1/9. Idiopathic recurring stupor: a case with possible involvement of the gamma-aminobutyric acid (GABA)ergic system.A patient had recurrent spontaneous episodes of stupor or coma in the absence of toxic, metabolic, or structural brain damage. Ictal electroencephalography showed fast 14 Hz background activity; sleep studies excluded narcolepsy. flumazenil (Anexate), a benzodiazepine antagonist, promptly resolved the episodes and normalized the electroencephalogram. Radioreceptor binding studies showed the presence of a ligand to the central benzodiazepine receptor in plasma and cerebrospinal fluid during the episodes, suggesting a gamma-aminobutyric acid (GABA)ergic system involvement in the origin of the attacks.- - - - - - - - - - ranking = 1keywords = stupor (Clic here for more details about this article) |
2/9. State of stupor from valproic acid during chronic treatment: case report.We describe the case of a 26 years old woman in chronic therapy with phenobarbital, carbamazepine, valproic acid (VPA) and clonazepam who showed a hyperammonemic encephalopathy after an increase in dosage of VPA. Similar cases have been reported, but with acute-subacute onset and no correlation with the plasma levels of VPA. Our case suggests the possibility that this toxic effect occurs during chronic treatment too, when the dosage of VPA is increased.- - - - - - - - - - ranking = 0.8keywords = stupor (Clic here for more details about this article) |
3/9. Meningoencephalopathy secondary to infectious mononucleosis. Unusual presentation with stupor and chorea.We report a case of infectious mononucleosis in which central nervous system involvement was the presenting and sole manifestation of the disorder. The major symptomatology consisted of stupor, chorea, and signs of aseptic meningitis. We also discuss the clinical and laboratory features of the neurological manifestations of infectious mononucleosis and the theories as to its pathogenesis.- - - - - - - - - - ranking = 1keywords = stupor (Clic here for more details about this article) |
4/9. insulinoma presenting as alcoholic stupor.We report a case of prolonged loss of consciousness due to hypoglycaemia following ethanol abuse in a non-diabetic. The patient also reported symptoms compatible with hypoglycaemia following heavy manual work. Further investigations revealed a pancreatic insulinoma, which was successfully removed surgically. The patient remains asymptomatic 18 months later, despite occasional episodes of ethanol abuse. This case illustrates how heavy exercise and/or alcohol abuse can aggravate spontaneous hypoglycaemia.- - - - - - - - - - ranking = 0.8keywords = stupor (Clic here for more details about this article) |
5/9. Pre-pubertal depressive stupor: a case report.A case of childhood affective disorder with episodes of depressive stupor in a 13-year-old pre-pubertal boy is described. Changes in the patient's clinical state were accompanied by changes in the dexamethasone suppression test. A family history of affective illness on the maternal side, with phenomenological similarities, is noted.- - - - - - - - - - ranking = 1keywords = stupor (Clic here for more details about this article) |
6/9. A case of severe dehydration with marked rhabdomyolysis.A 23-year-old male was admitted to hospital with severe dehydration and hypokalemic myopathy due to secondary aldosteronism. On admission serum sodium and chloride were markedly elevated to 198 mEq/l and 169 mEq/l, respectively, and serum potassium was down to 2.3 mEq/l. serum electrolytes were normalized by transfusion therapy, but subsequently rhabdomyolysis grew worse due to metabolic abnormalities such as dehydration, hypothermia, oppressive ischemia and metabolic acidosis, at the same time transient polyuria and the elevation of serum myoglobin and enzymes originating in muscle tissue were observed. serum CPK went up to 26,532 IU/l on the sixth day and other enzymes reached a peak following CPK. dexamethasone was administered when the increase in enzyme levels caused the patient to fall into a stupor. He rapidly regained consciousness from the 15th day after admission, and he was able to stand up on the 29th day. serum enzymes originating in muscle tissue decreased gradually to the normal range by the 30th day and no renal failure occurred.- - - - - - - - - - ranking = 0.2keywords = stupor (Clic here for more details about this article) |
7/9. Unusual 'spike-wave stupor' in a patient with manic-depressive psychosis treated with amitriptyline.'Spike-wave stupor' was observed in a 58-year-old male patient with manic-depressive psychosis. Almost continuous atypical spike-wave activity was seen in conjunction with a stuporous episode with stereotyped automatism. Intravenous diazepam ended both the electroencephalographic epileptiform discharges and the clinical stupor. Before and during this episode the patient was treated with an average-dose amitriptyline monotherapy. There was no family history of epileptic seizures. The patient had had electroconvulsive therapy. The history suggests that the analeptic property of amitriptyline induced the 'spike-wave stupor' in this patient.- - - - - - - - - - ranking = 1.6keywords = stupor (Clic here for more details about this article) |
8/9. hyperammonemia and valproate-induced alterations of the state of consciousness. A report of 8 cases.sodium valproate was administered to 38 patients, admitted to our unit in the last 18 months, and chosen because they had: (1) poor control of their seizures; (2) therapeutic concentrations in their plasma of at least two major antiepileptic drugs. In 8 of them, a therapeutic dosage of VPA caused modifications of the state of consciousness ranging from coma to drowsiness and stupor. These patients also showed gastrointestinal disturbances, asterixis, ataxia, tremor and a worsening of EEG abnormalities. The side effects of the drug were constantly associated with increased concentration of blood ammonia. Better penetration of ammonia into the CNS of patients undergoing frequent seizures and possibly having imperfectly functioning biological barriers, could explain our observations. In view of the unusually high percentage of patients suffering from serious VPA side effects, it is probably advisable to carefully monitor ammonemia in the first few days of VPA therapy in every patient treated with multiple anticonvulsants.- - - - - - - - - - ranking = 0.2keywords = stupor (Clic here for more details about this article) |
9/9. lorazepam in stupor.The use of lorazepam in relieving catatonic symptoms is illustrated by the dramatic response in a stuporous patient. The treatment allows further investigations and management. It is recommended that clinicians familiarise themselves with this simple pharmacological intervention.- - - - - - - - - - ranking = 1keywords = stupor (Clic here for more details about this article) |