False-Positive Serum Botulism Bioassay in Miller-Fisher Syndrome.

We describe a patient with acute progressive weakness and areflexia. Both botulism and Miller-Fisher variant of Guillain-Barré syndrome were initial diagnostic considerations, and she was treated with intravenous immunoglobulin and botulinum antitoxin. A mouse bioassay was positive for botulinum toxin A, although her clinical course, electrodiagnostic studies, and cerebrospinal fluid findings supported Miller-Fisher syndrome.

Association between out-of-hospital emergency department transfer and poor hospital outcome in critically ill stroke patients.

Introduction: Transfer of critically ill patients from outside emergency department has the potential for delaying the admission to the intensive care unit. We sought to determine the effect of outside emergency department transfer on hospital outcomes in critically ill patients with stroke.

Methods: We designed a retrospective cohort analysis using a prospectively compiled and maintained registry (Cerner Project IMPACT).

Acute treatment of hypertensive intracerebral hemorrhage.

Hypertensive intracerebral hemorrhage remains an entity in search of definitive treatment. It requires management in a specialized unit, where hypertension, hyperglycemia, seizures, and elevated intracranial pressure can be expertly managed. However, the exact target range of hypertensive therapy is uncertain.

Acute syphilitic meningitis in a man with seropositivity for human immunodeficiency virus infection and normal numbers of CD4 T lymphocytes.

Coinfection with the human immunodeficiency virus (HIV) and Treponema pallidum may predispose to accelerated neurosyphilis. The mechanism underlying this interaction is undefined, but usually presumed to result from HIV-induced suppression of cell-mediated immunity as reflected in the CD4 T-lymphocyte count. We report a patient infected with HIV who developed aggressive neurosyphilis despite a CD4 count of 1000/mm3.