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D'Angelo KM, Williams J, Wu L. Anti-GQ1b Antibody Syndrome Presented as Locked-In Syndrome: A Rare Case Report. Cureus 2023; 15:e49866. [PMID: 38170042 PMCID: PMC10760350 DOI: 10.7759/cureus.49866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/03/2023] [Indexed: 01/05/2024] Open
Abstract
Anti-GQ1b antibodies are considered a hallmark of Miller-Fisher syndrome (MFS), a rare variant of Guillain-Barré syndrome (GBS). The typical clinical presentation of MFS includes ophthalmoplegia, ataxia, and areflexia. Here, we present an unusual case of a 65-year-old man with acute-onset quadriplegia and bulbar weakness resembling locked-in syndrome. Imaging studies did not show structural lesions as a cause for his clinical symptoms. Nerve conduction studies showed severe axonal sensory-motor polyneuropathy. Serum studies were all negative except for a positive anti-GQ1b antibody. He was treated with plasmapheresis as MFS, with a quick improvement in muscle strength. Our case report provided further information on the clinical variation of anti-GQ1b syndrome. Physicians should pay more attention to unusual presentations of anti-GQ1b syndrome because, when it is recognized early with prompt treatment, patients are expected to have a good recovery.
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Affiliation(s)
- Kristen M D'Angelo
- Neurology, University of Texas Medical Branch at Galveston, Galveston, USA
| | - Jerilyn Williams
- Neurology, University of Texas Medical Branch at Galveston, Galveston, USA
| | - Laura Wu
- Neurology, University of Texas Medical Branch at Galveston, Galveston, USA
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2
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Gosain D, Das T. Myasthenia Gravis Presenting as Bulbar Palsy. Cureus 2023; 15:e46082. [PMID: 37900462 PMCID: PMC10611170 DOI: 10.7759/cureus.46082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/22/2023] [Indexed: 10/31/2023] Open
Abstract
Myasthenia gravis is a rare autoimmune condition that affects postsynaptic cholinergic receptors, resulting in symptoms of muscular fatigue. Clinical signs could be subtle and variable, often leading to many differentials. This leads to inappropriate tests being performed and a delay in diagnosis. Although ocular signs are more common, it may rarely present as bulbar palsy. Our patient, in her 30s, was referred to the emergency department after six months of symptom onset when she was discovered to be at a high risk of silent aspiration. Her presentation was predominantly bulbar palsy, but after appropriate tests, she was eventually diagnosed with generalized myasthenia gravis with a concurrent thymoma. Her treatment included pyridostigmine, corticosteroid, and immunoglobulins, while a thymectomy was scheduled as a planned procedure. Prompt diagnosis and timely management can reduce morbidity and mortality in such cases.
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Affiliation(s)
- Dhruv Gosain
- General Internal Medicine, Peterborough City Hospital, Peterborough, GBR
| | - Tapas Das
- Gastroenterology, Peterborough City Hospital, Peterborough, GBR
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3
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Gracey C, Balladares R. Symptoms of Myasthenia Gravis Obscured by Old Age and Unilateral Presentation. Cureus 2023; 15:e44737. [PMID: 37809196 PMCID: PMC10555472 DOI: 10.7759/cureus.44737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/03/2023] [Indexed: 10/10/2023] Open
Abstract
Myasthenia gravis (MG) is a neuromuscular junction disorder involving autoantibodies affecting the postsynaptic muscle membrane. We report an 81-year-old man who presented to the emergency department with three days of left facial droop, who later developed worsening bilateral ptosis, cervical weakness, dysphagia, and dysarthria following an assessment for Bell's palsy. Ultimately, he was diagnosed with MG. This patient's presentation was atypical and challenging. Specifically, the patient had droopy eyelids from a redundancy of skin and an anatomical neck droop, non-specific findings in older adults, which obscured the development of bilateral ptosis and cervical weakness, a classic sign of bulbar disease. The patient also presented with unilateral facial weakness, a rare finding in MG and concerning stroke in the elderly population. Our aim is to discuss the challenges of identifying MG in older populations and to discuss pharmacological challenges in assessing elderly patients with suspected bulbar palsies.
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Affiliation(s)
- Celeste Gracey
- Internal Medicine, Campbell University School of Osteopathic Medicine, Lillington, USA
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4
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Abu-Abaa M, Mousa A, Chadalawada S, Abdulsahib A. Bulbar Onset Amyotrophic Lateral Sclerosis in a COVID-19 Patient: A Case Report. Cureus 2023; 15:e37814. [PMID: 37214058 PMCID: PMC10197023 DOI: 10.7759/cureus.37814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/18/2023] [Indexed: 05/23/2023] Open
Abstract
Amyotrophic lateral sclerosis (ALS) is a devastating neurodegenerative disorder with a largely unknown etiology. In this case, we are presenting an 84-year-old male patient who was admitted for acute hypoxemic respiratory failure secondary to coronavirus disease 2019 (COVID-19) infection. He was neurologically intact. His infection improved and oxygen requirement was gradually weaned off allowing for discharge. However, he was admitted again a month later with progressive dysphagia and aspiration that were confirmed on videofluoroscopic study. He was also found to have mild dysarthria, bulbar muscle weakness, bilateral lower motor neuron facial nerve palsy, diffuse hyporeflexia on four extremities with intact sensory function. Diagnosis of ALS was suspected after extensive workup was pursued and ruled out nutritional, structural, autoimmune, infectious and inflammatory disorders. This case is only the third reported case in medical literature to suggest COVID-19 infection as a triggering/accelerating factor of ALS progression.
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Affiliation(s)
- Mohammad Abu-Abaa
- Internal Medicine, Capital Health Regional Medical Center, Trenton, USA
| | - Aliaa Mousa
- Internal Medicine, Capital Health Regional Medical Center, Trenton, USA
| | | | - Ali Abdulsahib
- Internal Medicine, Capital Health Regional Medical Center, Trenton, USA
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5
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Tiwari I, Alam A, Kanta C, Koonwar S, Garg RK, Pandey S, Jain A, Kumar R. Clinical Profile and Predictors of Mechanical Ventilation in Guillain-Barre Syndrome in North Indian Children. J Child Neurol 2021; 36:453-460. [PMID: 33331796 DOI: 10.1177/0883073820978020] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
OBJECTIVE To describe the clinical-laboratory profile of pediatric Guillain-Barre syndrome and delineate features associated with need of mechanical ventilation. METHODS In a prospective observational study at tertiary care hospital, clinical-laboratory assessment and nerve conduction studies were documented in consecutive children hospitalized with Guillain-Barre syndrome according to Brighton criteria. Clinical-laboratory features were compared between ventilated and nonventilated patients using univariate and multivariate analysis. RESULTS Forty-six children (27 boys) with a mean age of 69.1±35.2 months were enrolled. History of preceding infection was present in 47.8%, bulbar palsy in 43.5%, feeble voice in 41.3%, sensory involvement in 13%, and autonomic involvement in 39.5%. Tetraparesis was noted in 87% of cases. Hughes disability scale >3 was noted in 44 children at admission and 39 (84.7%) at discharge. The most common electrophysiological type was acute motor axonal neuropathy (46.5%) followed by acute motor sensory axonal neuropathy (39.5%), acute inflammatory demyelinating polyneuropathy (7%), and inexcitable nerves (7%). Nine (19.7%) children were ventilated, 3 (6.5%) died or were lost, and 43 were discharged. Factors associated with need of mechanical ventilation on univariate analysis were older age, hypertension, bulbar palsy, feeble voice, lower Medical Research Council (MRC) sum, raised total leucocyte count, and history of preceding infection. Logistic regression revealed older age, history of predisposing illness, lower MRC sum at presentation, and bulbar palsy as independent predictors of mechanical ventilation. CONCLUSIONS The most common electrophysiological subtype in northern Indian children is acute motor axonal neuropathy. Older age, preceding infection, low MRC sum, and bulbar palsy are predictors of mechanical ventilation in pediatric Guillain-Barre syndrome.
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Affiliation(s)
- Ishita Tiwari
- Departments of Pediatrics, 76140King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Areesha Alam
- Departments of Pediatrics, Era's Lucknow Medical College & Hospital, Lucknow, Uttar Pradesh, India
| | - Chandra Kanta
- Departments of Pediatrics, 76140King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Sciddhartha Koonwar
- Departments of Pediatrics, 76140King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Ravindra Kumar Garg
- Department of Neurology, 76140King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Shweta Pandey
- Department of Neurology, 76140King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Amita Jain
- Department of Microbiology, 76140King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Rashmi Kumar
- Departments of Pediatrics, 76140King George's Medical University, Lucknow, Uttar Pradesh, India
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6
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Agarwal A, Paul Wilson B, Kuruvilla Mathews P, Viggeswarpu S, Kango Gopal G. Amyloid cranial polyneuropathy: A rare neurological presentation of immunoglobulin light-chain amyloidosis. Aging Med (Milton) 2021; 4:61-65. [PMID: 33738383 PMCID: PMC7954838 DOI: 10.1002/agm2.12148] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 01/11/2021] [Accepted: 01/11/2021] [Indexed: 12/19/2022] Open
Abstract
Amyloidosis, a disease with extracellular tissue deposition of fibrils, results in clinical manifestations based on deposition of these fibrils in multiple organ systems. Usual manifestations include nephrotic-range proteinuria, cardiac failure, hepatosplenomegaly, and skin manifestations. Common neurological manifestations include peripheral and autonomic neuropathies. Cranial neuropathy has been seldom reported and is an unusual clinical feature of amyloidosis. Here, we report an older man who presented with cranial nerve palsies along with other clinical features, including heart failure, proteinuria, weight loss, anorexia and distal symmetric polyneuropathy and was diagnosed with immunoglobulin light-chain (AL) amyloidosis.
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Affiliation(s)
- Abhinav Agarwal
- Department of Internal MedicineChristian Medical College and Hospital VelloreVelloreIndia
| | - Benny Paul Wilson
- Department of GeriatricsChristian Medical College and Hospital VelloreVelloreIndia
| | | | - Surekha Viggeswarpu
- Department of GeriatricsChristian Medical College and Hospital VelloreVelloreIndia
| | - Gopinath Kango Gopal
- Department of GeriatricsChristian Medical College and Hospital VelloreVelloreIndia
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7
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Abstract
Sarcoidosis, which is a non-caseating granulomatous chronic inflammatory disease, can affect virtually any organ system, including the central nervous system (CNS). Very rarely, patients may present solely with neurosarcoidosis. It commonly presents with unilateral or bilateral seventh nerve palsy. Rarely it can present as dangerous progressive bulbar palsy and is a diagnostic and clinical challenge. We present a case of sarcoidosis with a unique presentation of isolated bulbar palsy. A 38-year-old male presented to the emergency with a sudden onset of dysphonia followed by dysphagia for both solids and liquids for one week and 5 kg weight loss in two months. The rest of the CNS exam was unremarkable. On labs, he had hypercalcemia and suppressed parathyroid hormone (PTH) intact. Detailed radiological investigations, lab tests, and lymph node biopsy helped confirm the diagnosis of neurosarcoidosis. The patient did not respond to first-line steroid therapy and hence received intravenous immunoglobulin (IVIG) subsequently with adequate response and complete neurologic recovery, confirmed by a follow-up visit.
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Affiliation(s)
| | - Fateen Ata
- Internal Medicine, Hamad Medical Corporation, Doha, QAT
| | | | - Rashid Kazman
- Internal Medicine, Hamad General Hospital, Doha, QAT
| | - Ali Rahil
- Internal Medicine, Hamad Medical Corporation, Doha, QAT
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8
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Pyun SY, Kim Y, Oh SI, Bae JS. Differences in nerve excitability properties between isolated bulbar palsy and bulbar-dominant amyotrophic lateral sclerosis. Neurol Res 2020; 42:133-140. [PMID: 31928339 DOI: 10.1080/01616412.2019.1710407] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Objectives: Isolated bulbar palsy (IBP) is a rare variant that can show a benign course, while progressive bulbar palsy (PBP) has been regarded as a bulbar-dominant type of classical amyotrophic lateral sclerosis (cALS). This study aimed to identify differences in the excitability properties between them.Methods: We consecutively collected data on 22 ALS patients: 13 with cALS, 5 with PBP, and 4 with IBP. An automated nerve excitability test (NET) was applied to measure the strength-duration time constant, threshold electrotonus (TE), current-threshold relationship, and recovery cycle. The axonal excitability properties were compared between the ALS groups and 25 controls.Results: Compared to controls, the cALS group showed a greater change in the depolarizing phase of TE of 90-100 ms after depolarizing current [TEd(90-100)] (53.3±1.3 [mean±SEM] for cALS and 49.0±0.7 for control, P<0.01) and lower S2 accommodation (19.6±0.8 and 22.6±0.7, respectively; P=0.01). There was a nonsignificant tendency for a high TEd(90-100) pattern to be less prominent in the IBP group than in the PBP group (51.5±4.22 and 48.8±1.5, respectively). In addition, all of the parameters of nerve excitability other than S2 accommodation in the PBP and IBP groups did not differ significantly from those in the controls.Conclusions: The excitability properties of IBP and PBP differ from those of cALS. The pattern of NET in PBP was more similar to that in cALS than that in IBP. These findings suggest that IBP is a different entity from bulbar-dominant ALS and PBP.
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Affiliation(s)
- So Young Pyun
- Department of Neurology, National Police Hospital, Seoul, Korea
| | - Yerim Kim
- Department of Neurology, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Seong-Il Oh
- Department of Neurology, Inje University College of Medicine, Busan, Korea
| | - Jong Seok Bae
- Department of Neurology, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
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9
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Zhu K, Chen J, Li J, Wang H, Huang X, Li Y, Feng H. Myasthenia Gravis With Thymoma, Manifesting as AChR-Ab-Positive, Distinct Bulbar Palsy Accompanied by Dysgeusia: A Case Series and Review of Literature. Front Neurol 2018; 9:214. [PMID: 29670572 PMCID: PMC5893777 DOI: 10.3389/fneur.2018.00214] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Accepted: 03/20/2018] [Indexed: 01/02/2023] Open
Abstract
In this review, we summarized three cases of myasthenia gravis (MG) with taste disorder and describe their clinical features in detail. Three MG patients presented with significant bulbar palsy symptoms, high AChR-Ab titers, and negative MuSK-Ab, were diagnosed with thymoma. Furthermore, we observed that dysgeusia could manifest earlier than the occurrence of typical MG symptoms, even predict a MG relapse or a myasthenic crisis in the course of MG. We believe that dysgeusia is a non-motor symptom of MG, which especially exists in MG patients with thymoma and serious bulbar palsy. Therefore, being alert to this symptom may facilitate the early diagnosis of MG and judge the progress of the disease.
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Affiliation(s)
- Kai Zhu
- Department of Neurology, The First Affiliated Hospital of Sun Yat-sen University, Sun Yat-sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory for Diagnosis and Treatment of Major Neurological Disease, Guangzhou, China
| | - Jiaxin Chen
- Department of Neurology, The First Affiliated Hospital of Sun Yat-sen University, Sun Yat-sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory for Diagnosis and Treatment of Major Neurological Disease, Guangzhou, China
| | - Jingjing Li
- Department of Neurology, The First Affiliated Hospital of Sun Yat-sen University, Sun Yat-sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory for Diagnosis and Treatment of Major Neurological Disease, Guangzhou, China
| | - Haiyan Wang
- Department of Neurology, The First Affiliated Hospital of Sun Yat-sen University, Sun Yat-sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory for Diagnosis and Treatment of Major Neurological Disease, Guangzhou, China
| | - Xin Huang
- Department of Neurology, The First Affiliated Hospital of Sun Yat-sen University, Sun Yat-sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory for Diagnosis and Treatment of Major Neurological Disease, Guangzhou, China
| | - Yan Li
- Department of Neurosurgical Intensive Care Unit, The First Affiliated Hospital of Sun Yat-sen University, Sun Yat-sen University, Guangzhou, China
| | - Huiyu Feng
- Department of Neurology, The First Affiliated Hospital of Sun Yat-sen University, Sun Yat-sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory for Diagnosis and Treatment of Major Neurological Disease, Guangzhou, China
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10
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Malcolmson J, Kleyner R, Tegay D, Adams W, Ward K, Coppinger J, Nelson L, Meisler MH, Wang K, Robison R, Lyon GJ. SCN8A mutation in a child presenting with seizures and developmental delays. Cold Spring Harb Mol Case Stud 2017; 2:a001073. [PMID: 27900360 PMCID: PMC5111007 DOI: 10.1101/mcs.a001073] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
The SCN8A gene encodes the sodium voltage-gated channel alpha subunit 8. Mutations in this gene have been associated with early infantile epileptic encephalopathy type 13. With the use of whole-exome sequencing, a de novo missense mutation in SCN8A was identified in a 4-yr-old female who initially exhibited symptoms of epilepsy at the age of 5 mo that progressed to a severe condition with very little movement, including being unable to sit or walk on her own.
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Affiliation(s)
- Janet Malcolmson
- Stanley Institute for Cognitive Genomics, Cold Spring Harbor Laboratory, Cold Spring Harbor, New York 11724, USA;; Genetic Counseling Graduate Program, Long Island University (LIU), Brookville, New York 11548, USA
| | - Robert Kleyner
- Stanley Institute for Cognitive Genomics, Cold Spring Harbor Laboratory, Cold Spring Harbor, New York 11724, USA
| | - David Tegay
- Stanley Institute for Cognitive Genomics, Cold Spring Harbor Laboratory, Cold Spring Harbor, New York 11724, USA
| | - Whit Adams
- Utah Foundation for Biomedical Research, Salt Lake City, Utah 84107, USA
| | - Kenneth Ward
- Affiliated Genetics, Salt Lake City, Utah 84109, USA
| | | | - Lesa Nelson
- Affiliated Genetics, Salt Lake City, Utah 84109, USA
| | - Miriam H Meisler
- Department of Human Genetics, University of Michigan, Ann Arbor, Michigan 48109-5618, USA
| | - Kai Wang
- Utah Foundation for Biomedical Research, Salt Lake City, Utah 84107, USA;; Zilkha Neurogenetic Institute, University of Southern California, Los Angeles, California 90089, USA;; Department of Psychiatry and Behavioral Sciences, Keck School of Medicine, University of Southern California, Los Angeles, California 90033, USA
| | - Reid Robison
- Utah Foundation for Biomedical Research, Salt Lake City, Utah 84107, USA
| | - Gholson J Lyon
- Stanley Institute for Cognitive Genomics, Cold Spring Harbor Laboratory, Cold Spring Harbor, New York 11724, USA;; Utah Foundation for Biomedical Research, Salt Lake City, Utah 84107, USA
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11
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Han TH, Kim DY, Park DW, Moon JH. Transient Isolated Lower Bulbar Palsy With Elevated Serum Anti-GM1 and Anti-GD1b Antibodies During Aripiprazole Treatment. Pediatr Neurol 2017; 66:96-99. [PMID: 28341090 DOI: 10.1016/j.pediatrneurol.2016.07.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2016] [Revised: 07/19/2016] [Accepted: 07/21/2016] [Indexed: 01/16/2023]
Abstract
BACKGROUND Transient bulbar palsy without involvement of the facial or extraocular muscles is a rare presentation. It is considered a form of cranial polyneuropathy, a variant of Guillain-Barré syndrome that is related to the autoimmune mechanisms induced by preceding infections or vaccinations. However, drug-induced cranial polyneuropathy has not previously been reported. We describe a boy with isolated bulbar palsy and positive serum antiganglioside antibodies during aripiprazole treatment. PATIENT DESCRIPTION This 12-year-old boy was admitted with a seven-day history of dysarthria, tongue discomfort, and tinnitus. Three weeks before symptom onset, aripiprazole was added to the patient's medications for attention-deficit hyperactivity disorder. On examination, he showed curtaining of the pharyngeal wall, tongue fasciculation and deviation, and a weak gag reflex. Cranial magnetic resonance imaging suggested lower cranial nerve involvement. Serum anti-GM1 IgG and anti-GD1b IgG antibodies were positive. After stopping aripiprazole, his bulbar symptoms improved. However, on readministration of aripiprazole seven weeks later, dysarthria recurred and again resolved after stopping the drug. CONCLUSION We describe the first patient with anti-GM1 IgG and anti-GD1b IgG antibodies-associated transient cranial polyneuropathy presenting as isolated bulbar palsy. These findings could be an adverse effect of aripiprazole treatment.
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Affiliation(s)
- Tae Hwan Han
- Department of Pediatric Neurology, Hanyang University Guri Hospital, Guri-si, Gyeonggi-do, Republic of Korea
| | - Do Yeon Kim
- Department of Pediatric Neurology, Hanyang University Guri Hospital, Guri-si, Gyeonggi-do, Republic of Korea
| | - Dong Woo Park
- Department of Radiology, Hanyang University Guri Hospital, Guri-si, Gyeonggi-do, Republic of Korea
| | - Jin-Hwa Moon
- Department of Pediatric Neurology, Hanyang University Guri Hospital, Guri-si, Gyeonggi-do, Republic of Korea.
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12
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Abstract
Tongguan Liqiao acupuncture therapy has been shown to effectively treat dysphagia after stroke-based pseudobulbar paralysis. We presumed that this therapy would be effective for dysphagia after bulbar paralysis in patients with brainstem infarction. Sixty-four patients with dysphagia following brainstem infarction were recruited and divided into a medulla oblongata infarction group (n = 22), a midbrain and pons infarction group (n = 16), and a multiple cerebral infarction group (n = 26) according to their magnetic resonance imaging results. All patients received Tongguan Liqiao acupuncture for 28 days. The main acupoints were Neiguan (PC6), Renzhong (DU26), Sanyinjiao (SP6), Fengchi (GB20), Wangu (GB12), and Yifeng (SJ17). Furthermore, the posterior pharyngeal wall was pricked. Before and after treatment, patient swallowing functions were evaluated with the Kubota Water Test, Fujishima Ichiro Rating Scale, and the Standard Swallowing Assessment. The Barthel Index was also used to evaluate their quality of life. Results showed that after 28 days of treatment, scores on the Kubota Water Test and Standard Swallowing Assessment had decreased, but scores on the Fujishima Ichiro Rating Scale and Barthel Index had increased in each group. The total efficacy rate was 92.2% after treatment, and was most obvious in patients with medulla oblongata infarction (95.9%). These findings suggest that Tongguan Liqiao acupuncture therapy can repair the connection of upper motor neurons to the medulla oblongata motor nucleus, promote the recovery of brainstem infarction, and improve patient's swallowing ability and quality of life.
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Affiliation(s)
- Chun-Hong Zhang
- Department of Acupuncture and Moxibustion, the First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Jin-Ling Bian
- Department of Acupuncture and Moxibustion, the First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Zhi-Hong Meng
- Department of Acupuncture and Moxibustion, the First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Li-Na Meng
- Department of Acupuncture and Moxibustion, the First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Xue-Song Ren
- Department of Acupuncture and Moxibustion, the First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Zhi-Lin Wang
- Department of Acupuncture and Moxibustion, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Xiao-Yan Guo
- Department of Acupuncture and Moxibustion, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Xue-Min Shi
- Department of Acupuncture and Moxibustion, the First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
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Abstract
Leigh syndrome (LS) is a heterogeneous familial or sporadic neurodegenerative disorder. It is typically seen in infancy or childhood, although rare cases of adult onset have been described. The authors describe a 37-year-old woman who presented with protracted gastrointestinal symptoms followed by acute brain stem syndrome with severe metabolic acidosis and who subsequently showed dramatic clinical and neuroradiological improvement.
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Affiliation(s)
- Shaik Afshan Jabeen
- Department of Neurology, Millennium Block, Nizam's Institute of Medical Sciences, Punjagutta, Hyderabad, Andhra Pradesh, India
| | - G Sandeep
- Department of Neurology, Millennium Block, Nizam's Institute of Medical Sciences, Punjagutta, Hyderabad, Andhra Pradesh, India
| | - Kandadai Rukmini Mridula
- Department of Neurology, Millennium Block, Nizam's Institute of Medical Sciences, Punjagutta, Hyderabad, Andhra Pradesh, India
| | - Angamuttu Kanikannan Meena
- Department of Neurology, Millennium Block, Nizam's Institute of Medical Sciences, Punjagutta, Hyderabad, Andhra Pradesh, India
| | - Rupam Borgohain
- Department of Neurology, Millennium Block, Nizam's Institute of Medical Sciences, Punjagutta, Hyderabad, Andhra Pradesh, India
| | - Challa Sundaram
- Department of Pathology, Nizam's Institute of Medical Sciences, Punjagutta, Hyderabad, Andhra Pradesh, India
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14
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Tso G, Kaldas K, Springer J, Barot N, Kamangar N. West Nile Meningoencephalitis Presenting as Isolated Bulbar Palsy With Hypercapnic Respiratory Failure: Case Report and Literature Review. J Intensive Care Med 2015; 31:285-7. [PMID: 26065427 DOI: 10.1177/0885066615589734] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Accepted: 05/11/2015] [Indexed: 11/15/2022]
Abstract
BACKGROUND Since the outbreak of West Nile virus (WNV) in the United States in 1999, the WNV neuroinvasive disease has been increasingly reported with a wide spectrum of neuromuscular manifestations. CASE We submit a case of a 46-year-old male with a history of alcohol abuse, diabetes, hypertension, and hepatitis C who presented with fever, nausea, shortness of breath, and dysphagia. The patient rapidly developed hypercapnic respiratory failure and was found to have WNV meningoencephalitis without obvious neuromuscular weakness. His hospital course was significant for repeated failures of extubation secondary to persistent bulbar weakness eventually requiring tracheotomy. CONCLUSION This is a unique case of WNV meningoencephalitis with bulbar palsy without other neuromuscular manifestations resulting in recurrent hypercapnic respiratory failure.
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Affiliation(s)
- Geoffrey Tso
- Department of Medicine, Olive View-UCLA Medical Center, UCLA David Geffen School of Medicine, Sylmar, CA, USA
| | - Kirsten Kaldas
- Department of Medicine, Olive View-UCLA Medical Center, UCLA David Geffen School of Medicine, Sylmar, CA, USA
| | - Joseph Springer
- Department of Medicine, Olive View-UCLA Medical Center, UCLA David Geffen School of Medicine, Sylmar, CA, USA
| | - Nikhil Barot
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Olive View-UCLA Medical Center, UCLA David Geffen School of Medicine, Sylmar, CA, USA
| | - Nader Kamangar
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Olive View-UCLA Medical Center, UCLA David Geffen School of Medicine, Sylmar, CA, USA
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15
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Chafale VA, Lahoti SA, Biswas A, Roy A, Senapati AK. Adrenomyeloneuropathy with bulbar palsy: A rare association. Ann Indian Acad Neurol 2014; 17:361-3. [PMID: 25221415 PMCID: PMC4162032 DOI: 10.4103/0972-2327.138530] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2014] [Revised: 03/06/2014] [Accepted: 04/29/2014] [Indexed: 11/04/2022] Open
Abstract
Adrenomyeloneuropathy (AMN) is a variant of adrenoleukodystrophy (ALD), an X-linked recessive peroxisomal disorder associated with accumulation of very long chain fatty acids (VLCFA). Mutations of this gene lead to abnormal peroxisomal β-oxidation, which results in the harmful accumulation of VLCFAs in affected cells. Neurological symptoms occur due to progressive demyelination and destruction of cerebral white matter and primary adrenal insufficiency. Bulbar palsy in a case of AMN is very unusual. We report a case of a 22-year-old male with AMN who developed adrenal insufficiency at the age of 4 years successfully treated by gluco- and mineralocorticoids followed by features of myeloneuropathy with bulbar palsy. AMN with prominent bulbar symptoms emphasizes the diverse clinical manifestation of this disease.
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Affiliation(s)
- Vishal Annaji Chafale
- Department of Neurology, Bangur Institute of Neurosciences, Kolkata, West Bengal, India
| | | | - Atanu Biswas
- Department of Neurology, Bangur Institute of Neurosciences, Kolkata, West Bengal, India
| | - Arijit Roy
- Department of Neurology, Bangur Institute of Neurosciences, Kolkata, West Bengal, India
| | - Asit Kumar Senapati
- Department of Neurology, Bangur Institute of Neurosciences, Kolkata, West Bengal, India
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16
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Jha S, Ansari M, Sonkar K, Paliwal V. Unusual features in chronic inflammatory demyelinating polyneuropathy: Good outcome after prolonged ventilatory support. J Neurosci Rural Pract 2013; 2:171-3. [PMID: 21897683 PMCID: PMC3159356 DOI: 10.4103/0976-3147.83586] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Severe respiratory muscle paralysis and ventilatory failure is rare in chronic inflammatory demyelinating polyneuropathy (CIDP). We report a 14 year child who presented with respiratory failure, bulbar and multiple cranial nerves involvement along with bilateral phrenic nerve paralysis. He was diagnosed with CIDP after electrophysiological evaluation. He required AMBU ventilation for about 4 months (including domiciliary use), after which he recovered significantly. Along with several unusual features of CIDP, this report highlights good example of steady basic intensive care to save lives and rewarding outcome of prolonged respiratory support, provided by AMBU ventilation which is a rather primitive, but inexpensive device.
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Affiliation(s)
- Sanjeev Jha
- Department of Neurology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
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