1/16. Coronary spasm with ventricular fibrillation during thyrotoxicosis: response to attaining euthyroid state.Although myocardial ischemia may occur in thyrotoxic patients with normal coronary arteries, the mechanism remains unclear. This report describes a woman with hyperthyroidism who had ventricular fibrillation during an apisode of myocardial ischemia. The event was documented with continuous ambulatory electrocardiography. Subsequent angiography revealed normal coronary anatomy with spasm of the right coronary artery that disappeared after ingestion of one sublingual nitroglycerin tablet. The angina, electrocardiographic evidence of myocardial ischemia, ventricular arrhythmias and the patient's need for nitroglycerin were eliminated after she became euthyroid. These findings suggest that coronary spasm may be associated with myocardial ischemia and arrhythmias in a hyperthyroid patient.- - - - - - - - - - ranking = 1keywords = state (Clic here for more details about this article) |
2/16. magnesium sulfate for control of muscle rigidity and spasms and avoidance of mechanical ventilation in pediatric tetanus.OBJECTIVE: To describe the use of intravenous magnesium sulfate for the control of muscle spasms and severe generalized rigidity in a child with moderate to severe tetanus without the need for prolonged deep sedation, mechanical ventilation, or neuromuscular blockade. DESIGN: Case report. SETTING: Pediatric intensive care unit in a tertiary care, university-based children's hospital. INTERVENTIONS: A continuous infusion of magnesium sulfate. MEASUREMENTS AND MAIN RESULTS: We describe a 12-yr-old child with moderate to severe tetanus who was treated with a continuous infusion of magnesium sulfate to control painful muscle spasms and severe generalized rigidity initially refractory to moderate sedation. Muscle spasms and severe generalized rigidity were improved with magnesium sulfate. No adverse effects associated with the use of magnesium sulfate were noted during the monitoring of cardiovascular and respiratory function, reflexes, and serum magnesium concentrations. CONCLUSIONS: An infusion of magnesium sulfate can be utilized to treat muscle spasms and severe generalized rigidity without the need for deep sedation, mechanical ventilation, or neuromuscular blockade. We recommend that magnesium sulfate be considered in the armamentarium of therapeutics utilized to treat muscle spasms and rigidity associated with tetanus, provided the patient's neurologic, cardiovascular, and respiratory status can be closely monitored in the pediatric intensive care unit.- - - - - - - - - - ranking = 14499.106107119keywords = rigidity (Clic here for more details about this article) |
3/16. Cyanotic breath-holding spell: a life-threatening complication after radical resection of a cervicomedullary ganglioglioma.Cyanotic breath-holding spell is a benign and self-limiting disease of young children but occasionally associated with sudden, unexpected death. The authors report a rare case in a 2-year-old girl with a severe form that started after radical resection of a cervicomedullary ganglioglioma. She was admitted to our hospital because of delayed and unstable gait. Since magnetic resonance imaging showed a cervicomedullary tumor, she underwent a radical resection and histology showed the tumor to be a ganglioglioma. Postoperatively, the function of the lower cranial nerves and cerebellum deteriorated and hemiparesis on the left became apparent, but she returned to the preoperative state in a few months. In addition, mild sleep apnea (Ondine curse) and severe cyanotic breath-holding spells occurred. The former responded to medication but the latter failed and continued several times per day with a rapid onset and progression of hypoxemia, loss of consciousness, sweating and opisthotonos. Five months after the operation, the patient returned home with a portable oxygen saturation monitor equipped with an alarm. This case indicates that cyanotic breath-holding spell, as well as sleep apnea, is critical during the early postoperative period. This is the first report observing that such spells may occur as a complication of radical resection of a cervicomedullary tumor.- - - - - - - - - - ranking = 0.25keywords = state (Clic here for more details about this article) |
4/16. Downbeating nystagmus and muscle spasms in a patient with glutamic-acid decarboxylase antibodies.PURPOSE: To report the ophthalmic findings and response to treatment in a patient with glutamic-acid decarboxylase antibodies. DESIGN: Case report. methods: A 55-year-old woman developed progressive, painful, low back muscle spasms, vertical diplopia, downbeating nystagmus, and asymmetric appendicular ataxia. RESULTS: Downbeating nystagmus was present in primary gaze with an alternating skew deviation in lateral gaze. serum and cerebrospinal fluid GAD antibodies were detected. Treatment with diazepam led to resolution of spasticity, whereas repeated courses of intravenous immunoglobulin improved cerebellar function, including appendicular ataxia and downbeating nystagmus. CONCLUSIONS: patients with GAD antibodies may have elements of both stiff-person syndrome (muscle rigidity and spasms) and prominent cerebellar dysfunction. Treatment with diazepam rapidly improved Stiff-person symptoms, whereas IVIg was partially effective at the early stage of cerebellar dysfunction.- - - - - - - - - - ranking = 1611.0117896798keywords = rigidity (Clic here for more details about this article) |
5/16. Rigidity and painful muscle spasms in a patient with probable myelitis.We describe a case of continuous motor unit potential (MUP) activity of central origin (unlike stiff man syndrome and progressive encephalomyelitis) characterized clinically by rigidity, painful muscle spasms, abnormal postures and spinal myoclonus. The topography of the manifestations, the subacute and benign course, the presence of stable sequels 2 years after onset and a searching process of differential diagnosis lead us to attribute the condition to an inflammation of the cord, which makes the case of particular clinical interest.- - - - - - - - - - ranking = 1611.0117896798keywords = rigidity (Clic here for more details about this article) |
6/16. Clinical neurophysiologic studies in stiff-man syndrome: use of simultaneous video-electroencephalographic-surface electromyographic recording.Three patients with a clinical diagnosis of stiff-man syndrome were studied with simultaneous video-electroencephalographic-surface electromyographic recordings in addition to routine electromyography in order to obtain objective data to confirm their diagnosis, to improve our understanding of the diagnosis of stiff-man syndrome, and to define reproducible clinical and neurophysiologic criteria for the stiff-man syndrome. These patients had the following features of this syndrome: (1) continuous muscle activity that varied with awake and sleep states, posture, passive and active movements, and medications; (2) superimposed intermittent generalized contractions while awake, which continued into drowsiness and interfered with onset of sleep; and (3) abnormal cocontractions of antagonistic muscles. The characteristic findings in the stiff-man syndrome can be recorded by using video-electroencephalographic-surface electromyographic techniques, a useful application of equipment already available in most electroencephalography laboratories. Neurophysiologic techniques can help in elucidating the clinical findings in the stiff-man syndrome. Further systematic study in patients before and during treatment is needed to identify common diagnostic criteria for this syndrome.- - - - - - - - - - ranking = 0.25keywords = state (Clic here for more details about this article) |
7/16. Cerebellar stimulation in man. Quantitative changes in spasticity.The effects of chronic anterior lobe cerebellar stimulation on patients with cerebral palsy have been investigated using a new method of quanitfying muscle rigidity and stretch reflexes. The ankle is oscillated sinusoidally, compliance is measured at several frequencies, and electromyographic activity of the extensor and flexor muscles is recorded. In some patients stimulation can reduce rigidity and coactivation of muscles immediately or slowly over days or months. In others no change is found.- - - - - - - - - - ranking = 3222.0235793597keywords = rigidity (Clic here for more details about this article) |
8/16. autoantibodies to glutamic acid decarboxylase in a patient with stiff-man syndrome, epilepsy, and type I diabetes mellitus.Stiff-man syndrome is a rare disorder of the central nervous system consisting of progressive, fluctuating muscle rigidity with painful spasms. It is occasionally associated with endocrine disorders, including insulin-dependent diabetes, and with epilepsy. We investigated the possible existence of autoimmunity against the nervous system in a patient with stiff-man syndrome associated with epilepsy and Type I diabetes mellitus. Levels of IgG, which had an oligoclonal pattern, were elevated in the cerebrospinal fluid. The serum and the cerebrospinal fluid produced an identical, intense staining of all gray-matter regions when used to stain brain sections according to an indirect light-microscopical immunocytochemical procedure. The staining patterns were identical to those produced by antibodies to glutamic acid decarboxylase (the enzyme responsible for the synthesis of gamma-aminobutyric acid). A band comigrating with glutamic acid decarboxylase in sodium dodecyl sulfate-polyacrylamide gels appeared to be the only nervous-tissue antigen recognized by cerebrospinal fluid antibodies, and the predominant antigen recognized by serum antibodies. These findings support the idea that an impairment of neuronal pathways that operate through gamma-aminobutyric acid is involved in the pathogenesis of stiff-man syndrome, and they raise the possibility of an autoimmune pathogenesis.- - - - - - - - - - ranking = 1611.0117896798keywords = rigidity (Clic here for more details about this article) |
9/16. Aseptic meningitis associated with naproxen.A rare complication of nonsteroidal antiinflammatory drug (NSAID) use, particularly in patients with collagen vascular or autoimmune diseases, is aseptic meningitis. A healthy 21-year-old man receiving naproxen for muscle spasm was admitted with a chief complaint of severe headache. Approximately one week after beginning naproxen, the patient developed headache, fever (T 38.8 degrees C), shaking chills, and nuchal rigidity with occasional nausea and vomiting resulting in a 15-lb weight loss. Findings from a cerebrospinal fluid examination revealed polymorphonuclear pleocytosis and elevated protein, but no evidence of infection with bacteria, fungi, mycobacteria, or viral agents was noted. Within 36 hours of discontinuing naproxen, the meningitis-like symptoms markedly improved. Rechallenge with naproxen was not performed. In patients exhibiting meningitis-like symptoms, a thorough drug history, including that of recent or intermittent NSAID use, should be obtained.- - - - - - - - - - ranking = 1611.0117896798keywords = rigidity (Clic here for more details about this article) |
10/16. The clinical recognition of subacute tetanus.The clinical features of a modified form of tetanus, termed 'subacute tetanus', occurring in non-immune patients are presented as manifested in five patients. Subacute tetanus has a good prognosis and favourable outcome. trismus and abdominal rigidity may be minimal or absent. Nocturnal, brief generalized muscle spasms, palpably contracted sternomastoid muscles and spastic limbs are common features of the disease. The pathophysiology of the nocturnal muscle spasms requires elucidation.- - - - - - - - - - ranking = 1611.0117896798keywords = rigidity (Clic here for more details about this article) |
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