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PubMed1998

[The one and a half vertical syndrome as the only evidence of bilateral thalamo-subthalamic infarction].

INTRODUCTION: The one and a half vertical syndrome consists of paralysis of upward vertical conjugated gaze and monocular paralysis of downward gaze or vice-versa. It occurs as a consequence of a mesencephalodiencephalic lesion, either unilaterally or bilaterally, due to effects on structures such as the interstitial nucleus of Cajal, posterior commissure and rostral interstitial nucleus of the medial longitudinal bundle. The arterial supply of the structures involved in the supranuclear control of vertical gaze depends on the paramedian thalamic arteries (or posterior thalamo-subthalamic arteries) and the paramedian peduncular arteries. CLINICAL CASE: We present the case of a 58 year old woman with non-insulin dependent diabetes mellitus who presented with sudden onset of diplopia of vertical gaze. On examination there was paralysis of superior vertical conjugated gaze and monocular paralysis of ocular infraversion (one and a half syndrome) with no other pathological findings. Cerebral angioresonance and Doppler studies of the territory supplied by the posterior cerebral artery were normal. CONCLUSIONS: Both unilateral and bilateral mesencephalodiencephalic infarcts usually present clinically as disorders of consciousness and of conduct (the almost universal form of presentation), involvement of the pyramidal tract, the third cranial nerves and a supranuclear disorder of vertical gaze. The unusual feature of the case we present is a bilateral thalamo-subthalamic infarct which presented solely as a one and a half vertical syndrome with no clinically apparent effect on anatomically adjacent structures. We have not found any similar cases in the literature.

Cerebral Infarction↗
PubMed2005

[Acute mental disorders in children and adolescents held as hostages by the terrorists in Beslan].

Stress reactions were studied in 92 children and adolescents held as hostages by the terrorists in Beslan (September, 2004). A special feature of mental trauma in this group of hostages is its extraordinary severity and duration, marked physical exhaustion and dehydration, a high proportion of small children, high frequency of burns, wounds and traumas. All the examinees demonstrated main signs of acute stress reactions (ASR): disturbed consciousness, psychomotor disorders, emotional disorders and autonomic changes. Moreover, there were such ASR appearances as repeated experience of trauma, avoidance, dissociation and regressive symptoms, hallucinations and delusion. A very high frequency of anxiety, fear and sleep disorder was registered. Age-specific characteristics of ASR are shown: higher frequency and longer duration of disturbed consciousness in small children, inverse relation between the degree of emotional experience differentiation and the victim's age. More severe mental disorders develop in victims who have lost their relatives.

Acute Disease↗
PubMed1994

Consciousness and psychotherapy.

The origins and resistance to change of neurotic procedures are considered with particular reference to the nature and role of consciousness. It is argued that the traditional opposition between conscious and unconscious systems provides an unsatisfactory model. The crucial role of language in the formation of human self-consciousness is emphasized. The restricted procedural repertoire of neurotic subjects, and their deficient self-consciousness, can be attributed to a number of factors. It is argued that the main use of consciousness in therapy should be to heighten the patient's awareness of his or her damaging or restricting procedural repertoire through the process of reformulation, which allows recognition, and in due course revision to be achieved.

Anxiety Disorders↗
PubMed1976

Psychiatric problems in intensive care. Five patients with acute confusional states and depression.

Five case histories are presented of patients with multiple trauma or severe infection, who developed psychiatric symptoms after an initially favourable response to intensive therapy. Alterations in the level of consciousness and behavioural pattern were observed, associated with the presence of acute depression, possibly primarily endogenous in origin. Following intravenous Clomipramine administration, considerable improvement was noted in all five patients, regarding both the depressive state and the clouding of consciousness. The importance of recognising psychiatric disorder in severly ill patients in an intensive therapy environment is stressed.

Adult↗
PubMed2004

["Mild" cranio-cerebral trauma occasionally have grave psychic sequelae].

Cranial injuries appear as neurological symptoms such as unconsciousness and focal neurological deficits. Mild cranio-cerebral traumas, that is, brain injuries without a serious neurotraumatologic symptom complex occuroften in practice. Nevertheless, even slight injuries, above all in the frontal cortical brain areas, can be accompanied by characteristic psycho-organic symptoms ("mild cognitive impairment" in the form of a "pseudoneurasthenic syndrome"). They are detected only after a thorough clinical psychiatric examination with a concomitant neuropsychological test. The diagnostics should be carried out as earlyas possible in order to identify and to immediately treat the respective disease. Chronicity and development of a depressive disorder can be, thus, prevented.

Brain Concussion↗
PubMed1993

[Typical pathology during the free immersion of a man under water].

The free immersion of a man under the water is accompanied by the threat of specific disorders which could cause the drowning. The article examines the causes, conditions and mechanisms of two most frequent pathological states, i.e. the compression of thorax and loss consciousness caused by CO2 action and hypoxia. The symptoms of these states, as well as prophylactic measures and first aid recommendations are enclosed.

Consciousness Disorders↗
PubMed2002

Conscious and unconscious uses of memory in multiple sclerosis.

Conscious and unconscious uses of memory and priming were studied in 30 patients with multiple sclerosis (MS) and 15 normal control (NC) subjects. MS patients were classified into two subgroups according to their cognitive status; 15 of them were cognitively deteriorated (the MS-D group) and 15 cognitively preserved (the MS-P group). A process dissociation procedure [J. Mem. Lang. 30 (1991) 513] was used to separate conscious and unconscious memory performance in a word stem completion task. The results showed that the MS-D group had deficient conscious memory performance, but had intact unconscious memory as well as priming. The MS-P group showed normal conscious and unconscious uses of memory and priming. Thus, in MS-related cognitive decline, conscious memory seems to be vulnerable, whereas unconscious memory remains intact. The results provide neuropsychological support for the distinction between conscious and unconscious memory processes. Moreover, the results show the importance of studying cognitively homogenous MS groups as opposed to heterogenous ones, in order to find the underlying mechanisms of memory deficits in MS. Interestingly, the neural systems needed for the unconscious use of memory do not seem to deteriorate even in MS patients with deficient overall cognitive capacity. This finding encourages the development of future rehabilitation programs, suggesting that unconscious remembering might help MS patients with deficient conscious memory to cope with their daily activities.

Adult↗
PubMed2002

The minimally conscious state: definition and diagnostic criteria.

OBJECTIVE: To establish consensus recommendations among health care specialties for defining and establishing diagnostic criteria for the minimally conscious state (MCS). BACKGROUND: There is a subgroup of patients with severe alteration in consciousness who do not meet diagnostic criteria for coma or the vegetative state (VS). These patients demonstrate inconsistent but discernible evidence of consciousness. It is important to distinguish patients in MCS from those in coma and VS because preliminary findings suggest that there are meaningful differences in outcome. METHODS: An evidence-based literature review of disorders of consciousness was completed to define MCS, develop diagnostic criteria for entry into MCS, and identify markers for emergence to higher levels of cognitive function. RESULTS: There were insufficient data to establish evidence-based guidelines for diagnosis, prognosis, and management of MCS. Therefore, a consensus-based case definition with behaviorally referenced diagnostic criteria was formulated to facilitate future empirical investigation. CONCLUSIONS: MCS is characterized by inconsistent but clearly discernible behavioral evidence of consciousness and can be distinguished from coma and VS by documenting the presence of specific behavioral features not found in either of these conditions. Patients may evolve to MCS from coma or VS after acute brain injury. MCS may also result from degenerative or congenital nervous system disorders. This condition is often transient but may also exist as a permanent outcome. Defining MCS should promote further research on its epidemiology, neuropathology, natural history, and management.

Humans↗
PubMed1976

Cerebral dominance for consciousness.

In a prospective study we evaluated the relationship of level of consciousness to hemispheric side of lesion following acute cerebrovascular injury. Fifty-seven percent of patients with left hemispheric lesions had initial impairment of consciousness, in contrast to 25% with right-sided damage.

Cerebrovascular Disorders↗
PubMed1989

Auditory perceptual problems in non-organic hearing disorder.

A series of 22 patients who presented with non-organic hearing disorder were examined for auditory perceptual problems. A test battery that examined eight areas of auditory perception revealed significant auditory perceptual problems in each of the 22 patients. The results indicate a view that differs from the traditional view of non-organic hearing disorder as either conscious feigning of a hearing disorder or an unconscious symptom of an unidentified emotional disorder. The information presented here indicates that specific auditory processing disorders could adversely affect patients' hearing and that auditory perceptual disorders could be diagnosed and treated.

Adolescent↗