Search

Magnetic resonance (MR) multimodality evoked potentials (MEPs) and clinical findings were correlated in a 47-year-old epileptic man in whom parenteral valproic acid (VPA) therapy induced severe comatose hyperammonemic encephalopathy without biological signs of hepatotoxicity (or hepatocytic dysfunction). Although the plasma VPA level remained within a normal therapeutic range, the ammoniemia increased to a toxic peak level at 411 micromol/l 24 h after symptom onset, requiring VPA therapy discontinuation. Brain MR monitoring demonstrated early cytotoxic edema evolving into delayed vasogenic edema and final brain atrophy. Concomitantly to abnormalities within the brainstem on MR images, an increase in brainstem conduction at MEPs and clinical disturbance of brainstem reflexes were observed at the initial phase of the disease course. Later, the resolution of the MR and MEPs abnormalities paralleled the clinical recovery of the reflexes. [ABSTRACT FROM AUTHOR]

We report a case of Brown-Sequard syndrome (BSS) caused by a penetrating knife injury in a 31-year-old woman who was involved in a fight and was stabbed on her occiput and on her back. Neurological examination on admission suggested the BSS. Cervical magnetic resonance imaging (MRI) and evoked potentials confirmed the diagnosis. The patient’s hemiparesis gradually improved and she underwent rehabilitation. The pertinent literature is reviewed and discussed. [ABSTRACT FROM AUTHOR]

The author argues against electroencephalography as a diagnostic tool for brain death (BD) patients. According to the author, a phenomenological approach to BD diagnosis by verifying the absence of all cerebral activity would not be possible. This pathophysiological approach should not modify the attitude toward BD diagnosis; it could be substantially modified in anencephaly and some extreme postanoxic states.