Rituximab (RTX) is a monoclonal antibody that targets CD20 on B cells and is used to reduce the relapse risk in neuromyelitis optica spectrum disorder (NMOSD). Some patients experience relapse or exacerbation shortly after RTX treatment. We report a 54-year-old female with seronegative NMOSD who relapsed soon after RTX treatment.

Background: Bell’s palsy (BP) is the most common cause of unilateral lower motor facial palsy. Recurrent paralysis of the facial nerve is unusual and reported in only 7-8%.
Methods: A total of 394 consecutive patients with acute BP patients were enrolled at Daegu Catholic University Hospital from July 2005 to September 2012. We classified the patients into two groups-single BP and recurrent BP-and compared them by patient characteristics, clinical features, MRI findings, electrophysiologic findings and prognosis. The degree of BP was graded according to the House and Brackmann facial nerve grading system.
Results: Recurrent BP was observed in 31 (7.9%) patients. The number of recurrence was varied from 2 to 5. The recurrent BP (9.7%) had more incidence of family history and MRI enhancement than those of single BP (2.2%, p=0.047). The single BP (63.4%) had better recovery than recurrent BP (45.2%, p=0.045).
Conclusions: The recurrent BP had more incidence of family history, MRI enhancement and poor prognosis than the single BP.

Citations

• Characteristics and Treatment Methods of Bell’s Palsy in Patients Visiting Korean Medicine Hospitals From August 2018 to July 2021
  Hyeon Kyu Choi, Min Ju Kim, Young Rok Lee, Hyun Ji Cha, Hyun Jin Jang, So Jeong Kim, Ju Hyun Jeon, Young Il Kim
  Journal of Acupuncture Research.2022; 39(2): 122.     CrossRef
• Correlation of Internal & External Factors with the Beginning Period of Improvement in Idiopathic Facial Paralysis※
  Hee Jin Sung, Su Sie Lim, Hyun Young Choi, Eun Yong Lee, Jung Du Roh, Cham Kyul Lee
  The Acupuncture.2016; 33(1): 57.     CrossRef
• A Clinical Study on Children and Adolescents Who Visited the Hospital of Korean Medicine for 284-Peripheral Facial Palsy
  Ki Yeon Kang, Hye Lim Lee, Jae Kyung Han, Yun Hee Kim
  The Journal of Korean Oriental Pediatrics.2014; 28(4): 45.     CrossRef

Intracranial hypotension is a benign disorder characterized by orthostatic headache. It is caused by CSF leakage, therefore its treatment of choice has been epidural blood patch when initial conservative treatments were not effective. We would like to report a 26-year-old patient with recurrent orthostatic intracranial hypotension in spite of the successful epidural blood patch several times. Her headache was caused by myelography 8 month ago. Cisternography showed a CSF leakage at the level of L1 vertebral body. Headache was resolved completely after epidural blood patch and then recurred 3 times several months after blood patch. Now, she is free from headache for 5 months after last blood patch.

Miller Fisher syndrome (MFS) is a variant of Guillian-Barre syndrome (GBS) characterized by the triad ofophthalmoplegia, ataxia, and areflexia. Although recurrent GBS is a well known entity, the recurrence of MFS is extremely rare. Here we report an unusual case of recurrent MFS. Initially, the patient had presented with ophthalmoplegia, ataxia, areflexia, and tingling sensation of all extremities. After resolution of the first episode, the patient presented with atypical MFS characterized by ataxia, areflexia, and tingling sensation without ophthalmoplegia.