1/23. The shaking trauma in infants - kinetic chains.The findings in three children who died as a consequence of shaking and those in another child who survived are presented. In the three fatal cases, a combination of anatomical lesions were identified at autopsy which appear to indicate the sites where kinetic energy related to the shaking episodes had been applied thus enabling the sequence of events resulting in the fatal head injury to be elucidated. Such patterns of injuries involved the upper limb, the shoulder, the brachial nerve plexus and the muscles close to the scapula; hemorrhages were present at the insertions of the sternocleidomastoid muscles due to hyperextension trauma (the so-called periosteal sign) and in the transition zone between the cervical and thoracic spine and extradural hematomas. Characteristic lesions due to traction were also found in the legs. All three children with lethal shaking trauma died from a subdural hematoma only a few hours after the event. The surviving child had persistant hypoxic damage of the brain following on massive cerebral edema. All the children showed a discrepancy between the lack of identifiable external lesions and severe internal ones.- - - - - - - - - - ranking = 1keywords = action (Clic here for more details about this article) |
2/23. Suppression of post-hypoxic and post-encephalitic myoclonus with levetiracetam.Posthypoxic and postencephalitic myoclonus is often poorly controlled with current treatments. The authors successfully treated three patients with posthypoxic and postencephalitic myoclonus by using levetiracetam, a new antiepileptic drug. Levetiracetam appears to be a promising agent for treating action myoclonus caused by hypoxic and encephalitic brain injury-the degree of functional improvement may depend on the severity of associated motor dysfunction.- - - - - - - - - - ranking = 9963.2588896022keywords = myoclonus, action (Clic here for more details about this article) |
3/23. Fatal anaphylactoid reaction to N-acetylcysteine: caution in patients with asthma.Paracetamol overdose is a common reason for presentation to the emergency department and N-acetylcysteine is frequently used in the treatment of toxic paracetamol ingestions. Adverse reactions to N-acetylcysteine are common though usually mild and easily treated. Serious reactions to N-acetylcysteine however, are rare and there have been no previous reported fatalities with its therapeutic use. This report describes the case of a 40 year old brittle asthmatic patient who died after treatment with intravenous N-acetylcysteine. asthma is a risk factor for adverse reactions to N-acetylcysteine and special caution should be exercised in its use in brittle asthmatic patients.- - - - - - - - - - ranking = 7keywords = action (Clic here for more details about this article) |
4/23. A case of area-specific stimulus-sensitive postanoxic myoclonus.The authors report a case of area-specific stimulus-sensitive postanoxic myoclonus and discuss possible pathophysiology. A 71-year-old man sustained cardiorespiratory arrest that lasted 10 minutes and remained unresponsive. On the first EEG obtained 8 hours after the arrest there was no cerebral electrical activity before stimulation of the trigeminal-innervated areas. Periorbital stimulation was associated with bursts of spike-wave activity and generalized myoclonic jerks, whereas other types of stimulation did not elicit any response. A second EEG obtained 32 hours later showed a nonreactive alpha coma pattern. The patient died 7 days after the arrest. Area-specific stimulus-sensitive postanoxic myoclonus is very rare. The regularity of generalized bursts of spike-wave activity (cortical response) in response to stimulation of trigeminal-innervated areas suggests that the resting EEG electrocerebral silence may have been a result of cortical suppression with disinhibition of stimulus-sensitive brainstem-generated myoclonus.- - - - - - - - - - ranking = 9962.2588896022keywords = myoclonus (Clic here for more details about this article) |
5/23. The effect of adult-acquired hippocampal damage on memory retrieval: an fMRI study.Bilateral hippocampal pathology typically results in significant memory problems. Despite apparently similar structural damage, patients with such lesions can differ in the pattern of impairment and preservation of memory functions. Previously, an fMRI study of a developmental amnesic patient whose anoxic hippocampal damage was incurred perinatally revealed his residual hippocampal tissue to be active during memory retrieval. This hippocampal activity was apparent during the retrieval of personal and general facts relative to a control task. In this study, we used a similar fMRI paradigm to investigate whether residual hippocampal activation was present also in patient VC with adult-acquired anoxic hippocampal pathology. VC's performance and reaction times on the experimental personal and general fact tasks were comparable to age-matched control subjects. However, in contrast to the elderly control sample and the previous developmental amnesic patient, his residual hippocampal tissue did not show activation changes during the experimental tasks. This finding indicates that patient VC's successful retrieval of personal and general facts was achieved without a significant hippocampal contribution. It further suggests that the hippocampal activation observed in the elderly controls and previous developmental amnesic patient was not necessary for successful task performance. The reason for this difference in hippocampal responsivity between VC and the developmental amnesic patient remains to be determined. We speculate that it may relate to the age at which hippocampal damage occurred reflecting plasticity within the developing brain, or to cognitive differences between VC, the developmental amnesic patient, and the control subjects.- - - - - - - - - - ranking = 1keywords = action (Clic here for more details about this article) |
6/23. Anoxic brain injury following near-drowning in children. rehabilitation outcome: three case reports.PRIMARY OBJECTIVE: To describe the outcome of near-drowning and rehabilitation contexts for recovery. methods AND PROCEDURES: Standardized measures were used to emphasize the functional impact of deficits over the first year post-injury in three children <2 years. Multimodal contexts for meaningful interplay were early adapted to the three cases. MAIN OUTCOMES AND RESULTS: The clinical pathways of recovery are identified. Initially all three cases manifested a generalized dystonia. Case 1 exhibited a good outcome with transient dyskinetic-dystonic syndrome; subsequently Balint's syndrome emerged. In this case, the rehabilitation approach was organized on the pickup of direct perception of task-specific affordances. Cases 2 and 3 had poor outcomes presenting the worsening of torsion dystonia (status dystonicus) that hindered rehabilitation intervention. CONCLUSIONS: The dynamic reaggregation of spatial organization through meaningful interaction in specific ecological contexts is the principal goal of rehabilitation intervention. Status dystonicus represents the worst feature for recovery.- - - - - - - - - - ranking = 1keywords = action (Clic here for more details about this article) |
7/23. Post-anoxic myoclonus: a case presentation and review of management in the rehabilitation setting.Post-anoxic myoclonus is a rare movement disorder manifested by diffuse action-triggered jerking movements that may result in significant disability. The incidence of this disorder is not clearly established, but over 122 cases have so far been reported in the literature. The pathogenesis is not entirely known, although it has been hypothesized that particular susceptibility of the Purkinje cells of cerebellum to anoxic injury may play a key role. A case is presented of an independently living 60-year-old woman admitted to the rehabilitation unit with diffuse myoclonus after sustaining a cardio-pulmonary arrest. She presented with severe jerking movements in all extremities with startle to noise and exacerbations upon attempting any purposeful actions. The patient's myoclonus was controlled by a variety of anti-epileptic medications. The patient initially responded to a combination of divalproex sodium and zonisamide, but relapsed in several weeks, requiring addition of levetriacetam and clonazepam. At a 1-year follow-up she demonstrated a significant improvement in ambulation and self-care activities. This case illustrates that, although patients with post-anoxic myoclonus cannot be fully cured, their quality of life can be significantly improved by rehabilitation interventions.- - - - - - - - - - ranking = 11387.438730974keywords = myoclonus, action (Clic here for more details about this article) |
8/23. Effect of therapy with oxygen under high pressure on regional cerebral blood flow in the interval form of carbon monoxide poisoning: observation from subtraction of technetium-99m HMPAO SPECT brain imaging.Changes in brain images with single photon emission computed tomography (SPECT) using 99mTc hexamethylpropyleneamine oxime (HMPAO) before and after therapy with oxygen under high pressure (OHP) were measured in a 66-year-old man with the interval form of carbon monoxide (CO) poisoning by a new technique, i.e., subtraction of brain images. This study was performed 187 days after acute CO poisoning, in a state of chronic akinetic mutism that followed a lucid interval. A diffuse, but frontal-dominant, hypoperfusion pattern involving both the gray and white matter was observed in the pre-OHP SPECT image. After OHP, regional cerebral blood flow increased in both the gray and white matter and markedly increased in the frontal cortical regions. The present finding suggests that OHP is effective against the chronic state of the interval form of CO poisoning.- - - - - - - - - - ranking = 5keywords = action (Clic here for more details about this article) |
9/23. A case of postanoxic encephalopathy with cortical action and brainstem reticular reflex myoclonus.A patient with postanoxic encephalopathy, with both action- and stimulus-sensitive reflex myoclonus, is described. The action myoclonus was multifocal and cortical in origin. In contrast, reflex myoclonus elicited by somaesthetic and auditory stimulation was generalised. The earliest reflex electromyograph activity was recorded in the sternocleidomastoid; myoclonic activity then spread up the brainstem and down the spinal cord, suggesting that this reflex myoclonus had its origin in the caudal brainstem. Stimulus sensitivity was greatest in the limbs. The bulbospinal motor pathways involved in the generalised reflex myoclonus were rapidly conducting, and this characteristic distinguishes this form of brainstem reflex myoclonus from that described in hyperekplexia.- - - - - - - - - - ranking = 14237.798413717keywords = myoclonus, action (Clic here for more details about this article) |
10/23. Changing interactions between bipolar affective disorder and anoxic brain damage.A manic-depressive young woman received mild brain damage from anoxia after attempting suicide by hanging. The case conference was held to elucidate whether her subsequent symptoms were functional or organic, and what courses of treatment should be tried in this very refractory case.- - - - - - - - - - ranking = 4keywords = action (Clic here for more details about this article) |
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