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An acute spinal epidural abscess is a rare cause of paraplegia, seen in seven patients over a period of ten years. All patients had fever and severe localized back-pain. Unless treated, within hours or a few days, there will be root defects and rapidly progressive paraplegia. Staphylococcus is the most frequent causative organism and clinically manifest septicaemia is common. Rapid diagnosis and treatment are essential in deciding the patient's fate. Myelography is an important additional examination as it demonstrates the abscess in 96% of cases. Non-contrast radiology is of little value. High-dosage antibiotics and surgical spinal decompression are the cardinal treatment procedures. Antibiotics alone are justified only so long as there are no neurological deficits and neurosurgical intervention, if needed, is immediately available.

Eine 57-jahrige Patientin litt seit zirka 2 Jahren an einer belastungsabhangigen generalisierten Muskelschwache ohne Doppelbilderwahrnehmung und Schluckstorungen. Aufgrund eines pathologischen Dekrements bei repetitiver Nervenstimulation und eines positiven Ausfalls eines Edrophoniumchlorid-Tests wurde das Vorliegen einer Myasthenia gravis vermutet. Diese Diagnose war jedoch unsicher, da Acetylcholinrezeptorantikorper im Serum fehlten und die Patientin angab, dass sie bereits in der Kindheit nur gering korperlich belastbar gewesen sei. Differentialdiagnostisch wurde deshalb das Vorliegen eines kongenitalen Myastheniesyndroms erwogen und eine Interkostalmuskelbiopsie veranlasst. Hier liesen sich immunhistochemisch Komplementfaktoren im Endplattenbereich nachweisen und somit die Diagnose einer Myasthenia gravis sichern. Der immunhistochemische Nachweis von Komplementfaktoren im Bereich der motorischen Endplatten ist eine einfache Methode, um auch in diagnostisch schwierigen Fallen bei fehlendem serologischen Nachweis von Acetylcholinrezeptorantikorpern die Diagnose einer Myasthenia gravis zu sichern.

Background: Sleep disorders can cause tiredness. The relationship between sleep disorders and fatigue in patients with multiple sclerosis (MS) has not yet been investigated systematically. Objective: To investigate the relationship between fatigue and sleep disorders in patients with MS. Methods: Some 66 MS patients 20 to 66 years old were studied by overnight polysomnography. Using a cut-off point of 45 in the Modified Fatigue Impact Scale (MFIS), the entire cohort was stratified into a fatigued MS subgroup ( n = 26) and a non-fatigued MS subgroup ( n = 40). Results: Of the fatigued MS patients, 96% ( n = 25) were suffering from a relevant sleep disorder, along with 60% of the non-fatigued MS patients ( n = 24) ( p = 0.001). Sleep-related breathing disorders were more frequent in the fatigued MS patients (27%) than in the non-fatigued MS patients (2.5%). Significantly higher MFIS values were detected in all (fatigued and non-fatigued) patients with relevant sleep disorders (mean MFIS 42.8; SD 18.3) than in patients without relevant sleep disorders (mean MFIS 20.5; SD 17.0) ( p Conclusion: Our results demonstrate a clear and significant relationship between fatigue and sleep disorders.