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At least 343 records · Page 19Linked to original sources
PubMed1997

[Cerebral infarction due to bacterial emboli associated with methamphetamine abuse].

The number of stimulant-drug addicts has recently been on the rise again, and they are being increasingly encountered in the emergency room. There are also frequent reports of cerebrovascular disorders complicating drug toxicity. These cerebrovascular disorders have included subarachnoid hemorrhage, intracranial hematoma, and a few cases of cerebral infarction. Here, we report the case of a 37-year-old male with drug toxicity, consciousness disorder, and hyperthermia. He was in a coma with a temperature of 43.1 degrees C and blood pressure of 58/35 mmHg when brought to our hospital. His condition worse rapidly deteriorated, and he died the same day. Cerebral infarction caused by gram-positive bacillus embolism, not necrotizing angiitis, was found at autopsy. Because drug addicts, especially stimulant-drug addicts, tend to inject themselves drug under unsanitary conditions, the possibility of this type of complication is always present. This is the first such case ever reported, and is therefore regarded as a rare complication of stimulant-drug intoxication.

Adult↗
PubMed2005

Sound-evoked neurogenic responses with short latency of vestibular origin.

OBJECTIVE: In ABR recording, a large negative deflection with a latency of 3 ms (N3) has been recorded in patients with peripheral profound deafness. It has been suggested that N3 might be of vestibular origin. So far, N3 has been recorded only in patients with peripheral profound deafness. If we can record N3 potentials in subjects with preserved hearing, recording N3 potentials might be a new clinical test of the vestibular system. To record neurogenic potentials (N3) of vestibular origin in healthy volunteers and patients with vestibular disorders. METHODS: Twelve healthy volunteers (10 men and two women, aged 23-37 years) and 12 patients with vestibular disorders (6 men and 6 women, aged 29-71 years) were enrolled in this study. To record responses, surface electrodes were placed on the ipsilateral mastoid and the vertex. An electrode on the nasion served as the ground. Recording was performed using an auditory evoked potential recording system with a mini-mixer and a stereo-amplifier. Signals at the vertex to the ispilateral mastoid were amplified and bandpass filtered (100-3000 Hz). One thousand-hertz short tone bursts (1 kHz STB; rise/fall time=0.5 ms, plateau time=1 ms) were presented to either ear through a headphone with or without white noise (WN) ipsilateral to the stimulated ear. The stimulation rate was 10 Hz, and the analysis time was 10 ms. The responses to 500 stimuli were averaged twice. RESULTS: When 1 kHz STB (95 dBnHL, equivalent to 130 dBSPL) were presented with 100 dBSPL WN (ipsilateral to the stimulated ear), a negative peak with 3-4 ms latency (N3) was observed in 23 of the 24 ears (95.8%) with reproducibility in healthy subjects. Without WN, N3 was observed in 17 of the 24 ears (70.8%). The threshold of N3 was 90.2 dBnHL on the average. The presence of N3 in the patients was in agreement with the presence of the VEMP, which were also recorded. CONCLUSIONS: Using techniques of WN exposure ipsilateral to the stimulated ear, we recorded N3 in healthy subjects and in vestibular disorder patients with preserved hearing. This negative peak is likely to be of vestibular origin. SIGNIFICANCE: N3 may be measured from subjects who cannot contract neck muscles due to their ages, mental states, or consciousness disorders. In other words, N3 may be measured from subjects from whom VEMP cannot be recorded. In combination with VEMP, N3 may be useful for the detection of lesion sites.

Acoustic Stimulation↗
PubMed1985

[Post-traumatic deficit syndromes].

We discuss the evolution of psychological disorders following head injury. Even when the trauma seems mild at first, it may then give rise to cerebral lesions, particularly in the brain stem. Cerebral contusions in closed head injuries are responsible for consciousness disorders of varying duration, which are followed by mental confusion. At this point akinetic mutism or a Kluver and Bucy syndrome may appear. We consider memory disorders and other cognitive ones, the focus being on psychiatric disturbances of various kind.

Akinetic Mutism↗
PubMed2000

[Beta-blocker intoxication].

SEVERITY: Beta-blocker intoxication is not frequent but can produce particularly severe or fatal conditions which must not be underestimated. Severity of beta-blocker intoxication varies from one compound to another. The more toxic drugs are propranolol, sotalol, oxprenolol, metoprolol, atenolol, acebutolol, labetalol, and carvedilol. Besides the drug type, history taking can provide a precise assessment of risk, particularly important in when elderly patients with a cardiovascular history have taken more than 20 tablets, when emergency care is provided late, and when other cardiotoxic or psychotoxic drugs have been coingested. IMPLICATIONS: The diagnosis of beta-blocker intoxication must be suspected in any case associating hypotension and bradycardia. The main cardiovascular complications are cardiogenic shock, atrio-ventricular conduction disorders, and obviously life-threatening ventricular arrhythmia with cardiac arrest. Centrally induced respiratory arrest is a rare but dreadful consequence which can occur suddenly even without hemodynamic failure. Neurologic toxicity is mainly expressed by consciousness disorders and more sporadically by seizures. Laboratory tests show variable serum potassium, lactic acidosis, hypoxia-hypercapnia resulting from hypoventilation, and rarely hypoglycemia. The ECG should be recorded early because electrocardiographic signs usually appear before clinical signs and QRS enlargement is a factor predictive of severe ventricular arrhythmia. INTENSIVE CARE: The patient must be placed in an intensive care unit for continuous multiparametric monitoring. Besides gastric evacuation and symptomatic measures, treatment essentially requires glucagon for its positive inotropic effect after high intravenous doses. If glucagon infusion is ineffective or unavailable, an alternative would be to use high doses of vasoactive agents, choosing isoproterenol or epinephrine as the first intention drugs.

Adrenergic beta-Antagonists↗
PubMedDate not supplied

[Shock].

UNLABELLED: Shock is a consequence of disturbed circulation and decreased blood perfusion of tissues which, on the whole, cause functional and morphological impairments of organic systems. Occurrence of shock is not high, but it is significant due to bad prognosis and high mortality rate. CLASSIFICATION: This is one of the classifications of shock: cardiogenic, extracardiogenic-obstructive, oligentic and distributive shock. PATHOPHYSIOLOGIC MECHANISMS OF SHOCK: Regardless of the cause of shock, the clinical picture is dominated by hypotension mostly caused by decrease of minute volume (septic shock may be an exception--minute volume might be high). Due to hypotension a lot of compensatory mechanisms are activated and in the beginning showing the compensatory phase of disease and if nothing is done decompensatory and in the end irreversible phase of shock occurs with fatal outcome. The clinical picture depends on the etiology of shock, type of shock, but it also has certain specificities. PROGNOSIS: The prognosis depends on the clinical picture dominated by the following symptoms: hypotension, decreased diuresis, acidosis, consciousness disorders, tachypnea, peripheral cyanosis, cold and damp skin. MANAGEMENT: These patients are managed in intensive care units, where the following parameters are followed-up: arterial pressure, central venous pressure, minute heart volume, systemic vascular resistance, diuresis, continual follow-up of heart rate, breathing and consciousness. In treatment of shock it is necessary to: normalize the circulatory volume, establish electrolyte balance, regulate glycemia and acid-base status, compensate the volume, calm the patient and alleviate pain.

Humans↗
PubMed2005

Wernicke's encephalopathy in a malnourished surgical patient: clinical features and magnetic resonance imaging.

We report a clinical and neuroradiological description of a severe case of Wernicke's encephalopathy in a surgical patient. After colonic surgery for neoplasm, he was treated for a long time with high glucose concentration total parenteral nutrition. In the early post-operative period, the patient showed severe encephalopathy with ataxia, ophthalmoplegia and consciousness disorders. We used magnetic resonance imaging (MRI) to confirm the clinical suspicion of Wernicke's encephalopathy. The radiological feature showed hyperintense lesions which were symmetrically distributed along the bulbo-pontine tegmentum, the tectum of the mid-brain, the periacqueductal grey substance, the hypothalamus and the medial periventricular parts of the thalamus. This progressed to typical Wernicke-Korsakoff syndrome with ataxia and memory and cognitive defects. Thiamine deficiency is a re-emerging problem in non-alcoholic patients and it may develop in surgical patients with risk factors such as malnutrition, prolonged vomiting and long-term high glucose concentration parenteral nutrition.

Ataxia↗
PubMedDate not supplied

[Prognostic significance of early CT changes in ischemic stroke patients].

The aim of the study was to establish the prognostic value of early CT findings in predicting the 30-day mortality after stroke, to assess the prevalence of these findings in acute stroke patients, and to examine the correlation between these findings and the clinical status. 134 patients (mean age 67.5 +/- 12.1) with supratentorial ischaemic stroke and CT performed within 12 hours from onset of the symptoms were included into the study. The neurological deficit and consciousness disturbances were assessed by means of Scandinavian Stroke Scale. The 30-day mortality was registered. CT findings were found in 84 (63.7%) patients, including hypodense lesions in 74 (55.5%), mass effect in 55 (41.0%) and hyperdense middle cerebral artery sign in 5 (3.7%) cases. Patients with mass effect had greater neurological deficit on admission (p < 0.0001), more frequently developed disorders consciousness (p = 0.001) and had greater 30-day mortality (p < 0.0001). Patients with hypodense lesions of at least two types presented with greater neurological deficit observed on the second day of hospitalization (p < 0.05) and had also greater 30-day mortality (p = 0.01). On multivariate analysis mass effect seen in early CT, as well as older age and greater neurological deficit appeared to be independent predictors of 30-day mortality.

Aged↗
PubMed2001

Acute postoperative metabolic complications of diabetes.

Because of several factors, including a change in the hormonal behavior, the postoperative period is at high risk for the diabetic patient to present a metabolic complication. On the other hand, a diabetic metabolic disorder may be secondary and reveal a severe underlying complication (sepsis...). Ketoacidosis is the consequence of an absolute or relative lack of insulin and occurs mainly in insulin dependent diabetic patients. Its incidence should be very low during the postoperative period since insulin protocols are systematically used. The main clinical and biological signs are a polypnea, signs of dehydration, an hyperglycemia associated with a high anion gap metabolic acidosis and the presence of ketoacids in the urine. Its treatment is mainly based on an active rehydration and an insulin and potassium supply. Sodium bicarbonate should not be used systematically any more, even during severe acidosis. Hyperosmolar non ketotic states affects insulin nondependent and older diabetic patients for the most part and occurs under similar conditions than ketoacidosis, revealing most of the time a severe underlying complication. Clinical and biological manifestations include a severe dehydration, alterations in consciousness and a major hyperglycemia associated to a moderate or mild metabolic acidosis. Its main treatment is an active rehydration and insulin plus potassium in a second time. Hypoglycemia is usually the consequence of a mistake in the diabetes care and in the insulin management. Every sickness or consciousness disorder occurring in a diabetic patient treated with insulin should lead to perform a blood glucose measurement. In case of severe manifestations, glucose should be administered in emergency, orally if the patient is conscious or intravenously if he is not. Lactic acidosis occurring during the postoperative period in a diabetic patient is usually non specific of diabetic disease and reflects the existence of an underlying complication (sepsis, hemorrhage, hypoxia,...), as it would in an non diabetic patient. Lactic acidosis due to a treatment with metformin is now very rare and occurs almost only in patients having a contraindication to the use of metformin.

Acidosis, Lactic↗
PubMed1986

[Evaluation of comatose states].

The most informative neurological symptoms allowing the differentiation of 7 phases of consciousness disorders have been identified on the basis of clinico-physiological correlations and mathematical processing. In the first phase of coma the patient cannot be waken up. Addition of muscle atonia characterizes the transfer to the second phase of coma and of bilateral mydriasis indicates the transfer to the third phase. Eye opening in response to sound or pain points to awakening and transfer to the phase of apallitic syndrome. The performance of simple instructions is characteristic of the phase of deep stupor. Responses to questions characterize stupor, and recovery of orientation in the environment indicates clear consciousness.

Brain↗
PubMed1980

Classification of organic brain syndromes by cluster analysis.

Cluster analysis was carried out on a sample of 92 patients with behavior disorders caused by degenerative, vascular, (alcohol) toxic, and other diseases of the brain. Rating variables of the AMDP system concerning mental state, social behavior, need for special care, sleep disorders, autonomic, physical, and neurologic symptoms were used in the absence of severe degrees of disordered consciousness such as stupor, coma, delirium tremens, and gross cerebral lesions. Results suggested the existence of four major groups of global cognitive impairment combined with neurasthenia and irritability in the first, hypochondriasis and depression in the second, withdrawal symptoms in the third, and severe disorientation in the fourth. At the seven-group level the groups were further distinguished according to severe withdrawal, amnestic syndrome, and dementia by various social and illness behaviors, sleep-wakefulness pattern, hypo- or hyperactivity, additional physical, and neurologic symptoms. Other minor types of organic brain syndromes were identified as individual cases by hallucinations or other circumscribed cognitive, psychomotor, affect, motivation, personality, and/or behavior disorder, symptomatic manic, or schizophreniform psychosis. The findings lent support to old classifications and new ones of organic mental syndromes (DSM-III).

Adult↗
PubMed2002

[Acute respiratory failure in obesity].

Obstructive sleep apnea, obesity-related hypoventilation - a hypoventilation which is independent of apneas and increased by sleep -, and hypoxemia related to local ventilation-perfusion disorders are the main mechanisms of respiratory failure occurring during acute respiratory decompensation following an often minimal triggering event. Non-invasive ventilation has been found to be an effective treatment, particularly with a ventilator capable of maintaining positive expiratory and pressure. The level of the expiratory positive airway pressure must be adapted to cure episodes of obstructive apnea or hypopnea. The level of the inspiratory positive airway pressure (pressure support ventilator), or the tidal volume (volume-controlled ventilator) must be adapted to correct the residual hypoventilation. These adaptations can be made by proper assessment of nocturnal SaO(2) recordings. In particularly severe cases, use of endotracheal ventilation may be necessary to control a state of shock or consciousness disorders incompatible with the patient cooperation necessary for non-invasive ventilation.

Acute Disease↗
PubMed1986

Clinical aspects of Japanese B encephalitis in North Vietnam.

The author reports the retrospective study of 116 children suffering from Japanese B encephalitis in recent epidemics. This disease often appeared in summer and affected 2 to 7-year-old children. In the acute stage the clinical picture included meningeal signs, motor disorders, consciousness dysfunction and neurovegetative disturbances. 90.4% of cases presented abnormal features in CSF. Serological tests with Nakayama and H.N-60 strains were positive. B.M-79 Arbo virus was isolated from 1 case. Neuropathological examination revealed typical lesions in 16 cases. Sero-, viro- and anatomical correlations with clinical course confirmed the role of J.B.E. in outbreaks of 'acute encephalitic syndrome' in North Vietnam.

Adolescent↗
PubMed1992

[Radioimmunoassay of serum and CSF myelin basic protein and its application to patients with acute cerebrovascular accident].

Myelin basic protein (MBP) was measured in the serum and CSF of patients with acute cerebrovascular disease (CVD, 34 cases), demyelinating disorders (DMD, 30 cases) and other neurological diseases (OND, 26 cases) by using a double antibody radioimmunoassay (RIA). Patients with acute CVD had a mean serum MBP concentration and positivity rate much higher than those with DMD and OND. The differences were significant (P < 0.05). In CSF, MBP levels in patients with acute CVD and patients with DMD were significantly greater than those in OND patients (P < 0.05). The results also show that there was a linear relationship between the CSF MBP levels and the serum MBP levels in patients with acute CVD (r = 0.72, P < 0.01), but no such relationship in patients with DMD and OND. The amount of serum MBP was also significantly correlated to the severity of acute CVD, to the level of consciousness disorder and limb paralysis, and to the extent and site of the cerebral lesion at CT-scan (P < 0.05). This study shows that the measurement of brain specific MBP in serum as a marker of cerebral damage may have clinical value in the diagnosis and prognosis of patients with CVD.

Cerebral Hemorrhage↗
PubMed1978

Acute encephalopathy, streptococcal infection, and cryoglobulinemia.

A 9-year-old girl had an acute encephalopathic illness characterized by disordered consciousness, seizures, and multiple cortical deficits. The acute illness was associated with serologic evidence of an antecedent streptococcal infection and the presence of a mixed cryoglobulin with specific antistreptococcal antibody activity. Although the patient had no other evidence of a systemic or central nervous system vasculitis, computerized tomography demonstrated changes compatible with a vasculitic process. Treatment with corticosteroids was associated with resolution of the cryoglobulinemia and complete clinical recovery.

Antibody Specificity↗
PubMed1988

Effects of a new TRH analogue, YM-14673 on a passive avoidance test as a possible criterion of improvement in cognitive disturbance in rodents.

Effects of a new TRH analogue, YM-14673 (N alpha-[[(S)-4-oxo-2-azetidinyl]carbonyl]-L-histidyl-L-prolinamide dihydrate) on cognitive disturbance of passive avoidance response were studied in rodents in comparison with those of TRH and CDP-choline. The latency for entering from the illuminated into the dark compartments was shortened in anoxia and scopolamine-treated rats, cycloheximide-treated mice and cerebral ischemic gerbils. The shortened latency in these models was prolonged by administration of both YM-14673 and TRH in doses without effect on spontaneous movement. YM-14673 was about 10 times more potent than TRH in ameliorating the cognitive disturbance, whereas CDP-choline showed no influence on the learning ability. These results suggest that YM-14673 and TRH possess facilitatory effects on cerebral function and that YM-14673 was distinct from CDP-choline in pharmacological profile.

Amnesia↗
PubMed1984

[Epileptic patients in the psychiatric clinic. From twilight attacks to psychosis].

Cases of epilepsy at the University Psychiatric Clinic of Bern during the decade 1968 to 1977 are analysed, and of 203 such cases 122 were psychotic. In comparison to the non-psychotic cases those with psychosis showed significantly more females, more kryptogenesis, more combined hereditary taint with epilepsy and other neuropsychiatric diseases (excluding neuroses and psychopathies) and more alteration of character, but not more intellectual deterioration. Psychomotor epilepsies were over-represented among the psychotic cases. They did not differ from other forms of epilepsy as regards kryptogenetic origin or number of first degree relatives with epilepsy, but this group did contain all 3 cases in our material who had first degree relatives with schizophrenia. The striking similarity between results of stimulation through deeply implanted electrodes in the limbic system and familiar symptoms of schizophrenia is indicated and discussed in this light.

Cognition Disorders↗
PubMed1977

[The frequency of rapid eye movements and blinks as an activation indicator (author's transl)].

Electrooculographic (EOG) records were studied in 10 neurological patients with disturbances of activation according to clinical assessment and in 12 normal subjects. Rapid horizontal eye movements (saccades) and movements of the eyelids (blinks) were measured. It was concluded that the frequency distribution of blinks and saccades indicates activation deficits in a sensitive and reliable way. The continuous decrease of activation from orthological to pathological states could be shown by counting the frequencies of blinks and saccades. The relationship between the two variables is interpreted with regard to its functional significance.

Adolescent↗