Morvan syndrome (MoS) is typically characterized by neuromyotonia, sleep dysfunction, dysautonomia, and cognitive dysfunction. However, MoS patients with mild peripheral nerve hyperexcitability (PNH) or encephalopathy features have been described. A 46-year-old woman presented with a 2-month history of constipation, hyperhidrosis, and insomnia. Neurologic examination revealed muscle twitching and needle electromyography showed myokymic discharges in all limbs. No clinical or electrophysiological features of neuromyotonia were present. Although the patient denied any cognitive symptoms, neuropsychological assessment revealed executive dysfunction, while other cognitive domains were preserved. Cranial and spinal MRIs were unrevealing and tumor investigation proved negative. Polysomnography examination revealed total insomnia, which was partially reversed upon immune-modulatory therapy. Investigation of a broad panel of antibodies revealed serum leucine-rich glioma inactivated protein 1 and contactin-associated protein 2 antibodies. The features of this case indicate that the presentation of PNH syndromes may show significant variability and that MoS patients may not necessarily exhibit full-scale PNH and encephalopathy symptoms.
Synthetic cannabinoids (SCBs) may cause central nervous system side effects associated with neurological and psychiatric findings. We described a patient with SCBs abuse who presented with confusion. Magnetic Resonance Imaging (MRI) of the brain showed periventricular and subcortical white matter and basal ganglia hyperintensities at T2 and fluid-attenuated inversion recovery sequence with partial rim contrast enhancement on T1-weighted MRI with gadolinium. The patient was treated with high dose methylprednisolone. SCBs can cause serious neurological and psychiatric symptoms. Due to lack of knowledge about these drugs, neuropsychiatric morbidity and mortality are not fully understood.
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