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PubMed1976

[Differential diagnostic question: traumatic unconsciousness or amnestic episode?].

Traumatic twilight state on the one and amnestic episode (transient global amnesia) on the other side are as a rule easy to differentiate from the patient's age, his behavior during the acute state of disease and the kind of its improving. Contrary to other authors' opinion, differentiation is not just possible by diagnosing an injury or its absence. In minor skull traumata preceding the traumatic twilight states injuries are often not manifest and otherwise amnestic episodes occasionnally occur after minor traumata. In a 64 years old woman an obviously typical amnestic episode appeared in direct connection with a probable fall on the back of the head. A 28 years old man underwent a five-hour amnestic episode whereas the EEG showed normal curves. The episode occurred 15 minutes after striking hard upon the ground with the back of the head during a ground roll without following unconsciousness. In both cases traumatic twilight states were not involved. In account of the interval of 15 minutes the trauma of the second case seems not be be the direct cause for the manifestation of amnestic episode. It also shows that the aspect of the disease in the rare occurrence in younger or middle-aged persons is on principle not different from that in old ones. Since a special medical examination during the acute state is only possible as exception the patient's amnestically seizable behaviour obtains greatest importance in differential diagnosis. For the rare coincidence the trauma is given no pathogenetic relevance in amnestic episodes.

Adult↗
PubMed1998

Neurological complications of intravenous immunoglobulin (IVIg) therapy: an illustrative case of acute encephalopathy following IVIg therapy and a review of the literature.

We report the case of a 73-year-old man who developed an acute encephalopathy during IVIg therapy for AIDP. The signs and symptoms of the encephalopathy completely resolved after discontinuation of the treatment. We also reviewed the literature over the major neurological complications of IVIg therapy, including aseptic meningitis, cerebral infarction, and acute encephalopathy. About 30 cases of aseptic meningitis are reported. They are probably related to an immunoallergic reaction, caused by the entry of the exogenous IgG into the CSF compartment. CSF examinations usually show a neutrophilic or a mixed pleocytosis. Three cases of cerebral infarction and 2 patients with acute encephalopathy, following IVIg therapy, were also reported in the literature. Cerebral vasospasm, cerebral vasculitis, and/or serum hyperviscosity may be implicated in the pathogenesis of these neurological complications. There is a clinical similarity between these IVIg-related encephalopathy and the "reversible posterior leukoencephalopathy syndrome", described by Hinchey et al., 1996.

Acute Disease↗
PubMed1976

[Dynamics of the clinico-pathophysiologic characteristics of psychoses in old age under the influence of azafen].

A study of singular doses and subsequent maintenance therapy by azafen on the higher nervous activity of mental patients in presenile age (67 cases) revealed that its action depends upon the dosage of the preparation and the nosological syndrome. A depressive involutional psychoses can be controlled by azafen in doses up to 75 mg daily. By dosages of 25 mg azafen reduces or cessates completely the syndrome of changed consciousness due to disorders of brain circulation. An arrest of a depressive syndrome in manic-depressive psychosis in old age can be attained by an introduction of 150-200 mg of azafen daily.

Aged↗
PubMed1987

Impairment of consciousness in migraine.

A series is reported of 25 subjects with migraine, whose attacks on some occasions involved impairment of consciousness. The disorder did not necessarily involve younger people, or occur early in the course of the malady.

Adolescent↗
PubMed2006

[Arousal disorders].

Altered states of consciousness are a common reason for visits to the emergency room and admission to intensive care unit. Management of unconscious patient can be difficult because the potential causes of an altered mental status are considerable and the time for diagnosis and effective intervention is short. First, the patient must airway, breathing, and circulation protected. It is important to obtain carefully taken history from eyewitnesses and to perform a general complete examination particularly neurologic focusing on pupillary responses, eye movements, and motor responses. Technical investigations like CT-scan and laboratory tests should make part of a careful diagnostic plan. The prognosis for recovery depends greatly on the underlying etiology as well as its optimal treatment, which seeks to preserve neurologic function and maximize the potential for recovery by reversing the primary cause of brain injury, if known, and preventing secondary brain injury from anoxia, ischemia, hypoglycemia, cerebral edema, and electrolyte disturbances.

Brain Diseases↗
PubMed1993

[Neuropediatric emergency].

The neuropaediatric emergency can be considered according to 1. The primary symptom, single or combined or 2. The diagnosed disease as a whole. Primary combined symptoms are: 1. Disturbance of Consciousness, fever, emesis, skin bleeding (inflammation). 2. Disturbance of consciousness, emesis, normal temperature, stretched fontanel (brain pressure). 3. Disturbance of consciousness, seizure disorder, normal temperature (epileptic fit). 4. Disturbance of consciousness, seizure disorder, fever (febrile seizure). 5. Disturbance of consciousness, bruise marks, normal temperature, accident (skull-cerebral trauma) Procedure used by the physician: 1. Avoidance of additional sequelae (aspiration, injury). 2. Protection of vital functions. 3. Ascertainment of causes. 4. Creating an intravenous access. 5. Drug therapy. 6. If necessary, intubation and respiration. 7. Transport to hospital

Adolescent↗
PubMed2004

[The disorders of blood circulation and consciousness in non-psychotic and delirious alcohol withdrawal syndrome].

One hundred and fifty-seven men with alcohol withdrawal syndrome, including 127 with delirium of different severity, have been studied. During delirium, sequestration of erythrocytes in the vessels and exudation of the fluid into the cellular space developed. There were marked capillary blood flow disturbances with erythrocyte aggregation, metabolic acidosis, compensated with respiratory alkalosis, total lactate dehydrogenase activity elevation, Na+ and K+ decrease in blood plasma and K+ reduction in erythrocytes in a severe form of alcohol delirium. The authors suggest that the complex of disorders observed is similar to shock process, and hemodynamic disturbances may be involved in the development of consciousness disorders.

Acidosis↗
PubMedDate not supplied

Consciousness: a neurobiological approach.

Consciousness and the disorders of consciousness can be more fully understood once they are integrated with the neurobiology of mental events. After a review of animal and human research, we found several anatomical structures in the central nervous system are required for consciousness. Identification of the critical structures, however, depends on what is meant by consciousness. In the general sense of mental responsivity, the reticular activating system must be intact. Consciousness has also been defined as the awareness of the sights, sounds, and feelings of everyday experience. In this sense, the system of sensory inputs and outputs of the anterior temporal cortex, amygdala, and the hippocampus must be functional. There is no neural evidence for "higher" consciousness.

Animals↗
PubMed2001

[Psychopathology and outcome in first-admission schizophrenia: a 13-year follow-up study at a medical school hospital].

BACKGROUND: The course and outcome of 'dementia praecox' have attracted considerable attention since it was first described. However, studies in which schizophrenic patients have been followed for more than ten years are rare. In this study, the course and outcome of first-admission schizophrenic patients in Jichi Medical School Hospital was investigated. METHOD: The subjects were 62 schizophrenic patients, 29 females and 33 males (the mean age at first hospitalization was 25.2 +/- 7.4 years), who were consecutively discharged from the Department of Psychiatry, Jichi Medical School Hospital, between June 1983 and May 1988. The mean interval between first-admission and follow-up was thirteen years. The social outcome was measured using Eguma's Social Adjustment Scale. The subjects were divided into two groups according to Eguma's Scale: a favorable outcome group and an unfavorable outcome group. The following data were obtained from clinical records and analyzed: sex, family history of mental disorders, educational background, job experience, marital status, age at first contact to a psychiatrist, age at first hospitalization, type of onset, subtype of schizophrenia (paranoid, catatonic, hebephrenic types) and symptoms at the time of first hospitalization. Symptoms at the time of first hospitalization included delusions, hallucinations, disorders of ego consciousness, thought disorders, emotional disturbances, lack of spontaneity, catatonic symptoms, hypochondriac-cenestopathic symptoms, disorganized behavior, and suicide attempts. RESULT: Fifty-six of the 62 patients were followed-up. Six patients could not be contacted. Nine of the 56 patients follow-up were dead; two had died suddenly and seven had committed suicide. Forty-seven patients were alive, eight of which were not under psychiatric treatment, while 39 patients were receiving treatment (33 as outpatients, 6 as inpatients). The 47 patients who were still living were divided into two groups: 22 were included in the favorable outcome group, and 25 in the unfavorable outcome group. No significant differences in premorbid status were found. The unfavorable outcome group had an earlier age at first contact and age at first admission than the favorable outcome group. In the favorable outcome group, acute onset was more common than chronic onset. A comparison of psychopathological symptoms at the time of first hospitalization between the favorable and unfavorable outcome groups revealed significant differences in lack of spontaneity and hypochondriac-cenestopathic symptoms. No significant differences were found for any other symptoms. In the favorable outcome group, paranoid type was more common than hebephrenic type. DISCUSSION: Lack of spontaneity may reflect negative symptomatology, which has been suggested to be a predictor of an unfavorable outcome. While hypochondriac-cenestopathic symptoms may reflect an insufficient psychic container for the body, which has been hypothesized to work as an enabler of body image or imaginary body and an enabler of ego function as well. CONCLUSION: First-admission schizophrenic patients followed up after a mean period of thirteen years, and of this group data could be obtained on 90% of them. Two symptoms (a lack of spontaneity and hypochondriac-cenestopathic symptoms) present at the time of first hospitalization were observed more frequently in the unfavorable outcome group than in the favorable outcome group.

Adolescent↗