Single Case Observation Research Articles

Methylphenidate fails to improve gait and muscle tone in patients with sporadic and hereditary spastic paraplegia

Based on its action on multiple neurotransmitters, including dopamine, methylphenidate (MPH) is of growing interest as a possible treatment option for several movement disorders. Of special interest are diseases that share gait disturbance and cognitive decline. Based on a single case observation in a patient with hereditary spastic spinal paraplegia (HSP) in which gait was improved with MPH, we performed an open-label study with a longitudinal follow-up in 22 patients with HSP and its sporadic form (SSP). The patients were treated for 6 months with 60 mg of MPH per day. Computerized gait analysis and different scores were performed at baseline, after 6 weeks, and after 6 months of treatment. Although at 6 weeks, the gait velocity was somewhat improved, the drug failed to show any effect on other gait parameters and had no beneficial effect at all after 6 months. Although MPH is of interest for several movement disorders, our study did not show a beneficial effect.

Severe anaphylactic reaction after intracameral antibiotic administration during cataract surgery

We read with interest the case report by Villada et al.1 commenting on the overall safety of routine cataract surgery using topical anesthesia after a single case observation of severe anaphylactic reaction triggered by an intracameral antibiotic. However, we do not concur with their argument. First, the eye is an immune-privileged organ, mostly evidenced in the anterior chamber.2 The anaphylactic reaction observed in this patient must have been the result of presentation of the culprit antibiotic molecules to the antigen-presenting cells within the bloodstream, triggering immunoglobulin E–mediated type-I hypersensitivity.3 Conceptually speaking, intracameral antibiotic administration in a patient with a history of antibiotic allergy is highly akin to the direct intravenous route of administration in terms of bioavailability, particularly in the face of a disrupted blood–aqueous barrier during phacoemulsification. Occurrence of anaphylactic reaction in this circumstance is not as unexpected as that supposed by the authors. The idiosyncrasy of intraocular delivery of immunogen has nothing to do with most of the standard steps of topical anesthesia cataract surgery. Second, nowadays, topical anesthesia cataract surgery is largely practiced without the addition of an intracameral antibiotic.3 Even in cases with intracameral antibiotic injection, Ragusa et al.4 have indicated, using a retrospective review of 2206 participants, that the risk for systemic anaphylaxis is as low as 0.06%. Understanding the standard art of practice in topical anesthesia cataract surgery, the pharmacokinetics of intracameral antibiotics, and the risk for systemic anaphylaxis may make the authors' generalization dubious.

Blood Pressure Surge Precedes Intracerebral Hemorrhage

Most patients with acute intracerebral hemorrhage (ICH) have very high blood pressure (BP) on presentation, but it is unclear whether such pressure elevation is the cause or a consequence of the ICH. This controversy could be clarified by determining the exact temporal relationship between the BP elevation and the onset of the ICH. Several case reports have attributed ICH to specific situations in which the BP was inferred to be high. Unfortunately, those cases lacked continuous monitoring of BP and neurological exam. Single case observation in a University-based tertiary medical center. A neurologically intact 64-year-old woman whose BP and neurological status were monitored during admission to a medical intensive care unit. The patient suddenly developed a decreased level of consciousness and a right hemispheric syndrome 3.5 hours after demonstrating systolic BP values in the range 200 mmHg. An unenhanced computed tomography scan of the brain demonstrated a right ICH. In this monitored case, the BP surge clearly preceded the onset of neurological symptoms by 3.5 hours, supporting the view that the acute BP elevation was the cause of ICH.

Atypical presentation of spontaneous discitis: case report

Background Spontaneous discitis is primarily a pediatric illness. Adult patients usually present at an average age of 69 years with a history of diabetes or with a systemic infection. The lumbar spine is the most frequent site of infection (54%), and the cervical is the least at 10%. The causative organisms are most commonly Staphylococcus aureus and β-hemolytic streptococcus species. Intravenous antibiotics are the mainstays of treatment, and surgical intervention is usually not required. Case presentation A single case observation with an unusual presentation from the statistically typical criterion of discitis is described. Conclusions Atypical discitis needs to be considered in the differential diagnoses in the middle-aged and healthy population.

Exogenous Melatonin in Periodic Limb Movement Disorder: An Open Clinical Trial and a Hypothesis

The etiology of Periodic Limb Movement Disorder (PLMD) as well as the precise role of melatonin in human physiology remains poorly understood. Inspired by a single case observation we performed the presented study in order to obtain first evidence for the hypothesis that exogenous melatonin would decrease PLM's and thereby improves symptoms of PLMD patients. N/A. N/A. Nine patients with first time diagnosis of PLMD without RLS were treated over a six-week period with 3 mg melatonin, taken between 10 and 11 p.m. N/A. Melatonin improved well-being in 7 of the 9 patients. Polysomnography, performed prior and at the end of melatonin treatment, demonstrated a significant reduction of investigated movement parameters, such as PLMs, PLM index, PLMs with arousals and PLM-arousal index. Actigraphy, measured over 14 nights prior and during the last 14 days of melatonin treatment, showed a significant reduction in movement rate and minutes with movements during Time in Bed. The temporal distribution of PLMs, as well as the coupling of PLMs with the phase position of circadian temperature curve, suggest an involvement of the circadian timing system in the pathophysiology of PLMD. Locomotor activity in animals clearly exhibits a circadian pattern and can be strongly influenced by exogenous melatonin. Results suggest a chronobiotic effect of exogenous melatonin in PLMD. More specifically, we hypothesize that the mode of action of melatonin in the presented PLMD patients might have been an increase of output-amplitude of the circadian timing system, thereby enhancing the circadian rhythmicity of locomotor activity with a reduction of sleep motor activity.

Is therapeutic work on inpatient relapses during qualified detoxification practicable and helpful? A single case observation

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