1/11. Complete recovery of consciousness in a patient with decorticate rigidity following cardiac arrest after thoracic epidural injection.A 46-yr-old man with dysaesthesia (burning sensation) following herpes zoster in the left upper chest region was treated with a single thoracic (T2/T3) epidural injection (1.0% lidocaine 3 ml 0.125% bupivacaine 3 ml) as an outpatient. Twenty minutes after the injection, a nurse noticed the patient to be unconscious with dilated pupils, apnoea and cardiac arrest. Following immediate cardiopulmonary resuscitation, the patient was treated with an i.v. infusion of thiamylal sodium 2-4 mg kg-1 h-1 and his lungs were mechanically ventilated. When the patient developed a characteristic decorticate posture, mild hypothermia (oesophageal temperature, 33-34 degrees C) was induced. On the 17th day of this treatment, after rewarming (35.5 degrees C) and discontinuation of the barbiturate, the patient responded to command. weaning from the ventilator was successful on the 18th day. About 4 months after the incident, the patient was discharged with no apparent mental or motor disturbances. We suggest that mild hypothermia with barbiturate therapy may have contributed to the successful outcome in this case.- - - - - - - - - - ranking = 1keywords = rigidity (Clic here for more details about this article) |
2/11. Decerebrate rigidity with preserved cognition and gait: a possible role of anoxic-ischemic brain damage.A case of stable decerebrate posture in the upper limbs following sudden loss of consciousness and prolonged coma is described. The patient recovered most of her cognitive functions and gait, without clinical, neurophysiological or neuroradiological evidence of brainstem lesion. MRI shows borderzone infarcts. It is suggested that anoxic-ischemic cortical damage, affecting specially corticoreticular neurons, could explain the development of decerebrate rigidity in patients without apparent brainstem lesion.- - - - - - - - - - ranking = 1.25keywords = rigidity (Clic here for more details about this article) |
3/11. MR findings of decerebrate rigidity with preservation of consciousness.We describe a case of decerebrate rigidity, with preservation of consciousness, caused by a discrete pontine tegmentum lesion identified on MR imaging. Lesions within a certain brain stem region are responsible for decerebrate rigidity in animal studies, but there has been a lack of MR imaging evidence in humans. This report also implies that a discrete lesion was responsible for the decerebrate rigidity, while consciousness was preserved.- - - - - - - - - - ranking = 1.75keywords = rigidity (Clic here for more details about this article) |
4/11. Reversible decerebrate posturing after profound and prolonged hypoglycemia.Decerebrate rigidity is one of several reversible neurological abnormalities which have been observed in the setting of metabolic coma. We present the case of a patient who recovered fully from prolonged decerebrate rigidity associated with hypoglycemic coma. This case emphasizes the possibility of recovery from severe, prolonged hypoglycemia.- - - - - - - - - - ranking = 0.5keywords = rigidity (Clic here for more details about this article) |
5/11. Primary brainstem injury without persistent coma and decerebrate rigidity. Report of 2 cases.Two patients with blunt head injury were examined by CT scanning. It was found that there was brainstem hemorrhage with unremarkable changes in the other parts of the brain. physical examination showed signs of upper brainstem lesion such as discoordination, bilateral Babinski signs, and internuclear ophthalmic palsy without persistent coma and decerebrate rigidity. The diagnosis of primary brainstem injury, well healed, was established. Basing on the results of these 2 cases, we believe that primary brainstem injury does exist, but it is not necessarily associated with persistent coma and decerebrate rigidity. CT scanning for diagnosing such cases is emphasized.- - - - - - - - - - ranking = 1.5keywords = rigidity (Clic here for more details about this article) |
6/11. Exertional rhabdomyolysis associated with decerebrate posturing.A case is presented in which decerebrate posturing after a head injury led to rhabdomyolysis and renal failure. Exertional rhabdomyolysis is caused by an energy deficient state in overworked musculature that leads to a loss of integrity of the muscle cell. The resultant myoglobin in serum leads to acute renal failure. This condition should be suspected in a comatose patient with fever, brown discoloration of the urine, and edema of the extremities. Laboratory results will show orthotoluidine positive urine with a clear serum, elevated serum creatine phosphokinase, and serum creatinine elevation out of proportion to blood urea nitrogen. Management consists of fluids and diuretics with dialysis if necessary. rhabdomyolysis with head injury and decerebracy may occur more frequently than has been previously reported.- - - - - - - - - - ranking = 1.896831506655E-7keywords = muscle (Clic here for more details about this article) |
7/11. Traumatic decerebracy with preserved consciousness and voluntary movement.Decerebrate rigidity is a frequent occurrence in cases of craniocerebral trauma. It is almost always accompanied by coma and usually denotes a poor prognosis. Primary focal brain stem lesions due to trauma are uncommon and may be accompanied by other diffuse cerebral lesions. This report reviews the anatomical basis and clinical findings of a unilateral brain stem lesion in a patient with traumatic decerebracy and preserved consciousness. The anatomical pathways and possible physiological mechanism are discussed, and a few comments on the prognosis of such lesions are given.- - - - - - - - - - ranking = 0.25keywords = rigidity (Clic here for more details about this article) |
8/11. The effect of decerebrate rigidity on intracranial pressure in man and animals.patients with decerebrate rigidity frequently show intracranial hypertension. The factors responsible for this effect and their inter-relationships were explored in cats and in patients with head injuries. animals: The factors examined, separately and in combination, were elevation of central venous, intrathoracic, intra-abdominal and systemic arterial pressures. The baselines thus established were used for the investigation of the effects of these factors on the intracranial pressure (ICP) in cats which had been rendered decerebrate by focal stereotactic mesencephalic lesions. Little or no change occurred in the ICP when: Rigidity was mainly unilateral. Bilateral limb rigidity was extreme. Persistent elevation of ICP occurred when: Truncal rigidity resulted in the simultaneous elevation of the intrathoracic and intra-abdominal pressures. Elevation of the systemic arterial pressure occurred in the presence of defective cerebrovascular homeostasis. Human: The dynamics and management of the complex clinical problem posed by decerebrate rigidity were investigated in patients with head injuries who exhibited well-developed bilateral rigidity under conditions of altered cerebral elastance. Rigidity was quantified by measuring the resonant frequency of the wrist induced by a printed-circuit motor. The brain elastance, ICP, intrathoracic and blood pressures were measured throughout the study. The effect of pharmacological muscle paralysis on the ICP and rigidity was examined. It appeared that well-developed decerebrate rigidity increased the ICP. The relationship was direct; the greater the rigidity or cerebral elastance, the greater the rise in ICP and vice versa. The two factors mainly responsible were muscle hypertonicity and cerebral elastance. The rises in ICP were caused by the rigidity and although it may not always be possible to reduce the abnormally increased elastance, the rigidity can certainly be abolished. As long as the cerebral vascular homeostatic mechanisms were intact, spontaneous waning of the rigidity or its abolition by muscle relaxants returned the ICP to its previous resting level. pancuronium produced much deeper and more lasting relaxation than either diazepam or chlorpromazine. During the period of mechanical ventilation, alterations in ICP were of prognostic value as regards the outcome of the injuries.- - - - - - - - - - ranking = 3.7500005690495keywords = rigidity, muscle (Clic here for more details about this article) |
9/11. Traumatic decerebrate rigidity and neurological recovery: a case report.Trauma is the most common cause of decerebrate rigidity (DR). DR has been incorrectly equated with extensor posturing alone, however, and the "classical" criteria of decerebration generally have not been incorporated in the neurological evaluation of head-injured patients. A high mortality rate is associated with extensor posturing in head injury, and there have been few reports detailing neurological recovery and the quality of survival of patients with traumatic DR. The criteria of Sherrington are applied to a case of DR caused by midbrain injury, accompanied by mild, diffuse, hemispheric white matter changes shown on computed tomographic scan. The neurological examination and recovery are discussed. The literature is reviewed and the potential of DR in the prognosis of head injury is suggested.- - - - - - - - - - ranking = 1.25keywords = rigidity (Clic here for more details about this article) |
10/11. Cerebellar stimulation for chronic extensor-flexor rigidity and opisthotonus secondary to hypoxia. Report of two cases.Two patients with chronic hypertonus (in a decerebrate state) as a result of hypoxia are described. Long-term cerebellar stimulation markedly modified their extraordinarily severe extensor-flexor rigidity phenomena that had resulted in chronic opisthotonus.- - - - - - - - - - ranking = 1.25keywords = rigidity (Clic here for more details about this article) |
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