiosis successfully treated with minocycline]

A 60-year-old man with surgically treated nocardia pyothorax was referred to our hospital since he became drowsy. Brain MRI revealed multiple brain abscesses. His cerebrospinal fluid (CSF) showed increase in polymorphonuclear cells and decrease in glucose. Since he was allergic to sulfamethoxazole * trimethoprim, ceftriaxone and then minocycline were given. Minocycline resulted in dramatic improvement of neurological symtoms, MRI findings and CSF cell count. PCR analysis of 16S ribosomal DNA using his resected thoracic wall revealed that nocardia from his tissue was strain IFM0860. Strain IFM0860 nocardia was found to be sensitive to minocycline but not to sulfamethoxazole * trimethoprim and ceftriaxone. Intravenous administration of minocycline was followed by three-year per os administration of minocycline during which he had no recurrence of brain abscess. Thus, brain nocardiosis could be successfully treated with appropriate antibiotics. The lesson from the present case is that identification of the type of nocardia by PCR analysis of 16S ribosomal DNA could help accomplish tailor-made antibiotic therapy.     

A potential case of peduncular hallucinosis treated successfully with olanzapine

Visual hallucinations have a differential diagnosis, both psychiatric and nonpsychiatric in nature. Described first by Lhermitte, peduncular hallucinosis is an uncommon etiology of visual hallucinations (VH). Typically, the offending lesion is vascular in origin and occurs at the level of the midbrain, thalamus, or rostral brainstem. Interestingly, the origin of the VH in our patient's case could have been either/both from an ischemic insult at the midbrain or compression of the brainstem due to aneurism. While evidence for treatment is scarce, we present a posited case of peduncular hallucinosis treated successfully with olanzapine.     

A case of severe motor and intellectual disability with tracheal stenosis due to granulation caused by metal stents treated successfully by silicone stents

A silicone stent (Dumon stent) was used in a severe motor and intellectual disability with severe tracheal stenosis due to granulation caused by an implanted the expanded metal stent (Ultraflex Nitinol Stent). To treat tracheobronchial malacia, diagnosed in infancy, expanded metalic stent was implanted at the ages of 30 and 32 years. However, a few months after the second implantation, progressive dyspnea appeared, and he had to use a respirator under intravenous anesthesia. Bronchoscopy showed re-stenosis of the trachea due to a granulation tissue within the stent. A Dumon stent was applied to control the re-stenosis. He was successfully weaned from a respirator. Since granulation tissue had recurred at the end of the Dumon stent after 3 months, a long term care of the airway and regular observation is necessary after implantation of stents.     

A case of Hirayama's disease successfully treated by anterior cervical decompression and fusion]

The authors report the case of a 16-year-old boy with Hirayama's disease(juvenile muscular atrophy of unilateral upper extremity). The present history began about 6 months previously, when he noticed slowly progressive weakness with atrophy of the left hand and forearm. Neurological examination on admission revealed diffuse distribution of muscular atrophy including the left hypothenar, thenar, forearm, and triceps muscles. However, EMG studies identified neurogenic changes in both upper extremities. There was no long tract sign of objective sensory impairment. Plain spinal radiograms showed abnormal kyphosis of the cervical vertebrae. Cervical MR images in the neutral position demonstrated focal atrophy of the cervical cord at the C 5-6 vertebral levels. When the neck was flexed, the cervical cord was displaced anteriorly and was compressed over the posterior surface of the C 5-6 vertebral bodies. He was diagnosed to have Hirayama's disease(cervical flexion myelopathy). Via an anterior approach, he underwent a C 5 vertebrectomy followed by fixation of C 4-6 vertebral bodies using iliac bone and plate system. He recovered from surgery without any complications and has been well for the past 6 months with remarkable improvement of muscle strength. Application of cervical collar for 3 to 4 years has been generally advocated for the treatment of Hirayama's disease because progression of signs and symptoms is usually expected to cease within several years. However, some patients were reported not to response to conservative treatment for more than 5 years after their onsets. To these patients surgery seems to be beneficial, because it can give rise to permanent stable fixation with much shorter period of external cervical immobilization compared with cervical collar therapy, in which long-term application is frequently unbearable in many patients. In conclusion, the present case emphasizes the importance of surgical treatment in Hirayama's disease not only to improve neurological deficits but regain better quality of life.     

A case of myclonus,resembling epileptic seizure,induced by short-term sulpiride treatment

An 86-year-old woman with delusional disorder was treated with oral sulpiride at a dose of 200 mg/day. On the seventh day of treatment, she suddenly developed abrupt brief rhythmical contractions every 5 s in her neck muscles, orofacial muscles, muscles of upper limbs and lower legs bilaterally. Although there was no impairment of consciousness, her speech was interrupted by the myoclonic episodes. We suspected that the epileptic seizure-like myoclonus might be a drug-induced acute extrapyramidal symptom. We therefore injected 5 mg of biperiden (i.m.), and the myoclonus ceased shortly thereafter. This myoclonus, resembling an epileptic seizure, did not recur subsequently after sulpiride treatment was discontinued. The present case shows that myoclonus can occur after even brief sulpiride treatment in certain elderly patients. (Int J Psych Clin Pract 2002; 6: 215-216 )