Dysarthria ; etiology ; Encephalitis, Viral ; complications ; Facial Paralysis ; etiology ; Humans ; Syndrome

A boy, aged 2 years and 4 months, had a sudden onset of blepharoptosis of the right eyelid, accompanied by the mouth deviated to the right side, drinking cough, nystagmus, and developmental regression. Cranial MRI showed softening lesions formed after infarction of the right dorsolateral medulla oblongata, while head CT angiography showed no imaging of the proximal part of the V4 segment of the right vertebral artery. The child was diagnosed with dorsolateral medulla oblongata syndrome and was treated with gamma globulin to regulate immune function, with mannitol to reduce neuronal edema, with low-molecular-weight heparin sodium to improve local hypercoagulation of occluded blood vessels, with hyperbaric oxygen to improve local ischemia and hypoxia and promote the recovery of brain function, and with neuromuscular electrical stimulation to promote the recovery of neuromuscular function. Before discharge, only mild right ataxia and Horner syndrome remained. This article reports the first case of infantile dorsolateral medulla oblongata syndrome and provides experience for the diagnosis and treatment of the disease.
Blepharoptosis/etiology* ; Child, Preschool ; Dysarthria/etiology* ; Humans ; Lateral Medullary Syndrome/diagnosis* ; Magnetic Resonance Imaging ; Male ; Medulla Oblongata/diagnostic imaging*

INTRODUCTIONInjecting drug abusers are vulnerable to many infectious complications. We describe a case of tetanus in a Singaporean who regularly abused buprenorphine.

CLINICAL PICTUREA 49-year-old male was hospitalised for progressive generalised spasms associated with dysarthria and opisthotonus. Tetanus was diagnosed clinically.

TREATMENTSupportive management was instituted in the intensive care unit (ICU). Toxicology samples tested positive for buprenorphine.

OUTCOMEHe recovered rapidly and was transferred out of the ICU after 8 days. Retrospective questioning confirmed parenteral abuse of buprenorphine.

CONCLUSIONThis case highlights an uncommon and potentially lethal complication of parenteral drug abuse.

Buprenorphine ; Disease Progression ; Dysarthria ; Humans ; Male ; Middle Aged ; Singapore ; Substance Abuse, Intravenous ; Substance-Related Disorders ; complications ; Tetanus ; diagnosis ; etiology ; therapy

Paragonimiasis is caused by ingesting crustaceans, which are the intermediate hosts of Paragonimus. The involvement of the brain was a common presentation in Korea decades ago, but it becomes much less frequent in domestic medical practices. We observed a rare case of cerebral paragonimiasis manifesting with intracerebral hemorrhage. A 10-yr-old girl presented with sudden-onset dysarthria, right facial palsy and clumsiness of the right hand. Brain imaging showed acute intracerebral hemorrhage in the left frontal area. An occult vascular malformation or small arteriovenous malformation compressed by the hematoma was initially suspected. The lesion progressed for over 2 months until a delayed surgery was undertaken. Pathologic examination was consistent with cerebral paragonimiasis. After chemotherapy with praziquantel, the patient was monitored without neurological deficits or seizure attacks for 6 months. This case alerts practicing clinicians to the domestic transmission of a forgotten parasitic disease due to environmental changes.
Animals ; Anthelmintics/therapeutic use ; Brain/parasitology/pathology ; Cerebral Hemorrhage/*etiology ; Child ; Dysarthria/etiology ; Facial Paralysis/etiology ; Female ; Humans ; Magnetic Resonance Imaging ; Paragonimiasis/*diagnosis/drug therapy/parasitology ; Paragonimus/isolation & purification ; Praziquantel/therapeutic use ; Tomography, X-Ray Computed ; Vascular Malformations/etiology

Paragonimiasis is caused by ingesting crustaceans, which are the intermediate hosts of Paragonimus. The involvement of the brain was a common presentation in Korea decades ago, but it becomes much less frequent in domestic medical practices. We observed a rare case of cerebral paragonimiasis manifesting with intracerebral hemorrhage. A 10-yr-old girl presented with sudden-onset dysarthria, right facial palsy and clumsiness of the right hand. Brain imaging showed acute intracerebral hemorrhage in the left frontal area. An occult vascular malformation or small arteriovenous malformation compressed by the hematoma was initially suspected. The lesion progressed for over 2 months until a delayed surgery was undertaken. Pathologic examination was consistent with cerebral paragonimiasis. After chemotherapy with praziquantel, the patient was monitored without neurological deficits or seizure attacks for 6 months. This case alerts practicing clinicians to the domestic transmission of a forgotten parasitic disease due to environmental changes.
Animals ; Anthelmintics/therapeutic use ; Brain/parasitology/pathology ; Cerebral Hemorrhage/*etiology ; Child ; Dysarthria/etiology ; Facial Paralysis/etiology ; Female ; Humans ; Magnetic Resonance Imaging ; Paragonimiasis/*diagnosis/drug therapy/parasitology ; Paragonimus/isolation & purification ; Praziquantel/therapeutic use ; Tomography, X-Ray Computed ; Vascular Malformations/etiology