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Rare cases of demyelinating neuropathy have been described in association with amyotrophic lateral sclerosis (ALS). We report two patients with typical ALS whose initial electroneuromyographic (ENMG) presentation could suggest the existence of a process of motor nerve fiber demyelination. However, subsequent ENMG examinations and the fatal course of the disease in a few months rather supported severe ongoing axonal degeneration at the origin of motor nerve conduction abnormalities. Repeated examinations could be required to distinguish between ENMG features of concomitant demyelinating neuropathy and rapidly progressive motor neuron loss in ALS., (Copyright © 2013 Elsevier Masson SAS. All rights reserved.)

Background: Although it is recommended that interferon-beta (IFNβ) injections be administered in the evening, it is possible that morning injections could more effectively decrease interleukin 6 secretion., Methods: This study evaluated the effects of switching from an evening injection of IFNβ to a morning injection on the intensity of flu-like syndrome in patients with multiple sclerosis (MS). We performed an intervention study that consisted of a quantitative evaluation of IFNβ-related flu-like syndrome in a cohort of 105 MS patients. Patients with persistent flu-like reactions who injected IFNβ in the evening were encouraged to switch to morning injections. After one month, we evaluated various quantitative and qualitative changes (e.g., severity of flu-like syndrome, sleep quality, antipyretic drug use)., Results: Of the 98 patients (93%) who injected IFNβ in the evening, 88 (85%) had a persistent flu-like syndrome (the severity score was 3.92±0.26). A total of 50 (57%) patients switched to morning injections. One month after changing the injection time, 29 patients (58%) reported that their flu-like syndrome was decreased, 11 (24%) thought that it was unchanged and 9 (18%) thought that it was increased (p=0.014). In addition, 23 patients (48%) reported improved sleep (p=0.001), and 33 (68%) patients chose to continue morning injections, whereas 17 (32%) patients switched back to evening injections (p=0.024). Quantitative measures, however, indicated that there was no change in the severity of flu-like syndrome or the number of antipyretic doses taken for its management., Conclusion: Morning injections qualitatively improved IFNβ-related flu-like syndrome and sleep. A change in IFNβ injection time from evening to morning could benefit a significant proportion of patients with MS., (Copyright © 2010 Elsevier B.V. All rights reserved.)

Five patients developed neurologic symptoms a few hours to 2 months after being stung by a non-hooking arthropod with immediate cutaneous reaction. The patients had no clinical or serologic evidence for Lyme borreliosis and rickettsial disease. Clinical and electrophysiologic findings were consistent with a mixed axonal and demyelinating mononeuropathy, a monomelic multiple mononeuropathy, a mononeuropathy multiplex, a radiculoneuritis, and a distal symmetric polyneuropathy. Muscle and nerve biopsies showed lymphoplasmacytic small-vessel vasculitis in all patients, and wallerian degeneration in three. These patients, and 17 others from the literature, indicate a spectrum of peripheral neuropathies occurring after insect and spider stings.

We report the case of an 80 year-old woman who developed an unilateral brainstem infarction with a lesion of the intraparenchymatous fibres of the IIIrd cranial nerve. Intraaxial lesions of this nerve are usually part of the alternate paralysis syndrome. Our case might be the second since the report of Achard and Levi in 1901. Infarction limited to the fascicular fibres of the oculomotor nerve sparing the oculomotor nuclei results in characteristic clinical manifestations. This in turn results from the highly selective distribution of the terminal arterial territories in the midbrain.