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Objectives - To describe the pattern of presentation, the types of dementia and the associated conditions in Saudi patients. Materials and methods -Hospital-based study using DSM-IV and ICD 10 criteria for consensus diagnosis of cases from clinical information and results of investigations. Dementia subtypes were made according to NINCDS-ADRDA, NINDS-AIREN and ICD 10 criteria while CDR was used for severity grading. Results - A total of 77 demented patients (49 males, 28 females) were studied. The hospital frequency was 19.3/100,000 patients. The mean age at presentation was 74.6 years and age at onset was below 65 years in 17 patients. The types of dementia were: Alzheimer's disease (51.9%), vascular dementia (18.2%), mixed cases (15.6%), dementia with Parkinson's disease (7.8%) and treatable dementia (5.2%). Only 3 patients were in the severe clinical stage and infections were important causes of deterioration. Conclusion - The hospital frequency appears to be low probably because of the relatively young population. The pattern of dementia with preponderance of AD is similar to that in western countries and intervention directed at the risk factors for stroke could reduce the burden of vascular dementia.

High dose intravenous immunoglobulin (IVG) is increasingly used in a broad range of immune mediated diseases. Thrombosis was exceptionally reported as a complication of this therapy. We describe three cases of thrombotic complications during or soon after IVIG treatment: myocardial infarction in a man and cerebral infarctions in an elderly man, associated with peripheral ischemia in a woman. In addition we review the published cases in the literature and discuss the possible etiologic factors.

We determined the motor terminal latency index [MTLI]of the median nerve across the carpal tunnel in 41 upper extremities of 31 patients with carpal tunnel syndrome. Changes in motor nerve conduction velocity [MNCV], motor terminal latency [MTL], sensory action potential and the amplitude of the compound muscle action potential recorded from the abductor pollicis brevis muscle were all suggestive of proximal and distal segment involvement of the nerve across the carpal tunnel. There was no correlation between forearm MNCV and MTL [r = 0.40], although MTLI was correlated with MTL [r = 0.67]but not with MNCV, indicating a disproportionate conduction across the carpal tunnel

High dose intravenous immunoglobulin (IVG) is increasingly used in a broad range of immune mediated diseases. Thrombosis was exceptionally reported as a complication of this therapy. We describe three cases of thrombotic complications during or soon after IVIG treatment: myocardial infarction in a man and cerebral infarctions in an elderly man, associated with peripheral ischemia in a woman. In addition we review the published cases in the literature and discuss the possible etiologic factors.

We determined the motor terminal latency index (MTLI) of the median nerve across the carpal tunnel in 41 upper extremities of 31 patients with carpal tunnel syndrome. Changes in motor nerve conduction velocity (MNCV), motor terminal latency (MTL), sensory action potential and the amplitude of the compound muscle action potential recorded from the abductor pollicis brevis muscle were all suggestive of proximal and distal segment involvement of the nerve across the carpal tunnel. There was no correlation between forearm MNCV and MTL (r = 0.40), although MTLI was correlated with MTL (r = 0.67) but not with MNCV, indicating a disproportionate conduction across the carpal tunnel.

Massive bilateral infarcts due to deep venous system thrombosis are extremely rare and poorly documented. We present a case with computed tomographic evidence of both thrombosis and infarction of the whole deep venous system. A previously healthy 30-year-old woman who had taken oral contraceptives for 3 years complained of recurrent headaches and transient visual obscuration. Three months later, she suddenly became comatose and was found to have papilledema. She rapidly worsened, became decerebrate, and died within 48 hours. Noncontrast computed tomographic scan showed the spontaneous hyperdensity of the thrombosed deep veins and a massive bilateral centrobasilar hypodensity suggestive of a deep venous system infarction. This case shows that cerebral venous thrombosis can masquerade during 3 months as benign intracranial hypertension and then make a dramatic extension to the deep cerebral veins. It illustrates extensive thrombosis of the deep venous system as a possible cause of rapid coma and decerebration and stresses the importance of computed tomographic scan to show both the thrombosed veins and the venous infarct, which allows delineation of the deep venous system territory.

A R Al Tahan1, R Zaidan1, S Jones2, A Husain3, A Mobeireek1, A Bahammam11Department of Medicine, 3Department of Physiology, College of Medicine, King Saud University, Riyadh, Saudi Arabia; 2Department of Neurophysiology, Institute of Neurology, London, UKBackground: Cognitive event-related potential (P300) is an index of cognitive processing time. It was found to be prolonged in dementia, renal, and hepatic encephalopathies, but was not extensively assessed in respiratory failure.Objective: To evaluate P300 changes in patients with respiratory failure, and especially those with mild or subclinical hypoxic–hypercapnic encephalopathy.Methods: Auditory event-related evoked potential P300 latency was measured using an oddball paradigm in patients with respiratory failure due to any cause (partial pressure of oxygen in arterial blood (PO2) should be 75 mm/Hg or less). Apart from blood gases measurement, patients underwent the Mini-Mental State Examination (MMSE). Patient performances were compared with that of matched normal control. Patients were admitted into the study from outpatient clinics and wards at King Khalid University Hospital and Sahara Hospital.Results: Thirty-four patients (12 women, 22 men) were admitted to the study. Ages ranged from 19–67 years with a mean of 46.1 years. Respiratory failure was severe or very severe in 11 patients (33%), and mild or moderate in the rest (66%). Mean value for PO2 and partial pressure of carbon dioxide in arterial blood (PCO2) were 63.7 and 45.2 mm/Hg, respectively. pH mean was 7.4 and O2 saturation was 90.7%. P300 latency ranged from 218 to 393 milliseconds, with a mean of 338.4 milliseconds. In comparison with control (309.9 milliseconds), there was a significant difference (P = 0.007). P300 amplitude differences were not significant. No significant difference in MMSE was noted between mild and severe respiratory failure. Results of detailed neuropsychological assessment were clearly abnormal but were limited by the small number of tested patients. P300 latency changes correlated significantly with age as well as severity of respiratory failure. P300 was also significantly delayed whether hypoxia occurred with or without hypercapnia.Conclusion: Results show a significant delay of P300 latency in patients with severe and mild respiratory failure. This was associated with subclinical encephalopathy in most patients, evidenced by a near-normal MMSE score. Apart from confirming the importance of P300 latency measurement as a marker of respiratory encephalopathy, this study asserts the causal relationship between hypoxemia and cognitive derangement. Furthermore, it promotes the early use of oxygen therapy in a selected group of patients with mild or moderate respiratory failure, who have responsibilities which involve taking rapid critical decisions.Keywords: event-related evoked potentials, hypoxic–hypercapnic encephalopathy, respiratory failure, chronic respiratory encephalopathy