A case of reversible Mobitz type II atrioventricular block after the use of injectable antipsychotics

Although Mobitz type II atrioventricular block is an arrhythmia based on a permanent organic disorder of the His-Purkinje system, reversible factors should be considered. Here, we report the association between a rare reversible Mobitz type II atrioventricular block and antipsychotic medication in a 75-year-old patient with schizophrenia.

Opinions and clinical practice of functional movement disorders: a nationwide survey of clinicians in China

Background There is rare reports about opinions and clinical practice of functional movement disorders (FMD) in China. The present survey aimed to investigate the views of FMD in Chinese clinicians. Methods The Chinese version survey of FMD were conducted in nationwide practitioners by means of an online questionnaire. Results Four hundred and thirty-four Chinese clinicians completed a 21-item questionnaire probing diagnostic and management issues in FMD. More than 80% of respondents considered that atypical movement disorder, multiple somatizations, and emotional disturbance were essential or absolutely necessary for clinically definite diagnosis of FMD. About three quarters of respondents requested standard neurological investigations to rule out organic causes. Over half believed that prior diagnosis of an organic disorder (59.9%), lack of associated non-physiologic deficits (51.8%), and evidence of physical injury (50.0%) were ‘very influential’ or ‘extremely influential’ for a non-FMD diagnosis. The majority (77.4%) of the respondents may refer patients to a neuropsychiatrist or psychiatrist experienced in FMD, followed by psychologist or psychotherapist experienced in FMD (53.2%). However, lack of guidelines, physician knowledge, and training often limited clinicians’ ability in managing patients with FMD. Early diagnosis of FMD, identification and management of concurrent psychiatric disorder, and acceptance of the diagnosis by the patient were considered most important for predicting a favorable prognosis. Conclusions Opinions and clinical practice of Chinese practitioners not only varied among Chinese neurologists, but also differed from international peers. Combined efforts are needed to promote related research and establish practice guidelines in China in the future.

HYSTERICAL BELCHING AND HYPERVENTILATION: A RARE CASE REPORT

Hysteria can present as similar to medical and organic disorder . Conversion symptoms may usually appear due to various stressors and emotional conicts in the individual. The bodily sensations or functions can be inuenced by a disorder of mind. Psychogenic origin of Belching is not unheard of and can be a part of conversion disorder, even though rare. Hyperventilation can occur due to psychogenic aetiology as a manifestation of somatisation and conversion disorders.

Orthostatic Headache in Children Including Postural Tachycardia Syndrome and Orthostatic Hypotension: A Near-Infrared Spectroscopy Study

Background and aim: Although head and/or neck pain attributed to orthostatic hypotension is included in international guidelines, its mechanisms and relevance remain unknown. This study examined the term’s relevance and aimed to elucidate the associated clinical features. Methods: An active stand test was performed to evaluate fluctuations in systemic and cerebral circulation in children and adolescents reporting complaints in the absence of a confirmed organic disorder. The subjects were categorized based on orthostatic headache presence/absence, and their characteristics and test results were compared. Results: Postural tachycardia syndrome was observed in 50.0% of children with, and 55.1% without, orthostatic headache. For orthostatic hypotension, the respective values were 31.3% and 30.6%. A history of migraine was more prevalent in children with orthostatic headaches (64.1% vs. 28.6%; p < 0.01). The observed decrease in the cerebral oxygenated hemoglobin level was larger in children with orthostatic headaches (Left: 6.3 (3.2–9.4) vs. 4.1 (0.8–6.1); p < 0.01, Right: 5.3 (3.1–8.6) vs. 4.0 (0.8–5.9); p < 0.01). Conclusion: Fluctuations in cerebral blood flow were associated with orthostatic headaches in children, suggesting that the headaches are due to impaired intracranial homeostasis. As orthostatic headache can have multiple causes, the term “head and/or neck pain attributed to orthostatic (postural) hypotension” should be replaced with a more inclusive term.

Primary or secondary chronic functional dizziness: does it make a difference? A DizzyReg study in 356 patients

In 2017, the term “persistent postural-perceptual dizziness” (PPPD) was coined by the Bárány Society, which provided explicit criteria for diagnosis of functional vertigo and dizziness disorders. PPPD can originate secondarily after an organic disorder (s-PPPD) or primarily on its own, in the absence of somatic triggers (p-PPPD). The aim of this database-driven study in 356 patients from a tertiary vertigo center was to describe typical demographic and clinical features in p-PPPD and s-PPPD patients. Patients underwent detailed vestibular testing with neurological and neuro-orthoptic examinations, video-oculography during water caloric stimulation, video head-impulse test, assessment of the subjective visual vertical, and static posturography. All patients answered standardized questionnaires (Dizziness Handicap Inventory, DHI; Vestibular Activities and Participation, VAP; and Euro-Qol-5D-3L). One hundred and ninety-five patients (55%) were categorized as p-PPPD and 162 (45%) as s-PPPD, with female gender slightly predominating (♀:♂ = 56%:44%), particularly in the s-PPPD subgroup (64%). The most common somatic triggers for s-PPPD were benign paroxysmal positional vertigo (27%), and vestibular migraine (24%). Overall, p-PPPD patients were younger than s-PPPD patients (44 vs. 48 years) and showed a bimodal age distribution with an additional early peak in young adults (about 30 years of age) beside a common peak at the age of 50–55. The most sensitive diagnostic tool was posturography, revealing a phobic sway pattern in 50% of cases. s-PPPD patients showed higher handicap and functional impairment in DHI (47 vs. 42) and VAP (9.7 vs. 8.9). There was no difference between both groups in EQ-5D-3L. In p-PPPD, anxiety (20% vs. 10%) and depressive disorders (25% vs. 9%) were more frequent. This retrospective study in a large cohort showed relevant differences between p- and s-PPPD patients in terms of demographic and clinical features, thereby underlining the need for careful syndrome subdivision for further prospective studies.

Pediatric Erosive Gastritis: A Case Report

Dyspepsia is a common gastrointestinal disorder which needs diagnostic examination test using endoscopy. Pediatric erosive gastritis, the case presented, is one of the diagnosis confirmed after endoscopy examination test which is mostly associated with Helicobacter pylori infection. A 10-year-old boy was presented to emergency department complaining cyclic vomiting, heartburn and constipation. Further inquiry revealed that similar progressive condition was also complained one year ago prompting endoscopy examination test to find out the underlying etiology. Erosive gastritis and Gastroesophageal Reflux Disease (GERD) were confirmed after examination. Investigation of Helicobacter pylori infection with fecal examination test was impossible due to constipation. Erosive gastritis is a gastric mucous inflammation commonly caused by Helicobacter pylori infection. The clinical manifestation of gastritis tends to be asymptomatic until a pathological component is found. Any pathology suspicion of the gastric lining may require further endoscopy examination test. The therapy of paediatric erosive gastritis includes Proton Pump Inhibitor (PPI), sucralfate sucralfate as also lifestyle modification could improve children’s condition. In conclusion, paediatric erosive gastritis is an organic disorder of gastric lining treated by Proton Pump Inhibitor (PPI), sucralfate and symptomatic agents for associated symptoms. Helicobacter pylori is often associated with erosive gastritis so that further examination is needed.

Reanalysis of the patients who were diagnosed with hystero-epilepsy by Charcot

Background: The term “hysteria” is now recognized to refer to non-organic and functional disorders. Jean-Martin Charcot once attempted to identify the lesions responsible for hysteria as an organic disorder in his later years, but his effort failed. He classified hysteria as usual and grand. Grand hysteria was also called hystero-epilepsy, which became obsolete after Charcot’s death and has been an enigma in modern neurology. After anti-NMDA receptor (NMDAR) encephalitis was established in the twenty-first century, a paradigm shift emerged in the interpretation of acute onset of neuropsychiatric symptoms. Patients with anti-NMDAR encephalitis demonstrate a characteristic multistage progression and stereotypical movements, including opisthotonic posture, which are analogous to the staging progressions and ‘ arc de cercle’ observed in Charcot’s hystero-epilepsy. Methods: To elucidate the full picture of Charcot’s hystero-epilepsy, we reviewed the patients presented in “the Tuesday Lessons”.Results: Eleven patients were shown to have hystero-epilepsy by Charcot himself. Of the 11 patients, 4 patients had acute-onset neuropsychiatric symptoms, and 2 patients had a condition that resembled anti-NMDAR encephalitis. Although the clinical courses were similar to those of anti-NMDAR encephalitis, we could not make conclusive diagnoses of anti-NMDAR encephalitis without examinations due to the lack of evidence of teratomas. One patient with alcohol withdrawal syndrome and one patient with chronic pain and morphine withdrawal syndrome were also classified as having hystero-epilepsy by Charcot. The other patients, who manifested chronic courses or varying hypnosis-induced neurological symptoms, could be diagnosed with conversion and dissociative disorders today.Conclusions: Charcot’s hystero-epilepsy has been suspected of being a syndrome encompassing conversion and dissociative disorders, drug withdrawal syndrome, and anti-NMDAR encephalitis-like manifestations. Charcot’s observations combined with the current progress in molecular biology suggest that a common dysfunctional basis exists, such as glutamate/NMDAR system dysfunction, among these conditions.

Recurent Abdominal Pain and Intestinal Parasitosis. Our Results in a one Year Study.

Background: Abdominal pain in children is the most common problem with which the pediatricians faces in their practice. Recurrent abdominal pain is defined as " the presence of at least three episodes of abdominal pain over a period longer than three months and severe enough to affect the activities of the children". Even though it is considered that functional bowel diseases are the most common cause of recurrent abdominal pain several studies have recognized that numerous organic disorder such as intestinal parasitic infections may lead to abdominal pain. Aim: The aim of this study is to observe the prevalence and the type of intestinal parasites in a representative sample of children living in the municipalities of Tetova and Dibra. Materials and methods: Our study was done in a period between January 2018-2019 in the municipalities of Tetova and Dibra. Totally 470 children examined due to recurrent abdominal pain from the pediatrician was subject of this study.Collected stool samples was checked for the presence of intestinal parasites in microbiological laboratories in Tetova and Dibra. Results: 470 children were included in our study. 248 of them were girls and 222 boys with a median age of 8.2 years. 67 of the children were positive (14.25 %) for intestinal parasites. Conclusions: Our study reveals that intestinal parasites were frequent among children in our country. The incidence of intestinal parasitosis is higher among the children who come from families with lower socioeconomic status compared to children who come from families with good conditions. The same situation is related to education, respectively children of educated parents are least vulnerable to intestinal parasitosis.