[Show abstract][Hide abstract] ABSTRACT: Varicella zoster virus (VZV) encephalitis is associated with large or small vessel vasculopathy. We report the case of a 67-year-old woman with a history of non-Hodgkin's lymphoma and cancers of the breast and colon, who presented with a zosteriform rash and Brown-Sequard syndrome. Despite 10 days therapy with intravenous acyclovir, meningoencephalitis developed and the patient died 15 days after onset of neurological symptoms. Autopsy showed meningoencephalomyelitis with necrotising vasculitis of leptomeningeal vessels, which is a rare complication of VZV, and we review the literature of the nine similar published cases. Polymerase chain reaction of cerebrospinal fluid for VZV was negative 6 days after onset of neurological symptoms, but became positive by day 10. Only one multinucleated giant cell with intranuclear Cowdry type A inclusions was seen within an endothelial cell in a leptomeningeal vessel involved by vasculitis.
[Show abstract][Hide abstract] ABSTRACT: Previous reports have shown that McArdle's disease may occasionally present in older patients (i.e. greater than 40 years of age) as a progressive myopathy that is clinically and sometimes electrophysiologically indistinguishable from idiopathic polymyositis. We report two such patients who in addition had muscle biopsies showing inflammatory infiltrates compatible with polymyositis. However, subsequent enzyme histochemistry demonstrated complete myophosphorylase deficiency and, in the absence of an alternative explanation, may be the reason for the inflammatory changes seen. These cases highlight the importance of a thorough evaluation of patients with an ‘inflammatory myopathy’ and the occasional diagnostic confusion that may arise in differentiating metabolic myopathies from idiopathic polymyositis. Diagnostic clarification is important to avoid the use of incorrect and potentially toxic treatment.
No preview · Article · Apr 1998 · Journal of Clinical Neuroscience