Hypoglycemic hemiplegia: two cases and a clinical review

Hypoglycemic hemiplegia mimics cerebrovascular disease. Two patients are reported who experienced multiple attacks of transient hemiplegia associated with hypoglycemia and who were initially diagnosed as having transient ischemic attacks. In both, angiography was normal and the attacks resolved with reduction of insulin dose. Recognition of hypoglycemia as the cause of transient hemiplegia is important, often obviating the need for cerebrovascular evaluation.     

低血糖性偏瘫（附三例报告）

低血糖偶尔仅仅表现为轻偏瘫．临床上常常认识不足；本文报告三例这种病人．其中二例为糖尿病及高血压病．山于其他疾病而未能正常进食，但仍继续口服降糖药物。另一例为非糖尿病病人，困误服降糖药而致病。低血糖偏瘫易误诊为急性脑血管病。本文三例病人均初诊为脑梗塞或TIA，认识到低血糖是偏瘫的病因之一十分重要．迅速纠正低血糖可以改善这种病人的预后。     

Cancer pathomimicry: a report of three cases

Three cases of alleged and feigned cancer are presented. The diagnostic and management problems presented are discussed through a review of the literature of feigned illness. This ranges across a spectrum from benign use of feigned or alleged symptoms, malingering, conversion reactions and hysterical manifestations to the severe and flamboyant clinical presentation of the Munchausen Syndrome. The cases presented mainly fit the criterion for malingering (conscious prevarication and simulation), although some elements of the Munchausen dynamics were present in two of the three. Also noteworthy was the fact that the "cancers" were presented to administration and lay people as an initial communication. The psychiatric consultation was with the lay people initially and the events of each episode were reconstructed through multiple sources of information including clinical interviews in two of the cases.     

Akinetic mutism: a report of three cases

Objectives – To report 3 new cases of akinetic mutism, a clinical syndrome defined by silent immobility with preserved visual alertness not accountable by lesion of the areas and/or effector pathways of speech and voluntary movements. Material and methods – Anatomopathological studies were performed in Cases 1 and 2; clinical follow-up, EEG, angiography and CT scans in Case 3. Results – Case 1: Bipallidal necrosis; Case 2: Left pallidal necrosis with right frontoparietal cortico-subcortical infarction; Case 3: Striato-capsular infarction on the left side, involving the caudate nucleus and the anterior arm of the internal capsule, together with obstructive hydrocephalus. Conclusion – The roles of both globus pallidus and prefrontostriatal circuits in the onset of voluntary movements are discussed.     

Hypoglycemic hemiplegia: Insulinoma masquerading as stroke.

We report a patient with recurrent episodes of hemiplegia caused by hypoglycemia. Investigations revealed an insulinoma, which was surgically removed. After this, the blood glucose level normalized and the patient remained asymptomatic for 9 months. We discuss pathophysiological mechanisms whereby hypoglycemia might cause focal neurological deficit.     

Psoriatic arthritis-associated polyneuropathy: a report of three cases

Psoriatic arthritis (PA) occurs in about 30% of patients with psoriasis. Although polyneuropathy is described in association with many connective tissue diseases, it is rarely reported in the autoimmune dermatoses. We describe 3 patients with polyneuropathy associated with PA. The clinical and electrophysiologic features are consistent with a chronic distal symmetric sensorimotor axonal process. PA-associated neuropathy should be considered in the differential diagnosis of chronic length-dependent axonal polyneuropathies.     

Deep cerebral venous thrombosis: a report of three cases and review of the literature]

Three cases of cerebral deep venous thrombosis (CDVT) were reported with review of the literature. A 47-year-old female had taken estrogen-derived drug. The other two patients had no specific past history. On MRI, T2-weighted and fluid-attenuated inversion recovery (FLAIR) images showed high signal intensity lesions at basal ganglia and thalamus. Diffusion-weighted image (DWI) detected only slightly high signal spots but apparent diffusion coefficient (ADC) images indicated mild increases of the ADC value. MR venogram and cerebral angiogram revealed obliteration of internal cerebral veins, great vein of Galen, and straight sinus. The two severely impaired patients received systemic heparinization, in which one patient preceded percutaneous transvenous angioplasty of straight sinus. One patient suffered cognitive disturbance and the other two patients fully recovered from their illness. The high signal intensity lesions on both T2-weighted image and FLAIR image disappeared and deep cerebral veins reappeared. The diagnosis of CDVT based on clinical symptoms is not simple but modern technology of MRI is very useful for diagnosis of CDVT. Once CDVT is detected, appropriate therapy should be started as soon as possible to avoid devastating outcome.     

Central phosphenes in man: a report of three cases

Chronic thalamic electrodes were implanted via the occipital lobe in three patients for the relief of intractable pain. Electrical stimulation of the electrode tract passing through the visual system led to the production of central phosphenes. These phosphenes were described as round, square, triangular, or rectangular. Some were white, some were patterned in black and white, and others were colored. Good visual angle constancy was demonstrated for one phosphene. Phosphenes were reliably evoked over the period of implantation. The temporal history of stimulation affected the location, brightness and threshold of the phosphene. The type of phosphene evoked by stimulation in the optic radiation area depends on the site of stimulation and the pulse frequency employed. Some phosphenes appear to move away from the fixation point, while others are stable for the duration of stimulation.     

Cystic meningioma: report of three cases

Meningioma with cystic component is not a commonly encountered tumor. We report three patients with cystic meningioma histologically confirmed. Tomographic images of these tumours resembled those of a glial or metastatic origin with cystic or necrotic changes and were easily confused. In a 2-year period (1997-1999) in our Department we had three patients with cystic meningioma who account for 5.4% of all patients with meningiomas we have.     

Refsum''s syndrome: report of three cases

The case-reports of three cases of Refsum's syndrome are presented, and the underlying metabolic abnormality discussed. The effect of treatment with a low-phytanic acid diet in one case is described.     

Melkersson-Rosenthal syndrome: report of three cases

Melkersson-Rosenthal syndrome is a rare disorder consisting of the triad of persistent or recurrent orofacial edema, relapsing facial paralysis and fissured tongue. It is far more uncommon to find the complete triad since it generally presents in oligosymptomatic forms. We present three cases of the Melkersson-Rosenthal syndrome with the classic triad of symptoms and discuss the etiology and the clinical and electomyography findings of this syndrome. Received: 14 July 1999 / Accepted in revised form: 2 February 2000     

Progressive collapse of PMMA-augmented vertebra: a report of three cases

Vertebroplasty using polymethylmethacrylate (PMMA) for augmentation is accepted as a safe and effective treatment for vertebral compression fracture. However, various complications related to PMMA vertebroplasty have recently been reported. We experienced three cases with progressive collapse of PMMA-augmented vertebra. Collapse progressed after augmentation in cases where PMMA conglomerated without contiguous bone interdigitation. A high viscosity of the PMMA preparation and vertebral body cavitory lesion may play a role in progressive vertebral collapse. To avoid this complication, bone cement should be injected sufficiently and permeate to contiguous bone to create strong support and anchorage.     

Sarcoidosis of the cauda equina: a report of three cases

Summary Three cases of sarcoidosis of the cauda equina are presented. In two there was no previous history suggestive of sarcoidosis and the presentation was one of a painful flaccid paralysis; in these the diagnosis was made after myelography and laminectomy with subsequent histology. The third patient had a previous diagnosis of lupus pernio and magnetic resonance imaging (MRI) was used to aid diagnosis. Only two previous cases have been reported of sarcoidosis presenting in the cauda equina with no other systemic manifestations. This is the first report of the use of MRI in sarcoidosis of the lower meninges.     

Hypoglycemic polyneuropathy: report of a case with insulinoma

A case of a young man who presented symptoms and clinical signs of polyneuropathy that occurred in connection with recurrent hypoglycemic episodes is reported. The hypoglycemia was probably caused by a pancreatic islet tumor. There were symmetric weakness and wasting of hands and feet, absent tendon reflexes and 'glove and stocking' loss of sensation. Electromyographic studies showed denervation potentials with slight reduction of nerve conduction velocities. Sural nerve biopsy studied by optic and electronic microscopy showed axonal degeneration without signs of demyelination or remyelination. There are only 30 similar cases reported in the literature. According to experimental findings, the authors believe that glucopenia is the mechanism responsible for the development of the neuropathy, and that at present time there is no evidence for a direct insulin effect.     

Os odontoideum: report of three cases.

Os odontoideum is a condition in which a smoothly corticated ossicle exists dorsal to the anterior arch of C1, taking the place of the rostral dens, but with no bony connection to the body of the axis. Three patients presented with this condition: the first with Lhermitte's phenomenon 10 years after significant trauma, the second as an incidental finding during routine cervical spine imaging following a road traffic accident, and the third with recurrent transient quadriparesis precipitated by falls from a surfboard. Patients had at least 10 mm of sagittal instability on dynamic imaging and the second patient had a minimum sagittal canal diameter of only 11.5 mm. Posterior atlanto-axial fixation was successfully achieved in all cases using polyaxial screws and rods with the assistance of computed tomography-based image guidance. Image guidance provided an invaluable aid to preoperative planning and intraoperative placement of the posterior spinal instrumentation.     

Midline telencephalic dysgenesis: report of three cases

A series of three complex cerebral malformations is presented. The series was characterized by incomplete development of the commissural and chiasmatic plate of the developing forebrain. Associated anomalies included hypoplasia of the hippocampus, heterotopias, and nonfusion of the cerebellum. Mild facial anomalies were present, as were somatic anomalies of the heart and kidneys. Emphasis is placed on the order and classification of similar cerebral anomalies.     

Astroblastoma revisited: A report of three cases

Summary The very existence of astroblastoma has been a question of considerable controversy, although there appears now to be sufficient documentation to establish it as a tenable entity. Due to the rarity of this tumor, little information exists in the literature as to its natural history, efficacy of therapy and its pathological and radiological appearance. We report three cases of astroblastoma, describing their natural history, the response to therapeutic interventions and their light microscopic, ultrastructural and immunohistochemical characteristics.