Primary Epstein-Barr virus (EBV) infection can manifest with a broad spectrum of neurological complications. There are only rare reports of Guillain-Barré syndrome (GBS) supervening on meningitis in patients with primary EBV infection. Clear evidence of central nervous system infection makes it difficult for the clinicians to consider a diagnosis of GBS. We present a patient with GBS supervening on meningitis in primary EBV infection.

Citations

• Neuromuscular Complications of SARS-CoV-2 and Other Viral Infections
  Sarah Jacob, Ronak Kapadia, Tyler Soule, Honglin Luo, Kerri L. Schellenberg, Renée N. Douville, Gerald Pfeffer
  Frontiers in Neurology.2022;[Epub]     CrossRef

Human immunodeficiency virus (HIV) infection presents various neurological complications. Cytomegalovirus (CMV) is a common opportunistic infectious pathogen and causes retinitis, encephalitis and lumbosacral polyradiculopathy in the patient with HIV infection in late course. CMV polyradiculopathy in early stage of acquired immune deficiency syndrome (AIDS) is rare. Herein, we report 43-year old man presented with CMV polyraculopathy as the first manifestation of AIDS. Prognosis of CMV polyradiculopathy in patient with AIDS is extremely poor, so early diagnosis and proper treatment is very important.

Arsenic trioxide has been steadily used as a treatment for acute promyelocytic leukemia over the decade. Peripheral neuropathy is a common complication of arsenic therapy and the symptoms are usually mild and reversible following discontinuation of the therapy. However, the clinical course of arsenic neurotoxicity in patient with coexistence of thiamin deficiency may potentially lead to be severe weakness and bad prognosis. It is important to determine the serum thiamine level of patients with acute promyelocytic leukemia before administrating Arsenic trioxide

Background
Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy. There are many additional electrophysiologic methods for diagnosis of CTS. However, these methods give unpleasant pain to patients and result in rising costs. We analyze routine nerve conduction studies to improve diagnostic simplification and sensitivity for CTS.
Methods
A total of 70 patients with clinically diagnosed CTS and 207 control subjects were enrolled. All subjects were examined by routine nerve conduction studies. Normal limits were derived by calculating the mean±2 standard deviations from the data of the controls. The sensitivity and specificity of each test were calculated.
Results
The difference between median and ulnar sensory peak latency was the most sensitive parameter for CTS. The sensitivity and specificity of the median-ulnar sensory latency difference was 59.4% and 96.5% respectively. The patients with 2 or more abnormal findings in 5 newly developed parameters (difference of motor terminal latency between median and ulnar nerve, difference of sensory peak latency between median and ulnar nerve, difference of sensory peak latency between median and radial nerve, difference of F wave latency between median and ulnar nerve and modified combined sensory index) could be more sensitive for CTS.
Conclusions
In our study, some parameters derived from routine nerve conduction studies, especially difference between median and ulnar sensory latency, could be more sensitive for diagnosis of CTS.

Nephrogenic systemic fibrosis (NSF) is a systemic disease that affects the skin and other tissues in patients with renalinsufficiency and exposure to gadolinium-containing contrast. A 55-year-old woman with end-stage renal disease on hemodialysiswas consulted for progressive general weakness. After she had undergone multiple MRIs with gadolinium-containing contrastmedia, muscle weakness and skin lesions were developed. Her skin and muscle biopsy specimens showed CD34+ fibroblastentrapping collagen bundles. There are few reports of NSF with myopathy.

Thenar motor neuropathy (TMN) is a compressive mononeuropathy of recurrent motor branch of median nerve. It is infrequentand may have different pathogenesis. It may be a unique entity of disease or considered a variant of carpal tunnelsyndrome involving the motor branch only. We report a case of TMN induced by vigorous massage that applied strong digitalpressure in the region of the base of palm and thenar muscles.

Mills

Pyridoxine has been known as an essential cofactor in many important biological reactions of tissue metabolism including blood, skin, and central nervous system. Nowadays, vitamins are widely consumed because of the belief that they provide health benefits with no harm. We report a patient with sensory ataxia who had a 3-year history of excessive vitamin B6 intake. Her clinical and electrodiagnostic findings were characteristic of sensory neuronopathy, which were probably caused by pyridoxine intoxication. Physicians should be aware of the toxicities of megavitamin therapy.

Repetitive nerve stimulation is a simple and widely used technique to demonstrate neuromuscular transmission defect. A significant decremental response for repetitive hypoglossal nerve stimulation was obtained from the surface recordings in the tongue of a patient with dysarthria and dysphagia. Repetitive hypoglossal nerve stimulation test may be useful in diagnosis of myasthenia gravis with bulbar symptoms only. We utilized repetitive hypoglossal nerve stimulation with tongue recordings and diagnosed a case of myasthenia gravis.

Miller-Fisher syndrome, Guillain-Barre syndrome with ophthalmoplegia, Bickerstaff s brainstem encephalitis and acute ophthalmoplegia share some clinical features, and common anti-GQ1b IgG antibody and these are introduced as anti-GQ1b antibody syndrome. These syndromes mostly present with paralysis of extraocular muscles and internal ophthalmoplegia rarely occurs. We report a case of acute isolated bilateral internal ophthalmoplegia associated with anti-GQ1b IgG antibody.

Background
s and Objectives : In the length-dependent axonal polyneuropathy like diabetic polyneuropathy (DPN), the distal part of the longer axons are affected earlier. In cases of minimal distal axonal changes, nerve conduction studies (NCS) are frequently normal. If sural nerve is affected in the early stage of DPN, supportive parameters to detect the early axonal degeneration may be helpful. We investigated whether the sural/lunar SNAP amplitude ratio (SUAR) may be a more sensitive indicator than sural amplitude alone in the diagnosis of early diabetic polyneuropathy. Methods: We analyzed medical records and electrophysiological studies of 141 patients with DM and 30 healthy subject. The patients with early stage of DPN were defined as those having symptoms of neuropathy and normal NCS findings among the patients with DM. We compared SUAR between 57 patients with early stage of DPN and 71 age-matched control subjects. Results: Fifty seven patients had an average SUAR of 0.8, compared to that of 1,1 in the 71 normal controls. The SUAR of less than 0.9 was supplementary predictor of axonal polynerupathy, with the best balance of sensitivity and specificity (70%). The SUAR did not vary significantly with age, height or duration of DM. Conclusions: We conclude that the SUAR is a useful electrodiagnostic indicator to detect early stage of DPN.