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This letter presents a case study of a 34-year-old man with relapsing-remitting multiple sclerosis (RRMS) who developed severe progressive multifocal leucoencephalopathy (PML) after using natalizumab. The patient was treated with various interventions, including plasmapheresis and intravenous immunoglobulin, but did not show clinical improvement. However, after receiving pembrolizumab, the patient experienced significant clinical improvement, including improved mobility and cognitive function. The use of pembrolizumab in PML associated with natalizumab is a novel approach, and more research is needed to determine its effectiveness in similar cases. [Extracted from the article]

To authenticate to the full-text of this article, please visit this link: http://dx.doi.org/10.1111/j.1552-6569.2008.00281.x Byline: Belgin Kocer (1), Yusuf Oner (1), Hale Batur (1), Bijen Nazliel (1), Bulent Cengiz (1), Turgut Tali (1) Keywords: Multiple sclerosis; clinically isolated syndromes; pathological laughing; pathophysiology; treatment Abstract: ABSTRACT The prevalence of pathological laughing and crying in multiple sclerosis (MS) is 10%. It has been speculated that the anatomical lesion responsible for the pathological laughing is located in the pontine base, prefrontal cortex, and cerebellum. We report an 18-year-old male patient presenting with pathological laughing and hypomania. In his neurological examination, he had a euphoric effect with ataxic walking and dysarthria speech. He had a bilateral conjugated gaze limitation, with a prominent bilateral horizontal nystagmus on left gaze, dysmetria, dysdiadokokinesia, and remarkable dysfunction in a heel-to-shin test on the left. The IgG index in cerebrospinal fluid was normal with an oligoclonal band was present. In cranial MRI, there was a lesion on central pons which was hypointense in T1 images with contrast enhancement and hyperintense in T2 and flair images. Also another lesion in right brachium pontis which did not contrast enhancement but was hyperintense on T2 and flair images was present. There was an elevation of myoinositol/creatine ratio and choline and a reduction of NAA in proton MR spectroscopy. MR spectroscopic evaluation of the patient demonstrated the demyelination process. There has been no report of patients in whom pathological laughter was the presenting symptom of clinically isolated brainstem syndrome. Author Affiliation: (1)Department of Neurology, Gazi University School of Medicine, Cankaya-Ankara, Turkey (BK, HB, BN, BC); and Department of Radiology, Gazi University School of Medicine, Cankaya-Ankara, Turkey (YO, TT). Article History: Acceptance: Received February 7, 2008, and in revised form April 20, 2008. Accepted for publication May 19, 2008. Article note: Correspondence: Address correspondence to Dr. Belgin Kocer, Sedat Simavi sokak 17/32 B Block, Cankaya-Ankara, Turkey. E-mail: ebkocer@yahoo.com.

Useless Hand Syndrome (UHS) is a rare clinical manifestation of an upper cervical cord lesion, which is most commonly associated with multiple sclerosis (MS). The pathophysiological mechanism underlying UHS remains unclear. We report a 25-year-old woman, who described numbness in her left upper extremity. Cervical magnetic resonance imaging revealed a posterior upper cervical cord lesion. There was no cortical lesion that could explain the clinical findings. We measured (1) short-latency afferent inhibition (SAI) by obtaining motor evoked potentials as an indicator of sensorimotor integration and (2) somatosensorial temporal discrimination threshold (STDT) to display central somatosensory pathway function. In the right cerebral hemisphere, we found an excessive increase in STDT and no inhibition in the SAI paradigm. These findings indicate that impairment of sensorimotor integration and central processing of sensory stimuli cause useless hand syndrome. [ABSTRACT FROM AUTHOR]

Spinal, general, and epidural anesthesia have been implicated in the exacerbation of multiple sclerosis. However, to date, no attack has been reported following usage of mandibular block articaine anesthesia. This article describes the case of a 30-year-old man who presented with a sudden occurrence of diplopia on lateral gaze the day after extraction of the mandibular right second and third molars. Two times 1.8 mL 4% articaine solution with 1/100,000 adrenaline was used for local anesthesia. On neurological examination, a restriction on external gaze of his left eye was observed. Immunoglobulin G index was high, and oligoclonal band was present in spinal fluid evaluation. MRI revealed demyelinated plaques on the left side of the midpons, right cerebellar hemisphere, and bilateral white matter and supraventricular spaces. The left abducens palsy completely improved after treatment with intravenous methylprednisolone. Mandibular block articaine anesthesia may precipitate multiple sclerosis onset or attack. This case indicates that dental clinicians and neurologists may be alerted to isolated abducens palsy as a possible adverse effect of mandibular block articaine anesthesia. [ABSTRACT FROM AUTHOR]

Objectives: Transverse myelitis (TM) is an uncommon neurologic condition characterised by the segmental involvement of the spinal cord. Although its etiology is unknown, a well established list of associations have been described, many items of which point towards an autoimmune and vasculitic process. TM is also a rare complication of Behçet's disease (BD), an autoimmune process. Herein we present 4 cases of TM associated with BD., Methods: Retrospective chart reviews of 104 patients were done. Diagnosis of BD was established in each case according to the diagnostic criteria established by the International Study Group for Behçet's Disease. Demographic data, clinical and radiologic presentations of TM, treatment strategies and outcomes were obtained from hospital records., Results: Among the 15 patients with neurological involvement, four cases (3 male, 1 female) of acute TM associated with BD were confirmed. TM associated with BD affected cervical and thoracic levels of the spinal cord. Myelitis involved multiple segments (4 cases). TM developed at any stage of the disease, even as a dramatic initial presentation, leading to the diagnosis of BD (1 case). The longest time elapsed since the diagnosis of BD prior to the development of TM was 10 years. A major association was the history of panuveitis in all four cases. Cyclophosphamide and steroid therapy were the mainstay of the treatment once the TM had developed. Treatment outcomes were variable, depending mostly on the severity of the neurologic involvement at presentation, timing of the initiation of the therapy and patients adherence with the treatment. Two of 4 cases recovered without major sequela., Conclusions: Although rare, the presented association and its detailed clinical discussions would serve to enhance our understanding of both TM and the spectrum of neurologic complications that BD may harbour. Early recognition and initiation of therapy are crucial for successful outcome.