Acute inferior homonymous quandrantanopia in a 71-year-old woman

A 71-year-old woman presented with acute inferior homonymous quadrantanopia initially mimicking acute ischemic stroke. As clinical signs and symptoms progressed to akinetic mutism with myoclonus the diagnosis of the Heidenhain variant of Creutzfeldt–Jakob disease was made. Brain MRI 4 days after symptom onset revealed ribbon-like high signal intensity in the medial occipital cortex.     

Isolated ptosis in a 58-year-old woman

A 60-year-old woman who had experienced isolated ptosis for two years was seen when it had been fixed for one year. She had a personal and familial history of stromal corneal dystrophy. The diagnosis of mitochondrial cytopathy was made on the basis of clinical, electrophysiological, biological and histological findings. Surgical repair of the ptosis allowed visual recovery. The relationship between ptosis, corneal dystrophy and mitochondrial cytopathy is discussed.     

Sacral ganglioneuroma in a 19-year-old woman

Ganglioneuroma is a rare benign neural crest tumour, located usually in the posterior mediastinum and retroperitoneum. It tends to acquire significant size before symptoms or clinical signs become apparent. We report a 19-year-old female who underwent excision of a pelvisacral ganglioneuroma via a Pfannenstiel incision, after an abdominopelvic CT scan for investigation of left iliac fossa pain and menorrhagia detected a pelvic mass. This report highlights the importance of complete surgical excision of these lesions and the collaboration of multiple surgical units in managing these often large, variably located tumours.     

Case of an 81-year-old woman with theophylline-associated seizures followed by partial seizures due to vitamin B6 deficiency]

We report an 81-year-old woman who suffered from theophylline-associated seizures followed by partial seizures due to vitamin B6 deficiency. She developed complex partial seizures. She had been treated with theophylline for two months because of chronic bronchitis. Brain diffusion-weighted magnetic resonance imaging (MRI) showed high intensity lesions in unilateral cerebral cortex and thalamus. Electroencephalogram presented periodic lateralized epileptiform discharges (PLEDs), and single photon emission computed tomography (SPECT) using 123I-IMP revealed increased blood flow in the same side of the cerebrum. We diagnosed as theophylline-associated seizures though blood theophylline concentration disclosed its therapeutic dose, and her symptom improved after theophylline was discontinued. She developed partial seizures again, after she suffered from diarrhea for two days. Laboratory examination showed that serum vitamin B6 was under the limitation of measurement, and intravenous supplementation of vitamin B6 stopped her seizures immediately. Theophylline may induce seizures independent of its blood concentration, and vitamin B6 deficiency may exist in the case of theophylline-associated seizures.     

Progressive personality and language changes in a 62-year-old woman

A 62-year-old woman with no known psychiatric illness had a 1.5-year history of progressive personality and language changes, leading to a loss of functional independence. Laboratory results revealed elevated autoimmune antibodies. She did not improve on high-dose steroid therapy and continued to deteriorate to her death, 2.5 years after symptom onset.     

Obsessive compulsive disorder arising in a 75-year-old woman

Presented is the case of a 75-year-old woman with obsessive compulsive disorder with an unusual age of onset at age 72 years. The patient was resistant to various treatments, but responded to lithium augmentation of fluoxetine.     

Acute intermittent porphyria, seizures, and antiepileptic drugs: a report on a 3-year-old Nigerian boy.

A 3-year-old Nigerian boy was treated with phenobarbitone after having a nonfebrile seizure. Two weeks later his urine was found to contain porphobilinogen, indicating that latent acute intermittent porphyria had been unmasked by phenobarbitone. The drug was discontinued and carbamazepine was substituted. The urine became free of porphobilinogen and the patient remained well. In developing countries phenobarbitone is the most widely used anticonvulsant; it must be avoided in acute intermittent porphyria, and carbamazepine may be tolerated.     

A 59-year-old woman with recurrent convulsive seizures, cerebral infarctions, dementia, and intracranial calcifications]

A 59-year-old woman with recurrent seizures and progressive dementia is reported. Her past history and familial history were unremarkable. She became short-tempered at 56 years old (Oct. 1991). She had the first seizure attack and was admitted to a hospital at March 4, 1993, with prolonged disturbance of consciousness and subsequent mental deterioration. Her brain CT showed multiple small calcifications in the subcortical white matter and pons. The laboratory data including blood count, serum chemistry, serological studies and CSF was normal. MRI and digital subtraction angiography of the cranial vessels were unremarkable. There was a decrease in accumulation in the right cerebral hemisphere on 123I IMP SPECT. Despite anti-convulsant therapy, she had recurrent seizures several times, with gradual worsening of her mental state. She had the latest seizure attack and was transferred to Matsusaka Chuo Hospital, on August 29, 1993. After the attack she had been in the apallic state, and died on Nov. 13, 1995. This case was discussed in a neurological CPC. The discussants suggested that the isolated angiitis of the central nervous system caused secondary seizures and cerebral infarctions. Post-mortem examination revealed the CNS findings of vasculitis at various stages, calcification or mineralization mainly in the subcortical white matter and pons, massive cerebral infarctions with massive exudate, fresh and old small bleedings and exudate around the inflamed or calcified vessels. The white matter degeneration resembled that of Binswanger leukoencephalopathy. The final pathological diagnosis was isolated angiitis of the central nervous system since there was no inflammatory changes or atherosclerotic change of the blood vessels in the extracranial organs.     

Acute psychosis in a woman with a prolactinoma

Changes in dopaminergic activity were inferred in a woman with a known prolactinoma several months prior to an acute psychotic episode. Serum prolactin levels reflected central dopaminergic activity, since both the endocrinologic regulation of prolactinomas and the pathophysiology of acute psychosis have been linked to alterations in dopaminergic activity. Serum prolactin levels fell approximately four months prior to onset of the psychotic episode and thus may have provided a predictive indicator of changing dopamine activity in both the tubero-infundibular and the mesolimbic-mesocortical dopaminergic systems.     

Contrast-induced seizures after cardiac catheterization in a 6-year-old child

Neurologic complications of cardiac catheterization are usually embolic events resulting in stroke or seizures of vascular origin. Contrast-induced seizures have been rarely described in children. This report presents clinical, neuroimaging, and follow-up data of a 6-year-old female subjected to cardiac catheterization for aortic coarctation who developed contrast-induced generalized seizures. Although rare, this condition adds to the neurologic complications of cardiac catheterization in children and should be considered in the differential diagnosis of seizures of vascular origin with obvious therapeutic and prognostic implications.     

Prolonged in vivo exposure therapy with a 70-year-old woman

A 70-yr-old woman with a debilitating fear of dogs was successfully treated in five sessions of in vivo exposure therapy, each lasting approximately one hour. This improvement followed 3 yr of unsuccessful verbal psychotherapy and self-administered gradual in vivo desensitization. Treatment gains were maintained at 6 month follow-up.