Visual and somatosensory evoked potentials in workers exposed to metallic mercury vapors]

Thirty-seven workers occupationally exposed to metallic mercury vapours were subjected to neurological examination and determination of visual (WPW) and somatosensory (SSPW) evoked potentials. In 6 cases slight sings of damage to the central nervous system was demonstrated. Prolonged WPW latency was noted in 15 cases. SSPW abnormalities were observed most frequently in the cortical components (13 cases), less frequently in the brainstem components (4 cases). Simultaneous WPW and SSPW changes were present in 10 cases. In the group of workers with changes of evoked potentials the mean urinary mercury levels were higher and the duration of exposure was longer than in the remaining workers. The use of multimodal electrophysiological methods increases the effectiveness of the diagnosis of subclinical damage to the nervous system in chronic mercury intoxication.     

Anatomical variation of the vertebral artery clinically mimicking myasthenia gravis

Cranial nerve palsy, most commonly trigeminal, abducens, or facial, caused by compression of an ectatic or elongated intracranial artery is a well-known phenomenon. Symptoms of brain stem compression by an abnormal artery have rarely been reported (Tomasello et al. Neurosurgery 56(suppl 1):117–124, 2005). The authors present a 59-year-old woman with intermittent ptosis of the right eye, diplopia and swallowing disturbances, enhanced after physical effort, implying myasthenia gravis. Typical diagnostic procedures, e.g. repetitive nerve stimulation tests, acetylcholine receptor antibodies level were within normal limit. Neurogenic changes from the orbicularis oculi muscle were found in EMG. MRI and angio-CT revealed anatomical variation of the vertebral artery (elongated and arcuate route), causing intermittent signs of brain stem lesion. We point out the similarity of the clinical symptoms of myasthenia gravis and vascular brain stem compression by abnormal vertebral artery. The two diseases require completely different therapeutic proceedings.     

Pure word deafness in a patient with bilateral ischemic stroke in the superior temporal gyrus (STG)

ABSTRACT

Introduction

Pure word deafness is a rare neurological disorder linked with an inability to comprehend speech. The precise localization of damage is still unclear.     

Jan Ewangelista Purkynie (1787–1869) – fizjolog,fenomenolog, wrocławianin

Radiotherapy is an important treatment modality for intracranial malignancies. Improved survival rates were achieved via a combination of surgery, chemotherapy and radiotherapy. On the other hand, improved survival rates made long-term complications of radiotherapy more apparent. Secondary neoplasms due to cranial irradiation are encountered more commonly in neurosurgical practice. Radiation-induced meningiomas are recognized as a common late complication of radiotherapy. However, radiation-induced meningiomas after radiotherapy for retinoblastoma have been reported rarely. Herein we report a patient who harboured multiple meningiomas 13 years after radiotherapy for unilateral retinoblastoma, which were recurrent despite surgical removal and chemotherapy.     

Opsoclonus-myoclonus syndrome with severe clinical course and beneficial outcome: A case report

Rationale:Opsoclonus-myoclonus syndrome (OMS) is a rare immune-mediated movement disorder, mostly of paraneoplastic or idiopathic origin. The disease usually has an acute onset, serious course and leads rapidly to disability in adult patients. To the best of our knowledge, this is the fourth presented case of OMS with a severe course and complete reversibility of neurological symptoms in a pregnant woman. This report includes videos and a literature review.Patient concerns:A 30-year-old woman in the 12th week of pregnancy developed severe nausea and vomiting, after several days balance and gait disorders appeared. On admission to hospital, neurological examination revealed opsoclonus, dysarthria, myoclonic jerks with ataxia of the trunk and limbs with inability to sit, stand or walk.Diagnosis:Well-known causes of OMS were excluded. Although in our patient the idiopathic origin of the disorder was taken under consideration, diagnosis of opsoclonus-myoclonus related to the pregnancy was highly likely.Interventions:After administration of steroids and benzodiazepines the patient improved.Outcomes:In the 6th month of pregnancy, after termination of immunotherapy, she recovered completely and was able to sit, stand and walk independently. In the 39th week of pregnancy, she delivered a healthy child.Lessons:We confirm that understanding of clinical symptoms and rare causes of OMS contributes to early diagnosis and therapy, which ensures an optimal outcome. One probable cause of OMS could be a physiological change to immune system regulation during pregnancy. The relationship between OMS and pregnancy remains uncertain and needs further investigation.     

Paroxysmal EEG changes in patients with multiple sclerosis]

The electroencephalograms (EEG) and visual evoked potentials (VEP) were recorded in 100 multiple sclerosis patients treated from 1981 to 1989. In 35 cases the EEG records were pathological and in 12 of them they showed paroxysmal changes. Pathological EEG were mostly seen in young patients, during the first relapse, with high degree of Kurtzke's disability score. Patients with paroxysmal changes showed on physical examination brain stem lesions that could be responsible for paroxysmal activity in EEG. The latencies of P100 wave and amplitudes of P100/N120 complex were analysed in two groups of patients (with and without paroxysmal activity in EEG). There was no statistically important difference between two groups, although in the group with paroxysmal changes in EEG some prolongation of the latency of P100 wave and a little higher amplitude of P100/N120 complex were recorded.     

Cancer-associated retinopathy in patients with breast carcinoma

Introduction: Cancer-associated retinopathy (CAR) is a paraneoplastic neurological syndrome resulting in progressive loss of vision and clinical signs of retinal degeneration. It is associated with various types of cancer and is also considered to be an autoimmune disorder that involves cross-reaction between autoantibodies and retinal proteins. The aim of this study was to establish whether immunoreactivity to retinal antigens (RAs) observed in patients with breast cancer is accompanied by any visual impairments. Materials and Methods: Sera of 295 patients with diagnosed breast cancer were screened for the presence of anti-RAs antibodies using immunoblotting. Cellular immunoreactivity to RAs present in retinal extracts and to purified recoverin and arrestin was determined by means of a lymphocyte proliferation assay. Six patients with high-titer antibodies to RAs then underwent ophthalmic and neurological examinations. Results: Four serum samples contained high-titer antibodies to a 46-kDa protein, most probably retinal α-enolase, three had antibodies to a 48-kDa protein identified as retinal arrestin, while 56-, 43-, 41-, and 34-kDa antigens were recognized only by one serum sample each. Moreover, weak cellular response to all the RAs tested was observed in one patient and another patient responded only to retinal extract. Two of the examined patients displayed symptoms of CAR. Conclusions: Immunoreactivity to RAs in patients with breast cancer may also be present in cases without clinical signs of CAR.     

Severe course of neuromyelitis optica in a female patient with chronic C hepatitis

Neuromyelitis optica (NMO) is a rare, disabling, recurring inflammatory demyelinating disease affecting the spinal cord and optic nerves with predominance in women.We present the case of a female patient with chronic C hepatitis, who, despite treatment, developed severe symptoms of NMO during pregnancy and postpartum.     

Influence of nocturnal hypoxemia on the function of the visual tract in the course of the obstructive sleep apnea syndrome

BACKGROUND AND PURPOSE: In patients with obstructive sleep apnea (OSA) syndrome the episodes of upper airway obstruction lead to hypoxemia during sleep. The aim of the study was to establish the influence of sleep hypoxemia on the function of the visual tract in OSA patients. MATERIAL AND METHODS: The latency and amplitude of wave P100 of visual evoked potentials have been studied in 35 patients with OSA syndrome (mean apnea index 48+/-19). The diagnosis of OSA was established on the basis of continuous recordings of the respiratory function during sleep with additional full polysomnography in 17 patients. RESULTS: Mean absolute latency of P100 was longer in OSA patients than in healthy controls (117.0+/-8.8 ms vs. 104.3+/-4.6 ms, p<0.001). The differences in the amplitude of P100 were not significant (5.9+/-2.6 mV in OSA patients and 7.62+/-3.04 mV in healthy persons). In 60% of patients the latency of P100 exceeded 118 ms; in this group of patients the mean SaO2 during sleep apneas was lower than in patients with normal P100 latency (46+/-15% vs. 69+/-10%, p<0.05). Full polysomnographic studies revealed that in patients with prolonged latencies as compared with patients with normal P100 latencies there were lower: minimal SaO2 during NREM sleep (63+/-12% vs. 78+/-8%, p<0.05), as well as mean and minimal SaO2 during REM sleep (53+/-15% vs. 80+/-5% and 46+/-15% vs. 69+/-10%, p<0.05), without differences in apnea index or apnea duration. CONCLUSIONS: In patients with OSA syndrome the electrophysiological abnormalities suggesting damage of the optical tract may develop probably as a consequence of profound sleep hypoxemia.     

Brainstem auditory evoked potentials in patients with primary Sjögren’s syndrome without central nervous system involvement

Clinical Rheumatology - Primary Sjögren’s syndrome (pSS) is an autoimmune, multisystem exocrinopathy characterized by dysfunction of the exocrine glands. Central nervous system (CNS)...