Neuropsychiatric disturbance detecting polycythemia vera myelofibrosis: a case report and literature review

Background

Neuropsychiatric disturbances and chorea are less recognized consequences of polycythemia vera (PV), and their role in post-PV myelofibrosis (MF) has not been reported. Clinical features that predict post-PV MF lack specificity.

Case presentation

We describe an elderly patient with PV who developed acute-onset reversible neuropsychiatric disturbances accompanied by generalized chorea and was finally diagnosed with post-PV MF after a bone marrow examination. We also reviewed four cases of late PV associated with neuropsychiatric symptoms since 1966 and analyzed their clinical characteristics and therapeutic effects.

Conclusion

Our case indicates that Janus kinase 2 (JAK2)-related PV is a treatable cause of late-onset chorea and that chorea may herald the deterioration of hematological parameters. Our case provides a clinically specific representation of post-PV MF. Patients with a long course of PV are recommended to undergo bone marrow re-examinations when they present with neuropsychiatric symptoms to achieve an early diagnosis of post-PV MF.

Ultrastructural alteration of pulmonary tissue under conditions of high oxygen concentration

OBJECTIVE

To determine the structure of pulmonary tissue under conditions of high oxygen concentration.

METHODS

Ten-week-old C57BL male mice and control mice were exposed to 100% oxygen and to room air for 72 hours, respectively. To follow the progression of lesions, the mice were sacrificed at 6, 12, 24, 48, and 72 hours after 100% oxygen administration. Lung specimens obtained from these mice underwent morphologic analysis and immunofluorescence studies. We used scanning and transmission electron microscopy to determine the ultrastructure of the pulmonary capillaries, including the endothelial glycocalyx. To visualize the endothelial glycocalyx, we performed lanthanum nitrate staining.

RESULTS

The survival rate of the 100% oxygen administration group was 5% (2/40) and that of the control group was 100%. Perivascular cavity enlargement was detected 12 hours after 100% oxygen administration and expanded over time. Ultrastructural analysis using electron microscopy revealed collapsed alveoli and pulmonary capillary wall and alveolar wall thickening in the 100% oxygen group. The pulmonary capillary endothelial glycocalyx was injured in the 100% oxygen group. The perivascular cavity decreased in mice that were returned to room air after 48 hours of 100% oxygen administration.

CONCLUSION

High-concentration oxygen causes perivascular cavity enlargement; this is thought to be a special characteristic of high oxygen damage. In addition, high-concentration oxygen may be involved in pulmonary endothelial glycocalyx injury.

Hemifacial hyperhidrosis associated with ipsilateral/contralateral cervical disc herniation myelopathy. Functional considerations on how compression pattern determines the laterality

Sweating is an important mechanism for ensuring constant thermoregulation, but hyperhidrosis may be disturbing. We present five cases of hemifacial hyperhidrosis as a compensatory response to an/hypohidrosis caused by cervical disc herniation. All the patients complained of hemifacial hyperhidrosis, without anisocoria or blepharoptosis. Sweat function testing and thermography confirmed hyperhidrosis of hemifacial and adjacent areas. Neck MRI showed cervical disc herniation. Three of the patients had lateral compression with welldemarcated hypohidrosis below the hyperhidrosis on the same side as the cervical lesion. The rest had paramedian compression with poorly demarcated hyperhidrosis and hypohidrosis on the contralateral side. Although MRI showed no intraspinal pathological signal intensity, lateral dural compression might influence the circulation to the sudomotor pathway, and paramedian compression might influence the ipsilateral sulcal artery, which perfuses the sympathetic descending pathway and the intermediolateral nucleus. Sweat function testing and thermography should be performed to determine the focus of the hemifacial hyperhidrosis, and the myelopathy should be investigated on both sides.