1/101. Subacute onset of oculogyric crises and generalized dystonia following intranasal administration of heroin.A case is reported of a patient who experienced sudden onset of severe respiratory failure, shock and coma after first-time intranasal heroin abuse. During the following days full consciousness was restored, revealing persistent oculogyric crises, axial retropulsive dystonia and ataxia. Initially computer tomography (CT) scans of the brain were normal and cerebral spinal fluid examination showed a slight elevation of lactate. magnetic resonance imaging (MRI) scans of the brain demonstrated diffuse bilateral subcortical white matter hyperintensities, with sparing of the U-fibers, symmetric bilateral hyperintensities of the globus pallidum and very hyperintensive subcortical foci in the right hemisphere. Differential diagnostic assessment, treatment, clinical and MRI course of a 6-month follow-up are discussed.- - - - - - - - - - ranking = 1keywords = brain (Clic here for more details about this article) |
2/101. death due to inhalation of ethyl chloride.A 30-year-old white male was found dead in a locked apartment with a rag held loosely in his mouth. Four cans (3 empty, 1 partially empty) containing ethyl chloride and labeled as VCR head cleaner were found next to the body. phenylpropanolamine and low therapeutic levels of diazepam (64 microg/L) and nordiazepam (126 microg/L) were detected during toxicological analysis. An unidentified peak was observed when performing ethanol analysis by headspace gas chromatography. The peak was identified as ethyl chloride and the concentrations in the blood, urine, vitreous, brain, and lungs of the deceased were 423 mg/L, 35 mg/L, 12 mg/L, 858 mg/kg, and 86 mg/kg, respectively. The results were compared with previously reported levels of ethyl chloride in blood and vitreous and, based on a literature search, we believe that this is the first report of ethyl chloride levels in tissue.- - - - - - - - - - ranking = 0.5keywords = brain (Clic here for more details about this article) |
3/101. naltrexone treatment of dementia with severe self-injurious behaviors: a single case study.The results of studies of the opiate antagonist naltrexone (NLTX) in the treatment of self-injurious behavior (SIB) in various psychiatric populations have been equivocal. The majority of studies has relied on small samples, many of which lacked scientific rigor and none of which occurred in a nursing facility. The present study investigates the use of NLTX on a patient with severe SIB who resides in a nursing facility. The patient is a 38-year-old male with a history of heavy drug and alcohol abuse. He has been in either a state hospital or nursing facility since age 21. The patient overdosed on alcohol and drugs in 1990, which led to a prolonged coma with organic brain damage.- - - - - - - - - - ranking = 0.5keywords = brain (Clic here for more details about this article) |
4/101. Drug dreams: a neuropsychoanalytic hypothesis.Recent studies have shown that the ventral tegmental pathway stimulates both dreaming and drug craving. To investigate a possible clinical link between these two psychic phenomena, psychotherapy notes from the first six months of an addicted patient's treatment were reviewed, together with verbatim notes from the four years of psychoanalysis that followed. Of 240 dreams reported by the patient,58 had manifest content involving the seeking or using of drugs. There was no particular temporal or emotional thematic pattern to these "drug dreams,"which persisted through four and a half years of sobriety. Drug dreams are observable phenomena that reflect both the innate structure of the brain and neural changes produced by exposure to addictive drugs. In some addicted persons, exposure to drugs produces a fixed change in neurological functioning with which they must contend for years, possibly the rest of their lives. Drug craving meets Freud's defining characteristics for a drive: it is a constant pressure, originating from within the organism, to do work, and it constantly demands satisfaction. Because ego and libidinal drives share a common neural pathway, they should not be separated conceptually. Solms's finding (in press) that the activating systems for dreaming and for craving are identical, a finding based on observations of tumor- or stroke-provoked brain lesions, is confirmed by observation of the dreams of a patient whose brain changes were created by drug exposure. This study provides further evidence that the origin of the dream is a wish.- - - - - - - - - - ranking = 1.5keywords = brain (Clic here for more details about this article) |
5/101. Acute lead poisoning: Five cases resulting from self-injection of lead and opium.Five cases of acute lead poisoning resulted from the self-injection of lead and opium pills which were crushed, heated and suspended in water. Two of the five patients died of illnesses in which hepatic failure and reversible acute tubular necrosis were prominent features. One of these two had a severe neuropathy, with flaccid quadriplegia and respiratory paralysis. The other three patients had relatively minor symptoms but unequivocal biochemical evidence of lead toxicity. autopsy changes included hepatic degeneration with inclusion bodies, regenerating renal tubular epithelium and wasting of skeletal muscle. Hepatic lead content was extremely high in one case. chelation therapy in the other fatal case resulted in a fall in blood lead to within normal limits and a clinical improvement, which was terminated by massive haemorrhage from a ruptured innominate artery.- - - - - - - - - - ranking = 27.392215942739keywords = haemorrhage (Clic here for more details about this article) |
6/101. Butane abuse associated Encephalopathy.Butane contained in household products is easily available for abuse and is not subject to legal prosecution in germany. The toxicological properties of butane mainly affect the heart and the CNS. A serious pathophysiological mechanism is asphyxia due to the replacement of oxygen by butane. We report an abusive butane inhalation in a 15-year old girl, resulting in cardiopulmonary resuscitation and subsequent development of severe brain damage. After reviewing the medical literature and questioning German toxicological information centres it became obvious, that abuse of butane is an increasing problem. We give an survey about the complications associated with butane intoxication.- - - - - - - - - - ranking = 0.5keywords = brain (Clic here for more details about this article) |
7/101. septo-optic dysplasia with digital anomalies associated with maternal multidrug abuse during pregnancy.We describe a 16-year-old female affected by septo-optic dysplasia (SOD) with digital anomalies as additional feature. This rare developmental anomaly of midline brain structures can result from different pathogenetical events, including mutations of the homeo box gene HESX1, recently suggested as the etiological cause at least in a subset of patients. The absence of mutational involvement of this gene in our patient led us to consider, in alternative terms of pathogenesis, the maternal multidrug abuse occurring during pregnancy. Our report, in accord with previous experimental evidences, points out that illicit drug use might have played a causative role in brain development anomalies, thus our patient could represent an additional case of birth defects caused by a prenatal toxic exposure. The neurologic abnormalities and the clinical history of the patient are extensively reviewed. The need to include the SOD phenotype amongst the possible teratogenic effects of multidrug abuse is evidenced.- - - - - - - - - - ranking = 1keywords = brain (Clic here for more details about this article) |
8/101. Subarachnoid haemorrhage with "Ecstasy" abuse in a young adult.Abuse of the drugs like amphetamine, cocaine and "Ecstasy" may be complicated by intracerebral, subdural or subarachnoid haemorrhage. Contrary to historical opinion, drug-related intracranial haemorrhage (ICH) is frequently related to an underlying vascular malformation. We report the case of an 18-year-old man with a history of Ecstasy abuse preceding the onset of severe occipital headache. Cerebral computed tomography revealed right-sided subarachnoid haemorrhage and cerebral angiography showed right-sided middle cerebral artery aneurysm of 1 cm diameter. The patient was treated surgically with aneurysm clipping. Three weeks after onset of intracranial haemorrhage, neurological examination demonstrated normal findings. A history of severe headache immediately after using amphetamine, Ecstasy, or cocaine should alert doctors to the possibility of intracerebral haemorrhage. Arteriography should be part of the evaluation of most young patients with stroke or non-traumatic ICH.- - - - - - - - - - ranking = 366.44298704518keywords = intracranial haemorrhage, haemorrhage (Clic here for more details about this article) |
9/101. Fatal accident caused by isoflurane abuse.A fatal accident after isoflurane abuse is presented in this report. A hospital employee was found dead in the operating area with a plastic bag over his head. In his locker an almost empty bottle of isoflurane was found. autopsy revealed signs of asphyxiation and toxicological examination revealed nordazepam and isoflurane in non-toxic concentrations in the blood. Quantification of the anaesthetic was also carried out in urine, gastric contents, liver, kidney and brain samples, and in addition, oxazepam, prothipendyl and metabolites of midazolam and prothipendyl were found in the urine. Although the drug problems of the deceased were known before, no efforts had been made to restrict access to these drugs.- - - - - - - - - - ranking = 0.5keywords = brain (Clic here for more details about this article) |
10/101. Magnetic resonance studies on brain dysfunction induced by organic solvents.A 38-year-old layer of parquet flooring was referred because of memory impairment, tiredness and diffuse headaches. His work involved using several neurotoxic organic solvents. Extensive laboratory, neuropsychological, clinical neurophysiological, neuroadiological, magnetic resonance (MR) imaging and spectroscopy studies were performed. The neuropsychological and behavioural assessments showed an organic brain syndrome. MR imaging and CT scanning of the brain revealed enlarged ventricles and generalized atrophy. 31P and 1H MR spectroscopic measurements did not show any abnormalities. Owing to recent improvements regarding sensitivity and facilitated assignment, MR spectroscopy may provide in the near future significant additional information on brain metabolism in patients with brain dysfunction presumably induced by organic solvents.- - - - - - - - - - ranking = 4keywords = brain (Clic here for more details about this article) |
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