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The state of awareness was studied over time in 449 patients with various forms of mental diseases: borderline, endogenic and organic psychoses, delirium tremens and chronic alcoholism. The clinical and psychopathological examinations of patients were supplemented with a number of new and modified methods of research into awareness whose description is given in the paper. It is established that the study into the pathology of awareness expands considerably the clinical examination of patients and contributes to the development of the optimal therapeutic and restorative measures.
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INTRODUCTION: Thalamic infarcts in paramedian artery territory are seen fairly frequently owing to certain peculiarities of the vascularization of the thalamus. However, clinical diagnosis is usually difficult because of the many varieties and peculiarities of the symptomatology. MATERIAL AND METHODS: We present a review of twelve cases of bilateral paramedian infarcts of the thalamus seen in our Department of Neurology and in a private surgery. We analyze the symptoms and their relationship to the neuro-radiological findings. Finally we compare our observations with the descriptions published by other authors and seek and anatomo-functional relationship for each of the symptoms and signs observed. RESULTS: The usual clinical outline in our patients included disorders of consciousness, different types of oculomotor disorders and cerebellar symptoms, mainly of gait. Other less common findings were memory disorders and abnormal movements. In no case were there sensory changes and pyramidal signs were rare in the absence of significant extra-thalamic lesions. CONCLUSIONS: Our findings, although generally comparable to those described in the literature consulted, were somewhat different with regard to cerebellar symptoms and the absence of sensory and pyramidal signs. We also emphasize the marked differences seen between the individual patients in our series. A good knowledge of the possible clinical variants of these lesions is necessary for a correct initial diagnostic approach in the study of these patients.
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The authors present some results regarding spontaneous bioelectrical brain activity and EEG reactions in functional loadings seen in 53 patients with oneiroid syndromes of a different nature. In most of the cases there were crude pathological changes in the EEG in the form of a disorganization of bioelectrical activity, unstable and fragmental registrations and intrahemispheric asymmetry of biopotentials. These data are not in correlation with the nozological disorders, type of the oneiroid condition, but are in coordination with the character of emotional-volutional disturbances which accompany dream-like disorders of consciousness. On the basis of stable pathological EEG changes which remain even during remissions, the authors come to the conclusion that these changes reflect the structural-functional disturbances of the brain which is the basis for the development of an oneiroid attack.
Disorders of consciousness continue to be the subject of hot debate in healthcare settings, research consortiums, bioethics departments and media forums. There are no standards of care to guide assessment and treatment decisions resulting in wide disparities in daily practice. In response to this problem, expert panels in neurology and neurorehabilitation were convened and charged with developing consensus-based definitions and diagnostic criteria for disorders of consciousness. The Multi-Society Task Force Report on the persistent vegetative state and the Aspen Workgroup statement on the minimally conscious state represent two such initiatives. This paper summarizes the practice recommendations proposed by these groups and discusses their implications for existing and future interventions.
To study self-consciousness changes in initial, manifesting and final stages of acute alcoholic hallucinosis, 60 patients have been examined. In 51 of them, the disease developed on the background of pseudo-dipsomania or constant hard drinking and in 9--of abstinent state. Initial stage of acute alcoholic hallucinosis was characterized by negative type of self-consciousness reaction. In manifesting stage the following variants of self-consciousness were detected: disturbation (vital, somatophysical, autopsychic), suppression (harmonic, dissociated), depersonalization and hyperactivity. In final stage, there were disactualization, nosognosia (adequate-, hypo- and hypernosognosia, anosognosia), partial and total reintegration of self-consciousness. These disorders of self-consciousness appear to be of prognostic and diagnostic value.
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Severe vigilance disturbances are rarely observed during sodium valproate treatment. Two such cases are reported, with rapid appearance of mental confusion after starting treatment, associated with an overall slowing of the E.E.G. the plasma levels of the different anti-epileptic agents were normal or only slightly raised and could not have caused the phenomenon. Clinical and electrical signs regressed as rapidly after stopping valproate administration as they had appeared after starting treatment.
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