Juvenile myoclonic epilepsy is the commonest form of idiopathic epilepsy which is usually misdiag... more Juvenile myoclonic epilepsy is the commonest form of idiopathic epilepsy which is usually misdiagnosed. Myoclonic morning jerking is the hallmark of the syndrome with generalized tonic clonic convulsion occurring in most, but absences are less frequent. The author describes his published experience on this syndrome which includes: clinical, EEG findings, some of genetic aspects and factors that lead to diagnostic errors. The current literature on the syndrome and some highlights on progressive myoclonic epilepsy, which is one of the commonest differential diagnoses, are also presented.
QJM: An International Journal of Medicine, Jul 1, 1988
Analysis of 121 consecutive cases with infection of the nervous system showed that the majority w... more Analysis of 121 consecutive cases with infection of the nervous system showed that the majority were the granulomatous infections, tuberculosis and brucellosis (53 cases (44 per cent)). Thirty-nine patients had tuberculosis and 14 had brucellosis. The clinical and microbiological pattern of infection differs from that frequently reported from Western countries. Tuberculosis lesions presented with features of intracranial space occupying lesions (14), spinal cord compression (13) and lumbosacral root compression (1 child). Ten adults and one child had tuberculous meningitis. Pyogenic meningitis present in 38 cases (31 per cent), was most common in children. The infecting organism was identified in 26 patients; Gram-positive cocci in 17, Haemophilus influenzae in four and other Gram-negative organisms in five. Eleven patients had brain abscesses, caused by bacterial infection in eight, fungal infection in two and Toxoplasma gondii in one. Nineteen patients had clinical and pathological features of viral meningitis. Fourteen patients (12 per cent) died including six children with pyogenic meningitis.
We describe two patients with renal transplants who developed pseudotumor cerebri (PTC) in the co... more We describe two patients with renal transplants who developed pseudotumor cerebri (PTC) in the course of their follow-up. They illustrate the diagnostic challenge in such situations. Patients with renal transplants usually have many other associated conditions which may lead to headache, visual disturbances or papilledema. A high index of suspicion is necessary for prompt diagnosis and management of this rare and serious but treatable combination.
Standard MRI confirms the diagnosis of posterior leukoencephalopathy syndrome (PLES), recently as... more Standard MRI confirms the diagnosis of posterior leukoencephalopathy syndrome (PLES), recently associated with an increasing number of medical conditions. In PLES, T2-weighted MRI demonstrates hyperintensity spreading out from posterior brain regions; the pathophysiology remains mysterious. In the acute setting, diffusion-weighted imaging (DWI), but not standard MR imaging, can distinguish ischemic injury from those conditions known to cause vasogenic brain edema. DWI is potentially valuable in understanding the pathophysiology of PLES and in diagnosing patients who do not have previously known risk factors. Serial CT and MRI studies (including DWI, apparent diffusion coefficient [ADC] maps, and, in one instance, perfusion-weighted imaging) were performed in three female patients with a neurologic syndrome consistent with PLES while hospitalized for treatment of other conditions. None of the patients had previously described risk factors for PLES; all had only mild elevations in blood pressure. MRI showed large, abnormal, T2 hyperintense regions in the posterior cerebrum with corresponding hyperintensity on ADC maps-signal characteristics predominantly consistent with vasogenic edema. There were also smaller patchy posterior cortical regions with decreased ADC and bright DWI consistent with infarction in one, and dramatic conversion of a large region to an ischemic pattern in another. ADC maps and DWI can successfully differentiate PLES from early cerebral ischemia, thus playing a pivotal role in treatment decisions. PLES is associated with a wider variety of conditions than has been previously reported and is not always reversible. Hyperintense DWI signal in patients with the syndrome likely marks a tissue stage of permanent brain injury.
The cases of 40 patients (aged, 18-40 y) who presented with papilledema without lateralizing sign... more The cases of 40 patients (aged, 18-40 y) who presented with papilledema without lateralizing signs (PWLS) were analyzed retrospectively, with particular reference to the underlying causes. Benign i...
Background and Purpose We undertook this study to determine the frequency, clinical patterns, and... more Background and Purpose We undertook this study to determine the frequency, clinical patterns, and etiologies of cerebral venous thrombosis in a Middle Eastern country. Methods Records of all adult patients admitted with an angiographically documented diagnosis of cerebral venous thrombosis from 1985 through 1994 in two major hospitals of Riyadh, Saudi Arabia, were reviewed. Results Forty patients (20 men, 20 women) aged 16 to 40 years were identified. Hospital frequency was 7 per 100 000 patients, and the relative frequency against arterial strokes was 1:62.5. Nineteen cases (47%) had a clinical picture of pseudotumor cerebri. Behçet’s disease was the cause in 10 cases (25%). Other causes included antiphospholipid antibodies in 4, protein S deficiency in 3, intracranial tumors in 3, systemic lupus erythematosus in 3, infections in 3, antithrombin III deficiency in 2, postpartum in 1, and oral contraceptives in 1. Conclusions Cerebral venous thrombosis in adults is not uncommon in S...
Juvenile myoclonic epilepsy is the commonest form of idiopathic epilepsy which is usually misdiag... more Juvenile myoclonic epilepsy is the commonest form of idiopathic epilepsy which is usually misdiagnosed. Myoclonic morning jerking is the hallmark of the syndrome with generalized tonic clonic convulsion occurring in most, but absences are less frequent. The author describes his published experience on this syndrome which includes: clinical, EEG findings, some of genetic aspects and factors that lead to diagnostic errors. The current literature on the syndrome and some highlights on progressive myoclonic epilepsy, which is one of the commonest differential diagnoses, are also presented.
QJM: An International Journal of Medicine, Jul 1, 1988
Analysis of 121 consecutive cases with infection of the nervous system showed that the majority w... more Analysis of 121 consecutive cases with infection of the nervous system showed that the majority were the granulomatous infections, tuberculosis and brucellosis (53 cases (44 per cent)). Thirty-nine patients had tuberculosis and 14 had brucellosis. The clinical and microbiological pattern of infection differs from that frequently reported from Western countries. Tuberculosis lesions presented with features of intracranial space occupying lesions (14), spinal cord compression (13) and lumbosacral root compression (1 child). Ten adults and one child had tuberculous meningitis. Pyogenic meningitis present in 38 cases (31 per cent), was most common in children. The infecting organism was identified in 26 patients; Gram-positive cocci in 17, Haemophilus influenzae in four and other Gram-negative organisms in five. Eleven patients had brain abscesses, caused by bacterial infection in eight, fungal infection in two and Toxoplasma gondii in one. Nineteen patients had clinical and pathological features of viral meningitis. Fourteen patients (12 per cent) died including six children with pyogenic meningitis.
We describe two patients with renal transplants who developed pseudotumor cerebri (PTC) in the co... more We describe two patients with renal transplants who developed pseudotumor cerebri (PTC) in the course of their follow-up. They illustrate the diagnostic challenge in such situations. Patients with renal transplants usually have many other associated conditions which may lead to headache, visual disturbances or papilledema. A high index of suspicion is necessary for prompt diagnosis and management of this rare and serious but treatable combination.
Standard MRI confirms the diagnosis of posterior leukoencephalopathy syndrome (PLES), recently as... more Standard MRI confirms the diagnosis of posterior leukoencephalopathy syndrome (PLES), recently associated with an increasing number of medical conditions. In PLES, T2-weighted MRI demonstrates hyperintensity spreading out from posterior brain regions; the pathophysiology remains mysterious. In the acute setting, diffusion-weighted imaging (DWI), but not standard MR imaging, can distinguish ischemic injury from those conditions known to cause vasogenic brain edema. DWI is potentially valuable in understanding the pathophysiology of PLES and in diagnosing patients who do not have previously known risk factors. Serial CT and MRI studies (including DWI, apparent diffusion coefficient [ADC] maps, and, in one instance, perfusion-weighted imaging) were performed in three female patients with a neurologic syndrome consistent with PLES while hospitalized for treatment of other conditions. None of the patients had previously described risk factors for PLES; all had only mild elevations in blood pressure. MRI showed large, abnormal, T2 hyperintense regions in the posterior cerebrum with corresponding hyperintensity on ADC maps-signal characteristics predominantly consistent with vasogenic edema. There were also smaller patchy posterior cortical regions with decreased ADC and bright DWI consistent with infarction in one, and dramatic conversion of a large region to an ischemic pattern in another. ADC maps and DWI can successfully differentiate PLES from early cerebral ischemia, thus playing a pivotal role in treatment decisions. PLES is associated with a wider variety of conditions than has been previously reported and is not always reversible. Hyperintense DWI signal in patients with the syndrome likely marks a tissue stage of permanent brain injury.
The cases of 40 patients (aged, 18-40 y) who presented with papilledema without lateralizing sign... more The cases of 40 patients (aged, 18-40 y) who presented with papilledema without lateralizing signs (PWLS) were analyzed retrospectively, with particular reference to the underlying causes. Benign i...
Background and Purpose We undertook this study to determine the frequency, clinical patterns, and... more Background and Purpose We undertook this study to determine the frequency, clinical patterns, and etiologies of cerebral venous thrombosis in a Middle Eastern country. Methods Records of all adult patients admitted with an angiographically documented diagnosis of cerebral venous thrombosis from 1985 through 1994 in two major hospitals of Riyadh, Saudi Arabia, were reviewed. Results Forty patients (20 men, 20 women) aged 16 to 40 years were identified. Hospital frequency was 7 per 100 000 patients, and the relative frequency against arterial strokes was 1:62.5. Nineteen cases (47%) had a clinical picture of pseudotumor cerebri. Behçet’s disease was the cause in 10 cases (25%). Other causes included antiphospholipid antibodies in 4, protein S deficiency in 3, intracranial tumors in 3, systemic lupus erythematosus in 3, infections in 3, antithrombin III deficiency in 2, postpartum in 1, and oral contraceptives in 1. Conclusions Cerebral venous thrombosis in adults is not uncommon in S...
To describe the clinical features of 5 patients with rare atypical presentation of idiopathic int... more To describe the clinical features of 5 patients with rare atypical presentation of idiopathic intracranial hypertension (IIH), and propose the possible mechanism of this atypical presentation. We carried out a retrospective study of 5 patients admitted at King Khalid National Guard Hospital, Jeddah, Kingdom of Saudi Arabia with IIH during the period from January 2001 to December 2005. All were females with their age ranges from 24 to 40 years. The clinical presentations, and the laboratory and imaging studies were analyzed. The opening pressures of the lumbar puncture tests were documented. All patients were presented with headache. One had typical pain of trigeminal neuralgia, and one with neck pain and radiculopathy. Facial diplegia was present in one patient, and 2 patients had bilateral 6th cranial neuropathy. Papilledema was present in all patients except in one patient. Imaging study was normal in all patients, and they had a very high opening pressure during lumbar puncture, ...
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