Cinnarizine and flunarizine are selective calcium blockers that have been used to treat and prevent vertigo. We studied 15 patients who had extrapyramidal syndromes after taking these drugs. Eleven patients had parkinsonism, one with persistent akathisia as well; one had an orofacial tremor; one, acute akathisia alone; and one an acute dystonic reaction. All but one improved when the drug therapy was discontinued. Seven patients were also depressed during treatment. Cinnarizine and flunarizine must therefore be added to the list of potentially risky drugs known to induce extrapyramidal reactions and depression.

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The objective of the study was to assess the cost of multiple sclerosis (MS) patients in Argentina categorized by disease severity using a societal perspective. Method: Cross-sectional study including MS patients from 21 MS centers in 12 cities of Argentina. Patients were stratified by disease severity using the expanded disability status scale (EDSS) (group 1 with EDSS score between 0 and 3; group 2 with EDSS .3 and ,7; group 3 with EDSS $7). Direct and indirect costs were analyzed for the second quarter of 2012 from public sources and converted to US Dollars. Results: 266 patients were included. Mean annual cost per MS patient was USD 36,025 (95%CI 31,985-38,068) forts patients with an EDSS between 0-3; USD 40,705 (95%CI 37,300) for patients with EDSS .3 and ,7, and USD 50,712 (95%CI 47,825-62,104) for patients with EDSS $7. Conclusions: This is the first Argentine study evaluating the costs of MS considering disease severity.Keywords: multiple sclerosis, costs, cost-of-illness, Argentina, Latin America. RESUMOEl objetivo del estudio fue evaluar el costo de los pacientes con esclerosis múltiple (EM) en Argentina categorizados por severidad de la enfermedad. Método: Estudio de corte transversal que incluyó pacientes con EM en 12 ciudades de Argentina. Los pacientes se estratificaron según expanded disability status scale (EDSS) (grupo 1 EDSS entre 0 y 3; grupo 2 EDDS .3 y ,7; grupo 3 EDSS $7). Los costos directos e indirectos fueron analizados para el segundo trimestre de 2012 y convertidos a dólares estadounidenses. Resultados: 266 pacientes fueron incluidos. El coste medio anual por paciente con EM fue de USD 36,025 (31,985-38,068 IC95%) para los pacientes con un EDSS entre 0-3; USD 40,705 (37,,300 IC95%) para los pacientes con EDSS .3 y ,7 y USD 50,712 (47,825-62,104 IC95%) para los pacientes con EDSS $7. Conclusiones: Primer estudio argentino evaluar los costes de la EM considerado la gravedad de la enfermedad.Palavras-chave: esclerosis múltiple, costos, enfermedad, Argentina, Latino-América.

Over the last few years, cases of movement disorders induced by flunarizine and cinnarizine have been increasingly reported. We describe a series of 101 patients, whose ages ranged from 37 to 84 years (mean 69.1), developing abnormal movements frequently associated with depression, secondary to treatment with either or both drugs. Symptoms closely resembled those induced by neuroleptic drugs and remitted on drug discontinuance in all but five cases after 5-22 months' follow-up. Whether or not such undesirable side effects are attributable to calcium antagonism and/or dopamine receptor blockade, long-term treatment with flunarizine or cinnarizine should be discouraged, particularly in the elderly.

We describe a patient who developed bilateral cavernous sinus septic thrombosis secondary to a suppurative lesion on the left cheek. Despite clinical improvement, left oculomotor symptoms recurred suddenly. A carotid artery aneurysm within the cavernous sinus was diagnosed by means of magnetic resonance imaging and confirmed by digital angiography. Follow-up angiograms showed an initial decrease in the aneurysm size, with subsequent enlargement. A latex contrast-filled balloon was successfully placed within the aneurysm, preserving the carotid parent artery blood flow. Our case illustrates the usefulness of the detachable balloon technique in the treatment of bacterial aneurysms of the cavernous sinus as an alternative treatment to carotid artery ligation. (Stroke 1989;20:1751-1754

A 48-year-old man with a long-standing history of communicating hydrocephalus is reported. Ventriculoperitoneal shunting led to clinical improvement, but symptoms recurred despite surgical re-exploration switching the shunt to an atrial drainage. Ten months after the last surgical procedure, an acute myelopathy developed. Concomitant pharyngeal granuloma examination identified Histoplasma capsulatum (Hc) yeasts. Despite initial response to amphotericin B, Hc was isolated from cerebrospinal fluid (CSF), valve reservoir and distal catheter after two courses of therapy. Fluconazole successfully sterilized CSF, but transverse myelopathy persisted unchanged, and shunting was needed to control hydrocephalus.

To our knowledge, no case of sporadic or secondary paroxysmal dystonic choreoathetosis (PDC) with an abnormal computed tomographic (CT) scan has been reported. Here we describe a case of sporadic PDC with bilateral basal ganglia calcifications demonstrated by CT scan.A 41-year-old right-handed woman, with no family history of PDC, had her first generalized tonic-clonic seizure at the age of 11 years. Thereafter she was treated with phenobarbital (200 mg per day) and was free of attacks for the next 20 years. Four years ago, she first experienced paroxysmal muscle spasms in the right arm, followed by dystonic flexion of the arm and wrist, finger clenching, and extension of the leg with inversion of the foot. Spasms are mostly dystonic in nature and are preceded by a feeling of tightness in the arm. They are not painful but severely impair gait. Sometimes choreoathetosis is also present. The attacks usually involve the right side, but occasionally they appear on the left. They occur one to four times per month and last between 10 minutes and 4 hours. The dystonic episodes occur at any time and are not precipitated by stress, movements, exercise, cold, fatigue, or consumption of coffee, tea, or alcohol.Neurological and general physical examination findings were normal, and she had no intellectual impairment. Routine laboratory values, including serum calcium, phosphorus, and alkaline phosphatase, were normal. The electroencephalogram during and between attacks showed no abnormalities. A C T scan showed bilateral and symmetrical calcifications of the globus pallidus (Figure). The patient was treated with clonazepam (2 mg per day), with dramatic improvement. However, 5 months later, the 'symptoms recurred and were only partially relieved by increasing the dosage of clonazepam. She also experienced dysarthria during the last spells. During the first month on clonazepam, a Computed tomographic scan showing bilateral calcijication of the globus pallidus.single-blind crossover with placebo for 20 days resulted in attacks occurring with twice the frequency as before treatment.The main differences between our patient and cases of familial PDC are the age of onset, absence of family history, and bilateral calcification of the globus pallidus, a previously undescribed association. Although a random association between PDC and basal ganglia calcification cannot be excluded, we would like to suggest the possibility that these calcifications could have been caused by the anticonvulsant therapy, and in turn the calcifications could have led to dysfunction of the basal ganglia, as manifested by this rare movement disorder.Recent reports suggest that the anatomical basis of symptomatic dystonia are putaminal lesions [l] and lesions of the thalamus or striaturn 121, which reach the thalamus by way of the globus pallidus [ 3 ] . We believe our patient represents the first reported case of sporadic PDC with an abnormal CT scan, and further indicates that paroxysmal dyskinesias are a basal ganglia disorder. ~ ~~The authors gratefully ...

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