phenicol and dexamethasone. The next morning his right upper limb was in a decorticate posture. His breathing was abnormal: there was a long and stertorous expiratory time and the patient tried to help himself by pressing his right hand on his sternum. Neurological examination revealed normal awareness, speech and intellectual function. There was a left central facial weakness and paralysis, hyperreflexia and spasticity of all four limbs. Sensory examination was normal. X-rays of the chest on admission revealed a patchy infiltrate at the base of the right lung. An electroencephalogram (EEG) showed theta-delta dysrhythmia on the right and irregular alpha rhythm on the left. A CT scan and bilateral carotid angiography were normal. Cerebrospinal fluid (CSF) was normal (table 1). Smears and cultures for bacteria, acid-fast bacteria, fungi and viruses were negative, as were cultures of blood, urine and pharyngeal secretions. The patient had a raised mean corpuscular volume due to cold-induced agglutination of the cells in the Coulter counter. As indicated in table 2, when the cold haemagglutinin level decreased, the mean corpuscular volume returned to a normal value. After the second day in hospital the diagnosis of acute disseminated encephalitis secondary to Mycoplasma pneumoniae infection was suspected; the patient was given 200 mg doxycycline daily, and the dexamethasone and chloramphenicol were gradually reduced.
Flumazenil, the first specific benzodiazepine (BZD) antagonist, is one of the most innovative drugs to become available within the last few years. Flumazenil is indicated for the reversal of the centrally depressant effects of BZDs, in BZD-induced anaesthesia, in BZD sedation in intensive care and in patients comatose after drug overdoses including BZDs. A conference of experts experienced in the treatment of mixed drug overdoses by various means, including flumazenil, was held in order to try to reach a consensus regarding the safe use of flumazenil in this indication. From the knowledge and experience gained to date, it was concluded that flumazenil may be useful and safe in the treatment of suspected BZD and mixed drug overdoses, provided that the appropriate precautions are observed.
The authors describe the case of an elderly woman exhibiting the clinical signs of occlusion of the anterior spinal artery at the cervical level. Pathological findings indicate that the material occluding not only this vessel but also the satellite veins is fibrocartilage. The authors review the literature concerning this unusual situation and discuss the mechanism by which the fibrocartilaginous emboli, in their case, are both arterial and venous. Large arteriovenous shunts within and around the spinal cord are likely to explain such a disturbing pathologic finding.
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