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PubMed1994

[Psychedelic experiences at the onset of productive episodes of endogenous psychoses].

Hallucinogenic drugs (psychedelics, e.g. Psilocybin, Mescaline, LSD) induce in humans qualitatively altered states of consciousness (ASC), which can be used as experimental models for endogenous psychosis. However, some researchers claim that these ASCs are not appropriate models for schizophrenia. We report two clinical cases of acute endogenous psychoses demonstrating striking similarities to psychedelic experiences. We consider the psychedelic-induced ASC to be an appropriate model for the beginning acute endogenous psychotic episode, but not for the schizophrenic disease as a nosological entity.

Adult↗
PubMed1978

Intracellular electrolytes in erythrocytes during and after shock: relation to impaired consciousness.

Of 32 patients in shock and catabolic state following shock with impaired consciousness 31 exhibited raised sodium content in their erythrocytes. On the assumption that the erythrocyte membrane acts the same as nerve cell membrane, the hypofunction of erythrocyte membrane may result in impaired consciousness. The hypofunction of erythrocyte membrane is assumed by its increased permeability in shock. A positive osmotic discrepancy between measured and calculated levels denotes altered membranous permeability. Subjectively, impaired consciousness was evaluated by clinical grading. Meanwhile, as a trial of quantification of conscious levels, we applied a new technique of analysis of power spectrum obtained by computer on the autocorrelogram of the EEG during intermittent photic stimulation. This new analytic method was useful in evaluating objective changes of cerebral function. There was a good correlation between raised sodium content in erythrocytes and depressed power spectrum. The degree of increased sodium in erythrocytes seems to correlate with patients' clinical prognosis.

Adult↗
PubMed1990

Mild head injury classification.

Inconsistencies across studies concerning outcome after mild head injury may reflect differences in the diagnostic criteria used for selection of patients. Consequently, we compared the neurobehavioral outcome in three groups of consecutively hospitalized patients (aged 16 to 50 years) who sustained a closed head injury (CHI) and had a Glasgow Coma Scale (GCS) score in the 9 to 15 range. These groups included patients with uncomplicated CHI with mild impairment of consciousness as reflected by a GCS score in the 13 to 15 range (n = 78), patients with initially mild impairment of consciousness complicated by brain lesion or depressed skull fracture (n = 77), and patients with moderate CHI (n = 60). Tests of memory, information processing, and verbal fluency were administered within 1 to 3 months after injury, and the Glasgow Outcome Scale was completed at 6 months. Neurobehavioral functioning was impaired in the groups with complicated mild CHI and moderate CHI as compared to the group with uncomplicated mild CHI. Although moderate CHI produced longer durations of impaired consciousness and posttraumatic amnesia than complicated mild head injury, patients in these groups did not differ in neurobehavioral performance. Global outcome at 6 months was better in the patients with mild CHI than in patients with complicated mild and moderate injuries. Analysis of the various complications of mild CHI revealed that the presence of an intracranial lesion was related to more severe neurobehavioral sequelae than injuries complicated by a depressed fracture.

Adolescent↗
PubMed1988

[Metrizamide encephalopathy in a child with hydrocephalus--effects of L-threo-DOPS on persistent disturbance of consciousness and L-dopa on extrapyramidal symptoms].

This report describes a case of metrizamide encephalopathy with persistent disturbance of consciousness and extrapyramidal symptoms. These two conditions have rarely been reported among the various adverse effects of metrizamide. An 11-year-old girl had been in almost good health until she was ten years old, at which time she received a ventriculo-peritoneal shunt operation, suffering from hydrocephalus of unknown etiology. At the age of eleven, she was admitted to our hospital due to hydrocephalus recurrence. She was examined by metrizamide shunt-gram (1200 mg iodide/4 ml). On the next day, she became drowsy. The CT scan disclosed the periventricular penetration of metrizamide into the medial part of the thalamus and the caudate nucleus. Thirteen days later, disturbance of consciousness continued, and extrapyramidal symptoms, that is, rigo-spasticity and postural tremor, were observed. Oral administration of L-threo-DOPS, the direct precursor of noradrenaline, was effective against the persistent disturbance of consciousness and L-DOPA was effective against the extrapyramidal symptoms. She soon recovered almost to normal and no neurological deficit remained. We thus conclude that the CT scan findings and effects of L-threo-DOPS and L-DOPA suggest that metrizamide encephalopathy in this case were respectively due to its periventricular penetration into the medial part of the thalamus and the caudate nucleus, and the resultant deficiency of the ascending noradrenergic reticular activating system and the nigrostriatal dopaminergic system.

Basal Ganglia Diseases↗
PubMed1988

High-G training for fighter aircrew.

From 8 Jan 85 through 12 Feb 86, 741 USAF fighter aircrew from Tactical Air Command underwent high-G training at the USAF School of Aerospace Medicine, the major objectives of the training being to increase their understanding of G stress and G protection and to raise their G tolerance. The didactics centered on discussion of the G-time tolerance curve and demonstration of an effective anti-G straining maneuver (AGSM). Exposure to G stress on the USAFSAM centrifuge allowed the trainees to determine their G tolerances and to perfect and practice their AGSM. The trainees' mean relaxed and straining G tolerances on the gradual-onset run (GOR) without anti-G suit inflation were 5.2 and 8.3 G, respectively; and 41% of the trainees reached the 9.0-G run limit. All but two of the trainees completed the 8-G, 15-s rapid-onset run (ROR) with anti-G suit inflated; 94% completed the 9-G, 15-s ROR; and 93% were able to tolerate the 9-G, 10-s ROR while looking back over their left shoulder. G-induced loss of consciousness (G-LOC) occurred in 9% of the trainees, most commonly on the GOR, less often on the 9-G RORs. Motion sickness was a significant problem in less than 1% of the trainees. Critiques provided by 382 trainees revealed 73% enthusiastic or positive assessments of the training, as opposed to only 2% negative or hostile responses. We conclude that high-G training is well-tolerated by fighter aircrew and is a highly appropriate method for minimizing the potential for aircraft mishaps due to G-LOC in flight.

Cognition Disorders↗
PubMed1982

[Benign secondary disturbance of consciousness (posttraumatic stupor) in children after cerebral trauma].

This is a report on a benign secondary disturbance of consciousness in children after commotio cerebri. The sleepy state is usually seen 15-60 minutes after the injury and continues for about 3 hours. Nearly 1/3 of the patient also had neurologic signs. The characteristic EEG changes consist of slight to moderate slowing-down of the basic activity. The clinical signs subside quickly but generally, the EEG is not normalised before 5 days to 6 weeks after the trauma. A detailed report is given on one child with this somnolent state as one of the 49 observed cases.

Adolescent↗
PubMed2003

Clinical picture, epidemiology and outcome of Loa-associated serious adverse events related to mass ivermectin treatment of onchocerciasis in Cameroon.

In August 2002, 65 cases of Loa-associated neurological Serious Adverse Events were reported after ivermectin treatment. The first signs, occurring within the 12-24 hours following treatment, included fatigue, generalized arthralgia, and sometimes agitation, mutism, and incontinence. Disorders of consciousness, including coma, generally appeared between 24 and 72 hours, and showed a rapid variation with time. The most frequent objective neurological signs were extrapyramidal. The patients presented with haemorrhages of the conjunctiva and of the retina. Biological examinations showed a massive Loa microfilaruria, the passage of Loa microfilariae into the cerebrospinal fluid, haematuria, and an increase in the C-reactive protein, all of which have been correlated with the high intensity of the initial Loa microfilaraemia. Eosinophil counts decreased dramatically within the first 24 hours, and then rose again rapidly. Electroencephalograms suggested the existence of a diffuse pathological process within the first weeks; the abnormalities disappearing after 3-6 months. Death may occur when patients are not properly managed, i.e. in the absence of good nursing. However, some patients who recovered showed sequelae such as aphasia, episodic amnesia, or extrapyramidal signs. The main risk factor for these encephalopathies is the intensity of the initial Loa microfilaraemia. The disorders of consciousness may occur when there are >50,000 Loa microfilariae per ml. The possible roles of co-factors, such as Loa strains, genetic predisposition of individuals, co-infestations with other parasites, or alcohol consumption, seem to be minor but they should be considered. The mechanisms of the post-ivermectin Loa-related encephalopathies should be investigated to improve the management of patients developing the condition.

Journal Article↗
PubMed1987

Familial mitochondrial encephalomyopathy with stroke-like episodes and episodic disturbances of consciousness: a study of pedigree including three generations with multisystemic abnormalities.

We report here two cases in a family with pleomorphic clinical features which include mitochondrial myopathy, encephalopathy, stroke-like episodes, episodic disturbances of consciousness and other multisystemic abnormalities. The other signs observed in multisystemic abnormalities were ophthalmoplegia, short stature, diabetes mellitus, diabetes insipidus, renal dysfunction, optic atrophy, retinal degeneration, impairment of hearing and mental retardation or deterioration. A symptomatological variation was observed in cases in the same family. It is suggested that these widely varying symptoms may be expressions caused by a common biochemical defect which involves different tissues in different individuals in the family. The syndromes observed in the present cases were compared with other possibly-related mitochondrial encephalomyopathies.

Adult↗
PubMed1976

Experienced reality in somatic patients more that 65 years old. A comparative study of disturbed and clear, but demented states of consciousness.

Eight experienced qualities of reality were examined in relation to five sorts of experience in 15 demented patients in clear states of consciousness (the CSC group), and in 15 patients in disturbed states of consciousness (the DSC group). Many more abnormal reality qualities appeared in the DSC than in the CSC group. In the DSC patients the tendency to experience non-existent fantasy items as being real was so much greater than in the CSC patients that it will be of value in differential diagnosis if it is confirmed in other patient materials. In DSC patients, furthermore, positive qualities of sensation were found attached to many experiences of items which were not present in the actual stimulus fiels - even in patients who were not clinically hallucinated. The reliability of the results was controlled by having each patient evaluated by two psychiatrists.

Aged↗
PubMed1988

A new look at the loss of consciousness experience within the U.S. Naval forces.

Two surveys on the incidence of G-induced loss of consciousness (G-LOC) in U.S. Navy aircraft have been completed. Questionnaires returned (981) indicated an incidence rate of 12.2% in the first survey. A slightly higher incidence rate was found in the second survey based on the 2,459 questionnaires returned. Results indicated that G-LOC is a significant problem in naval aviation in older as well as newer generation aircraft. Age, height, and weight of respondents did not appear to be related to incidence of G-LOC. Results indicated a need for improvement in the anti-G protective system and its use. Different forms of physical fitness training may differentially influence G-tolerance.

Adult↗
PubMed2006

Altered states of consciousness: processed EEG in mental disease.

Due to increasing life expectancy and a rising elderly population in Europe, the incidence of mild cognitive impairment which may predict diseases like Alzheimer's Disease or Vascular Dementia, is rising. Neurophysiological techniques are simple and inexpensive tools for early diagnosis and provide useful and objective correlates of cognitive activity both in normal subjects and patients suffering from the above conditions. Cognitive impairment due to different mental disease is characterized by decreased power and coherence in the alpha/beta band, which suggests functional disconnection among cortical areas, whereas both power and coherence in the delta and theta bands increase as a sign of cortical deafferentation from subcortical structures. Quantification of power and phase relationship by bispectral analysis suggests the Bispectral Index could be a useful but simple tool for early diagnosis of mental disease.

Aged↗
PubMed1985

Severe illness caused by the products of bacterial metabolism in a child with a short gut.

An 8-year-old boy with a short gut had six episodes of metabolic acidosis and neurological dysfunction over a 1 month period. The neurological features consisted of a depressed conscious state, confusion, aggressive behaviour, slurred speech and ataxia. The organic acid profile of urine demonstrated increased amounts of lactic, 3-hydroxypropionic, 3-hydroxyisobutyric, 2-hydroxyisocaproic, phenyllactic, 4-hydroxyphenylacetic and 4-hydroxyphenyllactic acids. Of the lactic acid 99% was D-lactic acid. The anaerobic gut flora consisted almost entirely of Lactobacilli in unusually large numbers. A course of vancomycin prevented further episodes. A urinary organic acid profile may be diagnostic when a person with a short gut develops metabolic acidosis or an unusual encephalopathy and bacterial metabolites should be considered in other patients with unusual combinations of organic acids in the urine.

Acidosis↗
PubMed1977

[Development of the comprehension of localization in deranged consciousness].

The controversy between narrow localisationism and equipotentialism which exists even nowadays shows that these two trends are not in a position to solve the localisation problem. The attempts to localize consciousness either in the cortex or in the subcortex and the area of the third ventricle should be considered groundless, as well as the assumption that the cortex only gives the contents of consciousness while the source of consciousness is found in the area of the third ventricle. Consciousness represents the synthesis of the psychical activity. The basic weak points of both trends arise from the very formulation of the question discussed, from the striving to find the solution of the localisation problem without bearing in mind the physiological processes which lie in the basis of the higher psychical functions, i.e. behind the processes of the higher nervous activity, as well as from the incorrect understanding of the conceptions of "function" and "centre". Thanks to the school of I. P Pavlov and his followers the prerequistions have been created of a new trend in the field of the localisation problem--the teaching of the dynamic localisation of the cerebral function.

Action Potentials↗
PubMed1987

Phase I trial of spiromustine (NSC 172112) and evaluation of toxicity and schedule in a murine model.

Phase I evaluation of spiromustine was performed using an every-3-week schedule and a weekly X 3 schedule. Neurotoxicity was the dose-limiting toxicity presenting as alterations in cortical integrative functions (orientation, language, coordination), leading to a decrease in the level of consciousness. Traditional criteria for grading neurotoxicity poorly characterized these toxicities. The maximum tolerated dose was 6 mg/m2 every 3 weeks and 3 mg/m2 weekly X 3. Concurrent murine studies confirmed spiromustine as a schedule independent drug with toxicity correlating with peak plasma levels. Physostigmine had little effect on decreasing neurotoxicity in the murine model. The solvating agent used was not responsible for the neurotoxicity. Injection of spiromustine on a split-dose schedule decreased the acute neurological toxicity in mice and allowed a larger total dosage to be delivered (compared to single bolus dosage). Based on these results a split-dose schedule is suggested for future clinical trials.

Animals↗
PubMed1988

Current and emerging technology in G-LOC detection: pulse wave delay for +Gz tolerance assessment.

We have found that pulse wave delay increases linearly with +Gz experienced by conscious subjects and that G-tolerance limits, as measured using conventional light bars, occur repeatedly at the same pulse wave delays or delta delay. When protective modalities such as anti-G suits or supinating seats are used, the delta delays increase at a slower rate as a function of +Gz. G-tolerance thresholds occur at higher +Gz levels with protection but the delta pulse wave delays reach the same value for all tolerance levels. This parameter can be used to warn expert systems of the approach of G-LOC during actual flight and/or provides an objective measure of G protection provided by new or modified anti-G equipment. Therefore, this tool can be used in the research setting to evaluate the efficacy of G-protective equipment in an objective manner.

Cognition Disorders↗
PubMed1985

The electroencephalogram in altered states of consciousness.

The EEG can be very helpful in the evaluation of patients with altered states of consciousness. Diffuse slowing of background rhythms and the presence of triphasic waves suggests metabolic dysfunction, particularly hepatic. Generalized fast activity may be seen in patients with a drug intoxication. Abnormalities, such as PLEDs or focal continual PDA, support a diagnosis of supratentorial lesion, whereas a normal appearing EEG in a comatose patient suggests a brain-stem lesion. In addition, the EEG may reveal that the alteration in consciousness is due to continual epileptic activity without motor manifestations (nonconvulsive status) that had not been suspected. As indicated, certain patterns have prognostic implications. However, as these patterns are not specific for a single etiology, the EEG is of most help when the cause is known. For example, burst suppression or a diffuse alpha pattern coma can be seen in either hypoxia or a drug intoxication. With hypoxia, these patterns carry an extremely poor prognosis for useful recovery, whereas complete recovery is often seen in cases secondary to drug ingestion. As a more extreme example, a patient whose EEG shows ECS secondary to drug intoxication may recover but will not if the ECS is due to hypoxia or severe head trauma. If the etiology of the encephalopathy is unknown, then sequential records are needed for prognosis.

Adolescent↗
PubMed2006

Relationship between regional cerebral metabolism and consciousness disturbance in traumatic diffuse brain injury without large focal lesions: an FDG-PET study with statistical parametric mapping analysis.

BACKGROUND: The cerebral metabolism of patients in the chronic stage of traumatic diffuse brain injury (TDBI) has not been fully investigated. AIM: To study the relationship between regional cerebral metabolism (rCM) and consciousness disturbance in patients with TDBI. METHODS: 52 patients with TDBI in the chronic stage without large focal lesions were enrolled, and rCM was evaluated by fluorine-18-fluorodeoxyglucose positron emission tomography (FDG-PET) with statistical parametric mapping (SPM). All the patients were found to have disturbed consciousness or cognitive function and were divided into the following three groups: group A (n = 22), patients in a state with higher brain dysfunction; group B (n = 13), patients in a minimally conscious state; and group C (n = 17), patients in a vegetative state. rCM patterns on FDG-PET among these groups were evaluated and compared with those of normal control subjects on statistical parametric maps. RESULTS: Hypometabolism was consistently indicated bilaterally in the medial prefrontal regions, the medial frontobasal regions, the cingulate gyrus and the thalamus. Hypometabolism in these regions was the most widespread and prominent in group C, and that in group B was more widespread and prominent than that in group A. CONCLUSIONS: Bilateral hypometabolism in the medial prefrontal regions, the medial frontobasal regions, the cingulate gyrus and the thalamus may reflect the clinical deterioration of TDBI, which is due to functional and structural disconnections of neural networks rather than due to direct cerebral focal contusion.

Adult↗
PubMed1975

Empirical investigations on the reliability and the value for differential diagnosis of 21 clinical symptoms of disturbed states of consciousness.

Two groups of patients in disturbed states of consciousness (DSC's) were compared with three groups of patients in clear states of consciousness (CSC's): demented, schizophrenic, and non-psychotic patients. In each of the groups, 15 patients were evaluated for 21 "objective" symptoms; each patient was evaluated by two psychiatrists. In this way, reliable symptoms were sought out which could discriminate: 1) elderly patients in DSC's from elderly demented but clear patients; and 2) schizophrenic patients from patients in DSC's caused by either withdrawal states after abuse of alcohol or barbiturates, or psychogenic psychoses. Reliable and discriminating symptoms were found. However, different symptoms discriminated when patients in different diagnostic groups were compared. Three kinds of discriminating values of a symptom may be distinguished from one another: 1) only the presence of a symptom is informative; 2) only its absence is informative; 3) both presence and absence of the symptom are informative.

Adolescent↗