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PubMedDate not supplied

[The forensic psychiatric expertise of victims who received craniocerebral trauma in a criminal situation].

Thirty victims of criminal situations with craniocerebral injuries were examined. Clinical picture and time course of changes in the mental disorders, that are the most important for practical forensic medical expert evaluation, were analyzed, and approaches to the choice of the correct expert conclusion in assessment of the severity of injuries and of the victims' abilities discussed.

Acute Disease↗
PubMed1978

[Psychic disturbance in normal pressure hydrocephalus (author's transl)].

After reviewing the literature on psychic disturbance in normal pressure hydrocephalus, the author reports on 26 cases of CSF drainage. Impairment of memory and concentration were always present in normal pressure hydrocephalus; behaviour disorders were very frequent and characterized by both types of frontal behaviour; the mental picture also comprised difficulties of calculation, writing, visuoconstructive praxis and, less frequently, impaired speech and reading ability. CSF drainage brought clinical improvement in 73% of the cases. Disorders of consciousness, mental function and behaviour regressed generally progressively as soon as the operation had been performed. Two major factors affecting therapeutic efficacity appear to be the patient's age and the length of time between onset of the symptoms and start of therapy.

Adolescent↗
PubMed1990

[Lesions of the brain stem and cerebellum of alcoholic and nutritional deficiency origin].

Lesions of the brain stem and cerebellum due to toxic substances or nutritional deficiencies are mostly seen in chronic alcohol abuse and, more rarely, in severe malnutrition. Four clinical entities are described: Wernicke's encephalopathy is the most frequent of these, with progressive development of disorders of consciousness, oculomotor palsies and ataxia. The condition regresses under massive vitamin BA therapy, but it often leaves neuropsychological sequelae (e. g. Korsakoff's syndrome). The best treatment is prevention by giving thiamine to alcoholics and to malnourished subjects who receive glucose infusions. Cerebellar atrophy of alcoholic origin is responsible for subacute ataxia which, as a rule, is definitive. Central pontine myelinolysis is rare and presents as sudden quadriplegia with pseudobulbar palsy and sometimes "locked-in" syndrome. Beside alcohol, a frequent cause is major ionic disorders, such as hyponatraemia or its excessively rapid correction. Pellagra is a classical disease rarely seen in this country. It is due to nicotinamide (vitamin PP) deficiency.

Alcoholism↗
PubMed1997

[Organically-induced delusional syndrome in psittacosis].

We report on a case of psittacosis which presented first as an atypical pneumonia and in the further course as a paranoid syndrome with a concomitant disorder of consciousness. In contrast with reports from the literature there were no obvious neurologic signs and symptoms which would have indicated the organic nature of the illness. Therefore, the correct diagnosis was based on a careful anamnesis, clinical and psychopathological examination and confirmatory results of serological tests.

Adult↗
PubMed1990

Community hospital-based stroke programs in North Carolina, Oregon, and New York. IV. Stroke diagnosis and its relation to demographics, risk factors, and clinical status after stroke.

The use of diagnostic tests, the accuracy of stroke type diagnosis, and their relationship to outcome are important from the standpoint of patient management and health care costs. To address this issue, we examined the differences between stroke types in terms of demographics, risk factors, diagnostic tests, and clinical outcome in the 4,129 patients who comprise the Community Hospital-Based Stroke Program. Previous transient ischemic attacks were equally frequent among patients with embolic and those with thrombotic stroke. For all stroke types, previous stroke was as frequent as previous transient ischemic attacks. Hypertension and cardiac disease were the most common risk factors, but 10% of all stroke patients had no recognized risk factors. Intracerebral hemorrhage was most often associated with death (45%). There was a strong direct relation between in-hospital mortality and a decreased level of consciousness at admission. Overall, 30% of patients did not receive a specific stroke type diagnosis; these patients were elderly, usually nonwhite, and often had an altered level of consciousness at admission but had a risk factor profile similar to that of patients who received a specific stroke type diagnosis. In summary, our findings suggest the continued need for physician education about and refinement of stroke type diagnosis.

Aged↗
PubMedDate not supplied

[The reflection of the adaptive restructurings of the human brain in disordered cerebral functions in the parameters of interhemispheric asymmetry in EEG coherence].

In this work was studied a hemispheric specificity of the human brain in a realization of adaptive-compensatory reactions of the CNS. The interhemispheric correlation of EEG coherence functions of the left and the right hemispheres was computed in patients with brain focal lesions in early postsurgery period after an extraction of the medially-located tumor or in far-off time after a hard brain injury (i.e. at different stages of cerebral compensation). The observed peculiarities of changes of the interhemispheric biopotential relations revealed the dynamic character of preferable switching on the right or the left hemisphere in a formation of adaptive-compensatory brain reactions. The specificity of this switching depended on the stage of the pathologic process and reflected the degree of consciousness disturbance.

Adaptation, Physiological↗
PubMedDate not supplied

[Study of dissociative disorders and depersonalization in a sample of young adult French population].

UNLABELLED: Questioned by several researches about dissociative disorders, the authors study differences established on the nosographic register, through a quantitative study and a psychodynamic argumentation in a sample of french population. From the utilisation of the Dissociative Experiences Scale (DES) created by Bernstein E and Putnam FW (1986), which is an excellent screening tool for dissociative disorders and constructed on DSM II diagnostic criterions, the authors will show the interest of a psychodynamic analysis of dissociative disorders, in the face of the diagnostic difficulty in relation to several approaches of this concept. This difficulty is studied giving the background to dissociative disorders and depersonalization. Ionescu (1999) shows that between 1890 and 1910 dissociation represents one of major themes of psychology, psychopathology and psychiatry. Then, this interest about dissociation decreases and will be almost non-existent in the middle of the twentieth century. The interest for dissociative disorder will grow in the eighties with north-american studies about multiple personality disorders. Until 1980, dissociative disorders exist in DSM II as a list of symptoms included into hysterical neurosis, among the conversive disorders. In 1980, the publication of DSM III replaces the notion of hysteria with the notion of dissociative disorder. In this way, we can see on the one hand somatoform disorders quarterly corresponding to the ancient version of conversive hysteria, and on the other hand dissociative disorders characterized by a perturbation of consciousness, memory, identity or perception of environment. In 1994, The DSM IV delete the notion of hysteria and neurosis and keeps only the notion of dissociative disorders. They include now the five following categories: dissociative amnesia, dissociative fugue, depersonalization disorder, dissociative identity disorder, dissociative disorder not otherwise specified (including derealization). Depersonalization disorders consist of "persistent or recurrent episodes of depersonalization characterized by a feeling of detachment or estrangement from one's self. The individual may feel like an automation or like he or she is living in a dream or movie" (DSM IV). Depersonalization disorder cannot be diagnosed if it is part of schizophrenia, panic disorder, acute stress disorder or dissociative identity disorder. Various depressive disorders, hypocondriasis or obsessive-compulsive disorders can accompany depersonalization disorder. The first purpose of this study will search the frequency of dissociative disorders and depersonalization in a sample of normal population. Further, the inclusion of depersonalization amongst dissociative disorders seems not so evident: depersonalization belongs to self-consciousness disorder in french psychiatry. This fact seems more logical insofar as dissociative disorders have all together a memory and consciousness perturbation, and this perturbation is missing from depersonalization's feeling. The second purpose will be to clarify and specify the particularity of depersonalization among dissociative diorders, from the psychopathological point of view. METHODOLOGY: The sample (n = 248) is made up of french young adults aged 17 to 30 (mean age = 20, SD = 15 and 24% is male population). Subjects were streamming from universities. The screening tool which was used is the Dissociative Experiences Scale, a 28-item patient questionnaire regarding various dissociative symptoms. The subject is asked to indicate the percentage of time, to the nearest 5%, that particular symptom is experienced. The score is made by adding the various percentages and finding a mean that is expressed in numbers from 0 to 100. Normal scores are in the range of 5 to 15 in american adults. RESULTS: The utilization of principal component analysis (PCA) with varimax rotation is justified by the will to compare this study with American's studies. The mean score obtained is 17.44%, and 13.3% of the scores exceed a psychiatric threshold at 30%. The descriptive analysis shows that the component 1 (PCA without varimax rotation) represents 33.02% of total explained variance. This result demonstrates that the structure of the DES is based on one concept, the same as the american population, it is the concept of dissociation. The Principal Component Analysis with varimax rotation of the DES ratings yielded a tree-factor solution: imaginative absorption (F1), depersonalization-derealization (F2) and dissociative amnesia (F3). Mean score for each factor is respectively: F1 = 21.56%, F2 = 13.95%, F3 = 11.04%. DES reliability was studied through computation of Cronbach's coefficient (0.92). The PCA with varimax rotation brings to the fore a full dissociative disorder without any trouble of memory and consciousness. This fact questions again once more the link between hysteria and dissociative disorders. There is here a clinical distinction between depersonalization-derealization and other dissociative disorders. Indeed, the absence of significant alteration of memory and conscience is specific of depersonalization and derealization in this study. CONCLUSION: Finally, this study concurs with DSM IV dissociative criterions. At last, one factor of PCA is composed by the association of depersonalization and derealization, in contradiction with DSM IV definition. This result shows that, into the french population, we cannot divide the two concepts.

Adult↗
PubMed1999

Stroke units in their natural habitat: can results of randomized trials be reproduced in routine clinical practice? Riks-Stroke Collaboration.

BACKGROUND AND PURPOSE: Meta-analyses of randomized controlled trials of acute stroke care have shown care in stroke units (SUs) to be superior to that in conventional general medical, neurological, or geriatric wards, with reductions in early case fatality, functional outcome, and the need for long-term institutionalization. This study examined whether these results can be reproduced in clinical practice. METHODS: A multicenter observational study of procedures and outcomes in acute stroke patients admitted to designated SUs or general medical or neurological wards (GWs), the study included patients of all ages with acute stroke excluding those with subarachnoid hemorrhage, who were entered into the Riks-Stroke (Swedish national quality assessment) database during 1996 (14 308 patients in 80 hospitals). RESULTS: Patients admitted to SUs who had lived independently and who were fully conscious on admission to the hospital had a lower case fatality than those cared for in GWs (relative risk [RR] for death, 0.87; 95% confidence interval [CI], 0.79 to 0.96) and at 3 months (RR, 0.91; 95% CI, 0.85 to 0.98). A greater proportion of patients cared for in an SU could be discharged home (RR, 1.06; 95% CI, 1.03 to 1.10), and fewer were in long-term institutional care 3 months after the stroke (RR, 0.94; 95% CI, 0.89 to 0.99). No difference was seen in outcome in patients cared for in SUs or GWs if they had impaired consciousness on admission. CONCLUSIONS: The improvement in outcomes after stroke care in SUs compared with care in GWs can be reproduced in the routine clinical setting, but the magnitude of the benefit appears smaller than that reported from meta-analyses.

Activities of Daily Living↗
PubMed1996

Posterior fossa lesions associated with neuropsychiatric symptomatology.

We reviewed 7 cases with posterior fossa structural abnormalities (3 tumors, 2 megacisterna magna and 2 Dandy-Walker syndrome) presenting with neuropsychiatric symptomatology. Derangement in the balance of dopamine, serotonin and noradrenergic networks has been implicated in the pathogenesis of schizophrenia, affective and even personality disorders. Disruption of the cerebellar output to mesial dopaminergic areas, locus coeruleus and raphe nuclei, or deafferentation of the thalamolimbic circuits by a cerebellar lesion may lead to behavioral changes. Seven patients (pts) (comprising 4 men and 3 women with mean age 22 years) were diagnosed as suffering from psychosis (2 pts), major depression (1 pt), personality disorders (2 pts) and somatoform disorders (2 pts) (DSM-IV criteria). Brain CT scan (7 pts) and MRI (4 pts) revealed tumors of the posterior fossa (2 pts), megacisterna magna (2 pts) and Dandy-Walker variant (2 pts). In one patient a IVth ventricle tumor was removed in childhood.

Adult↗
PubMed1988

[Changes in the function of the cardiovascular system and cerebral circulation in patients poisoned by carbon monoxide and methane].

Altogether 68 patients with carboxyhemoglobinemia and 58 patients poisoned with methane were investigated. Toxic encephalopathy was observed in all of them: I degree of severity--in 13 patients, II degree in 29, III degree in 24, and IV degree in 60. To control CVS function, indices of central hemodynamics were investigated using methods of whole-body rheography and ECG; a volumetric rate of cerebral circulation was determined. A decrease in volumetric cerebral circulation was noted in patients with encephalopathy, III-IV degree, by 37.5% (carboxyhemoglobinemia) and by 26.1% (methane poisoning). Central hemodynamic disorders were more noticeable in carboxyhemoglobinemia. Multimodality intensive therapy included HBO and drugs to restore cerebral circulation, microcirculation in the brain, cerebral metabolism, and CVS function. Of 126 patients CNS functional restoration without neurological deficiencies was noted in 108 patients, neurological and psychic deficiencies were noted in 9 patients; 9 patients died.

Adult↗
PubMed1981

[Dynamics of psychopathologic disorders in neuroinfectious diseases].

Data of dynamic observations of 212 patients with psychic disturbances of the neuroinfectious genesis are presented. The authors analyzed 1696 admissions, or 8 admissions per each patient. The analysis revealed a number of regularities in the alternation of the psychopathological syndromes on repeated admissions. These regularities were found to depend on the initial symptoms, the patient's age, and the character of additional exacerbation-provoking pathogenetic factors. A tendency to copying the initial psychopathological disturbances was revealed.

Adolescent↗
PubMed2002

Jules Cotard (1840-1889): his life and the unique syndrome which bears his name.

Dr. Jules Cotard (1840-1889) was a Parisian neurologist who first described the délire des négations. Cotard's syndrome or Cotard's delusion comprises any one of a series of delusions ranging from the fixed and unshakable belief that one has lost organs, blood, or body parts to believing that one has lost one's soul or is dead. In its most profound form, the delusion takes the form of a professed belief that one does not exist. Encountered primarily in psychoses such as schizophrenia and bipolar disorder, Cotard's syndrome has also been described in organic lesions of the nondominant temporoparietal cortex as well as in migraine. Cotard's delusion is the only self-certifiable syndrome of delusional psychosis. Jules Cotard, a Parisian neurologist and psychiatrist and former military surgeon, was one of the first to induce cerebral atrophy by the experimental embolization of cerebral arteries in animals and a pioneer in studies of the clinicopathologic correlates of cerebral atrophy secondary to perinatal and postnatal pathologic changes. He was the first to record that unilateral cerebral atrophy in infancy does not necessarily lead to aphasia and was also the pioneer of studies of altered conscious states in diabetic hyperglycemia.

Consciousness Disorders↗
PubMedDate not supplied

Declining incidence and mortality of stroke?

The incidence and mortality from stroke in Espoo-Kauniainen, Finland, in 1972-73 were compared to the incidence and mortality from stroke in the same area 1978-80. The factors at the acute stage influencing case fatality were also analyzed. A declining trend in age-adjusted incidence of stroke was observed, though failing to reach statistical significance. The greatest decline was seen in the incidence of cerebral hemorrhage in men, with a statistically significant difference. The incidence of subarachnoid hemorrhage also decreased, and in women the decline was significant. There was no decrease at all of the incidence of cerebral infarction. The total mortality displayed no clear declining trend. However, the mortality from cerebral hemorrhage after three months from stroke had gone down from 72% to 59%. The most important factors responsible for increased case fatality were: lowered level of consciousness, cerebral hemorrhage and old age. The case fatality was also higher for women than for men. Previous heart diseases increased the mortality, but hypertension, diabetes, pure myocardial infarction and previous transient ischaemic attacks had no influence on mortality. The cause of decline in the incidence of cerebral hemorrhage might be improved care of hypertension: the decline in the incidence of subarachnoid hemorrhage however remains unclear.

Adolescent↗
PubMed1981

[Predictive value of the ajmaline test for the diagnosis of distal paroxysmal atrioventricular block (author's transl)].

An ajmaline test was conducted in 120 patients with a history of disorders of consciousness : Adams-Stokes syndrome (n = 49), loss of consciousness (n = 42), or lipothymia (n = 29). Four types of response were observed after ajmaline : VH less than 80 ms (n = 63); VH between 80 and 100 ms (n = 19); VH greater than 100 ms (n = 17); distal block (n = 21). One hundred and fifteen of these patients were followed-up for from three to six years (mean 56 months). Pacemakers had been fitted in 46 of them. Atrioventricular block was eventually detected in 37 patients but was excluded in the other 78 cases, either because the syncope attacks did not recur or because another cause was demonstrated. The predictive value of the ajmaline test was confirmed by the subsequent course of the disorders. Based on only clinical findings, diagnosis was confirmed in 42 p. cent, excluded in 12 p. cent, and impossible to define in 46 p.cent of cases. After the ajmaline test, diagnosis was confirmed in 79 p.cent, excluded in 6 p.cent, and impossible to define in 15 p.cent. The risk of atrioventricular block can be evaluated as 1-6 p.cent when the increase in VH is less than 80 ms, 35.3 p.cent when the increase is between 80 and 100 ms, 62.5 p.cent when it is greater than 100 ms, and 100 p.cent when there is a distal block. The indications for fitting a pacemaker depend upon the results of this test. If contra-indications are respected (recent history of an infarct, cardiac failure, marked enlargement of the heart), complications are rare, being observed in less than 3 p.cent of cases.

Aged↗
PubMed2004

Ritual homicide during dissociative trance disorder.

A case report is described of a man who developed a single period of recurrent episodes of dissociative trance disorder (DTD) during a family stress. The cultural environment was permeated by thoughts and beliefs in magic. During one trance state, the man performed an exorcism on the 6-month-old baby of his brother-in-law, and the baby died from cerebral hemorrhage. In the 5-year follow-up, no other episodes of DTD developed, and the man is serving an 18-year sentence.

Ceremonial Behavior↗
PubMedDate not supplied

[Disorders of systemic hemodynamics in the acute period of severe craniocerebral trauma].

Disorders of systemic hemodynamics were studied in 68 patients in the acute period of severe cerebrocranial trauma. Three types of systemic hemodynamics were revealed: normodynamic--in corticohemispheric level of brain injury, hypodynamic--in injury to the stem, and hyperdynamic--in hemispheric-subcortical damage. The authors consider the hyperdynamic and hypodynamic types of the responses of systemic hemodynamics as a prognostically unfavourable sign.

Acute Disease↗
PubMedDate not supplied

Personality profiles of patients with dissociative trance disorder in Singapore.

This report studies the personality of individuals who suffer from dissociative trance disorder and examines whether the personality profiles could predict the individual's frequency of trance states. A total of 58 cases were given the Eysenck Personality Questionnaire (EPQ) and their personal information harvested from the case notes and through subsequent interviews. The subjects were also reassessed 1 year later to obtain their frequency of trance states. For both sexes, there were lower extraversion scores and higher psychoticism, neuroticism, and lie scores in the sample compared to the Singapore norms. Of the 47 subjects traced, total episodes of trances that occurred over the 1-year period was positively correlated with neuroticism and negatively with extraversion scores. The high lie scores in individuals with dissociative trance disorder could be a reflection of their concern of how others perceive them. The motivation could be that of restoration of self-esteem or "face." The profiles in the EPQ could be used to predict the individual's frequency of trance states. Subjects with personality traits like nervousness, excitability, and emotional instability were more likely to have a higher frequency of trance states.

Adult↗
PubMed1988

[Neurological manifestations of Behçet's disease].

Characterised classically by the association of buccal and genital ulceration and uveitis with hypopyon, Behçet's disease has many other manifestations, amongst which the neurological ones (often referred to as Neuro-Behçet) are important in view of their frequency and their gravity. Anatomically, it produces a subacute haemorrhagic and necrotising meningo-encephalitis, which most typically effects the hypothalamus and brainstem. Clinically, there is extreme polymorphism, central manifestations being the most frequent: seizures, organic brain syndromes, disorders of consciousness, aphasia, hemiplegia, cranial nerve palsies, pseudobulbar and extrapyramidal syndromes and meningism. The peripheral nerves and muscles are rarely affected. Alongside Neuro-Behçet per se, attention has recently been directed to the various cerebro-vascular manifestations, dominated by venous thrombosis. A review of the principal neurological manifestations is given, with comment on anatomico-pathological aspects, clinical presentation, investigational techniques, diagnostic difficulties, prognosis, and treatment.

Behcet Syndrome↗