Abstract:Having a recent history, the neurological condition called myasthenia gravis has raised dilemmas and questions among doctors since it was first discovered in the 16th century and it has not ceased to be a challenge. Nowadays, neuroscience researchers from around the world have been striving to perfect a modern treatment of this condition. Our paper is an incursion into the past, more precisely into the history of the treatment of this disease, from its origin to date, when immunological therapy has progressed.
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Klippel-Trenaunay-Weber syndrome (KTW syndrome), also known as congenital dysplastic angiopathy or angioosteohypertrophy syndrome, is a rare, sporadic, complex malformation that involves congenital malformations of veins, capillaries, and/or lymphatics, which leads to soft tissue hypertrophy and port-wine stains. We report a case of a 37 year old woman with congenital Klippel Trenaunay Weber syndrome. She had many vascular abnormalities from birth which increased in time such that she had many surgical interventions. These abnormalities of veins and capillaries were leading to hypertrophy of the extremitiesfinger macrosomia. She had orthopedic comorbidities like Chopart amputation of the anterior part of her left foot and dorsal kyphoscoliosis because of the external scars. Studying similar cases from the literature, we found that Klippel-Trenaunay-Weber syndrome could be associated with brain abnormalities. We admitted the patient for additional investigations because some of these patients could have cerebral malformations in the absence of neurologic abnormalities. We considered at that time that it was necessary to look for any unknown vascular abnormality. Management of this syndrome should aim to correct any of the abnormalities present, if technically possible, and if the abnormality is causing symptoms.
Central nervous system (CNS) involvement represents almost 1% of all cases of active tuberculosis. It represents a form with a high level of morbidity and mortality in spite of appropriate treatment. There isn't any agreement regarding the duration of the antituberculous treatment. We report a case related to cerebral tuberculomas and another case related to interactions between antiepileptic drugs and antituberculous treatment. The first case involves cerebral tuberculomas discovered on brain imaging (CT scan, cerebral MRI) and secondary epilepsy. The patient did an antituberculous treatment for pulmonary tuberculosis and tuberculous meningitis for one year, consisting of 4 drugs (HRZE). Six months later, he checked into our clinic with a tonic clonic seizure and we discovered tuberculomas on the cerebral MRI. Shortly thereafter we started the treatment with 5 drugs (HRZES) and anticonvulsants. Five months later the MRI showed multiple enhancing lesions described as "a bunch of grapes", potentially matching multiple tuberculomas. The second case shows the interaction between anticonvulsants and antituberculous drugs in concomitant pulmonary tuberculosis and epilepsy with tonic clonic seizures. We measured the concentration of anticonvulsants in the blood during the antituberculous treatment.
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