1/26. The minimally conscious state in children.The minimally conscious state (MCS) is a condition of severely altered consciousness in which minimal but definite behavioral evidence of self- or environmental awareness is shown. Diagnostic criteria recently have been proposed for entry into and emergence from the MCS. We present clinical and neuroimaging data on 5 children diagnosed with MCS and discuss the limited information available concerning its epidemiology, etiology, pathology, and prognosis. Issues related to the evaluation and care of children suspected of having MCS are also reviewed as well as current ethical and legal controversies.- - - - - - - - - - ranking = 1keywords = state (Clic here for more details about this article) |
2/26. L-carnitine administration reverses acute mental status changes in a chronic hemodialysis patient with hepatitis c infection.A chronic hemodialysis patient presented with elevated serum ammonia concentration (189 micromol/l) and acutely altered mental status. He had been adequately dialyzed over the prior months and had no evidence of liver dysfunction, despite serological evidence for hepatitis c virus infection. His mental status deteriorated to coma despite vitamin replenishment, intensive hemodialysis, lactulose treatment, and blood pressure control over a 3-day period. Blood free L-carnitine concentration was depressed, and total carnitine concentrations was normal. Three hours after a single 2 g dose of L-carnitine was administered intravenously, the mental status reverted to normal. hyperammonemia resolved over a 5-week period. We suspect that subclinical liver dysfunction and dialysis status in tandem contributed to the carnitine deficiency, hyperammonemia, and confusion and that the L-carnitine administration reversed these biochemical and clinical abnormalities.- - - - - - - - - - ranking = 0.75167300237118keywords = confusion (Clic here for more details about this article) |
3/26. Jamais vu episodes in relationship to baclofen treatment: a case report.A 37-year-old man presented with new onset jamais vu episodes. Jamais vu is a mental state characterized by a sense of unfamiliarity in a familiar situation. The patient's episodes of jamais vu were unrelated to any known factor other than his use of baclofen. The episodes, which occurred as each baclofen dose wore off, resolved after the baclofen dose that triggered it was discontinued. The patient has had no recurrence of jamais vu states after discontinuation of his baclofen. This is the first known case report of jamais vu episodes caused by baclofen. Although jamais vu episodes can occur in healthy persons, they are known to occur more frequently in persons with epilepsy, fatigue, psychologic states, or intoxications. This case suggests that medications should be considered as a possible cause of jamais vu episodes.- - - - - - - - - - ranking = 0.6keywords = state (Clic here for more details about this article) |
4/26. Clinical and EEG findings in six patients with altered mental status receiving tiagabine therapy.Tiagabine (TGB), a novel GABA reuptake inhibitor antiepileptic drug, has been reported to induce nonconvulsive status epilepticus (NCSE) in patients with generalized or partial onset seizures. We describe six patients with refractory partial epilepsy treated with add-on TGB. They developed acute intermittent or progressive chronic confusion associated with diffuse slowing of the electroencephalogram (EEG), shortly after an increase in dose of TGB. This remitted in each situation after reduction of the daily dose. The possibility of nonconvulsive status epilepticus or toxic encephalopathy is discussed.- - - - - - - - - - ranking = 0.75167300237118keywords = confusion (Clic here for more details about this article) |
5/26. consciousness disturbances in megalencephalic leukoencephalopathy with subcortical cysts.Megalencephalic leukoencephalopathy with subcortical cysts (MLC) is a genetic disorder featuring diffuse MRI white matter abnormalities and a discrepantly mild clinical picture. It is related to different mutations in MLC1 gene encoding a putative membrane protein of still unknown function. We report on a genetically proven MLC patient who presented with a peculiar clinical course characterized by a prolonged comatose state following a minor head trauma at 12 years of age. The disturbance of consciousness lasted for over four months and then gradually improved. Proton MR spectroscopic imaging studies showed a moderately severe depletion of N-acetylaspartate restricted to the white matter with sparing of the cortical grey matter. The full recovery from coma suggests a transitory functional impairment of the structures implicated in the maintenance of consciousness.- - - - - - - - - - ranking = 0.2keywords = state (Clic here for more details about this article) |
6/26. Wernicke's encephalopathy: unusual contrast enhancement revealed by magnetic resonance imaging.Wernicke's encephalopathy is a serious neurologic disorder caused by vitamin-B1 or thiamine deficiency. The classical triad of clinical symptoms described by Wernicke (gait ataxia, ophthalmoplegia, and confusion) are found in only a third of patients upon initial examination. Typical findings upon MR imaging in patients with Wernicke's encephalopathy are well documented, with signal intensities in the medial thalami and periaqueductal regions of the midbrain. We report a case of Wernicke's encephalopathy revealing an unusual contrast enhancement. It is therefore important to note that the acute stage of Wernicke's encephalopathy may be associated with an intense contrast enhancement upon MR-imaging reflecting the disruption of the blood-brain barrier and inflammatory processes caused by thiamine deficiency. As a consequence from the guideline for managing Wernicke's encephalopathy by the Royal College of physicians early B-vitamin treatment in suspected is recommended cases.- - - - - - - - - - ranking = 0.75167300237118keywords = confusion (Clic here for more details about this article) |
7/26. Considerations for the use of assistive technology in patients with impaired states of consciousness.While there is limited literature addressing the application of assistive technology in patients in persistent vegetative state (PVS) and minimally conscious state (MCS), it is believed that it can assist with the assessment, diagnosis and treatment as well as management of these patients. The use of technology to assist in PVS and MCS is mostly limited to the application of simple binary switch devices to determine whether a motor response is consistent or otherwise. However, the application of such technology is often undermined due to a lack of established protocols for use by the multidisciplinary team (MDT), as well as a lack of available technical resources. Therefore the ongoing development of assessment instruments as well as effective outcome measures used by an MDT is imperative. This article aims to discuss some key aspects to consider in the use of assistive technology when assessing and treating people in impaired conscious states. Possible considerations and suggestions will be discussed through this paper and a case study will be used to demonstrate some of these interventions.- - - - - - - - - - ranking = 1.4keywords = state (Clic here for more details about this article) |
8/26. music therapy with patients in low awareness states: approaches to assessment and treatment in multidisciplinary care.This paper outlines the rationale for and role of music therapy as a clinical intervention and diagnostic tool in multidisciplinary (MDT) rehabilitation programmes for patients in low awareness states. A review of the literature indicates that music is a useful clinical tool in stimulating a range of behavioural, physiological and expressive responses in patients in low awareness states. Referral criteria for music therapy with this patient group are provided, along with suggested methods for collaborative multidisciplinary work. A case vignette is presented of a client whose diagnosis of vegetative state (VS) was contradicted by her purposeful responses within music therapy assessment, contributing towards a changed diagnosis to minimally conscious state (MCS). The case illustrates the particular role of music therapy in assisting with diagnosis in complex cases. music therapy provides a clinical forum in which recovery of function can be assessed in an informal way, using a medium which does not rely on language, is non-evasive and elicits emotional responses.- - - - - - - - - - ranking = 1.6keywords = state (Clic here for more details about this article) |
9/26. Leptomeningeal carcinomatosis in a patient with metastatic prostate cancer: case report and literature review.BACKGROUND: Leptomeningeal metastasis is discovered at autopsy in approximately 5% of patients with systemic cancer. Until recently with the introduction of magnetic resonance imaging (MRI), premorbid diagnosis was extremely difficult. In particular, initial spinal fluid cytology is diagnostic in less than 50% of autopsy-verified patients, although repeated spinal fluid examinations may increase the yield significantly. Leptomeningeal metastasis in metastatic prostate cancer has been reported in only 14 patients previously. CASE DESCRIPTION: We recently studied such a patient and were able to establish a correct diagnosis based solely on the MRI and the presence of an elevated cerebrospinal fluid (CSF) prostate-specific antigen (PSA). Only 3 previous patients with leptomeningeal prostate metastasis have undergone CSF PSA evaluations. CONCLUSION: We believe that, in such patients, the combination of MRI and CSF studies can overcome the lack of sensitivity of CSF cytology.- - - - - - - - - - ranking = 1.4keywords = state (Clic here for more details about this article) |
10/26. A complicated case of intracranial hypotension: diagnostic and management strategies.We report a case of a patient aged 66 years, with spontaneous intracranial hypotension presenting initially with postural headache, complicated by subdural haematomas and followed by progressive decline of his clinical condition evolving in obtundation state, cranial nerve involvement and gaze paralysis. The patient underwent a long course of different therapeutical approaches: medical and surgical treatment, intrathecal saline infusion and epidural blood patching (EBP). Rapid and dramatic relief of the patient's symptoms was obtained after a third lumbar EBP and he was discharged asymptomatic two weeks later.- - - - - - - - - - ranking = 0.2keywords = state (Clic here for more details about this article) |
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