1/14. De novo absence status of late onset following withdrawal of lorazepam: a case report.The aim of this report is to describe the clinical and electroencephalographic findings seen in an elderly woman without previous history of seizures who developed a nonconvulsive generalized status epilepticus following acute withdrawal of lorazepam. scalp video-EEG monitoring was obtained using the standard 10/20 system of electrode placement. Cognitive and speech functions were specifically tested during the evaluation. Continuous irregular rhythmic generalized 2.0-2.5 Hz sharp-and-slow wave complexes intermixed with spikes and polyspikes more prominent over the frontocentral areas were seen on the EEG. This epileptic activity was continuous and unmodified by sensory stimulation and eyes opening and closing. Intravenous injection of diazepam caused a rapid normalization of the EEG with disappearance of the clinical manifestations. De novo absence status is a specific epileptic condition that should be suspected in all elderly subjects on chronic treatment with psychotropic drugs presenting in a confusional state. An urgent EEG is essential to confirm the diagnosis.- - - - - - - - - - ranking = 1keywords = essential (Clic here for more details about this article) |
2/14. Spontaneous intracranial hypotension causing confusion and coma: a headache for the neurologist and the neurosurgeon.Spontaneous intracranial hypotension presenting with confusion and coma has rarely been reported. A case is presented and the clinical features of spontaneous intracranial hypotension are discussed.- - - - - - - - - - ranking = 127162.18475165keywords = intracranial hypotension, hypotension (Clic here for more details about this article) |
3/14. Delayed neuropsychiatric impairment after carbon monoxide poisoning from burning charcoal.Poisoning by carbon monoxide from burning charcoal has become one of the popular and lethal ways of attempting suicide in hong kong. survivors of the carbon monoxide poisoning often face acute and delayed adverse problems in both their physical and mental health. We report two cases of delayed onset neuropsychiatric complications caused by carbon monoxide poisoning from burning charcoal. These symptoms were characterised by a latent period, followed by an abrupt and profound deterioration in the neurocognitive function with a seemingly reversible course. The literature is reviewed regarding the aetiology, pathophysiology, and management of this condition. Regular monitoring of their neurocognitive function and forewarning of this potential complication to the survivors of carbon monoxide poisoning and their families should be essential.- - - - - - - - - - ranking = 1keywords = essential (Clic here for more details about this article) |
4/14. Spontaneous intracranial hypotension presenting as mental deterioration.A 55-year-old woman had new onset of postural headache followed by change of mental status 3 weeks later. magnetic resonance imaging (MRI) of the brain and whole spine showed typical spontaneous intracranial hypotension (SIH) findings, bilateral subdural hematoma, and cerebrospinal fluid leakage over the T7-T9. Her headache and mentality improved after epidural blood patches. Early recognition and correct diagnosis are crucial for successful treatment in patients with SIH presenting with mental confusion.- - - - - - - - - - ranking = 105968.48729304keywords = intracranial hypotension, hypotension (Clic here for more details about this article) |
5/14. Prolonged confusional state following electroconvulsive therapy--diagnostic clues from serial electroencephalography.INTRODUCTION: Cognitive impairment occasionally occurs after electroconvulsive therapy (ECT) and usually resolves within a few days. Any prolonged cognitive alterations or confusional states may have additional causes and require extensive diagnostic effort. Since cognitive dysfunction can also be caused by ictal states, electroencephalography (EEG) is an essential tool for these conditions. methods: We report on a female patient with pharmacotherapy resistant major depression who had been treated by a series of ECT and subsequently developed severe confusion and fluctuating amnesia. RESULTS: Laboratory and neuroimaging examinations were normal, however, EEG revealed a severe intermittent slowing with rhythmic high amplitude delta-/theta-activity and sporadic bitemporal sharp waves. Oral application of 1 mg lorazepam led to a sudden improvement of EEG abnormalities. Consequently, non-convulsive status epilepticus (NCSE) was suspected and the patient was regularly treated with lorazepam, accordingly. Clinically the confusional and amnesic symptoms declined, whereas serial EEG recordings showed a further improvement and normalization of brain electric activity. CONCLUSION: Routine EEG is an indispensable tool in patients with sudden deterioration of cognitive functions and unclear neuropsychiatric symptomatology. A testing dose of lorazepam can help to classify EEG abnormalities in terms of ictal EEG patterns.- - - - - - - - - - ranking = 1keywords = essential (Clic here for more details about this article) |
6/14. Hyponatraemia after transurethral resection of the prostate.Transurethral resection (TUR) syndrome is a complication of transurethral resection of the prostate characterized by bradycardia, hypotension and postoperative confusional state, which is generally attributed to hyponatraemia occurring during or immediately after operation. In a prospective study of 100 consecutive patients undergoing transurethral resection of the prostate, changes in serum sodium were estimated before and after operation and correlated with various parameters including weight of prostate resected, volume of irrigant fluid and resection time. Seven patients showed a significant drop (greater than 10 mmol/litre) in serum sodium: two of these had the clinical features of TUR syndrome and one of them died. The pathogenesis and management of this syndrome are discussed.- - - - - - - - - - ranking = 354.50190071136keywords = hypotension (Clic here for more details about this article) |
7/14. Cystocerebral syndrome. Acute urinary retention presenting as confusion in elderly patients.The diagnosis of acute mental status changes in the elderly patient is often very difficult. Many causes are possible, and there is often little history obtainable. The physical examination occasionally provides the essential clues needed to discover the source of the sudden deterioration. We have recently evaluated four episodes of acute delirium in three elderly patients who presented with no readily apparent cause for these changes. On further evaluation, the patients were found to have marked bladder distention associated with acute urinary retention. None of these patients complained of discomfort, and none had any awareness or recollection of their deterioration. Each patient had rapid resolution of symptoms on bladder decompression. To our knowledge, this "cystocerebral syndrome" has not been previously described, and we suggest that it be considered in the evaluation of acute confusional states in elderly men.- - - - - - - - - - ranking = 1keywords = essential (Clic here for more details about this article) |
8/14. Multiple cholesterol emboli syndrome after angiography.Multiple cholesterol emboli syndrome (MCES) after angiography has been reported infrequently. Seven patients (from five reports) who developed MCES after angiography are reviewed. An eighth case is described. All patients had evidence of extensive atherosclerosis. Following angiography of the eight patients, six demonstrated livedo reticularis below the umbilicus; technical difficulties were reported in four; four became febrile and/or hypertensive; and only one survived. Since therapy has been unsuccessful, careful angiographic technique is essential to prevent this syndrome.- - - - - - - - - - ranking = 1keywords = essential (Clic here for more details about this article) |
9/14. Temporary neurological deterioration after extracranial-intracranial bypass.Five patients who experienced temporary neurological deterioration after extracranial to intracranial bypass procedures are reported in detail. These patients suffered transient ischemic attacks or more prolonged deficits usually of a different nature than the preoperative symptoms. All patients had a good outcome and the spells ceased; the neurological deficits improved within a maximum of 2 weeks. Obvious causes of deterioration such as intra- or extracerebral hematomas, occlusion of a previously stenotic vessel, or graft occlusion were ruled out by computed tomography and angiography in each case. Intraoperative causes of neurological deterioration such as anesthetic effect, hypotension, and temporary occlusion of the cortical vessel or sacrifice of its small branches were not likely to be the cause of the deficits because in each case, the patient awoke satisfactorily and deterioration occurred hours to days later. In each case, postoperative angiography showed good perfusion of at least one major division of the middle cerebral territory. Anticoagulation with heparin in three patients did not change the clinical course. In one patient who was not anticoagulated, embolism could have been responsible for a single prolonged ischemic event, but in the other patients thromboembolism does not seem likely to have been responsible for the deficits. The cause of the deterioration in these patients remains unexplained. We speculate that hyperperfusion of chronically ischemic brain tissue and shifts in the watershed region resulting from the new flow pattern after bypass grafting are two mechanisms that may have been of importance in the etiology of these deficits.- - - - - - - - - - ranking = 354.50190071136keywords = hypotension (Clic here for more details about this article) |
10/14. Transient global amnesia associated with bradycardia and temporal lobe spikes.This paper presents electroencephalographic evidence of bilateral independent temporal lobe spiking during an episode of transient global amnesia. The amnesia occurred during a period of hypotension secondary to sinus bradycardia. The amnesia recurred in absence of bradycardia and hypotension. The temporal lobe spiking leads credence to the thought that transient global amnesia occurs as the result of seizure activity.- - - - - - - - - - ranking = 709.00380142271keywords = hypotension (Clic here for more details about this article) |
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