Biomedical subjects
Publications and source records attributed to B D Snyder.
A young woman south medical care for headache, nausea, and evolving focal neurologic signs. The CSF was normal; cerebral angiography showed segmental narrowing and irregularity of intraparenchymal arterioles. Isolated cerebral vasculitis was the clinical diagnosis made by careful exclusion; the illness reponded well to steroids and there was later angiographic evidence of healing.
Operating room personnel were studied for evidence of acute reversible or chronic cumulative cognitive dysfunction as measured by psychometric testing. In comparison with matched controls, no acute reversible deficits were noted in a relatively unpolluted operating room environment. There were only 2 marginally significant test differences between the control and operating room groups; however, control subjects did better than operating room personnel on 16 of 18 tests at both the beginning and end of the work week. Analyses of the deficit patterns and correlations with years of operating room exposure only weakly support the hypothesis that the test differences are due to toxic exposure.
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On the basis of his experience as an examiner, the author discusses the problems encountered in assessing psychiatrists' abilities in clinical neurology for certification by the American Board of Psychiatry and Neurology. Hoping to stimulate discussion among trainees, training programs, and the Board, he outlines five paradigms designed to survey neurological knowledge and skill potentially needed by psychiatrists in various situations; these are reduced to specific topics on which Board candidates should be questioned. Relationships between training and examination expectations are discussed.
A retrospective survey of survivors of cardiorespiratory arrest included 34 patients. Twenty-one had a good outcome neurologically and 13 were seriously impaired. Depth and duration of postarrest coma correlated significantly with poor neurologic function. Seventy percent of the seriously impaired patients never regained consciousness and none emerged from coma within 5 days; 90 percent of patients with good outcome were alert within 18 hours after resuscitation. Coma motor unresponsiveness, absent pupillary light reflexes, and absent oculocephalic responses were closely associated with dismal prognosis for neurologic functioning. This retrospective study cannot provide a basis for discontinuation of life support at any specific time.
Transverse cervical myelopathy, at C-6 level, followed injection of Renografin-60 into the right thyrocervical trunk during cerebral angiography. Review of the literature yielded only two cases in which attempted posterior fossa angiography resulted in cervical myelopathy. Two more cases were found. In one, cervical myelopathy occurred during aortography in a patient with coractation of the aorta, and in the other it followed mediastinal angiography. Summation of anoxia, hemorrhage, and cellular toxicity is responsible for spinal cord necrosis following arterial injection of contrast material.
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With attentive medical management, the elderly demented patient can live in greater comfort, dignity and independence. Errors in supervision can result in a drug intoxication, misdiagnoses, and personal neglect. Many of the elderly have a chronic dementing illness, and disability often is accelerated by complications. However, some of these complications are treatable. Case histories are presented to illustrate pitfalls in the care of such patients.
A healthy woman had two episodes of transient, complete respiratory arrest without preceding neurologic abnormalities. Following the second episode, she lapsed into coma and autopsy disclosed a thrombosed basilar artery aneurysm. Primary respiratory arrest is a rare condition but should prompt extensive and immediate neurologic evaluation.
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To corroborate thiopental protection from cerebral anoxia after cardiopulmonary arrest, 23 sedated, curarized, adult dogs were asphyxiated by plugging the endotracheal tube. Cardiopulmonary resuscitation (CPR) was started 7 minutes after electrocortical silence. Twelve animals received no other treatment (controls), 10 regained consciousness and spontaneous respirations, but remained decerebrate, blind, unable to drink or feed. Two dogs returned to a normal neurologic state. Ten dogs were treated with thiopental after CPR, 7 received 15 mg/kg the first minute, followed by 23 mg/kg over 1 hour; 3 received 60 mg/kg in the first 3 minutes, followed by 30 mg/kg over 1 hour. Except for 1 dog in the low-dose group that recovered neurologically, thiopental-treated dogs showed no neurological or survival improvement over the controls.
To determine the effect of blocking central nervous system (CNS) serotonin reuptake in the outcome of acute cerebral infarction (ACI), 49 patients were studied in a double blind, randomized trial. All patients suffered hemispheric ACI, were seen within 24 hours of onset, and were treated with low dose, subcutaneous heparin to prevent venous thrombosis; 25 received 10 mg. of trazodone hydrochloride intravenously every 12 hours for seven days and 24 were given an identically appearing placebo. To monitor trazodone effect, indol derivatives were measured in spinal fluid collected before and after treatment in 38 patients. Treatment and placebo patients had similar demographic characteristics, comparable risk factors, and neurologic deficit at onset. No appreciable difference was seen between treatment and control patients in regard to intercurrent events, degree of neurologic deficit, time of hospitalization, and mortality. Indol derivatives were consistently higher in the spinal fluid of trazodone patients after treatment, confirming serotonin reuptake blockage; however, this seems to have had no beneficial effect on the outcome of ACI.