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New antiviral drugs
No full textThe number of available antiviral drugs increases constantly. Beyond antiretroviral compounds with activity against HIV, most of the recently introduced virustatic drugs unfold their activity against members of the Herpesvirus family, especially herpes-zoster- and herpes-simplex viruses. However, controlled studies on viral infections of the nervous system are rare, perhaps with the one exception of herpes zoster. Some studies on herpes zoster indicate that with modern antiviral substances like famiciclovir or valaciclovir acute zoster pain and post zoster neuralgia may be shortened in duration and reduced in frequency. Concerning the antiviral treatment of encephalitis with new virustatics, our experience is mainly based on case reports. Nevertheless, the broader spectrum of antiviral substances offers the possibility to treat individual encephalitis patients with drugs that have at least in vitro activity against the causative virus. In herpes-simplex-encephalitis, aciclovir remains the antiviral drug of first choice
Reader response: The two lives of neurologist Helmut J. Bauer (1914–2008): Renowned MS specialist and National Socialist
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Rhabdomyolysis after intake of Venlafaxin
No full textVenlafaxin is a serotonine-noradrenaline reuptake inhibitor that is used for treatment of depression and concomitant anxiety disorders. We report on a 38 years old woman, who developed a generalised seizure, agitation and somnolence, fever, hyponatriemia, rhabdomyolysis and a tachyarrhytmia absoluta. In a blood sample, which was collected about one day after the ingestion of venlafaxin, we detected 12 ng/ml venlafaxin and 105 ng/ml of its active metabolite O-desmethyl-venlafaxin. Considering the pharmacokinetic of venlafaxin and O-desmethyl-venlafaxin toxic plasma levels of both substances can be calculated for the time when symptoms had occurred. Under treatment with volume, diuretics and substitution of electrolytes the patient recovered consciousness very quickly. However, serum levels of creatine-kinase increased steadily to a maximum of 14 926 U/I on day 3 and declined slowly thereafter. In addition, a tachyarrhytmia absoluta developed suddenly on day 4 and reversed spontaneously one day later. While seizures, fever, hyponatriemia and loss of consciousness are typical symptoms of intoxication with venlafaxin, rhabdomyolysis and the late occurrence of tachyarrhytmia absoluta are uncommon
Gadolinium encephalopathy due to accidental intrathecal administration of gadopentetate dimeglumine
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Core hypothermia in multiple sclerosis: case report with magnetic resonance imaging localization of a thalamic lesion
No full textHypothermia is a rare condition in multiple sclerosis (MS). We report on a patient with a long-standing secondary progressive MS and six episodes of recurring hypothermia down to 29.9 degrees C with associated hypotension, bradycardia, coagulopathy and electrolyte dysequilibrium. Magnetic resonance imaging (MRI) demonstrated severe involvement of the corpus callosum with an associated lesion in the right posterior thalamus. These findings may link hypothermia in MS with callosal and associated thalamic pathology to Shapiro's syndrome, where agenesis of the corpus callosum and associated abnormalities are related to episodic spontaneous hypothermia. In MS, hypothermic episodes may be triggered by preceding infections, as shown in the present case
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