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Cognition Disorders↗
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[Altered states of consciousness induced by N,N-dimethyltryptamine (DMT)].
In a controlled study on 38 volunteers the effects of 250 mcg/kg N,N-Dimethyltryptamine (DMT) i.m. were assessed. 26 subjects received DMT and 12 placebo. The altered states of consciousness and the somatic changes were measured by several questionnaires administered after the experiment. In spite of the low dose as compared to previous studies significant differences to placebo were found in the following syndromes of altered states of consciousness: visual hallucinations rep. illusions, impairment of memory and attention, changes of body image, depersonalization syndrome, derealization syndrome, euphoric state, anxious-depressive state and delusion. The somatic side effects were mainly subjective respiratory troubles, dizziness and weakness.
Adult↗
Stuporous episodes during treatment with sodium valproate: report of seven cases.
Of 13 patients with complex partial seizures who experienced stuporous states during treatment with sodium valproate (VPA), 4 received VPA only, 4 VPA and phenobarbital (PB) and 5 VPA, PB, and a third anticonvulsant. Seven cases were described in detail. Side effects-stupor or confusion-appeared a few days after efficacious drug plasma levels were attained, persisted until therapy was readjusted, and disappeared 24 to 72 h after VPA withdrawal. Therapeutic trials established the role of VPA in the onset of stuporous states. The adverse effects of VPA were potentiated by the concomitant administration of other anticonvulsants. Stupor was not due to VPA overdoses, and plasma concentration of the drugs were not correlated with the electroclinical signs. The EEG showed spike and wave discharges or continuous sharp theta and delta waves persisting during VPA treatment. The fact that all 13 stuporous, VPA-treated patients were subjected to partial seizures with complex symptomatology, and none were cases of generalized epilepsy, together with the observations that the disturbances of consciousness started with focal symptoms and EEG signs resembling those of spontaneously occurring partial seizures, suggest that VPA given alone or in association with other antiepileptics has a paradoxical epileptogenic effect in certain forms of epilepsy.
Anticonvulsants↗
Altered consciousness as a precocious manifestation of intussusception in infants.
Two infants aged 5 and 8 months respectively who developed a marked alteration in consciousness as a precocious manifestation of ileo-colic intussusception are reported. Previously described abnormalities of central nervous system function accompanying intussusception are reviewed. It is suggested that in the face of acutely altered sensorium without apparent cause in the infant the diagnosis of intussusception should be considered.
Cognition Disorders↗
The diagnostic value of the short sleep EEG and other provocative methods following sleep deprivation.
One hundred and eighty-five EEGs recorded after deprivation of sleep for 24 h were evaluated. Valuable diagnostic information was found in 59% of the EEG recordings; 24% of the EEGs contained seizure activity. The duration of the stages of sleep and the frequency of seizure activity, paroxysmal sharp wave groups and localizing findings were analyzed. The sleep stages A to C (based on the Loomis scale) were reached for about equal duration by an EEG recording of 30--40 min; sleep stage D was reached only shortly and stage E was not observed. Pathological EEG findings appeared for the most part in the sleep stages A and B. Localized findings were pronounced in stage C. No significant differences pertaining to the occurrence and form of EEG patterns were found between patient groups with primary generalized seizures, psychomotor seizures or those with unclarified disturbances of consciousness. The combination of the short sleep EEG following 24 h of sleep deprivation with subsequent use of the additional provocative methods of hyperventilation, photostimulation and hydration, yielded, in all, new information in 50% of the patients. Each of these additional methods contributed nearly equally to this information.
Adult↗
Level and contents of consciousness in connection with partial epileptic seizures.
The present study introduces concepts and methods that can be used in the systematic psychological study of a seizure, to gain more insight into the seizure as it is experienced by the patient and the significant other. Fourteen patients reported 40 descriptions of their subjective experiences during complex partial seizures. We analyzed the descriptions with respect to the temporal progression of the seizure and the level and contents of consciousness. There were three main findings: (1). We identified an impairment of the voluntary control of attention ("forced attention") that seems to characterize the early stages of the seizure in all patients. (2). Although most patients reported the total absence of consciousness, we identified a subgroup of patients with a fluctuating level of consciousness during the seizure. (3). The patients who reported some contents of consciousness during the seizure were found to usually experience internal mental images rather than other contents of consciousness (e.g., sensations or perceptions). We propose that use of a qualitative methodology for the psychological assessment of seizures could lead to a better understanding of seizures as experienced from the patient's perspective and thereby to improvements in the treatment of seizures.
Adult↗
An integrated neuropathophysiological model of schizophrenia.
Schizophrenia is a disease of consciousness. The different neuroscientific disciplines have reported correlations with dysfunction and pathology at various levels in the hierarchy of biological explanation. A holistic model of schizophrenia is presented, developed from the premise that the neurophysiological correlate of consciousness is the cortical electrical interference pattern produced by the superimposition of the sensory event related potential on the basal alpha rhythm. The role of the Isodendritic Core of the Brain is discussed and the genesis of schizophrenic symptoms is related to post mortem histopathological findings that can be attributed to viral induced fibrillary gliosis.
Alpha Rhythm↗
[Shy-Drager syndrome with disturbances of the respiratory rhythm and consciousness. A propos of an anatomo-clinical case].
The case, including pathological description, of a 65 year old man is presented. Severe disturbances in respiratory rhythm and consciousness occurring during wakefulness and sleep, progressing by acute exacerbations, developed after the disease had been present for 4 years and resulted in death after three months. Small degenerative lesions of the pontine nucleus, the locus coerulus, the intermedio-lateral column and the substantia nigra were seen.
Aged↗
Pharyngeal aspiration in normal adults and patients with depressed consciousness.
A sensitive technic using indium111 chloride was devised to investigate the occurrence of pharyngeal aspiration. Twenty normal subjects and 10 patients with depressed consciousness were studied. Forty-five per cent of the normal subjects aspirated during deep sleep. Normal subjects who did not aspirate were noted to sleep poorly. Seventy per cent of the patients with depressed consciousness aspirated. Aspiration of pharyngeal secretions occurs frequently in patients with depressed sensorium and also in normal adults during deep sleep. Bacterial pneumonia may result when aspirated bacteria are not effectively cleared. This may result when clearance mechanisms are impaired or when they are overwhelmed by large volumes of aspirated secretions.
Adult↗
Executive functioning following mild closed head injury.
This study was aimed to identify impaired attentional components in mild CHI patients. The CHI features taken into account were age (< or = 30 vs. > 30 years), loss of consciousness (yes vs. no), and time after injury (few days vs. some months). The groups tested were composed of 26 patients and 26 controls (matched for age, sex and education). Experiment 1 used a dual-task paradigm (Umiltà et al., 1992), which taps executive functions. The double task-single task difference was greater for the CHI group, but only for patients older than 30 years and/or with consciousness loss. Two years after injury, some of these patients were retested: The results showed that this deficit was still present. Experiment 2 studied visual selective attention using the Navon (1977) paradigm. In this case, there were no differences between patients and controls. The results are discussed with reference to the anterior/posterior attention systems.
Adolescent↗
Clinical neurologic assessment tool: development and testing of an instrument to index neurologic status.
The clinical neurologic assessment tool (CNA) is a 21-item instrument assessing response to verbal and tactile stimulation, ability to follow commands, muscle tone, body position, movement, chewing, and yawning in the patient with head trauma. The CNA was developed to detect subtle changes in the patients' neurologic status that may indicate transitions in the comatose state. The CNA has been extensively pilot tested. Reliability determined by using Cronbach's alpha revealed an internal consistency of 0.96. Concurrent validity testing with the Glasgow Coma Scale indicated a strong positive correlation, r = 0.94. Construct validity was assessed with factor analysis using 0.50 for a loading criterion. Three factors were demonstrated: general level of consciousness, muscle tone and resistance, and chewing or yawning. Discriminant function analysis revealed that the CNA scores correctly classified 95.1% of the patient observations into their respective Glasgow Coma Scale categories. The CNA is reliable, valid, convenient, and easily scored and captures the subtle changes in the patient with head trauma.
Adolescent↗
Impairment of memory and consciousness in migraine: clinical and EEG study.
We report the clinical and EEG study of three migraine patients who presented with peculiar clinical phenomena related to migraine attack. The first case is a transient global amnesia that followed a classic migraine status. The second is a confusional state that complicated a classic migraine attack. The third is a complex attack with combined features of migraine and epilepsy.
Adolescent↗
[An autopsied case of type II citrullinemia--transient effectiveness with either citrate or benzoate to the consciousness disturbance].
A 44-year-old man suffered from repeated impairment of consciousness associated with flapping tremor, myoclonus and generalized convulsions, and died in coma 6 months after admission. He had had a psychosomatically underdeveloped childhood, with a propensity for legumes without a family history of the same or a record of consanguinity. On admission, he had disturbed consciousness and emaciation without other physical abnormalities. The EEG revealed diffuse slow waves with occasional appearance of triphasic waves. A high level of serum citrulline (534.7 nmol/ml) was recognized and the assay of urea cycle enzymes in the liver demonstrated decreased argininosuccinate synthetase (ASS) activity (0.062 U/g liver, 7.4% of that in normal liver), although no kinetic abnormality was found. Accordingly he was diagnosed as having type II citrullinemia. In addition, this case could be classified as cluster type of localization of the ASS in the liver by immunohistochemical study. There were characteristic findings concerning his clinical picture and laboratory data, such as a significant correlation between the grade of disturbed consciousness and arterial blood gas pH (r = 0.61, p less than 0.01). However, the blood ammonia level did not always correlate with the severity of disturbed consciousness. Oral treatment with sodium citrate and sodium benzoate was very effective, though transiently, for disturbed consciousness in this case. Pathological findings of the autopsied liver were fatty change and fibrosis. Neuropathologically, characteristic findings were brain edema with cerebellar tonsilar herniation, laminar necrosis with spongy formation in cerebral cortex, and Alzheimer type II glia. The relationship between citrullinemia and other hepatic encephalopathy was also discussed.
Adult↗
[Assessment of major stroke at onset in cerebral ischemia. In consideration of acute revascularization].
Since the acute revascularization was adopted as a probable means of surgical treatment for the acute cerebral ischemia, it became essential to discuss how the initial symptom at onset can predict the subsequent development of severe or mild cerebral infarction. In the 2 past years, 207 cases of cerebral ischemic lesion were admitted non-selectively and mostly in the early stage after the attack. Excluding 40 cases of surgical treatment, 167 cases were classified into 30 cases of TIA, 13 cases of RIND, 94 cases of minor completed stroke and 30 cases of major completed stroke. In 30 cases of major completed stroke, 21 cases developed severe motor hemiplegia from the onset and the rest 9 cases initially mild hemiparesis which gradually developed to severe hemiplegia thereafter. The cases of minor completed stroke showed mild or moderate hemiparesis initially and did not worsen thereafter. In the group of TIA and RIND, no case had developed severe hemiplegia in any stage of clinical course. The disturbance of consciousness were noted in 5 cases out of 94 cases of minor completed stroke (5%) and 12 cases out of 30 cases of major completed stroke (40%) in the following time course. More than half of the cases of major completed stroke were considered to be cerebral embolism including the retrospective review.
Aged↗
Elevated myo-inositol concentrations in cerebrospinal fluid of neonates and of patients with an impaired state of consciousness.
A simple, semiquantitative paper chromatographic method was used to identify samples of cerebrospinal fluid containing elevated concentrations of myo-inositol. All patients whose CSF inositol concentrations were greater than 70 mug/ml (as determined by S. carlsbergensis microbiological assay) showed disturbances of the state of consciousness, reported as stupor, coma or confusion in adults, or apathy and stupor in infants. An elevated level of inositol in cerebrospinal fluid appeared to be a characteristic finding in infants under one year of age. Among other age groups no common etiology was correlated with high inositol concentration.
Adolescent↗
[Carcinoma of the colon associated with diffuse metastatic leptomeningeal carcinomatosis (DMLC) presenting as disturbance of consciousness--a case report].
A 58-year-old man was admitted to Saiseikai Hospital complaining of vertigo and visual acuity disturbance. His admission physical examination was unremarkable; his spinal fluid contained 69 large mononuclear cells/mm3. Cytological examination was not done. His disturbance of consciousness rapidly progressed to coma and he died on the 10 th hospital day. At autopsy, Borrmann Type II carcinoma (3 cm in diameter) was found in the cecum. Microscopical examination revealed that the tumor was a poorly differentiated adenocarcinoma. Diffuse metastasis was found in the leptomeningium , but there was no evidence of metastasis to other organ.
Adenocarcinoma↗
Altered circadian rhythm of catecholamines in patients with apallic syndrome.
Circadian rhythms of catecholamines were investigated in 4 healthy subjects and in 6 patients suffering from an apallic syndrome. The clinical picture of this syndrome is characterized by disturbed consciousness (coma vigile), by suspension of the sleeping and waking rhythm, by lack of emotional reactions and by appearance of primitive motor patterns. 5 of the 6 apallic patients showed an abolished rhythmicity compared with the control group. These results were interpreted as an indication that endogenous, centrally controlled processes are the cause of circadian rhythms.
Adolescent↗