Biomedical subjects

S J Howell

Publications and source records attributed to S J Howell.

10 recordsLinked to original sources

PubMed1992

Acute bilateral ballism in a patient with intravascular dissemination of gastric carcinoma.

An 84-year-old woman presented with an acute onset of violent bilateral ballism-chorea. She was admitted to the local neurology unit, but not definite diagnosis could be made of the underlying condition, although she did appear to have bronchopneumonia. At autopsy the stomach wall was thickened, and the lesser curve lymph nodes were firm and enlarged. A single nodule was noted in the liver while the lungs appeared consolidated. Histology revealed a moderate-to-poorly differentiated gastric adenocarcinoma with extensive intravascular dissemination which included the central nervous system (CNS). Numerous small infarcts related to vessels occluded by tumour were present throughout the brain, and we feel that this was the underlying mechanism for the acute onset of ballism.

Adenocarcinoma↗

PubMed1989

Profiles of instant heart rate during partial seizures.

Instant heart rate (R-R intervals) can be readily studied during spontaneous seizures recorded with ambulatory cassette AEEG/AECG techniques. Ninety-three seizures were recorded in 32 patients with complex partial epilepsy. Instant R-R interval plots showed that 74% of seizures were associated with a dominant tachycardia, the most characteristic features of which were the initial steep acceleration phase at seizure onset and the wide fluctuations in heart rate ('exaggerated sinus arrhythmia') which occurred during and immediately after the seizure. Five percent of seizures were associated with a dominant but transient phase of heart rate slowing during or towards the end of the seizure. Nineteen percent of seizures showed equivocal or negative ictal effects on the heart rate and rhythm despite unequivocal AEEG seizure discharges. Conversely, other patients had characteristic heart rate changes despite equivocal AEEG abnormality. The heart rate profiles showed striking seizure-to-seizure similarities when multiple fits were recorded in the same patient. Ratemeter profiles may be clinically useful to locate epileptic seizures in long duration records; they can help to locate seizures which are either inaccurately timed or poorly identified by the event marker, or not clearly associated with definite AEEG changes. The secondary cardiac effects of epilepsy may be misdiagnosed if their primary cerebral origin is not suspected.

Adult↗

PubMed1989

Cardiac asystole associated with epileptic seizures: a case report with simultaneous EEG and ECG.

Cardiac arrhythmias occurring in association with epileptic seizures are a potential source of diagnostic confusion and a possible cause of sudden unexpected death in epilepsy. A case is described in which simultaneous ambulatory electroencephalography and electrocardiography revealed periods of asystole coinciding with epileptic seizures. The aystole appeared to precede obvious changes in the scalp recorded electroencephalogram (EEG), but clinical attacks and EEG seizure activity were not altered by pacemaker correction of the cardiac arrhythmias.

Arrhythmias, Cardiac↗

PubMed1989

Ictus emeticus.

Explore the source record for details and available documents.

Adult↗

PubMed1989

Pseudostatus epilepticus.

Thirteen patients with pseudostatus (simulated status epilepticus) have been compared to 13 patients with true status epilepticus seen at a regional neurological centre. Pseudostatus was common in patients with pseudoseizures and was often misdiagnosed as status epilepticus. Complications of this misdiagnosis included eight episodes of anticonvulsant-induced respiratory arrest. Patients with pseudostatus commonly had multiple episodes of 'status'. They usually also had a history of other unexplained illness and of deliberate self-poisoning. Management of these patients was difficult and emphasizes the need for specialist expertise for patients with epilepsy and apparent epilepsy.

Adolescent↗

PubMed1988