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At least 55 records · Page 3Linked to original sources
PubMed2000

Successful cardiopulmonary resuscitation outcome reviews.

An implicit question in every pre-hospital cardiopulmonary resuscitation (CPR) scenario is 'what will be the quality of life if a save is achieved?' This issue has implications for doctrine, policy, training and post-CPR counselling of both resuscitator and victim. Post-salvage neurological syndromes in surviving victims include amnesia, personality change, cognitive loss, depression, Parkinsonian syndromes, decorticate and decerebrate states and permanent brain damage with vegetative existence. Children who are salvaged by CPR rarely have pre-existing co-morbidities; but 75% of adults have pre-existing cardiac disease, cancer or diabetes. Such, of course, continue after a successful resuscitation. In the case of children who are resuscitated from acute hypoxic insults, the quality of life is generally good and, in the specific instance of survivors from near-drowning, some 95% will lead lives relatively unmodified. Although successful CPR resuscitation rates remain low in adults, the quality of life of those who leave hospital remains generally high. CPR involves two feature subjects, the resuscitator and the victim. Just as for the victim, so too the resuscitator's life is modified by CPR and its aftermath, whether immediate salvage has been achieved or not. This review addresses these issues, as a successful CPR (dramatic as it is) is not a conclusion but the beginning of a new phase of life for both resuscitator and victim.

Adult↗
PubMed1976

[Cavitating neutral fat leukodystrophy with recurrent course].

A girl with non-contributory family history, at the age of 7 years developed a recurrent ataxic-spastic syndrome followed by disorders of consciousness and seizures. She died in a decerebrate state at the age of 10 9/12 years. Diffuse EEG abnormalities changed in accordance with the clinical course. CSF findings were always negative. Brain biopsy performed at the age of 9 5/12 years was non-diagnostic. No clinical signs of adrenal insufficiency were present. Neuropathological examination disclosed severe demyelination of the cerebral white matter with formation of large periventricular cavities, relative sparing of the subcortical arcuate fibers, and peripheral myelin breakdown of the orthochromatic (neutral fat) type. There was complete absence of inflammatory lesions, comparative preservation of axons and oligodendroglia with moderate astroglial reaction. The optic system and cerebellum were not involved. Additional postanoxic changes were seen in the thalamus and hippocampus. The sporadic case is suggested to represent a cavitating form of neutral fat (simple orthochromatic) leukodystrophy which is to be separated from Schilder's diffuse sclerosis and adrenoleukodystrophy. The etiology of the disorder is unknown.

Ataxia↗
PubMed1987

Dendritic activities of spinal motoneurones in pigs and rabbits enhanced through chronic stimulation of a dorsal root.

1. The L6 or L7 dorsal root in 7-10-day-old pigs was chronically stimulated for 3 or 4 h a day for 4 days/week. The stimuli were 50 or 500 Hz pulse trains delivered at 0.5/s. The induced movements were limited to the hip and hind leg on the stimulated side without any sign of pain. There was evidence that not only the monosynaptic, but also polysynaptic pathways to the motoneurones were chronically stimulated. After 2-6 days of chronic stimulation, all pigs were studied in acute experiments either under pentobarbitone (Nembutal) anaesthesia or in the decerebrated state. Normal (unstimulated) 15-28-day-old pigs were also studied in acute experiments under similar conditions, as the controls. 2. In thirty-three out of fifty-six motoneurones of normal pigs there were all-or-none potentials of 2-6 ms duration and 1-5 mV amplitude. These have been named D-spikes. They occurred in response to tibial nerve and/or dorsal root stimulation and/or spontaneously. They could be abolished by injection of a hyperpolarizing current. These results show that D-spikes are different from any of the well-established all-or-none events of the motoneurone, i.e. the spikes of the axon, initial segment, soma and unitary excitatory post-synaptic potentials. Several kinds of D-spikes could exist in the same motoneurone, as judged from their wave forms and thresholds. This argues for the dendrites as the sites of origin for D-spikes, because only the dendrites can have multiple sites for spike generation. D-spikes were shown to summate to form a larger depolarization. 3. In pigs chronically stimulated with 500 Hz pulses seventy-five motoneurones were studied in acute experiments. In sixty-one motoneurones D-spikes were observed. This indicated that D-spike occurrence was enhanced in the chronically stimulated motoneurones as compared with controls. 4. Characteristic of the chronically stimulated motoneurone was the presence of a depolarization of all-or-none nature which was more than 10 ms in duration and 2-12 mV in amplitude. The depolarization is referred to as the D-wave. The D-wave was similar in properties to the D-spike described above, except that it was of longer duration. Consequently, it is assumed that the D-wave is summed D-spikes. D-waves were observed in nineteen motoneurones.(ABSTRACT TRUNCATED AT 400 WORDS)

Action Potentials↗
PubMed1992

GM1 gangliosidosis type 2 in two siblings.

A sister and brother, now aged 7 and 9 years, presented with developmental arrest, gait disturbance, dementia, and a progressive myoclonic epilepsy syndrome with hyperacusis in the second year of life. Then, spastic quadriparesis led to a decerebrate state. In the absence of macular or retinal degeneration, organomegaly, and somatic-facial features suggesting mucopolysaccharidosis, the presence of hyperacusis together with sea-blue histiocytes in bone marrow biopsies and deficient beta-galactosidase activity but normal glucosidase, hexosaminidase, and neuraminidase activity on lysosomal enzyme assays constitutes the clinical-pathologic-biochemical profile of GM1 gangliosidosis type 2. This is a rare, late infantile onset, progressive gray-matter disease in which beta-galactosidase deficiency is largely localized to the brain, though it can be demonstrated in leukocytes and cultured skin fibroblasts. It must be distinguished from the Jansky-Bielschowsky presentation of neuronal ceroid lipofuscinosis, mitochondrial encephalopathy, lactic acidosis, strokelike episodes (MELAS) and myoclonic epilepsy with ragged-red fibers (MERRF) syndromes, atypical presentations of GM2 gangliosidoses (Tay-Sachs and Sandhoff's diseases), primary sialidosis (neuraminidase deficiency), galactosialidosis, and Alpers' disease.

Biopsy↗
PubMed1979

Multiple cystic encephalomalacia of infancy: computed tomographic findings in two cases with associated intracerebral calcification.

Two initially healthy infants developed acute encephalopathic illnesses characterized by stupor, seizures, cerebrospinal fluid (CSF) erythrocytic and monocytic pleocytosis, increased CSF protein, and decreased CSF glucose and progression to chronic decerebration. In one case, herpes simplex virus was recovered from cutaneous lesions. The initial computed tomography (CT) scan revealed widespread subcortical increased attenuation with further increase after contrast medium injection and patchy areas of decreased attenuation in the deep cerebral white matter. Subsequent CT scans demonstrated progressive cortical calcifications and persistence of low attenuation areas. Autopsy revealed multiple cystic encephalomalacia. The second infant had similar clinical, CSF, and CT findings but remains in a chronic decerebrate state at 14 months of age. The CT abnormalities seen in these patients have not been encountered in any of 13 other infants with the clinical diagnosis of meningitis or encephalitis. Multiple cystic encephalomalacia of infancy is a rare condition with a uniformly bleak prognosis. Computed tomography may prove useful in the early diagnosis, thereby aiding clinicians in counseling and in the acute and long-term management of patients with this lesion.

Brain Diseases↗
PubMed1978

Brainstem lesion with coma for five years following manipulation of the cervical spine.

A woman, aged 38, lost consciousness immediately after manipulation of the cervical spine and remained in coma for nearly 5 years in a combined decorticate and decerebrate state. Cerebral angiography revealed impaired circulation in the vertebrobasilar system. The EEG initially showed generalized cerebral dysrhythmia but tended, over the years, to become more normal with desynchronized fast activity of low voltage. Neuropathological examination postmortem revealed a large cystic lesion in the pressure equalization area of the carotid and basilar circulation in the upper pons, mesencephalon, posterior hypothalamus and basal thalamus. No definite stenosis or occlusion was seen in the cerebral vessels on angiography or at the postmortem examination. The mechanism of the lesion is considered to have been temporary interference with the blood flow in the vertebrobasilar system during manipulation of the cervical spine sufficient to cause ischemia and subsequent infarction of the brainstem. The pathogenesis of vascular lesions of the brain stem following manipulation of the cervical spine is discussed briefly.

Adult↗
PubMed1979

Factors influencing the outcome of coma in severely injured patients.

From this analysis we may conclude that the most important factors influencing the outcome of coma due to injury are age, vegetative state, level of coma, decerebration, and hypocapnia. In all cases where a combination of four or more of any of the above-mentioned factors was present the patient died. EEG seems less predictive in the early period, but may give some information for late prognosis.

Adolescent↗
PubMed1985

A case of attempted suicide by self-hanging.

A young man arrived at the accident and emergency department after attempting suicidal self-hanging. He was cyanosed and showed severe respiratory distress. His posture, hyperreflexia and state of consciousness suggested decerebration. A dire prognosis was expected. Four days later he recovered. No residual physical or mental sequelae were found during follow up. The "post-suspension syndrome" in our case was similar to those recorded in several continental reviews. Apart from a case report of a "miraculous deliverance" following an unsuccessful judicial hanging at Oxford in 1650, no other report of this syndrome has been made in the English literature. This syndrome has an excellent prognosis and requires very little active intervention to ensure a favourable outcome.

Adult↗