Coma and the acute confusional state in the emergency room.
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Biomedical subjects
Publications and source records attributed to T D Sabin.
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An arachnoid cyst lying anterior to the cervical cord at level C6-7 was found in a 28-year-old woman believed to have syringomyelia. This diagnosis was based both on previous findings at laminectomy and on computerized tomography. The diagnosis of arachnoid cyst was suspected because of clinical features atypical for classical syringomyelia and a history of arachnoid cysts found during childhood. Air myelography demonstrated an extramedullary intradural mass anteriorly that proved to be an arachnoid cyst. Drainage and subtotal resection resulted in marked clinical improvement. This case illustrates the need for reevaluation when a patient with "known" syringomyelia presents an atypical clinical picture. Anterior cervical arachnoid cyst, which may accompany or succeed posterior arachnoid cysts, should be considered.
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This paper presents a set of probabilistic models which reproduce the proximodistal gradient of sensory deficit in peripheral neuropathies, on the basis of the occurrence of axonal dysfunction as a result of randomly distributed abnormalities. The models, which are based on conduction block, loss of temporal coherence, and weak interactions between nerve fibers, demonstrate that randomly distributed axonal dysfunction provides a sufficient condition for distal sensory deficit. The models predict a marked reduction in the length for normal sensory conduction with small increases in the probability of axomal dysfunction, providing a possible correlate for the rapid clinical progression of some neuropathies. The hypothesis that weak interactions between fibers result in paresthesiae in peripheral neuropathies is also discussed.
Three patients presenting predominantly with acute confusional states (ACS) are shown to have infarctions in the distribution of the right middle cerebral artery. It is suggested that the main deficit in ACS is in the function of selective attention. On the basis of cortical connections of homologous areas in the monkey brain, it is argued that this deficit arises from lesions in convergence areas for association cortex.
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A 65 year old man developed progressive signs of pontine and medullary dysfunction with striking bilateral paralysis of lateral gaze, dysarthria, dysphagia, and ataxia. A respiratory death occurred seven months from the onset. Pathological examination revealed focal brain-stem changes of perivascular lymphocytic cuffing, microglial infiltration, glial nodules, and neuronophagia. No underlying malignancy or general disease impairing immunity mechanisms was discovered.
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A 68 year-old woman presented with a two-week history of amaurosis fugax, ipsilateral fronto-temporal headache and jaw claudication suggesting carotid giant cell arteritis. However, this syndrome proved to be due to atherosclerosis causing complete occlusion of the external carotid artery at its origin and narrowing of the internal carotid artery. Combined external and internal carotid endarterectomy relieved the symptoms. The symptom complex of temporal arteritis may be rarely mimicked by carotid atherosclerotic occlusive disease.
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