Search

Methadone is a long-acting opioid medication used for maintenance therapy in heroin addiction. Presenting a case of a patient on methadone therapy who developed neurological complications as mental status changes and choreiform movements. Workup revealed lesions involving the subcortical white matter and basal ganglia. and movements improved with treatment.

Tremors have been well-described in association with monoclonal gammopathy. We report a case of a patient with asymmetric hands tremor who responded well to levodopa-carbidopa treatment. Further workup showed an underlying gammopathy. To our knowledge, this is one of the rarest case reports of successful treatment of gammopathy-related tremors with levodopa-carbidopa. The patient was a 75-year-old male who presented to the neurology clinic for a one-year history of worsening tremors in bilateral upper extremities. A review of systems was only remarkable for mild numbness and tingling in his feet. His neurological examination was remarkable for asymmetric right more than left (R > L) resting and kinetic tremor in both upper extremities associated with mild rigidity and bradykinesia in right upper extremity and decreased bilateral ankle jerks. With the primary diagnosis of Parkinson’s disease, he was started on levodopa-carbidopa and a neuropathy workup was requested. His follow-up visit after three months was remarkable for significant improvement of his tremors with carbidopa-levodopa. However, his blood work was consistent with a significant increase in lambda light chain levels and the presence of an M spike in serum protein electrophoresis. Based on the presentation and clinical workup, he was finally found to have both multiple myeloma and ​Waldenstrom’s macroglobulinemia. Underlying malignancy was treated with chemotherapy and immunotherapy. Levodopa-carbidopa was discontinued after three months of chemotherapy and his tremor did not recur in one year of follow-up. Gammopathy is one of the well-known causes of tremors in the adult population. It can cause both resting and kinetic tremors in the upper extremities. It is supposed that peripheral neuropathy associated with gammopathy is the main underlying cause of tremors in these groups of patients. However, central causes are also suggested. In this case, we are led to conclude that our patient’s tremor was centrally mediated since it responded well to dopamine replacement therapy. However, further study is needed to elucidate the role of dopamine depletion in the pathogenesis of tremors associated with gammopathies.

Being one of the widespread parasitic infections in particular parts of the United States, babesiosis may present with varying severity of clinical manifestations. Depending on the severity and degree of hemolysis, some patients may need a more aggressive approach, such as repeated red blood cell (RBC) transfusions, while in others, symptoms may be well-controlled with conservative therapy only using a disease-specific approach. We are presenting two cases with a significant difference in severity and medical therapy.

Acute colonic pseudo-obstruction (Ogilvie’s syndrome) is a rare disorder associated with spontaneous colonic dilatation with signs and symptoms of mechanical bowel obstruction and dilatation on imaging. We report a 37 year-old female, with three-month history of Caesarian Section at 38th week of pregnancy due to fetal malpresentation. Abdominal CT-scan revealed chronic diffuse colonic distention, 17 cm in diameter. No cause of obstruction could be determined. A diagnosis of Ogilvie’s syndrome was made. The increased size of the colon with leukocytosis warranted urgent colonoscopic decompression. The patient recovered well. If not managed appropriately, Ogilvie’s syndrome can progress to bowel ischemia and perforation with significant morbidity and mortality. The first line of treatment of early disease is conservative management with neostigmine or colonoscopic decompression. Our purpose is to review the diagnosis and management of this potentially lethal rare condition.