1/117. Pseudo-subarachnoid hemorrhage: a rare neuroimaging pitfall.OBJECTIVE: We report an unusual case of the CT appearance of diffuse subarachnoid hemorrhage in a patient with anoxic encephalopathy, a situation which neurosurgeons, neurologists, and neuroradiologists should be aware of. CLINICAL PRESENTATION: A young man collapsed unconscious in jail after abusing an unknown quantity and variety of drugs. CT scan showed a picture compatible with diffuse subarachnoid hemorrhage. INTERVENTION: As the patient had a Glasgow Coma Score of 3 no heroic intervention was undertaken. An autopsy performed 40 hours after the initial ictus and 24 hours after death revealed no evidence of subarachnoid hemorrhage but gross and microscopic evidence of anoxic encephalopathy. CONCLUSION: Anoxic encephalopathy can mimic diffuse subarachnoid hemorrhage on CT.- - - - - - - - - - ranking = 1keywords = encephalopathy (Clic here for more details about this article) |
2/117. Acute encephalopathy and intractable seizures in a 10-year-old boy.We report a 10-year-old child with Robinow's syndrome who had a 2-week history of headaches and dizziness. On the day of admission, he developed a focal onset seizure with rapid secondary generalization. The seizures were intractable despite adequate doses of benzodiazepine, phenytoin, and phenobarbital, requiring a pentobarbital drip. Continuous electroencephalogram (EEG) monitoring showed persistence of the epileptiform discharges for 13 days. cerebrospinal fluid and brain biopsy studies were unrevealing. Mycoplasma pneumonia titers showed elevation of both immunoglobulins G and M that doubled during the tenth hospital day. High-dose methylprednisolone was begun, and within 12 hours of initiation the patient sat up and began to follow commands appropriately. The overall EEG background markedly improved. central nervous system mycoplasma pneumoniae infection should be suspected in patients with an encephalopathy of unclear etiology.- - - - - - - - - - ranking = 1.6666666666667keywords = encephalopathy (Clic here for more details about this article) |
3/117. Hypoglycemic coma masquerading thyrotoxic storm.A 59-year-old woman was hospitalized in hypoglycemic coma. Although hypoglycemia was promptly reversed, she was in a somnolent, restless state with tachycardia, tremor, profuse sweating, and high body temperature. Thyrotoxic storm was highly suspected and vigorous antithyroid regimens gradually brought her up to normal mental and cardiovascular states in several days. However, profound generalized myopathy necessitated the maintenance with a respirator. One month later, an episode of angina pectoris was followed by generalized convulsion, coma, and death in a few days. neuroimaging study disclosed posterior leukoencephalopathy syndrome. This case is instructive in that hypoglycemic coma may masquerade the major symptomatology of thyrotoxic storm, and that profound myopathy and angiopathic or angiospastic processes of the brain and the heart may interfere with the outcome.- - - - - - - - - - ranking = 0.33333333333333keywords = encephalopathy (Clic here for more details about this article) |
4/117. Encephalopathy complicating high-dose melphalan.High-dose melphalan (HDM) with peripheral blood stem cell transplant (PBSCT) is a common treatment for patients with multiple myeloma (MM) and more recently also with AL amyloidosis (ALA). We report two female patients with severe renal failure who underwent treatment with HDM for MM (patient 1) and ALA (patient 2). Both patients developed severe encephalopathy with generalised tonic-clonic seizures and a glasgow coma scale (GCS) of 3/15. Causes for coma such as infections, metabolic disturbances, cerebral ischaemia or haemorrhage were excluded. Patient 1 died on day 25 post transplant while comatose. Patient 2 recovered from her comatose state 18 days after transplantation. To our knowledge this is the first report on a possible role of high-dose melphalan in the development of encephalopathy.- - - - - - - - - - ranking = 0.66666666666667keywords = encephalopathy (Clic here for more details about this article) |
5/117. mycoplasma pneumoniae: a cause of coma in the absence of meningoencephalitis.mycoplasma pneumoniae encephalitis is a recognized cause of reversible coma in children. As an etiology of infectious encephalitis, it yields a relatively poorer prognosis than most other causes of infectious encephalopathies. Encephalitis is generally diagnosed by a constellation of clinical symptoms and confirmed by a cerebrospinal fluid (CSF) examination revealing cell pleocytosis and elevated protein. That mycoplasma pneumoniae encephalopathy can occur in the presence of a normal CSF examination is less well appreciated. The authors report two children who presented with coma and normal CSF findings in whom a diagnosis of acute mycoplasma pneumoniae infection was made. The two children both had rapid and complete recovery over several days. These cases exemplify that coma can result from acute infection with mycoplasma pneumoniae in the absence of an inflammatory CSF response and that a normal CSF may herald a more favorable prognosis.- - - - - - - - - - ranking = 0.33333333333333keywords = encephalopathy (Clic here for more details about this article) |
6/117. Prolonged sedation requiring mechanical ventilation and continuous flumazenil infusion after routine doses of clorazepam for alcohol withdrawal syndrome.We report the cases of two patients who developed prolonged sedation after routine doses of clorazepam for alcohol withdrawal syndrome. They required prolonged mechanical ventilation (10 days for both patients) followed by continuous flumazenil infusion (16 days for one patient and 3 days for the other) to avoid reintubation. In the two patients, nordazepam accumulation (main active metabolite of clorazepam) was demonstrated as the cause of the coma. This accumulation could be attributed, in one case, to impaired hepatic cytochrome P 450 3A4 activity. Caution is required when prescribing benzodiazepines to alcoholic patients and the use of benzodiazepine which do not undergo hepatic oxidation by cytochrome P 450 such as oxazepam or lorazepam is suggested.- - - - - - - - - - ranking = 0.0008537708482437keywords = hepatic (Clic here for more details about this article) |
7/117. Prolonged coma due to cerebral fat embolism: report of two cases.Fat embolism syndrome remains a rare, but potentially life threatening complication of long bone fractures. The true incidence is difficult to assess as many cases remain undiagnosed. Cerebral involvement varies from confusion to encephalopathy with coma and seizures. Clinical symptoms and computed tomography are not always diagnostic, while magnetic resonance imaging is more sensitive in the detection of a suspected brain embolism. Two cases of post-traumatic cerebral fat embolism, manifested by prolonged coma and diffuse cerebral oedema, are presented. The clinical course of the disease as well as the intensive care unit management are discussed.- - - - - - - - - - ranking = 0.33333333333333keywords = encephalopathy (Clic here for more details about this article) |
8/117. diffusion-weighted magnetic resonance imaging in a case of methanol intoxication.BACKGROUND: methanol intoxication is an uncommon clinical problem leading to profound metabolic acidosis with serious neurological deterioration. We describe methanol induced brain lesions on diffusion-weighted MR images and discuss the pathophysiology of these lesions in light of diffusion changes. CASE REPORT: brain imaging was performed in a 32 year-old man in a coma with focal neurological signs. Bilateral putaminal [hyperintensity] was seen on fast spin echo T2-weighted sequences, on Fluid Attenuated Inversion Recovery (FLAIR) and on diffusion weighted images. Decreased ADC values were observed bilaterally in the putamina. In addition, FLAIR images showed diffuse hypersignal in the subarachnoidal space. The patient showed rapid neurological deterioration while blood chemical tests revealed a severe metabolic acidosis and plasma methanol levels of 21 mmol/L. The patient died from hepatic failure thirty six hours after admission. CONCLUSION: Although decreased ADC values on diffusion-weighted imaging are commonly associated with arterial ischemic stroke, this pattern can also be observed in the case of putaminal necrosis following methanol ingestion.- - - - - - - - - - ranking = 0.00042688542412185keywords = hepatic (Clic here for more details about this article) |
9/117. A case of post-anoxic encephalopathy with initial massive myoclonic status followed by alternating Jacksonian seizures.To contrast stimulus-sensitive generalized myoclonus with ensuing multifocal localized myoclonus in a patient with post-anoxic coma, we stressed the clinical as well as electroencephalographical differences between his initial generalized and subsequent focal myoclonus. While generalized myoclonus was presumably of extracortical origin and responsive to valproic acid, alternating Jacksonian seizures were definitely cortical and suppressed with phenytoin. These two different types of myoclonus should not be confused in post-anoxic coma.- - - - - - - - - - ranking = 1.3333333333333keywords = encephalopathy (Clic here for more details about this article) |
10/117. Severe neurotoxic reaction associated with oral ingestion of low-dose diethyltoluamide-containing insect repellent in a child.N,N-Diethyl-m-toluamide (deet) is the major component of almost all tick repellent products. Reports of severe adverse reactions following voluntary ingestion are rare and primarily involve adults. This report describes a case of a toxic reaction after ingestion of low doses (80 mg/kg) of deet in a child. The signs and symptoms were coma and seizures within 2 hours of ingestion. The patient recovered without sequelae. It is concluded that even scant doses of deet may provoke severe encephalopathy in small children, and caution should be used when leaving this chemical unattended.- - - - - - - - - - ranking = 0.33333333333333keywords = encephalopathy (Clic here for more details about this article) |
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