Presentation of Case First admission. A 45-year-old man was admitted to the hospital because of increasing confusion and a lymphocytic pleocytosis.The patient was well until approximately 3 1/2 months earlier, in late February, when he traveled to Texas on a business trip. During his stay he worked in an enclosure where numerous insects were present and was exposed to fumigation in a motel room; there was no available information about the agent used. At some point he began to experience a metallic taste accompanied by anorexia. On returning to his home in the metropolitan Boston area two weeks . . .

Case Records of the Massachusetts General Hospital from The New England Journal of Medicine — Case 50-1991 — A 71-Year-Old Woman with a Sensorimotor Neuropathy and Radiographically Demonstrable Abnormalities

Presentation of CaseA 35-year-old man was admitted to the hospital because of the gradual onset of a change in mental status and left-sided neurologic abnormalities.The patient was well until four or five months earlier, when he began to experience difficulty in finding his way while driving his car over familiar routes. During ensuing months he had increasing problems in carrying out activities that were dependent on previously acquired information and also experienced difficulty in organizing new memories. Two or three weeks before admission he began to have episodes of lightheadedness and became aware of unsteadiness of gait, with . . .

Presentation of CaseA 60-year-old man was admitted to the hospital because of progressive neurologic dysfunction and persistent elevation of the lactic dehydrogenase (LDH) level.The patient was well until 18 days earlier, when he experienced bilateral facial and head pain that was treated with pseudoephedrine and a few tablets of penicillin. The pain persisted, and about two weeks before admission he had diplopia for five minutes.Eight days before entry the patient awoke in the morning with an excruciating right periorbital and frontal headache and was taken to another hospital. General physical examination was reported to be negative, with . . .

The effect of acute administration of small doses of iodide on the activity of the thyroid iodide transport mechanism was studied in intact and hypophysectomized iodine-deficient rats and correlations were sought between alterations in iodide transport and the thyroidal iodinations so induced. When organification of the administered iodide was permitted for 2 hr, values for thyroid/serum iodide concentration ratios (T/S) were depressed significantly below control values. Administration of these same doses of iodide in the presence of PTU-blockade resulted in no change from control values. The demonstration of acute lowering of T/S by iodide in the hypophysectomized rat indicated the autoregulatory nature of the response, which was also shown to be dependent upon organification of some of the administered iodide load. To further assess the relationship between lowering of T/S and the amount and nature of newly formed organic iodine, double isotope experiments were performed so as to permit measurement of organic iodinations and T/S in the same animal. In response to widely varying doses of iodide, T/S values were depressed to a similar extent, despite wide variations in both total iodinations and in the amounts of newly synthesized mono-and diiodotyrosine and iodothyronines induced. Thus, while the acute depression of T/S following iodide administration is clearly dependent in some manner on organification of some of the dose, the extent of the response is not directly dependent upon the newly synthesized quantities of the major products of organic iodinations. (Endocrinology83: 737, 1968)