Objective:To describe the neuropathologic findings and clinical course of 2 patients who underwent temporal lobectomy for medically refractive epilepsy and were later found to have high anti–glutamic acid decarboxylase (GAD) concentrations.Methods:Small case series.Results:Neuropathologic examination of both patients revealed International League Against Epilepsy (ILAE) type 3 hippocampal sclerosis. Following surgery, both developed signs and symptoms of stiff person syndrome and later cerebellar ataxia. Laboratory studies demonstrated high concentrations of anti-GAD antibodies in both patients.Conclusions:These cases suggest that ILAE type 3 hippocampal sclerosis may be immunologically related to and may exist as part of a broader anti-GAD–related neurologic syndrome in some instances.

A 55-year-old woman with lung cancer presented with leg numbness. Her systemic disease was wellcontrolled. MRI was precluded by a metallic cardiac device and spinal CT was unremarkable. On 2 occasions, examination of CSF demonstrated minimally elevated protein, but no abnormal cells. CT myelogram revealed bulky disease and CSF obtained a third time during the procedure confirmed the diagnosis (figure). To detect leptomeningeal carcinomatosis with 90%-98% sensitivity, 3 taps are needed. False-negatives can be minimized by withdrawal of 10.5 mL of CSF and immediate processing. AUTHOR CONTRIBUTIONSDr. Glover worked on manuscript draft, editing, and image editing. Dr. Brook worked in image acquisition, caption drafting, and editing. Dr. Welch worked as senior author and oversaw all drafting and editing. The sagittal images reveal focal masses in the intradural, extramedullary space behind L1 and C6 consistent with metastases from the patient's known lung cancer.

Electromyography demonstrated a pattern of early full recruitment as well as myotonia during the period of acute toxicity. Additionally, solanaceous compounds, in particular solasonine and solanidine, were identified in leftover berries and the patient's serum. Store-bought commercial berries and subsequent serum samples were free of such toxic compounds. EMG studies, together with a laboratory analysis of berries or serum can assist in the differential diagnosis of stroke, and provide both a prognostic screening and confirmation of suspected glycoside toxicity.