Inserting nasoenteral tubes in patients with depressed sensoria.
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Aged↗
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Results for “Consciousness Disorders”
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Loxapine-lorazepam-induced hypotension and stupor.
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Adult↗
Transcendental meditation, altered reality testing, and behavioral change: a case report.
This paper presents the case of a 39-year-old woman who, several weeks following initiation into transcendental meditation (TM), experienced altered reality testing and behavior. We discuss the course of this episode, present evidence for a causal relationship between her practive of TM and altered behavior, and discuss the appropriate treatment of such phenomena.
Adult↗
Postconcussion symptoms after head trauma: interpretation and treatment.
Postconcussion symptoms frequently present significant barriers to recovery after head injury. For most patients, emphasis on either organic or functional factors as the sole basis for such symptoms is unwarranted. In addition to the psychologic and behavioral impact of such deficits, recognition of cognitive deficits arising from head injury is an important means of comprehending postconcussion symptoms. We recommend structured recovery programs involving the matching of cognitive capabilities to stress level in treating postconcussion symptoms.
Acute Disease↗
Failure to awaken after general anesthesia due to cerebrovascular events.
Failure to awaken after general anesthesia is a rare complication that may be caused by residual drug effect, systemic abnormalities, or neurologic injury. Failure to awaken often is initially attributed to residual drug effect, potentially delaying correct diagnosis. Three cases of failure to awaken because of neurologic injury are reviewed. Differential diagnosis of failure to awaken is discussed, and the importance of distinguishing pathologic causes from residual anesthetic is stressed.
Aged↗
Selected postoperative complications of cranial surgery.
Selected postoperative complications following a craniotomy are discussed in relation to assessment and nursing care. Clinical differentiation between structural and metabolic postoperative complications is emphasized. The signs, symptoms, diagnostic aids and nursing implications related to each of these two major classifications of complications are presented. The specific postoperative complications discussed include: cerebral edema, intracranial bleeding, hydrocephalus, cerebral infarction, tension pneumocephalus, hypoxia, water and electrolyte imbalances, hypoglycemia, endocrine disturbances, hyperthermia, and seizures.
Brain Edema↗
Episodic twilight state with severe autonomic symptoms in an epileptic patient.
A boy suffering from epileptic seizures experienced five episodes of a twilight state. His twilight states continued for at least two weeks, and were characterized by behavioral disorders and severe autonomic symptoms. Sometimes functional ileus was present. The electroencephalographic finding in the first episode was 6-per-second phantom spike and wave complex (PSW). For treatment, a combination of carbamazepine and sodium valproate was useful in preventing the reappearance of the episode of the twilight state and in suppressing PSW. From the clinical and electroencephalographic findings and therapeutic response to antiepileptics, the episodes were considered to have originated in localized epileptic discharges in the hippocampal, amygdaloidal and hypothalamic regions.
Amygdala↗
Natural sleep as an aid to electroencephalographic diagnosis in young children.
A total of 300 children aged five years and under, referred for routine EEG investigations, were included in this study. It was possible to obtain recordings during natural sleep in 250 of the 300 children, using stick-on electrodes. Of the 250 with natural-sleep recordings, 110 children had normal records both awake and asleep. In 73 cases the awake record was normal but the asleep record showed abnormalities, the most common being spike discharges (60 children). Of these 60 children, 52 had a history suggestive of epilepsy or of febrile convulsions. A further 27 children had recordings which were equally abnormal awake and asleep, and 37 showed abnormalities while awake but greater abnormalities while asleep. It is concluded that useful additional information can be obtained from the EEG if young children are encouraged to sleep naturally during the recording, and that this can be done without sedation, even in a busy, routine EEG department.
Child Behavior Disorders↗
An investigation of certain factors concerned in the aetiology of depersonalization.
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Adolescent↗
Stupor: a review of 25 cases.
Twenty-five cases of stupor referred to a psychiatric teaching hospital over 15 years are reviewed. Ten cases presented with a depressive syndrome, four cases with catatonic phenomena and a further 10 cases with established organic aetiology; one case was considered to be psychogenic in origin. The overall mortality was high (16%), attributable to the basic pathology. Compared with earlier series there was a reduction in cases with catatonic features with a corresponding increase in the proportion of organic cases.
Adolescent↗
Misdiagnosis and delayed diagnosis in traumatic intracranial haematoma.
Out of 51 patients with traumatic intracranial haematoma admitted to a teaching hospital 11 (22%) died undiagnosed, and out of 307 such patients transferred to the West of Scotland Regional Neurosurgical Centre 111 (36%) had been deteriorating for more than 12 hours in another hospital. In two-thirds of these cases the delay was due to an erroneous diagnosis, either of cerebrovascular accident or of alcoholic intoxication.
Alcoholic Intoxication↗
Parkinsonism following bilateral lesions of the globus pallidus: performance on a variety of motor tasks shows similarities with Parkinson's disease.
OBJECTIVES: The authors report the results of detailed investigations into the motor function of a patient who, after a heavy drinking binge and subsequent unconsciousness, respiratory acidosis, and initial recovery, developed parkinsonism characterised by hypophonic speech and palilalia, "fast micrographia", impaired postural reflexes, and brady/akinesia in proximal (but not distal) alternating upper limb movements. METHODS: In addition to brain magnetic resonance imaging (MRI), different aspects of motor function were investigated using reaction time (RT) tasks, pegboard and finger tapping tasks, flex and squeeze tasks, movement related cortical potentials (MRCPs), and contingent negative variation (CNV). Cognitive function was also assessed. The results were compared to those previously reported in patients with Parkinson's disease (PD). RESULTS: Brain MRI showed isolated and bilateral globus pallidus (GP) lesions covering mainly the external parts (GPe). These lesions were most probably secondary to respiratory acidosis, as other investigations failed to reveal an alternative cause. The results of the RT tasks showed that the patient had difficulties in preparing and maintaining preparation for a forthcoming movement. MRCP and CNV studies were in line with this, as the early component of the MRCP and CNV were absent prior to movement. The patient's performance on pegboard and finger tapping, and flex and squeeze tasks was normal when performed with one hand, but clearly deteriorated when using both hands simultaneously or sequentially. CONCLUSIONS: In general, the present results were similar to those reported previously in patients with PD. This provides further indirect evidence that the output of globus pallidus is of major importance in abnormal motor function in PD. The possible similarities of the functional status of GP in PD and our case are discussed.
Acidosis, Respiratory↗
The use of lumbar puncture in a district general hospital.
A survey of lumbar punctures performed in adults in a district general hospital over a two year period was carried out. As well as being used for conventional, specific indications, lumbar puncture was often employed as a screening investigation in undiagnosed neurological illness. Although this was not inappropriate in patients with meningeal symptoms and signs, or patients with disordered consciousness, lumbar puncture was also used in patients with focal neurological signs. Although the dangers of lumbar puncture in these latter patients, and the fact that it is unlikely to yield information unobtainable by other investigations have been stated by many authorities, almost 20% of patients fell into this group. This suggests that these points require further emphasis.
Adult↗
Cerebral protection before, during and after neurosurgical procedures.
Not only the pathology but also the neurosurgical procedure itself can lead to an impairment of cerebral structures. This may cause neurological symptoms like confusion, disorientation or cognitive deficits which have hardly been noticed until now. Neuroprotective substances can help to reduce this. As an example of the effectiveness, based on our own experiences and international trials, two different medical drugs, Nimodipine and Cerebrolysin, are presented. In conclusion one has to realize that nowadays neurosurgeons have to focus their interest more and more to neuroprotective adjuvant treatment possibilities.
Amino Acids↗
Symptomatic cyst of the septum pellucidum treated by stereotactic intraventricular drainage.
Symptomatic cavum septi pellucidi is a rare occurrence. Clinically, it can manifest with persistent or intermittent symptoms of internal hydrocephalus and consciousness disorders, simulating a colloid cyst of the third ventricle, possibly with mental symptoms, focal deficits, epilepsy, ataxia and pyramidal signs. This is a case of a 24-year-old woman with persistent symptoms of hydrocephalus due to obstruction of the foramina of Monro produced by a cyst of the septum pellucidum. The condition was successfully treated by stereotactic ventriculocystotomy.
Adult↗
Epidemiology of stroke in Tilburg, the Netherlands. The population-based stroke incidence register: 2. Incidence, initial clinical picture and medical care, and three-week case fatality.
The results of a prospective population study of stroke in Tilburg are reported. The average annual over-all incidence (per 100,000 population) for the period October 1, 1978-September 30, 1980 was 174 for total cases, 145 for first-ever cases. Males and older persons were at greater risk for a stroke. The vast majority of strokes were thrombo-embolic infarctions. Hemiplegia was the predominant neurological deficit resulting from an insult. Patients with speech problems, as opposed to those without, demonstrated more extreme motor deficit when such occurred. Seventy-four per cent of stroke cases had hypertensive blood pressure readings shortly after onset. Most patients were under hospital care during the initial phase of their attacks. The presence of such handling was related to specific patient characteristics. Three-week stroke case fatality was 30% for all patients registered, and varied significantly by age, sex and diagnostic type.
Aged↗
Angiographical analysis of acute cerebral infarction followed by "cascade"-like deterioration of minor neurological deficits. What is progressing stroke?
In order to understand the mechanism of clinical worsening in patients with cerebral infarction, attention was focused on the changes in cerebral angiograms obtained repeatedly before and after neurological deterioration. Among 212 stroke patients with minor neurological deficits, incomplete hemiparesis progressed to complete hemiplegia in 15 patients several days after the beginning of symptoms. On admission, 3 had internal carotid artery occlusion, 2 had stenosis of the internal carotid artery, 5 had occlusion of the middle cerebral arterial trunk, 2 had occlusion of the middle cerebral arterial branch, and 3 had no angiographically visible occlusion. The changes between the first and the second angiograms were of different varieties: another recurrent occlusion, progression of occlusion, new occlusion in the cerebral arteries opacified through the collateral pathway, recanalization of the initially occluded artery, and no change. Such different patterns of pathophysiological events show that the mechanism of neurological worsening in infarcted patients is not uniform. Based on the results from the present study, several problems which arose during the investigation and the somewhat vague definition of "progressing stroke" currently in use are discussed.
Acute Disease↗