Cases reported "Seizures"

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1/14. Fetal seizures causing increased heart rate variability during terminal fetal hypoxia.

    Fetal seizures together with both abnormal breathing movements and fluctuations in fetal blood pressure and heart rate resulting in increased fetal heart rate variability have been observed in brain-damaged fetal sheep shortly after an asphyxial insult. We report a clinical example of convulsions and increased heart rate variability during terminal fetal hypoxia.
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keywords = breathing
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2/14. A case of effective gastrostomy for severe abdominal distention due to breathing dysfunction of Rett's syndrome: a treatment of autonomic disorder.

    We report a case of 13-year-old-girl with Rett's syndrome and effectiveness of gastrostomy for severe paradoxical respiration, seizures and abdominal distention. Since the age of 3, she was observed to have typical hand-washing movement and autistic behavior. At the age of 8, she began to have hyperventilation and seizures in awake stage. Her symptoms were worse from year to year. At the age of 13, gastrostomy was done to treat severe abdominal distention. Her symptoms were improve dramatically by the gastric air removal through gastrobutton.
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keywords = respiration, breathing
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3/14. Ropivacaine-induced convulsion immediately after epidural administration--a case report.

    Ropivacaine is a new long-acting amide-type local anesthetic with less toxic effects compared with bupivacaine. Here, we report a case who sustained convulsion immediately after administration of epidural ropivacaine. A 75-year-old woman was scheduled for total knee replacement. Epidural catheter was inserted smoothly. After aspiration test and injection of a test dose of 3 ml of 2% lidocaine containing 15 micrograms epinephrine, 160 mg ropivacaine was administered epidurally. Unfortunately, a generalized tonic-clonic convulsion of sudden onset occurred right after ropivacaine injection. After he was given 100% oxygen and intravenous thiopental 150 mg, the patient recovered uneventfully. During the episode of convulsion sinus tachycardia at a rate of 120 beats/min without the interposal of other form of cardiac arrhythmia was noted, and respiration remained intact. This suggests that ropivacaine offers a good cardiovascular stability. This example serves as another evidence to remind us that even with a negative aspiration following epidural catheter placement and an uneventful test dose injection, inadvertent intravascular injection may still happen, particularly in the elderly.
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keywords = respiration
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4/14. A case of acute encephalitis with refractory, repetitive partial seizures, presenting autoantibody to glutamate receptor Gluepsilon2.

    An 11-year-old male was admitted to our hospital because of high-grade fever, repetitive seizures, and prolonged impairment of consciousness (glasgow coma scale E1, M5, V1). His seizures were repetitive complex partial seizures that expanded from the unilateral face to the corresponding side of the body. He sometimes developed secondary generalized seizures. While most seizures lasted 1 or 2 min, intractable seizures also frequently (about 5 times/h) occurred. We diagnosed him as encephalitis/encephalopathy, and treated him with artificial respiration, thiamylal sodium, mild hypothermia therapy, steroid pulse therapy, massive gamma-globulin therapy, etc. Afterwards, he had sequelae, such as post-encephalitic epilepsy (same seizures continued to recur), hyperkinesia, impairment of immediate memory, change in character (he became sunny and obstinate), dysgraphia, and mild atrophy of the hippocampus, amygdala, and cerebrum. However, he could still attend a general junior high school. He was diagnosed as acute encephalitis with refractory, repetitive partial seizures (AERRPS). In this case, he was positive for autoantibody to glutamate receptor Gluepsilon2 IgG or IgM in an examination of blood and spinal fluid, and we presumed that this may have influenced his sequelae. In this case, a combination of mild hypothermia therapy, steroid pulse therapy, and massive gamma-globulin therapy was effective.
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keywords = respiration
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5/14. Induced microseizures in West syndrome.

    Induced microseizures (IMS) were observed in a 5-month-old girl with symptomatic West syndrome. The seizures occurred following the suppression of infantile spasms with adrenocorticotropic hormone therapy and disappeared following the cessation of clonazepam administration. The ictal manifestations consisted of periods of irregular respiration, and respiratory arrest lasting for several seconds which often involved opening of the eyes and mild extension of the neck corresponding with the diffuse fast wave bursts in EEG activity observed during sleep. These seizures were thought to be equivalent to the IMS in Lennox-Gastaut syndrome, which have never been reported before in patients with West syndrome.
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keywords = respiration
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6/14. Bialaphos poisoning with apnea and metabolic acidosis.

    A 64-year-old man with ethanol intoxication, ingested a bottle of Herbiace (100 ml, 32 w/v% of bialaphos, CAS #35597-43-4, Meiji Seika Kaisha, tokyo, japan). He had severe metabolic acidosis and was treated with infusions of sodium bicarbonate and furosemide, plus gastric lavage and enema. The metabolic acidosis improved 15 hours after treatment but nystagmus, apnea and convulsions were progressive. Although his sensorium was clear, spontaneous respirations were not observed for 64 hours. The electroencephalographic findings of atypical triphasic waves and slow waves suggest a unique response to bialaphos poisoning. His clinical course indicates that the management of apnea is critically important to recovery from bialaphos poisoning.
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keywords = respiration
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7/14. masturbation mimicking abdominal pain or seizures in young girls.

    Five girls, 7 to 27 months of age, had masturbatory posturing that did not involve rubbing of the genitalia or copulatory movements. This activity was mistakenly attributed to abdominal pain or seizures, and prompted unnecessary diagnostic tests. The posturing began at 3 to 14 months and consisted of "leaning episodes" in which the suprapubic region was applied to a firm edge or the parent's knee in one patient, stiffening of the lower extremities in a standing or sitting position in the second patient, and stiffening of the lower extremities while lying on their sides or supine in three infant patients. The posturing was often accompanied by irregular breathing, facial flushing, and diaphoresis, and lasted less than a minute to hours at a time. Management consisted of convincing the parents of the harmless nature of the activity, which then lessened the reinforcing effect of their responses. The posturing subsided, in time, without medical or surgical treatment.
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keywords = breathing
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8/14. Pseudoseizures caused by hyperventilation resembling absence epilepsy.

    During the 4-year period, 1982-1986, 18 patients presented to the Children's Hospital, Camperdown, Sydney, with the following features: (1) Recurrent "absences" clinically indistinguishable from childhood absence epilepsy, (2) Normal clinical examination, (3) Electroencephalogram (EEG) demonstrating normal waking background and sleep activity. On hyperventilation, "absences" occurred, characterized on EEG by a marked build-up of paroxysmal slow-wave activity unassociated with evidence of epileptic activity. We designate these attacks "pseudoseizures caused by hyperventilation resembling absence epilepsy." Individual cases demonstrated a variety of other symptoms consistent with the hyperventilation syndrome. There was an identifiable environmental stress in 13 of the 18 cases. Follow-up of 13 patients after a mean period of 20 months revealed that only two children continued to have occasional absences, associated with a clear history of breathing up when upset. Treatment did not influence outcome. On repeat hyperventilation with EEG and respiratory monitoring, five of the 13 had pseudoseizures. There was no indication that susceptibility to these episodes was associated with an abnormal CO2 response. It is postulated that the occurrence of pseudoseizures is related to cerebrovascular immaturity and an excessive vasoconstrictor response to a given level of CO2.
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9/14. apnea and seizures caused by nicotine ingestion.

    tobacco products are potentially hazardous to children. Small oral doses may create marked toxic effects. physicians treating children with gastrointestinal complaints, altered consciousness, and seizure with depressed respiration should seek a history of possible exposure to tobacco products, including gum used for smoking abstinence. Intoxication can be verified by a urine toxicology screen utilizing chromatography.
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keywords = respiration
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10/14. The "4A" syndrome: adrenocortical insufficiency associated with achalasia, alacrima, autonomic and other neurological abnormalities.

    The triad of adrenocortical insufficiency with alacrima and achalasia is an unusual disease entity in paediatrics. The association of autonomic and peripheral neuropathies has more commonly been reported in older individuals. We describe four children (two siblings) with this disorder, aged between 3 and 6 years at diagnosis, all of whom had clinical neurological abnormalities when examined between 6 and 8 years of age. In addition, we performed cardiovascular autonomic testing in three subjects: heart rate variation during deep breathing was abnormal in all three; Valsalva ratio was abnormal in two; and postural systolic blood pressure response was abnormal in one. Pupillary reflexes were abnormal in the only subject in which they could be measured. These results indicate that subtle neurological and, in particular, autonomic abnormalities can be detected at an early age. We propose that autonomic neuropathy be considered as an integral feature of this rare condition and suggest the term "4A" syndrome as a useful mnemonic for the association of adrenocortical insufficiency, achalasia and alacrima with autonomic and other neurological abnormalities.
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