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PubMed1981

Evaluation of disturbances of consciousness.

Consciousness as the highest form of neuronal activity is very difficult to define. It is superior to unconditioned reflex activity and vigilance, and its most important sign is verbal signalization. Therefore, a scheme of evaluation of impaired consciousness was elaborated by the author, in which in the first group a strong painful impulse is the stimulus, in the second group of consciousness proper the word is the stimulus. This simple scheme of 8 points can be applied also by nurses.

Cognition Disorders↗
PubMed2001

Consciousness in schizophrenia: a metacognitive approach to semantic memory.

Recent studies have shown that schizophrenia may be a disease affecting the states of consciousness. The present study is aimed at investigating metamemory, i.e., the knowledge about one's own memory capabilities, in patients with schizophrenia. The accuracy of the Confidence level (CL) in the correctness of the answers provided during a recall phase, and the predictability of the Feeling of Knowing (FOK) when recall fails were measured using a task consisting of general information questions and assessing semantic memory. Nineteen outpatients were paired with 19 control subjects with respect to age, sex, and education. Results showed that patients with schizophrenia exhibited an impaired semantic memory. CL ratings as well as CL and FOK accuracy were not significantly different in the schizophrenic and the control groups. However, FOK ratings were significantly reduced for the patient group, and discordant FOK judgments were also observed more frequently. Such results suggest that FOK judgments are impaired in patients with schizophrenia, which confirms that schizophrenia is an illness characterized by an impaired conscious awareness of one's own knowledge.

Adult↗
PubMedDate not supplied

[Clinical features of cerebral toxoplasmosis in Cuban patients with AIDS].

INTRODUCTION: Neurotoxoplasmosis (NTX) is one of the commonest opportunist infections in patients infected by the human immunodeficiency virus. It presents with a variety of clinical features in the immunocompromised patient. PATIENTS AND METHODS: We made a horizontal retrospective descriptive study of 88 patients with a diagnosis of NTX treated in the Pedro Kour Institute during a three years period. Our aim was to find which were the most common forms of clinical presentation in our setting and to evaluate the use of paraclinical examinations in reaching the presumptive diagnosis. The patients had clinical examinations, CSF studies, detection of indirect immunofluorescence titres (IFI) for Toxoplasma, imaging studies (CAT) and lymphocyte counts. RESULTS: The commonest symptoms were: headache in 79%, fever in 55.68%, motor defect in 44.31% and disorders of consciousness in 29.54% of the patients. The IFI titres were negative in 31.54% of the patients, between 1/16 and 1/32 in 38.34% and between 1/64 and 1/1,024 in only 30.07% of cases. The T CD4+ lymphocyte count was less than 200 cells in 66.7% of the patients; 72% of imaging studies showed typical lesions, in association with other disorders in 38% of the cases (lymphomas, cryptococcosis, tuberculous meningoencephalitis and cytomegalovirus encephalitis). CONCLUSIONS: NTX in a patient with AIDS often presents in our setting with headache and fever, motor deficit and alterations of consciousness. The diagnosis should be confirmed by immunological or imaging studies since in this disease serology and CSF studies are less specific.

Acquired Immunodeficiency Syndrome↗
PubMed1978

An unusual case of portasystemic encephalopathy caused by splenic vein occlusion following gastrectomy.

A patient with recurrent episodes of consciousness disturbance following partial gastrectomy is presented. Angiographic examination revealed a great portasystemic shunt, which probably developed following the postoperative splenic vein thrombosis. This is suspected a rare cause of the condition. In chronic liver disease, recurrent encephalopathy which is caused by portasystemic shunt is well known as one of the most frequent complications. It is very uncommon in adults, however, when the liver is not concerned in the shunt formation. In the present paper the authors report an unusual case of recurrent consciousness confusion which is due to the great portasystemic shunt probably caused by postgastrectomy splenic vein thrombosis.

Cognition Disorders↗
PubMed1989

[Epileptic impaired consciousness in adults].

Alterations of consciousness with impaired perception and drive persisting over hours to days can be due to a nonconvulsive status epilepticus. This possibility has to be considered not only in patients with already known epilepsy, but also in those with a negative history for seizure disorders. The immediately recorded electroencephalogram (EEG) provides decisive clues. In the case of petit mal status most frequently appear tiredness, reduced vigilance and lack of drive. The EEG shows a generalized spike-wave activity. In status psychomotoricus, the clinical symptomatology varies from case to case. It can be characterized by anxiety, dreamy states or productive-psychotic states with agitation, automatisms and hallucinations. In the EEG a temporal or temporally-accentuated epileptic activity will be recorded. Transitional and mixed forms of petit mal status and status psychomotoricus can also be found. I.v. injections of benzodiazepines (clonazepam, diazepam) are an appropriate therapy for any type of nonconvulsive status epilepticus. Phenytoin is indicated in status psychomotoricus, but contra-indicated in the case of petit mal status.

Adult↗
PubMed1988

[The unified interdisciplinary classification of closed cranio-cerebral trauma].

The article gives an account of the classification of cranio-cerebral traumas recommended by the IIIrd All-Union Congress of Neurosurgeons. Main clinical forms of cranio-cerebral traumas are described: concussion of the brain, contusion of the brain of light, mild and critical degree, compression of the brain against the background of its contusion and without it. A uniform gradation of disturbed consciousness and criteria for the assessment of the patient's state are presented.

Brain Concussion↗
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↗
PubMed1975

The concepts: Disturbed state of consciousness and psychosis.

A theoretical analysis is made of the two concepts: "disturbed state of consciousness" (DSC) and "psychosis", and these concepts are defined in ways which are consistent with actual clinical psychiatric work on the Continent. Concerning DSC's two points are emphasized: Whether we, as psychiatrists, are conscious of it or not--one of our premisses for classifying a state as a pathological DSC is an evaluation of the client's ability to change the state voluntarily. Furthermore, stating that a DSC was present in the time interval tl0tn implies stating that all experiences were abnormal in some way during the interval--when the word "experience" is taken in the broad sense, including William James' "fringe" and "embeddedness" in the stream of consciousness. Reality testing may remain the cardinal point in the definition of "psychosis"--if we make the distinction between theoretical, "fullblown", syndromes and concrete syndromes with fewer symptoms clear to ourselves.

Alcoholic Intoxication↗
PubMed1981

Eye movement as an indicator of brain function.

The level of consciousness between the alert and drowsy states was classified into four stages (Alert, Resting I, Resting II, Drowsy) by studying three factors of the EEG patterns on 23 normal subjects. The eye movements recorded by electro-oculograph were divided into two groups, i.e. rapid eye movements (R type, r type) and slow eye movements (S type, s type). The occurrence of each type of eye movements was confirmed to change in close correspondence to the stages of consciousness. The eye movement on 43 cases with a disturbance of consciousness by metabolic disease were recorded longitudinally according to clinical states. The S type movements were predominantly observed in a state of clouding of consciousness, while the R type and R-S type were observed in a delirious state.

Adult↗
PubMed1986

Concentrations of glycine and serine in cerebrospinal fluid during disturbed consciousness; a study of the therapeutic effect of thyrotropin-releasing hormone on the consciousness level.

The concentrations of aliphatic amino acids (glycine, serine, valine, threonine, alanine, leucine, isoleucine) in lumbar cerebrospinal fluid from patients with consciousness disturbances and normal controls were measured. Thyrotropin-releasing hormone (TRH) was administered to patients and the changes of levels of consciousness and amino acid concentrations were followed before and after TRH administration. The concentrations of glycine and serine from patients were significantly higher than those from controls; they returned to the control values with improvement of consciousness disturbances. The influence of TRH upon these amino acid concentrations was not observed. These results suggest that within the central nervous system, an alteration of the level of consciousness is associated with a distortion of glycine and serine metabolism and that TRH itself has no influence upon these amino acid concentrations.

Adolescent↗
PubMed1983

Concentrations of sulfur-containing free amino acids in lumbar cerebrospinal fluid from patients with consciousness disturbances.

The concentrations of sulfur-containing amino acids (taurine, methionine, cystine, cystathionine, homocystine) in lumbar CSF from patients with consciousness disturbances and controls were measured, and it was investigated whether there was any correlation between the sequential changes of these amino acid concentrations and of the level of consciousness. In all patients, thyrotropin-releasing hormone (TRH) was administered and the changes of levels of consciousness and amino acid concentrations were followed before and after administration. The concentrations of taurine and cystathionine from the patients were significantly lower, and methionine and cystine significantly higher than those from the controls; they returned to the control values in parallel with improvement of consciousness level. Homocystine was not detected in either patients or controls. These results suggest that the alteration in the level of consciousness is associated with distortion of sulfur-containing amino acid metabolism within the central nervous system, at least in the CSF.

Adolescent↗
PubMed1990

Alcohol and conscious level.

Many patients presenting to the Emergency Medical Services have recently consumed alcohol. This may profoundly affect their behaviour, conscious level and response to illness and treatment. The blood alcohol level (BAL) is of little use in the evaluation of these responses. Abnormal conscious level should never be ascribed to alcohol intoxication alone. It is only a diagnosis of exclusion. The most commonly associated conditions are head injury, cerebro-vascular incidents, hypoglycaemia and other drug intoxications.

Alcoholic Beverages↗
PubMed1994

Informative usefulness of age, sex and vital signs in the differential diagnosis of disturbed consciousness among 175 emergency outpatients.

Final diagnoses were determined among 175 emergency patients with disturbed consciousness with a Glasgow Coma Scale (GCS) of less than 15 and diagnostic usefulness of basic information was assessed using clinico-epidemiological indices. Subject patients included 98 males and 77 females with average age 53.4 years. Final diagnoses were as follows: intracranial lesions in 69 patients (39.4%), metabolic and systemic diseases in 97 (55.4%), mental diseases in 4 (2.3%), and diseases of unknown origin in 5 (2.9%). Cerebrovascular disorders and epilepsy were most frequent among the intracranial lesions, and poisoning, hypoglycemia, acute alcoholism and hypoxic encephalopathy among the metabolic and systemic diseases. Informative usefulness of age, sex and vital sings in diagnosing cerebrovascular disorders was analyzed with the use of ROC curves, showing that cut-off points of age over 60 years and of systolic blood pressure greater than 160 mmHg were most useful.

Age Factors↗