He failed to recover his mentality and the function of the limbs remained poor finishing several treatment options including medications and physical therapy. The poor prognosis of this patient is thought to be associated with cortical involvement of MBD.
Moreover, the case was relevant to a rare clinical presentation of MBD with cortical involvement which was associated with poor prognosis. The patients' consciousness level generally decrease and progress to confusion and even to death. MBD has some characteristic features in the brain such as acute edema and necrosis of corpus callosum accompanying with subsequent symmetric demyelination [ 1 , 2 ]. When the disease progress, those lesions eventually produce the atrophy of involved structures [ 1 , 2 ].
One recently reported case of MBD presented that other structures of brain can also be affected and the cortical or subcortical lesions of MBD can imply the poor prognosis [ 3 ]. Meanwhile, Wernicke encephalopathy WE is also a neurological disorder caused by thiamine deficiency and mostly affects chronic alcohol abusers. The clinical diagnosis of WE is characterized by clinical triad of ocular signs, ataxia and altered consciousness, but the clinical presentation varies widely.
WE occurs characteristically in the structures around the third ventricle, such as the medial nuclei of the thalamus, the tectal plate, the mamillary bodies and the periaqueductal gray matter [ 4 , 5 ]. Additionally, alcoholic polyneuropathy AP is another rare complication of chronic alcohol abuse [ 6 ].
We believe that this is the first report demonstrating the features of 3 distinct disease entities in the same patient showing the clear evidences by magnetic resonance imaging MRI and nerve conduction studies NCS. A year-old male was hospitalized to neurology department with 6 months history of impaired walking and weakness of upper and lower limbs. He had experienced dysarthria, altered sensorium, decreased consciousness, and ataxia for 2 days prior to the admission.
He had underlying hypertension. Though he had been diagnosed with diabetes mellitus DM 10 years ago, he had not been treated by medications or injections. He had no history of medical consulting for the symptoms of DM complications. He smoked a pack of cigarettes a day for 25 years. The latest alcohol consumption was reported to be 7 days before the admission. Three years ago, he had admitted to our hospital with complaints of altered mentality and ataxia of both lower limbs.
He was treated with thiamine on the suspicion of WE on the basis of the clinical features and the brain imaging findings. At that time, he refused further hospitalization and discharged to home. Since then, follow-up was loss. His family reported that impaired walking and weakness of upper and lower limbs were getting worsen gradually after that event. Eventually he could not be sitting or lying down for last 6 months.
Since then, he didn't eat food and only drank the alcohol. He abruptly stopped drinking the alcohol 7 days ago from this admission. Click for larger image Download as PowerPoint slide. On the admission day, he was consulted to our department for early rehabilitation. He was in drowsy mentality, and showed disoriented features in time and place.
Psychiatric evaluation showed ideomotor apraxia presented as involuntary movements and uncontrolled motor functions, which were characteristically associated with the lesion involving the corpus callosum. Spontaneous speech was seldom observed and the speech was slurred and incomprehensible. All these signs and symptoms indicated the hemispheric disconnection. Muscle strength was generally 3 grade in the both upper limbs and 1 to 2 grade in both lower limbs by manual muscle test.
The muscle strength of bilateral ankle dorsiflexion was especially low as 1 grade. Atrophy of both lower limb muscles was generally observed. Nevertheless, it is utmost important to remember the time schedule of rehabilitation therapies in these patients and not to rush active therapies at the initial stages which can aggravate bleeding and thrombotic complications.
The possibility of thrombotic complications should not be ruled out in ITP patients, and continuous neurologic examination should be planned in order to diagnose cerebral infarctions at an early stage.
Moreover, post-stroke rehabilitative therapies must be carried out at an early stage, but with a strict time schedule of escalation to gain maximal functional level improvement and to avoid complications at the same time. Thus, both bleeding tendencies and thrombotic complications presents a great challenge, and the rehabilitative treatment should be individualized on a case-by-case basis.
Conflict of Interest: The authors have no potential conflicts of interest to disclose. Case Report Open Access. Brain Neurorehabil. Published online Mar 18, Correspondence to Hyoung Seop Kim. Email: rehappydoc gmail. Go to:. Recurrent ischemic stroke in a patient with idiopathic thrombocytopenic purpura.
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Eur J Haematol ;— Kohli R, Chaturvedi S. Epidemiology and clinical manifestations of immune thrombocytopenia. Hamostaseologie ;— Antiphospholipid antibodies and antiphospholipid syndrome in patients presenting with immune thrombocytopenic purpura: a prospective cohort study. Blood ;— Int J Stroke ;— Clinical practice guideline for stroke rehabilitation in Korea Brain Neurorehabil ;e Cerebral infarction in idiopathic thrombocytopenic purpura: a case report.
BMJ Case Rep ;bcr A patient with idiopathic thrombocytopenic purpura presenting with an acute ischemic stroke.
J Stroke Cerebrovasc Dis ;— Ischemic stroke in the setting of chronic immune thrombocytopenia in an elderly patient--a therapeutic dilemma. Hint: Click on the tab below to simply browse between the application actions, to quickly get a list of recommended software, which is able to perform the specified software action, such as opening, editing or converting bnr files.
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These MPI implementations monitoring, and control functions provided by an underly- are designed to operate on multiple computers, perhaps ing process management system. While these pack- which we call BNR. The major goals of the BNR interface ages have many differences, they also contain strong points are: of commonality in that they must all deal with hetero- geneous communication protocols, security mechanisms, 1.
For example, work on MPICH-G2 as information that allows dynamic, on demand, estab- at Argonne National Laboratory and Northern Illinois Uni- lishment of communication links between processes; versity has focused in particular on process management is- and sues, using Globus services [7] to achieve single sign-on, co-allocation, startup, monitoring, and process management 3.
We believe that these face, which in turn allow scalable initialization and op- capabilities are of general value. But, because these fea- erations of parallel jobs.
MetaMPI, they cannot take advantage of Globus services. What makes the posium on High Performance Distributed Computing, pages interface abstract is that there are no reserved keys. Parallel database access requires some sort of synchro- [5] G.
Fagg, K. London, and J. Applicants will be able to download it. Save my name, email, and website in this browser for the next time I comment.
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