1/41. sound localization in hemispherectomized subjects: the contribution of crossed and uncrossed cortical afferents. The aim of the present study was to evaluate how hemispherectomized subjects localize sounds in free field using residual auditory structures under monaural testing conditions. The main objective of using a monaural condition with these subjects, who lack the terminal fields of auditory projections on one side, was to evaluate how the crossed and uncrossed pathways compare, with the aim of resolving this biologically critical function. In this model, crossed and uncrossed inputs refer to auditory stimulation presented to the unobstructed ear on the contralateral and the ipsilateral side of the intact hemisphere, respectively. Three hemispherectomized subjects (Hs) and ten control subjects (Cs) were tested for their accuracy to localize broad band noise bursts (BBNBs) of fixed intensity presented on the horizontal plane. BBNBs were delivered randomly through 16 loudspeakers mounted at 10 degrees intervals on a calibrated perimeter frame located inside an anechoic chamber. Subjects had to report the apparent stimulus location by pointing to its perceived position on the perimeter. Hs were less accurate than Cs in the baseline binaural condition, confirming the finding that with a single hemisphere and/or residual (subcortical) structures they cannot analyze binaural cues to sound localization as efficiently as with two fully functional hemispheres. In the monaural condition, Hs localized poorly when they had to depend on the uncrossed input, but performed as well or even better than the Cs with the crossed input. These findings suggest that monaural spectral cues, which constitute the only residual cue to localization under the monaural testing condition, are treated more efficiently, that is, they lead to better localization performance when relayed to the cortex via crossed pathways than through uncrossed pathways. ( info) |
2/41. 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. ( info) |
3/41. Proximal M2 false aneurysm after head trauma--Case report. A 72-year-old male presented with a post-traumatic false aneurysm of the right proximal M2 artery with massive subarachnoid hemorrhage after closed head injury. Serial computed tomography (CT) and angiography showed the development of the aneurysm which was verified at autopsy. He was admitted in a drowsy state just after a motorcycle accident. Initial brain CT showed subarachnoid hemorrhage without skull fracture. Follow-up brain CT showed a huge hematoma in the right temporal lobe. He died 47 hours after the accident. Histological examination of the aneurysm showed a false aneurysm. delayed diagnosis of traumatic aneurysms leads to high mortality, so early surgical treatment is essential to save such patients. ( info) |
| OBJECTIVE: To report a live birth with IVF-ET and intracytoplasmic sperm injection (ICSI) using sperm retrieved from a moribund man being maintained on life support systems. DESIGN: Case report. SETTING: Nonprofit private teaching hospitals. PATIENT(S): A 27-year-old man who was decorticate after an accident. INTERVENTION(S): Epididymal sperm retrieval and sperm cryopreservation, pastoral psychologic counseling, and subsequent IVF-ET with ICSI. MAIN OUTCOME MEASURE(S): pregnancy and delivery. RESULT(S): Birth of a healthy child after IVF-ET with ICSI and single blastocyst transfer. CONCLUSION(S): First report in peer-reviewed medical literature of a live birth after sperm retrieval from a moribund man. ( info) |
5/41. herpes simplex virus encephalitis simulating a frontoparietal convexity neoplasm. The unusual occurrence of a single, cell circumscribed encephalitis due to herpes simplex virus in the frontoparietal convexity is described and served to underline the importance of considering this pathology in the event of a rapidly expanding lesion presenting in any portion of the brain. The valuable, but limited, usefulness of brain scanning and cerebral angiography in making this diagnosis is discussed. Neurosurgical intervention and brain biopsy are required to make the definitive diagnosis. ( info) |
6/41. syringomyelia presenting as paroxysmal arm posturing resembling seizures. A 9-year-old female presented with daily episodes of medically refractory paroxysmal bilateral arm posturing, which had long been thought to be epileptic seizures. She also had other types of episodes, including daily staring spells and infrequent generalized tonic-clonic convulsions. neurologic examination was normal except for delayed cognitive development. The results of previous electroencephalograms (EEG) were normal, and magnetic resonance imaging of the head revealed a Chiari I malformation. Video EEG monitoring revealed no EEG changes during the attacks, and magnetic resonance imaging of the spine revealed a large cervical syrinx associated with the Chiari malformation. The episodes of paroxysmal bilateral dystonic arm posturing resolved after surgical intervention for the syrinx. This report illustrates that cervical cord disease is an unusual although potentially treatable condition to be considered in the differential diagnosis of paroxysmal episodes with dystonic movements of the arms, even in the absence of other physical findings of myelopathy. ( info) |
7/41. Intrathecal baclofen withdrawal mimicking sepsis. baclofen (Lioresal) is a drug of choice to treat spasticity and is increasingly being administered intrathecally via an implantable pump in cases refractory to oral therapy. Emergency physicians will likely treat patients with baclofen withdrawal or overdose as this treatment becomes more widespread. The syndrome of baclofen withdrawal presents with altered mental status, fever, tachycardia, hypertension or hypotension, seizures, and rebound spasticity, and may be fatal if not treated appropriately. baclofen withdrawal may mimic other diseases including sepsis, meningitis, autonomic dysreflexia, malignant hyperthermia, or neuroleptic malignant syndrome. Treatment consists of supportive care, reinstitution of baclofen, benzodiazepines, and diagnosis and eventual repair of intrathecal pump and catheter malfunction. ( info) |
8/41. 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. ( info) |
9/41. A case of treatment-related leukoencephalopathy: sequential MRI, CT and PET findings. A case of treatment-related leukoencephalopathy is presented. A patient with medulloblastoma was postoperatively treated with craniospinal axis irradiation. One month after irradiation, weekly intrathecal administration of methotrexate was performed 4 times to treat cerebrospinal fluid dissemination of the tumor. Two months after the initiation of intrathecal chemotherapy, the patient became somnolent and developed decerebrate posturing. magnetic resonance imaging showed diffuse leukoencephalopathy. Positron emission tomography revealed a diffuse decrease in glucose uptake in the deep white matter. Auditory evoked potential also showed diffuse abnormalities, not only in the cerebrum, but also in the brain stem. High dose intravenous leucovorin rescue was attempted without any neurologic improvement. ( info) |
| Catecholaminergic polymorphic ventricular tachycardia (VT) is a rare arrhythmogenic disorder, which may cause sudden death and whose relationships with mutations in cardiac ryanodine receptor gene have been recently established.The present article reports a catecholaminergic polymorphic VT case of a 9-year-old girl, without any previous history of syncope, who has been found unconscious while playing and referred comatose to pediatric intensive care unit.The electrocardiogram pattern showed runs of bidirectional and polymorphic VT degenerating into ventricular fibrillation, without QT interval abnormalities. Various attempts of cardioversion, lidocaine, and magnesium sulfate intravenous infusions were only partially effective.Owing to catecholaminergic polymorphic VT highly suggesting electrocardiogram pattern, intravenous propranolol was administered, achieving immediate VT interruption. Long-term nadolol therapy effectively prevented further arrhythmias, with no relapses up to 10 months later; a good neurologic recovery was also obtained.Genetic evaluation revealed in this patient-but not in relatives-a mutation in ryanodine receptor gene on chromosome 1. ( info) |