Neuromyotonia is a neuromuscular hyperexitability disorder characterized by muscle stiffness caused by continuous muscle fiber activity. It is an immune mediated disorder with elevated antibody level against presynaptic, voltage gated potassium channels, either as isolation or as a paraneoplastic process. Symptoms usually include muscle twitching during rest (myokymia), cramps, peudomyotonia (delayed relaxation), increased sweating, and sometimes motor weakness. In this case report, we present a seventy two year old man who presented with pain in both thighs for one month. It gradually became worse to involve feet and chest. His brain CT scan showed features of brain atrophy. EMG showed fasciculation along neuromyotonic discharges with characteristic wave in frequency and amplitude typical of Isaacs syndrome. Potassium channel antibodies were very high. Diagnosis of Isaacs syndrome was made. He was followed up for two months with treatment by three day course of methyl prednisolone followed by oral steroid and methotrexate with much improvement. This is the first case of Isaacs syndrome in Kurdistan.

This case report highlights the role of hyperglycaemia in a dissociative syndrome that may be overlooked by physicians, until it results in significant consequences. Traditionally dissociation is considered as an escape from overwhelming distress with partial or complete loss of control on voluntary actions or alienation of oneself or external world. Possible biological factors implicated in pathogenesis include reduced perfusion in inferior prefrontal and anterior temporal regions in the right hemisphere and abnormal functioning of the Hypothalamo-Pituitary-Adrenal dysfunction, Glutamate/N-Methyl-D-Aspartate (NMDA) receptor, Serotonin (5-HT2a, 5-HT2c), Gama-Amino Butyric Acid (GABA), and Opioid receptors.

Repeated transcranial magnetic stimulation (rTMS) is a non-invasive brain stimulation method that may be preferred as an augmentation strategy for psychiatric patients who may not have responded well enough to psychotropic drugs. In psychoses rTMS may act via changing cortical excitability, connectivity and plasticity. rTMS may induce transcallosal inhibition and antipsychotic drugs may extend the duration of this inhibition. We present a first episode psychosis patient initially unresponsive to antipsychotic treatment, in whom 20 sessions of right 1Hz rTMS augmentation resulted in clinical response and who remained in remission by the 8th month of treatment. We suggest that rTMS is a well-tolerated treatment that may not be reserved only for treatment resistant patients but may also be considered early on in the management of psychiatric disorders.

Specific serotonin reuptake inhibitors have been associated with extrapyramidal dysfunction manifesting as parkinsonism, dystonia, tremor, and akathisia. Here, we describe a old female patient with a diagnosis of moderate depressive episode who developed tremor with sertraline in the absence of concurrent prescription of medications, which have potential action on the dopaminergic system and whose symptoms resolved after the drug was discontinued.

This single-subject study studied the ability of functional magnetic resonance imaging (fMRI) to discern normal visual condition compared to feigned visual loss and induced-refractive blur condition. Under the normal binocular vision condition, activation of the parieto-occipital area reflected normal patterns of blood oxygenation level-dependent (BOLD) signals in the visual pathway. During the feigned/functional visual loss and refractive-induced blur condition, there was hypoactivation in the parieto-occipital visual pathway. This study showed that the subject could strongly influence the fMRI results, thus, further investigation and protocol refinement are needed to maximize the ability of fMRI to reliably serve as a clinical diagnostic tool in individual functional patients.

In this case we report the efficacy of repetitive transcranial magnetic stimulation for treatment resistant auditory verbal hallucinations. The majority of protocols have utilized low-frequency suppressive repetitive transcranial magnetic stimulation over the left temporoparietal cortex with some therapeutic benefits in ameliorating auditory hallucinations. Normalizing the functional connectivity between the temporoparietal and frontal brain regions may underlie the therapeutic effect of repetitive transcranial magnetic stimulation on auditory hallucinations in schizophrenia. Regarding side effects, the rTMS intervention was well tolerated in this case. Future research must focus on the optimum stimulation site and parameters.

The present study focuses on describing characteristics of swallow among Huntingtons Disease (HD) with Chorea before and after dysphagia therapy. 3 female siblings of 21, 22 and 33 years having juvenile type onset of HD with chorea were included. The patients were evaluated comprehensively for swallowing using Manipal Manual for Swallowing Assessment. Each patient was subjected to ingestion of solid, thin liquid and thick liquid of 5ml and 10 ml quantified using a standard measurable cup. Descriptive statistics was administered on the data using statistical package SPSS (Version 17). On observation, all 3 patients presented with sensory and motor issues in addition to posture instability with abrupt body movements, food spillage, piece meal deglutition, intra bolus retention, wet voice and cough. Following which cognitive approach and behavioural approach based intervention was initiated. The symptoms of intra bolus retention and cough decreased post therapy with no change in sensory aspects. The present study evidences three female siblings with severe cognitive deficits and dysphagia secondary to HD. Despite rehabilitation being provided, they could not completely waiver off the symptoms. These evidences highlight the importance of identifying and addressing swallow based treatment outcomes in HD with chorea.

Progressive nonfluent aphasia is a slowly progressive degenerative disease characterized by atrophy in left hemisphere particularly frontotemporal. It is one of three subtypes of frontotemporal lobar degeneration (frontotemporal dementia). Unlike Alzheimer’s disease it begins between 45-65 years of age and occurs equally in both sexes usually. The reported youngest case was 21 years old. Atrophy is seen in the left hemisphere more in temporal lobe on magnetic resonance imaging. Approximately half of the cases have family history. In early it might confuse with depression and therefore diagnosis may be delayed. Brain magnetic resonance imaging is important for verification of diagnosis. In this paper, a case who early onset progressive nonfluent aphasia was mentioned.

In this report, we present a 51 year old postmenopausal woman with clinical presentation of “delusional disorder-somatic type” and also facial hirsutism and subclinical hypothyroidism. Blood tests revealed thyroid gland dysfunction with high TSH and anti-TPO levels but other blood tests and radiological investments were found to be normal. The relationship between thyroid dysfunction, hirsutism and psychosis is discussed in the context of this particular case. In presence of limited case reports in literature indicating a relationship with subclinical hypothyroidism and psychotic symptoms, we think that our case is important for reminding clinicians to consider endocrine disorders providing a basis for psychiatric disorders and to investigate thyroid function deficiency not only in patients with depression but with other psychiatric presentations like psychosis.

Galactorrhea is defined as non-puerperal lactation and frequently occurs as an adverse drug reaction due to typical antipsychotics. Furthermore, antidepressants, especially SSRIs, cause galactorrhea since the introduction of imipramine to psychiatry practice. Although galactorrhea usually accompanies increased prolactin levels, in some cases prolactin levels could be within the normal range. To date there are two case reports of normoprolactinemic galactorrhea due to sertraline and here we report a patient who developed normoprolactinemic galactorrhea 1 month after initiating sertraline 50 mg/day.