Secondary Headache in Secondary Syphilis

We describe a patient with a history of recurrent headaches who developed severe and persistent left fronto-orbital and vertex head pain, in conjunction with a maculopapular rash, and was subsequently diagnosed with secondary syphilis. With the incidence of syphilis recently on the rise, we suggest that secondary syphilis should be considered in the differential diagnosis of any patient who presents with headache and a rash. Serologic screening tests for syphilis and a dermatology consultation should be obtained promptly for diagnostic confirmation and institution of treatment with antibiotics.     

Pure Sensory Stroke as an Isolated Manifestation of the Lateral Medullary Infarction

Pure sensory stroke is a common manifestation of a thalamic stroke and may occur less frequently in the infarction of the brainstem, internal capsule, and parietal cortex. The authors report a 47-year-old man who presented with loss of pain and temperature sensation in the left face, arm, trunk, and leg and was found to have a right lateral medullary infarction on diffusion-weighted magnetic resonance imaging. To the authors' knowledge, this is the first case describing pure sensory stroke as a single, isolated manifestation of the lateral medullary infarction that was detected by diffusion-weighted magnetic resonance imaging. This case suggests that with the availability of diffusion-weighted magnetic resonance imaging, pure sensory stroke may carry a broader spectrum of the anatomical localizations than previously determined and can localize to the lateral medulla. Therefore, a possibility of medullary infarction should be considered when a patient presents with pure sensory stroke, especially when diffusion-weighted magnetic resonance imaging is not immediately available to provide radiographic correlation.     

Immunotherapy with subcutaneous immunoglobulin or plasmapheresis in patients with postural orthostatic tachycardia syndrome (POTS)

Journal of Neurology - Postural orthostatic tachycardia syndrome (POTS), one of the most common autonomic disorders, is associated with significant morbidity and functional impairment. Although...     

Vitamin B1 deficiency in patients with postural tachycardia syndrome (POTS)

Objective: POTS is a heterogeneous disorder of the autonomic nervous system that can result from multiple etiologies. An increased prevalence of vitamin B12, vitamin D 25-OH and iron deficiencies has been observed in patients with POTS. This study examined the prevalence of vitamin B1 deficiency and assessed response to vitamin B1 supplementation in the deficient POTS patients.

Methods and Results: Medical records of 65 consecutive patients with POTS evaluated at our clinic were reviewed. In this cohort (mean age 32, range 13–54 years; 89% female), 6% had vitamin B1 deficiency, and one of four deficient patients experienced significant improvement of POTS after oral vitamin B1 supplementation.

Conclusion: A small subset of patients with POTS may have vitamin B1 deficiency. Testing for vitamin B1 deficiency and correcting the deficiency is recommended.     

Transient vertical diplopia and nystagmus associated with acute thalamic infarction

We describe a patient who presented with a 1-h history of vertical diplopia and nystagmus and was found to have acute left ventrolateral thalamic infarction on the diffusion-weighted magnetic resonance imaging (DWI MRI). This is the first case report demonstrating that vertical diplopia and nystagmus, which typically suggest a lesion in the brainstem or cerebellum, may also occur in acute thalamic infarction. DWI MRI can detect thalamic infarction as early as 1 h after its clinical manifestations.