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Cotard's syndrome as an adverse effect of acyclovir treatment in renal failure
Abstracts / Journal of the Neurological Sciences e629 (2013) e629–e678
doi:10.1016/j.jns.2013.07.2254
C. Atsumia, N. Sasakia, K. Kawaguchia, T. Hirayamaa, H. Takasunab, Y. Tanakab, M. Doic, M. Takagic, Y. Hasegawaa. aDepartment of Neurology, St. Marianna University School of Medicine, Kawasaki, Japan; bDepartment of Neurosurgery, St. Marianna University School of Medicine, Kawasaki, Japan; cDepartment of Pathology, St. Marianna University School of Medicine, Kawasaki, Japan Background: Influenza is one of the viral infections that cause epidemic or pandemic disease every year, and it is generally known as the most common and often causes serious complications. Preventive medicine for influenza achieved remarkable results by the spread of worldwide influenza vaccine. On the other hand, it may cause unusual neurological disorders such as acute encephalopathy by influenza vaccination. Influenza vaccinated acute encephalopathy (IVAE) is rare and its pathology is unclear. Objective: We describe a 24-year-old male who presented with headache and difficultly of speech but no focal neurological deficits the day after influenza vaccination. 10 days later, generalized convulsive seizure presented and urgent hospitalization in neurology. Neurological examination presented amnestic aphasia. Furthermore, blood examination, viral cultures and CSF were negative. Brain MRI, DWI and FLAIR showed localized subcortical white matter hyperintensity area in the left inferior temporal gyrus. After hospitalization, convulsion attack became frequent and aggravated. Brain biopsy showed central chromatolysis around the Nissl bodies without inflammatory or demyelination changes. We started steroid pulse therapy after brain biopsy, and his neurological disorders and convulsive seizure improved immediately. Radiological examination improved and subcortical white matter lesion completely disappeared three months later with favorable outcome. Conclusion: We concluded in this case that neuronopathy occurred due to toxic influence. Permeability obstacle of cell membrane and excitatory amino acid was excessively released triggered by the influenza vaccine. This case showed a different pathology from ADEM. IVAE is very important as influenza vaccination may have neurological sequels.
DP
Abstract — WCN 2013 No: 1920 Topic: 36 — Other Topic Cotard's syndrome as an adverse effect of acyclovir treatment in renal failure
Abstract — WCN 2013 No: 1912 Topic: 36 — Other Topic Atypical case of influenza vaccinated acute encephalopathy diagnosed by pathological approach. A case report and review of the literature
OF
Methods: Questionnaire-based paper survey among 118 participants of a neurology course for young neurologists in 2011. Results: Ninety-seven (82%) returned the survey. Most of them had at one point considered relocating within or to the EU for postgraduate education (87%) or employment (71%). Common motives were superior prospects for clinical training (85%), better resources at work and academic environment (both 80%), and higher income (70%). 52% of the surveyed would intend to return to their home country some time, yet 43% would not mind moving to another EU country. The attractiveness of the EU for migration is ranked over the United States, Australia/New Zealand or Switzerland (only 5% would instead prefer these options). The most common reasons which discourage cross-border relocation are the loss of family connection (53%) and uncertainty (40%), whereas language issues were less relevant (20%). Conclusion: The interest of the upcoming generation of neurologists to relocate within and to the EU is strong. The driving forces are additional training and career opportunities as well as inadequate remuneration in certain regions. Therefore it is critical to take action to harmonize training and working conditions in Europe in order to ensure neurology service and patient care.
RO
e650
TE
T. Lindéna,b, A. Helldénc. aNeuroscience & Physiology, Gothenburg University, Gothenburg, Sweden; bBrain Research Centre, The Florey Institutes of Neuroscience and Mental Health, Melbourne, VIC, Australia; c Institute of Clinical Pharmacology, Karolinska Institute, Stockholm, Sweden
UN
CO
RR
EC
Background: Aciclovir (ACV) is a well-known drug for treating herpes virus infections. ACV is generally considered safe and atoxic. However ACV-induced neuropsychiatric side effects (AINS) occur in about 1% of treated patients, mainly in patients with renal failure. We have earlier shown that AINS correlates to elevated levels of the ACV main metabolite, 9-carboxymethoxymethylguanine (CMMG). AINS can present as confusion, agitation, visual/auditory hallucinosis and psychosis. In some patients, we have noted an acutely appearing anxiety with delusions of being dead, or variations thereof, which we interpret as equivalent to the rare Cotard's syndrome. Objective: To pool reports of Cotard's syndrome in acyclovir-treated patients and to investigate the relation of symptoms to CMMG concentrations. Patients and methods: We searched different sources – the PubMed, the Swedish adverse drug reaction database SWEDIS, and the Therapeutic Drug Monitoring (TDM) database – for symptoms of Cotard's syndrome in ACV-treated patients. Signs and symptoms were collated along with clinical and laboratory findings. Results: We describe seven cases of ACV-treated patients with renal failure with what we interpret as Cotard's syndrome. In two cases the delusion was accompanied by an ‘alien hand’ variant of hemispatial neglect and in one case with Capgras delusion. In cases with known concentrations of CMMG, it relates to AINS and Cotard's syndrome. Conclusion: In patients with impaired renal function, ACV treatment can result in AINS and Cotard's syndrome. High CMMG levels may be used as a marker for AINS. doi:10.1016/j.jns.2013.07.2255
doi:10.1016/j.jns.2013.07.2256
Abstract — WCN 2013 No: 1910 Topic: 36 — Other Topic Cytomegalovirus infection presenting with multiple low cranial nerve palsies C.K. Ha, H.-K. Park. Department of Neurology, Inha University Hospital, Incheon, Republic of Korea Background: Cytomegalovirus(CMV) is a viral genus of the viral family known as herpes viruses. Although they may be found throughout the body, CMV infection is typically unnoticed in healthy people, but can be life-threatening for the immunocompromised patients. Diagnosis is usually done histologically by finding the inclusion bodies in infected tissue. We experienced one unusual case of CMV infection involving multiple cranial nerves. Case: A 55-year old man had severe left eyeball pain, three months before admission. He then presented with throat pain, dysarthria and severe dysphagia with dehydration. On admission, neurological examination showed left seventh, ninth, tenth and twelfth nerve
doi:10.1016/j.jns.2013.07.2254
C. Atsumia, N. Sasakia, K. Kawaguchia, T. Hirayamaa, H. Takasunab, Y. Tanakab, M. Doic, M. Takagic, Y. Hasegawaa. aDepartment of Neurology, St. Marianna University School of Medicine, Kawasaki, Japan; bDepartment of Neurosurgery, St. Marianna University School of Medicine, Kawasaki, Japan; cDepartment of Pathology, St. Marianna University School of Medicine, Kawasaki, Japan Background: Influenza is one of the viral infections that cause epidemic or pandemic disease every year, and it is generally known as the most common and often causes serious complications. Preventive medicine for influenza achieved remarkable results by the spread of worldwide influenza vaccine. On the other hand, it may cause unusual neurological disorders such as acute encephalopathy by influenza vaccination. Influenza vaccinated acute encephalopathy (IVAE) is rare and its pathology is unclear. Objective: We describe a 24-year-old male who presented with headache and difficultly of speech but no focal neurological deficits the day after influenza vaccination. 10 days later, generalized convulsive seizure presented and urgent hospitalization in neurology. Neurological examination presented amnestic aphasia. Furthermore, blood examination, viral cultures and CSF were negative. Brain MRI, DWI and FLAIR showed localized subcortical white matter hyperintensity area in the left inferior temporal gyrus. After hospitalization, convulsion attack became frequent and aggravated. Brain biopsy showed central chromatolysis around the Nissl bodies without inflammatory or demyelination changes. We started steroid pulse therapy after brain biopsy, and his neurological disorders and convulsive seizure improved immediately. Radiological examination improved and subcortical white matter lesion completely disappeared three months later with favorable outcome. Conclusion: We concluded in this case that neuronopathy occurred due to toxic influence. Permeability obstacle of cell membrane and excitatory amino acid was excessively released triggered by the influenza vaccine. This case showed a different pathology from ADEM. IVAE is very important as influenza vaccination may have neurological sequels.
DP
Abstract — WCN 2013 No: 1920 Topic: 36 — Other Topic Cotard's syndrome as an adverse effect of acyclovir treatment in renal failure
Abstract — WCN 2013 No: 1912 Topic: 36 — Other Topic Atypical case of influenza vaccinated acute encephalopathy diagnosed by pathological approach. A case report and review of the literature
OF
Methods: Questionnaire-based paper survey among 118 participants of a neurology course for young neurologists in 2011. Results: Ninety-seven (82%) returned the survey. Most of them had at one point considered relocating within or to the EU for postgraduate education (87%) or employment (71%). Common motives were superior prospects for clinical training (85%), better resources at work and academic environment (both 80%), and higher income (70%). 52% of the surveyed would intend to return to their home country some time, yet 43% would not mind moving to another EU country. The attractiveness of the EU for migration is ranked over the United States, Australia/New Zealand or Switzerland (only 5% would instead prefer these options). The most common reasons which discourage cross-border relocation are the loss of family connection (53%) and uncertainty (40%), whereas language issues were less relevant (20%). Conclusion: The interest of the upcoming generation of neurologists to relocate within and to the EU is strong. The driving forces are additional training and career opportunities as well as inadequate remuneration in certain regions. Therefore it is critical to take action to harmonize training and working conditions in Europe in order to ensure neurology service and patient care.
RO
e650
TE
T. Lindéna,b, A. Helldénc. aNeuroscience & Physiology, Gothenburg University, Gothenburg, Sweden; bBrain Research Centre, The Florey Institutes of Neuroscience and Mental Health, Melbourne, VIC, Australia; c Institute of Clinical Pharmacology, Karolinska Institute, Stockholm, Sweden
UN
CO
RR
EC
Background: Aciclovir (ACV) is a well-known drug for treating herpes virus infections. ACV is generally considered safe and atoxic. However ACV-induced neuropsychiatric side effects (AINS) occur in about 1% of treated patients, mainly in patients with renal failure. We have earlier shown that AINS correlates to elevated levels of the ACV main metabolite, 9-carboxymethoxymethylguanine (CMMG). AINS can present as confusion, agitation, visual/auditory hallucinosis and psychosis. In some patients, we have noted an acutely appearing anxiety with delusions of being dead, or variations thereof, which we interpret as equivalent to the rare Cotard's syndrome. Objective: To pool reports of Cotard's syndrome in acyclovir-treated patients and to investigate the relation of symptoms to CMMG concentrations. Patients and methods: We searched different sources – the PubMed, the Swedish adverse drug reaction database SWEDIS, and the Therapeutic Drug Monitoring (TDM) database – for symptoms of Cotard's syndrome in ACV-treated patients. Signs and symptoms were collated along with clinical and laboratory findings. Results: We describe seven cases of ACV-treated patients with renal failure with what we interpret as Cotard's syndrome. In two cases the delusion was accompanied by an ‘alien hand’ variant of hemispatial neglect and in one case with Capgras delusion. In cases with known concentrations of CMMG, it relates to AINS and Cotard's syndrome. Conclusion: In patients with impaired renal function, ACV treatment can result in AINS and Cotard's syndrome. High CMMG levels may be used as a marker for AINS. doi:10.1016/j.jns.2013.07.2255
doi:10.1016/j.jns.2013.07.2256
Abstract — WCN 2013 No: 1910 Topic: 36 — Other Topic Cytomegalovirus infection presenting with multiple low cranial nerve palsies C.K. Ha, H.-K. Park. Department of Neurology, Inha University Hospital, Incheon, Republic of Korea Background: Cytomegalovirus(CMV) is a viral genus of the viral family known as herpes viruses. Although they may be found throughout the body, CMV infection is typically unnoticed in healthy people, but can be life-threatening for the immunocompromised patients. Diagnosis is usually done histologically by finding the inclusion bodies in infected tissue. We experienced one unusual case of CMV infection involving multiple cranial nerves. Case: A 55-year old man had severe left eyeball pain, three months before admission. He then presented with throat pain, dysarthria and severe dysphagia with dehydration. On admission, neurological examination showed left seventh, ninth, tenth and twelfth nerve