1/53. Parenchymatous cerebral neurocysticercosis in a quadriplegic patient.OBJECTIVE: To present and discuss a case of cerebral neurocysticercosis in a quadriplegic patient. DESIGN: Case report of a case of neurocysticercosis in a high level spinal cord injury (SCI) patient who developed episodes of autonomic dysreflexia and orthostatic hypotension associated with transient neurologic deficits and seizures. SETTING: spinal cord Unit of the University Hospital of Geneva, switzerland. SUBJECT: Single patient case report. MAIN OUTCOME MEASURE: Clinical and radiological magnetic resonance imaging follow-up of the patient between July 1995 and October 1997. RESULTS: Treatment of cysticercosis with praziquantel relieved the patient from autonomic dysreflexia, symptomatic orthostatic hypotension, transitory neurological deficits and seizures. CONCLUSION: diagnosis of neurocysticercosis in a quadriplegic patient might be difficult because of frequent overlaps with some usual symptoms occurring in high level SCI, mostly autonomic dysreflexia and orthostatic hypotension. neurocysticercosis should be kept in mind when a SCI patient living in, or coming from endemic zones presents with new neurological abnormalities and seizures. magnetic resonance imaging appears to be more sensitive than computerised tomography to confirm the diagnosis of active cysticercosis. Treatment with praziquantel associated with cimetidine to increase the drug bioavailability and prednisone to reduce the inflammatory reaction gives good results.- - - - - - - - - - ranking = 1keywords = seizure (Clic here for more details about this article) |
2/53. cerebral palsy and pyruvate dehydrogenase deficiency: identification of two new mutations in the E1alpha gene.Pyruvate dehydrogenase (PDH) complex deficiency, a common cause of congenital lactic acidosis, is mostly due to mutations in the X-linked gene coding for the E1alpha subunit of the complex. We have studied two unrelated girls presenting a static encephalopathy with spastic quadriplegia, microcephaly and seizures and in one girl, hypocalcaemia, a new finding in PDH complex deficiency. PDH deficiency was diagnosed in adolescence and both girls had low PDH complex activity in muscle but normal amounts of all subunits on Western blotting, and a normal lactate/pyruvate ratio in blood and CSF. mutation analysis of the E1alpha gene at the cDNA or dna level revealed an arginine to histidine substitution at amino acid position 288 (R288H) in the girl with hypocalcaemia and a 12 bp insertion, predicting a four amino acid duplication at the c-terminal end of the protein in the second girl. They both carried a normal and a mutated E1alpha gene and X-inactivation studies showed skewed patterns. CONCLUSION: mutation identification in pyruvate dehydrogenase complex deficiency remains important especially for the determination of the recurrence risk and for reliable genetic counselling in couples with an affected child.- - - - - - - - - - ranking = 0.33333333333333keywords = seizure (Clic here for more details about this article) |
3/53. Delayed diffuse upper motor neuron syndrome after compressive thoracic myelopathy.A 54-year-old man developed progressive spastic paraparesis beginning 2 weeks after a back injury caused by a subacute compressive thoracic myelopathy attributable to a post-traumatic arachnoid cyst. Three to 18 months after surgical decompression of the thoracic arachnoid cyst, the patient developed a diffuse predominantly upper motor neuron syndrome characterized by spastic quadriparesis, pseudobulbar paresis, and pseudobulbar affect. Retrograde corticospinal tract degeneration and upper motor neuron death after spinal cord injury is recognized. This case suggests that focal upper motor neuron injury can occasionally precipitate diffuse upper motor neuron dysfunction.- - - - - - - - - - ranking = 6.8487672500449keywords = post-traumatic (Clic here for more details about this article) |
4/53. Bilateral frontoparietal polymicrogyria and epilepsy.Two patients with bilateral frontoparietal polymicrogyria are reported. Severe developmental delay, mental retardation, spastic tetraplegia, and seizures were the main clinical features. magnetic resonance imaging revealed a bilateral thick cortex with irregular gyri and a festoonlike gray-white matter junction. Bilateral frontoparietal polymicrogyria may represent a further form of the bilateral polymicrogyria syndromes in addition to perisylvian and parasagittal parieto-occipital polymicrogyria.- - - - - - - - - - ranking = 1.5108480188777keywords = seizure, epilepsy (Clic here for more details about this article) |
5/53. Bilateral basal ganglia-thalamic lesions subsequent to prolonged fetal bradycardia.We report two infants with bilateral basal ganglia-thalamic lesions subsequent to prolonged fetal bradycardia. Cardiotocogram revealed severe bradycardia lasting for more than 20 min in both. They demonstrated a significant encephalopathy, abnormal muscle tones and signs of brainstem injury. Clinical or electrical seizures were not observed in either of them. CT during early neonatal period demonstrated decreased tissue attenuation in basal ganglia and thalami in the absence of extensive cortical changes. Both of them developed severe mental retardation and quadriplegia. MRI in late infancy demonstrated abnormal high intensity areas in bilateral basal ganglia, thalami and around central sulci on T2-weighted image. Close correlation between prolonged fetal bradycardia and basal ganglia-thalamic lesion was suggested.- - - - - - - - - - ranking = 0.33333333333333keywords = seizure (Clic here for more details about this article) |
6/53. Improvement of sleep apnea in a patient with cerebral palsy.Intrathecal baclofen (ITB) can reduce spasticity in adults and children with cerebral palsy. Benefits of ITB therapy include improved Ashworth scores, activities of daily living, and mobility. The impact of ITB therapy on sleep apnea in patients with cerebral palsy has not been reported. This case report describes a 29-yr-old female with mixed spastic athetoid quadriparetic cerebral palsy with dystonia, gross motor function IV, who had sleep apnea, requiring nightly continuous positive airway pressure. She received ITB with the goal to improve her wheelchair positioning and decrease her excessive movements. After the initiation of the ITB, reduction of her spasticity and dystonia was noted, as well as improvement of her sleep apnea. This case suggests that ITB therapy may improve respiratory function through reduction of respiratory muscle spasticity.- - - - - - - - - - ranking = 0.051479000727232keywords = impact (Clic here for more details about this article) |
7/53. The use of a neoprene "thumb-sock" to prevent trauma in a thumb-sucking child with intractable epilepsy.A nine-year-old girl with spastic quadriplegia, mental retardation, poor vision, a gastrostomy, and intractable epilepsy was referred by her pediatrician for a dental assessment with a view to extracting her anterior teeth as a means of preventing repeated damage to the skin over the proximal phalanx of her left thumb, which she sucked at night. This was the time of day when the frequency of her epileptic seizures was highest. A simple solution to the problem was developed by a dentist and an occupational therapist in which nylon-coated 3-mm neoprene sheeting (wet-suit material) was formed into a "thumb-sock" with a simple Velcro fastening around the wrist. No trauma to the thumb from epileptic seizures has occurred since the "thumb-sock" was fitted 24 months ago.- - - - - - - - - - ranking = 2.1385600235971keywords = seizure, epilepsy (Clic here for more details about this article) |
8/53. Powered mobility and preschoolers with complex developmental delays.OBJECTIVE: The purpose of this study was to explore the effects of a powered mobility riding toy on the participation behaviors of young children with complex developmental delays. METHOD: A single-subject withdrawal design was used to study the effects of powered mobility on child-initiated movement occurrences, initiation of contact with others, and affect. The participants were two young children with complex developmental delays, including spastic quadriplegia. The intervention consisted of having the children use a powered mobility riding toy in their school settings during gym class and outdoor recess. RESULTS: Primary findings were that use of the powered mobility riding toy (a) increased the number of self-initiated movement occurrences; (b) appeared to have some effect on initiation of contacts with adults and, for one child, negative adult initiations and positive peer initiations; and (c) did not have a clear impact on the amount of positive affect. CONCLUSION: For some young children with severe motor impairments and developmental delay, use of a powered mobility device may increase self-initiated movement occurrences during free play.- - - - - - - - - - ranking = 0.051479000727232keywords = impact (Clic here for more details about this article) |
9/53. autonomic dysreflexia associated with transient aphasia.STUDY DESIGN: Case report of autonomic dysreflexia presenting with transient aphasia in a subject with C4 tetraplegia. OBJECTIVES: To report a rare case of autonomic dysreflexia. SETTING: rehabilitation Service, The ohio State University, USA. CASE REPORT: A 21-year-old man with a C4 spinal cord injury (ASIA B) developed aphasia associated with autonomic dysreflexia. He was treated with an adrenergic blocking agent. CONCLUSION: autonomic dysreflexia manifested by a transient aphasia and seizures is uncommon.- - - - - - - - - - ranking = 0.33333333333333keywords = seizure (Clic here for more details about this article) |
10/53. hyperbaric oxygenation as a successful therapeutic approach in oral wound dehiscence after operative stabilization of an unstable post-traumatic odontoid non-union.The non-operative treatment of unstable traumatic Anderson's type II odontoid fractures has a high risk potential to develop non-unions. Even after operative stabilization literature reveals non-union rates up to 20%. Acute life threatening complications are tetraplegia and apnoea. Long-term complications induce chronic myelopathy resulting from persistent myeloradicular compression. We report the case of a patient with a 17-year-old post-traumatic pseudarthrosis of the dens axis following conservative treatment of an unstable type II fracture. By that time, the female patient, then 37 years old, was admitted to our hospital with early signs of cervical tetraplegia. After initial reposition and short-term immobilization with a halothoracic vest we performed a ventrodorsal atlantoaxial spondylodesis. Failure of anterior cervical plate stabilization and autologous graft resorption without a solid segmental fusion instigated a secondary surgical intervention. Postoperative therapy-resistant oral wound dehiscence showed an exposed autograft and osteosynthetic material. The reported positive effect of hyperbaric oxygenation on wound healing in problem cases led us to attempt this means of therapy. With a daily exposure to hyperbaric oxygenation, the dehiscence closed within 25 days. As a result of our experience in this case, hyperbaric oxygenation should be considered as a therapeutic option in postoperative complication management in orthopaedic surgery.- - - - - - - - - - ranking = 34.243836250225keywords = post-traumatic (Clic here for more details about this article) |
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