Cases reported "Brain Damage, Chronic"

Filter by keywords:



Filtering documents. Please wait...

1/15. Fulminant radiation-induced necrosis after stereotactic radiation therapy to the posterior fossa. Case report and review of the literature.

    The problem of radiation-induced necrosis of normal brain surrounding the target area has been a major catalyst for the development of stereotactically focused radiation therapy. According to current opinion, the effects of stereotactic irradiation are confined to the region targeted. The authors present a case in which the administration of a conventional dose of stereotactically focused irradiation for treatment of a pilocytic astrocytoma produced fulminant necrosis that necessitated a combination of intensive surgical and medical management, after which the patient improved over the course of 1 year. Concomitant with his improvement, the initially remarkable findings on magnetic resonance imaging gradually resolved. In this presentation the authors emphasize the need to evaluate alternatives carefully before a decision is made to administer therapeutic irradiation. Furthermore, they explore the roles that target, host, and dosage factors play in hypersensitivity to radiation injury, the detection of these factors before treatment, and the administration of radioprotective agents. With the growing use of stereotactically focused irradiation as a primary treatment modality for a variety of neurosurgical conditions, it is important to be cognizant of its uncommon but potentially lethal side effects. A cooperative multicenter database in which the outcomes and morbidity following stereotactic irradiation are recorded is essential to the detection of relatively uncommon but severe complications such as those observed in this case.
- - - - - - - - - -
ranking = 1
keywords = alternative
(Clic here for more details about this article)

2/15. Central acetylcholinesterase inhibitors in the treatment of chronic traumatic brain injury-clinical experience in 111 patients.

    PURPOSE: Theoretically, central acetylcholinesterase inhibitors (CAIs) could alleviate at least some of the main symptoms of chronic traumatic brain injury (TBI). The aim of this report is to describe clinical experience of the treatment of chronic TBI with these drugs. GENERAL methods: From an outpatient clinic material, 111 patients were selected having chronic stable TBI with at least one of the following target symptoms: fatigue, poor memory, diminished attention or diminished initiation. patients received in random donepezil, galantamine or rivastigmine. The evaluation of the treatment response was based on the subjective view of the patient. FINDINGS: As first treatment, 27 patients received donepezil, 30 galantamine and 54 rivastigmine. Altogether 41 patients tried more than one drug, but only three patients tried all three alternatives. In total, 61% of patients had a marked positive response and 39% a modest or no response. The clearest effect was in almost all responders a better vigilance and attention causing better general function. About half of the patients (55%) wanted to continue therapy with one of these drugs. The therapeutic response became very quickly and at low doses. There were no significant differences between the three drugs either in effect or tolerability. The age, sex, type of injury, severity of TBI or elapsed time after injury did not affect the response. The mean dose in maintenance therapy was 7.2 mg od for donepezil, 5.0 mg bid for galantamine and 2.3 mg bid for rivastigmine. Side effects or inadequate therapeutic response were the main causes for discontinuation with nearly equal frequency. Paradoxical responses were seen in some patients. CONCLUSIONS: CAIs show a very promising therapeutic potential in the treatment of chronic TBI. There were no significant differences between the three drugs. Large-scale randomised double-blinded placebo-controlled studies are clearly needed.
- - - - - - - - - -
ranking = 1
keywords = alternative
(Clic here for more details about this article)

3/15. Behaviour rehabilitation of the challenging client in less restrictive settings.

    Individuals who have sustained traumatic brain injury may provide friends, family, and rehabilitation professionals with challenges through an increased likelihood of their engaging in socially inappropriate behaviours. At extremes the inappropriate behaviours include vocal and physical assault, non-compliance, self-injurious behaviours, elopement, and property destruction. While these maladaptive behaviours are by themselves troublesome, for some individuals they provide severe barriers to rehabilitation. One option for the challenging rehabilitation client is a neurobehavioural programme, typically offering an access-limited or otherwise secure physical environment and which focuses on behaviour reduction. While outcomes from neurobehavioural programmes are typically positive, their expense and the negative connotations of this type of programme will at times dissuade family members from enrolling the client. We describe an alternative, less restrictive behavioural programme operated in the physical and social context of a larger, more typical community-based rehabilitation programme for traumatically brain-injured individuals. This programme has been in operation for nearly three years, successfully serving more than 200 clients, of which approximately 20% posed behaviour management problems. Identified variables accounting for these successes include: formal guidelines for programme development, staff training and monitoring, data collection, integration of an interdisciplinary team, discharge planning and post-discharge follow-up. We provide a general programme description followed by discussions of four brief case studies to illustrate basic principles of the programme. Programme strengths are discussed, as are constraints placed on the programme by the physical and social environments in which it operates.
- - - - - - - - - -
ranking = 1
keywords = alternative
(Clic here for more details about this article)

4/15. Can recognition of living things be selectively impaired?

    brain damage sometimes seems to impair recognition of living things, despite relatively preserved recognition of nonliving things. The most straightforward interpretation of this dissociation is that the recognition of living things depends on some specialized mechanisms that are not needed for the recognition of nonliving things. However, there are alternative interpretations of the dissociation in terms of the greater complexity or inter-item similarity of living things, or the more specific, within-category identifications that are usually required for living things. Surprisingly, the relevant tests to discriminate among these rival hypotheses have never been performed. We took the factors of visual complexity, inter-item similarity, specificity of identification, as well as others, into account in analyzing the visual recognition performance of two head-injured visual agnosic patients. In each case we found that recognition of living things was still disproportionately impaired when the effects of the other factors were accounted for.
- - - - - - - - - -
ranking = 1
keywords = alternative
(Clic here for more details about this article)

5/15. Neuropsychological assessment of the transcallosal approach.

    The long-term consequences of partial callosal lesions were examined in 7 neurosurgically treated patients. Detailed clinical and neuropsychological assessment of the interhemispheric transfer (multimodal sensory and motor tasks) as well as memory and attention tests were used. The results revealed some disconnection symptoms with minor clinical significance, which could not be attributed to particular sites of the corpus callosum, except the splenium. It is questionable whether the reported memory and attention impairments are caused by the callosal lesion or by extracallosal pathology. The results indicate that the transcallosal approach is a safe and feasible alternative in the management of pathological midline processes in the brain.
- - - - - - - - - -
ranking = 1
keywords = alternative
(Clic here for more details about this article)

6/15. The effect of intrathecal baclofen on electrical muscle activity in spasticity.

    The efficacy of intrathecally administered baclofen was demonstrated in three patients with different types of muscular hypertonia (supraspinal rigidity, spasms shortly after spinal trauma, spasms for many years induced by multiple sclerosis) using integrated electromyography. Reduction of muscular electrical activity was accompanied by clinical improvement during long-term infusion via an implanted pump. The three patients have been observed for more than 1 year, during which time the antispastic activity of intrathecally infused baclofen has remained stable. Intrathecal application of baclofen may be considered as a possible alternative to surgery.
- - - - - - - - - -
ranking = 1
keywords = alternative
(Clic here for more details about this article)

7/15. Word-form dyslexia.

    In this study we have reported our investigation of two patients with an acquired dyslexia characterized by letter-by-letter reading, whole word reading being apparently impossible. It has been shown that this phenomenon of letter-by-letter reading cannot be accounted for by visual or perceptual factors nor by impairment of visual span of apprehension. The exceptionally slow speed of reading was documented and a clear relationship between word length and reading speed established. Performance on tasks considered to maximize whole word reading which at the same time prevent the possibility of letter-by-letter reading, namely, reading script and reading with tachistoscopic presentation, was impaired. The satisfactory performance of these two patients on tasks of picture interpretation suggests that the two components of the syndrome simultanagnosia, letter-by-letter reading and piecemeal perception of complex scenes, are dissociable. Three alternative explanations of letter-by-letter reading are considered and we conclude that in this type of acquired dyslexia there is damage to the system through which a visual word-form is attained.
- - - - - - - - - -
ranking = 1
keywords = alternative
(Clic here for more details about this article)

8/15. Cognitive-perceptual abilities of a neurologically impaired infant: an alternative assessment strategy.

    A 26-month-old boy with quadriplegia, untestable using traditional developmental tests, was assessed using a visual-discrimination paradigm (i.e. habituation-dishabituation). The results were interpreted as evidence that this infant could visually attend to, and discriminate between photographic slides varying in shape and/or colour. It is suggested that this paradigm may eventually be used as an alternative clinical testing protocol for assessing the perceptual-cognitive abilities of CNS-damage infants.
- - - - - - - - - -
ranking = 5
keywords = alternative
(Clic here for more details about this article)

9/15. status epilepticus. A perspective from the neuroscience intensive care unit.

    patients with GCSE and NCSE are common and may present to the emergency department or the NICU. In the NICU, NCSE is a more common presentation than GCSE. In the emergency department, GCSE commonly evolves to NCSE, either as a late sequela of prolonged SE or due to partial treatment with antiepileptic medication or neuromuscular blocking agents. In the emergency department, acute cerebral injuries are commonly found in patients presenting with SE, regardless of whether they have preexisting epilepsy. In the NICU, almost by definition, SE occurs in patients with acute cerebral injuries. status epilepticus has been found to evolve sequentially through several stages, the end-point of which is a condition of refractory SE leading to neuronal necrosis and permanent cerebral injury. The responsiveness of SE to treatment is time-dependent. This makes early diagnosis and initiation of treatment essential. Most published treatment algorithms stress a 60-minute time window from the diagnosis of SE to its successful control. Unfortunately, the practical problem of patients with SE accessing such treatment protocols has been overlooked. Our preliminary (unpublished) data suggest that this access problem must be solved for treatment algorithms to improve the outcome of SE. In the NICU, access is less of a problem, and the determining factor is early diagnosis by NICU personnel. Because these patients usually sustain NCSE, which can be difficult to diagnose, a high index of suspicion and, optimally, continuous EEG monitoring are necessary for early diagnosis. NICU patients may be more susceptible to the ravages of SE because of their preexisting cerebral injuries. Expedited treatment may therefore be more important in this patient group. Clinical management of SE requires meticulous attention to ventilation and oxygenation, maintenance of adequate blood pressure, prevention of hyperthermia, and close monitoring for cardiac abnormalities. No specific medication is ideal for controlling SE. The knowledgeable and prompt use of intravenous lorazepam, a diazepam-phenytoin combination, or phenobarbital is acceptable as first-line treatment and as part of a systematic treatment algorithm. Refractory SE has been treated conventionally with high-dose intravenous barbiturate coma. Recent evidence suggests that high-dose intravenous midazolam may provide a useful alternative.
- - - - - - - - - -
ranking = 1
keywords = alternative
(Clic here for more details about this article)

10/15. A study of anomia: evidence for a distinction between nominal and propositional language.

    We describe our investigations of the word retrieval abilities of a patient (NOR) with a very severe anomia. NOR had the greatest difficulty naming even very common objects to confrontation yet his word comprehension, word repetition and reading skills were intact. We documented the efficacy of different types of cues for name retrieval. Phonological and semantic cues were either ineffective or had a minor effect. By contrast a sentence frame even a low probability sentence frame (e.g. I went to the shop to buy a ...?) had a very significant facilitatory effect for object naming. In a series of experiments we explored the basis of this facilitation. It was shown that neither a picture frame, an associated verb, nor a syntactically correct but semantically meaningless sentence frame were effective cues. Our findings challenge the orthodox linear models of object naming. We interpret our observations in the context of Luria's distinction between nominative and propositional language. It is suggested that there may be two 'routes' to name retrieval, one that utilises a nominative system and an alternative one that utilises an on-line language processor that constructs propositional speech. It is the integrity of this latter system that could account for the facilitation of naming by a sentence frame in NOR, and also for the frequently observed phenomenon of the preservation of fluent speech in patients with a grave anomia.
- - - - - - - - - -
ranking = 1
keywords = alternative
(Clic here for more details about this article)
| Next ->


Leave a message about 'Brain Damage, Chronic'


We do not evaluate or guarantee the accuracy of any content in this site. Click here for the full disclaimer.