1/7. anxiety, vocalization, and agitation following peripheral nerve block with ropivacaine.BACKGROUND AND OBJECTIVES: central nervous system (CNS) and cardiovascular toxicity are potential side effects of local anesthetics. However, ropivacaine has been reported to be less CNS toxic than bupivacaine in human volunteers. methods: We describe three cases of peripheral nerve blockade with ropivacaine that resulted in unusual symptoms of CNS toxicity. RESULTS: In three patients, unexpected behavioral changes occurred during administration of ropivacaine. The patients became extremely agitated, anxious, and screamed, and they did not respond to verbal commands. CONCLUSION: This case report shows that ropivacaine may cause CNS toxicity that differs from classical signs of local anesthetic-induced toxicity. This effect might be related to the unique structure of ropivacaine, which is formulated in an S-enantiomer preparation. It has been shown that S-enantiomers bind differently to receptors in both the CNS and cardiovascular systems. This property may account for the disinhibition of select neural pathways that are specifically involved in mediation of anxiety and aggression.- - - - - - - - - - ranking = 1keywords = nervous system (Clic here for more details about this article) |
2/7. west nile virus encephalitis.west nile virus (WNV) is a mosquito-borne virus that has caused a large number of deaths in the united states since the first outbreak in new york city in 1998. The outbreak initially was limited to the northeast but has since spread across the entire continental united states. WNV causes a variety of clinical symptoms, but the most severe consequences result from central nervous system infection, resulting in meningitis, encephalitis, or meningoencephalitis. We present a case of a 62-year-old male with metastatic cancer, who died as a result of WNV encephalitis. This is followed by a discussion on the epidemiology of WNV and a detailed summary of the methods and resources available to make a diagnosis of WNV infection postmortem. The material presented in the discussion should provide the forensic pathologist with all the information necessary to make a diagnosis of WNV infection postmortem. If nothing else, the routine collection and storage of serum, cerebrospinal fluid, and tissue for every case can enable the forensic pathologist to make this diagnosis even in cases in which WNV is not suspected until after autopsy.- - - - - - - - - - ranking = 3.5628939397746keywords = central nervous system, nervous system (Clic here for more details about this article) |
3/7. Acute respiratory failure with a single dose of quetiapine fumarate.OBJECTIVE: To report a case of acute respiratory failure after a single dose of quetiapine fumarate in an elderly patient with a history of chronic obstructive pulmonary disease (COPD). CASE SUMMARY: A 92-year-old woman with a history of COPD was admitted to the hospital with pneumonia. Her symptoms improved with antibiotics. Because of acute agitation and delirium, quetiapine 50 mg twice daily was started. After receiving the first dose, the woman developed acute respiratory failure and severe central nervous system depression. She required mechanical ventilation and supportive care in the intensive care unit (ICU). She had a full recovery within 24 hours. DISCUSSION: Quetiapine is an atypical antipsychotic that has been used successfully for the treatment of schizophrenia and bipolar disorder for many years. Recently, it has also been used to treat delirium and agitation. It has proven to be very safe, even in the elderly. In previously reported cases, serious adverse effects were seen in patients who ingested very high doses of quetiapine. Those patients required intubation and supportive care in the ICU. To our knowledge, as of January 19, 2006, this is the first case report of acute respiratory failure of such severity with one dose of quetiapine. Using the Naranjo probability scale, we conclude that the acute respiratory failure observed in this patient was probably related to quetiapine. CONCLUSIONS: This case suggests that quetiapine can have significant adverse effects even with a single 50 mg dose. Elderly patients, especially those with significant underlying pulmonary pathology, should be monitored closely when started on this medication.- - - - - - - - - - ranking = 3.5628939397746keywords = central nervous system, nervous system (Clic here for more details about this article) |
4/7. Intravenous administration of lisuride in the treatment of neuroleptic malignant syndrome.The neuroleptic malignant syndrome (NMS) is a very rare but life-threatening complication of neuroleptic treatment. The mortality of NMS has been estimated at 8-30% and the most common cause of death is respiratory failure. signs and symptoms of NMS are attributed to impairment of dopaminergic neurotransmission in the central nervous system. We describe two cases of NMS successfully treated with intravenous lisuride in combination with oral L-Dopa.- - - - - - - - - - ranking = 3.5628939397746keywords = central nervous system, nervous system (Clic here for more details about this article) |
5/7. Acute cerebral symptomatology, a rare presentation of scleromyxedema.A 65 year old male with the entity, scleromyxedema, experienced exacerbation of the disease in which the main clinical features involved the central nervous system. He presented with clouded sensorium, disorganized thinking, combative behavior, headache, unsteady gait and grand mal seizures. A few days after hospital admission the symptoms abated. After a 6 day hiatus, the symptoms suddenly recurred, continuing for another week. The symptomatology again suddenly ceased with complete clearance of mental status. During the full-blown delirium, the electroencephalogram had demonstrated diffuse slowing while lumbar puncture, brain scan, E.M.I. scan and cerebral arteriogram failed to contribute to the understanding of the clinical presentation. scleromyxedema rarely involves the central nervous system. This case illustrates a very unusual manifestation of scleromyxedema, prominent central nervous system involvement presenting as an acute organic brain syndrome. It is the only case which includes formal mental status examination, cerebrospinal fluid findings and electroencephalogram results.- - - - - - - - - - ranking = 10.688681819324keywords = central nervous system, nervous system (Clic here for more details about this article) |
6/7. hypertensive encephalopathy after bilateral carotid endarterectomy.BACKGROUND: hypertension occurs frequently after carotid endarterectomy and may lead to cerebral vascular complications and myocardial infarction. Its pathophysiology has recently been related to surgically induced damage of carotid baroreceptors. CASE DESCRIPTION: A 45-year-old normotensive man with no history of epilepsy was admitted 3 weeks after bilateral carotid endarterectomy for severe repetitive paroxysmal headaches, vomiting, and agitation that were closely associated with attacks of marked hypertension. During one of these attacks, he had a grand mal seizure. plasma catecholamine levels during hypertensive attacks were highly elevated despite the absence of pheochromocytoma, reflecting abnormalities in baroreceptor sensitivity that lead to unrestrained activation of the central sympathetic nervous system. heart rate response to valsalva maneuver showed suppression of the usual tachycardia, indicating baroreceptor reflex insensitivity. CONCLUSIONS: We report the first case of hypertensive encephalopathy associated with baroreflex failure syndrome after bilateral carotid endarterectomy. The role of blood pressure monitoring may be critical in revealing carotid baroreceptor insensitivity in such clinical settings.- - - - - - - - - - ranking = 1keywords = nervous system (Clic here for more details about this article) |
7/7. neuroleptic malignant syndrome: two cases without muscle rigidity.OBJECTIVE: Two patients with neuroleptic malignant syndrome without muscle rigidity are described. CLINICAL PICTURE: Both patients developed fever and altered consciousness while taking neuroleptic but did not develop muscle rigidity; the symptoms subsided when the neuroleptic was stopped but recurred when it was given again. TREATMENT: The neuroleptic was stopped; one patient received supportive treatment and the other received bromocriptine. OUTCOME: One patient died while the other survived. CONCLUSION: The pathophysiology is proposed as a combination of involvement of the central thermoregulatory, neuroregulatory and autonomic nervous systems, and the peripheral skeletal muscle. It supports the concept of a spectrum of clinical severity of neuroleptic malignant syndrome.- - - - - - - - - - ranking = 1keywords = nervous system (Clic here for more details about this article) |