Alejandro Hornik

Diabetic Peripheral Neuropathy and the Management of Diabetic Peripheral Neuropathic Pain

Abstract Diabetic peripheral neuropathy (DPN) affects approximately half of patients with diabetes. Neuropathic pain is a major complaint of patients with diabetic polyneuropathy. Diabetic peripheral neuropathy can also lead to autonomic dysfunction. This article provides an outline of the clinical subtypes, pathophysiological features, and diagnosis of DPN. Disease–modifying treatments are reviewed, with particular attention paid to DPN pain management.

Cocaine induced hippocampi infarction

A middle age man presented with disorientation and memory impairment due to bilateral hippocampal strokes secondary to cocaine use. This is the second report of cocaine induced hippocampi ischaemic strokes. In contrast to the previous report, this middle age man did not have cardiac arrest.

Central and Extrapontine Myelinolysis Affecting the Brain and Spinal Cord. An Unusual Presentation of Pancreatic Encephalopathy

Pancreatic encephalopathy refers to a gamut of neuropsychiatric symptoms complicating acute pancreatitis. Osmotic myelinolysis is a known complication of pancreatic encephalopathy. We evaluated a 58-year-old woman with pancreatic encephalopathy associated to pontine and extrapontine myelinolysis involving the brain and spinal cord. To our knowledge, this is the first clinic pathological case report of pancreatic encephalopathy involving the spinal cord.

Late Onset CNS Immune Reconstitution Inflammatory Syndrome in an Immunocompetent Patient

Immune reconstitution inflammatory syndrome (IRIS) refers to the presence of paradoxical clinical deterioration attributable to immune system recovery during highly active antiretroviral therapy (HAART). We present an immunocompetent patient with multifocal leukoencephalopathy on HAART, with central nervous system (CNS) IRIS pathology of unknown infectious etiology. CNS IRIS pathology should be suspected in patients on longstanding HAART without immune reconstitution, presenting with unexplained leukoencephalopathy.

Refractory fulminant acute disseminated encephalomyelitis (ADEM) in an adult

Acute disseminated encephalomyelitis (ADEM) is characterized by its rapid progression with variable symptoms and severity in adults and children. Multiple therapeutic options have been proposed, but solid evidence is yet to be gathered. We describe an adult man with a fulminant form of ADEM unresponsive to numerous treatment modalities.

Wegener's disease presenting with occipital condyle syndrome.

Tumors or chronic inflammatory lesions of the occipital condyle may cause occipital pain associated with an ipsilateral hypoglossal nerve injury (occipital condyle syndrome). We describe a young woman with recurrent otitis media and occipital condyle syndrome associated with a limited form of Wegener’s disease.

Adverse Reactions from Botulinum Toxin Administration

As a biopharmaceutical, botulinum toxin has increasingly been administered for therapeutic indications both approved and not approved by the US Food and Drug Administration. Local adverse effects from its administration have been recognized since its original introduction, but recently generalized and remote adverse effects have been witnessed, some life threatening or fatal. While uncommon, these effects are currently unexplained and necessitate practitioner familiarity with their potential occurrence as well as requiring clear and consistent education of patients as to the risk, benefits and early signs of adverse reactions after botulinum toxin administration.

Pearls on primary stroke center.

Abstract Stroke is a leading cause of morbidity and mortality in the United States. The Brain Attack Coalition (BAC) provided goals and standards for development of primary and comprehensive stroke centers. There are over 800 primary stroke centers certified by The Joint Commission. This article provides a practical summary of recommendations to develop a primary stroke center, including some pearls that result from the experience of our institution in the field.

Undifferentiated Trigeminal Autonomic Cephalalgia in Lateral Medullary Infarction

A 58-year-old man presented with severe retro-orbital headache with autonomic symptoms, vertigo, dysarthria, dysphagia, hypaesthesia, dysmetria, and ataxia. Brain magnetic resonance imaging demonstrated lateral medullary infarction with no evidence of vertebral artery dissection. Undifferentiated trigeminal autonomic cephalalgia may occur in the setting of lateral medullary infarction, probably secondary to trigeminal system dysfunction.