1/89. citalopram treatment of traumatic brain damage in a 6-year-old boy.Traumatic brain damage may cause acute emotional symptoms such as uncontrolled crying, apathy, and sleep problems. rehabilitation may be less effective in patients afflicted by these symptoms. citalopram, a selective serotonin reuptake inhibitor (SSRI), has a documented immediate and dramatic effect on pathological crying in stroke patients. The present case history of a 6-year-old boy with a traumatic right-sided hemorrhage in the basal ganglia indicates that early SSRI treatment has a dramatic effect on pathological crying and in addition may have a concomitant beneficial effect on motor paresis, sleep disturbance, and neurobehavioral problems.- - - - - - - - - - ranking = 1keywords = paresis (Clic here for more details about this article) |
2/89. Real-time continuous visual biofeedback in the treatment of speech breathing disorders following childhood traumatic brain injury: report of one case.The efficacy of traditional and physiological biofeedback methods for modifying abnormal speech breathing patterns was investigated in a child with persistent dysarthria following severe traumatic brain injury (TBI). An A-B-A-B single-subject experimental research design was utilized to provide the subject with two exclusive periods of therapy for speech breathing, based on traditional therapy techniques and physiological biofeedback methods, respectively. Traditional therapy techniques included establishing optimal posture for speech breathing, explanation of the movement of the respiratory muscles, and a hierarchy of non-speech and speech tasks focusing on establishing an appropriate level of sub-glottal air pressure, and improving the subject's control of inhalation and exhalation. The biofeedback phase of therapy utilized variable inductance plethysmography (or Respitrace) to provide real-time, continuous visual biofeedback of ribcage circumference during breathing. As in traditional therapy, a hierarchy of non-speech and speech tasks were devised to improve the subject's control of his respiratory pattern. Throughout the project, the subject's respiratory support for speech was assessed both instrumentally and perceptually. Instrumental assessment included kinematic and spirometric measures, and perceptual assessment included the Frenchay dysarthria Assessment, Assessment of Intelligibility of Dysarthric speech, and analysis of a speech sample. The results of the study demonstrated that real-time continuous visual biofeedback techniques for modifying speech breathing patterns were not only effective, but superior to the traditional therapy techniques for modifying abnormal speech breathing patterns in a child with persistent dysarthria following severe TBI. These results show that physiological biofeedback techniques are potentially useful clinical tools for the remediation of speech breathing impairment in the paediatric dysarthric population.- - - - - - - - - - ranking = 0.026636703453186keywords = muscle (Clic here for more details about this article) |
3/89. Air-puff-induced facilitation of motor cortical excitability studied in patients with discrete brain lesions.Air-puff stimulation applied to a fingertip is known to exert a location-specific facilitatory effect on the size of the motor evoked potentials elicited in hand muscles by transcranial magnetic stimulation. In order to clarify its nature and the pathway responsible for its generation, we studied 27 patients with discrete lesions in the brain (16, 9 and 2 patients with lesions in the cerebral cortex, thalamus and brainstem, respectively). Facilitation was absent in patients with lesions affecting the primary sensorimotor area, whereas it was preserved in patients with cortical lesions that spared this area. Facilitation was abolished with thalamic lesions that totally destroyed the nucleus ventralis posterolateralis (VPL), but was preserved with lesions that at least partly spared it. Lesions of the spinothalamic tract did not impair facilitation. The size of the N20-P25 component of the somatosensory evoked potential showed a mild correlation with the amount of facilitation. The facilitation is mainly mediated by sensory inputs that ascend the dorsal column and reach the cortex through VPL. These are fed into the primary motor area via the primary sensory area, especially its anterior portion, corresponding to Brodmann areas 3 and 1 (possibly also area 2), without involving other cortical regions. The spinothalamic tract and direct thalamic inputs into the motor cortex do not contribute much to this effect. Some patients could generate voluntary movements despite the absence of the facilitatory effect. The present method will enable us to investigate in humans the function of one of the somatotopically organized sensory feedback input pathways into the motor cortex, and will be useful in monitoring ongoing finger movements during object manipulation.- - - - - - - - - - ranking = 0.026636703453186keywords = muscle (Clic here for more details about this article) |
4/89. trismus resulting from central nervous system lesion.Three cases of unusual trismus are reported, occurring in patients with lesions of the central nervous system. On the basis of the clinical and electromyographical findings and observation of the course of the trismus this is interpreted as a symptom of a lesion of the brain stem, causing a dis-synergism of the masticatory muscles.- - - - - - - - - - ranking = 0.026636703453186keywords = muscle (Clic here for more details about this article) |
5/89. The shaking trauma in infants - kinetic chains.The findings in three children who died as a consequence of shaking and those in another child who survived are presented. In the three fatal cases, a combination of anatomical lesions were identified at autopsy which appear to indicate the sites where kinetic energy related to the shaking episodes had been applied thus enabling the sequence of events resulting in the fatal head injury to be elucidated. Such patterns of injuries involved the upper limb, the shoulder, the brachial nerve plexus and the muscles close to the scapula; hemorrhages were present at the insertions of the sternocleidomastoid muscles due to hyperextension trauma (the so-called periosteal sign) and in the transition zone between the cervical and thoracic spine and extradural hematomas. Characteristic lesions due to traction were also found in the legs. All three children with lethal shaking trauma died from a subdural hematoma only a few hours after the event. The surviving child had persistant hypoxic damage of the brain following on massive cerebral edema. All the children showed a discrepancy between the lack of identifiable external lesions and severe internal ones.- - - - - - - - - - ranking = 0.053273406906372keywords = muscle (Clic here for more details about this article) |
6/89. Chronic subdural hematoma with vasogenic edema in the cerebral hemisphere--case report.An 80-year-old male with a history of hypertension presented with chronic subdural hematoma manifesting as progressive consciousness disturbance and left hemiparesis. T1-weighted and fluid attenuation inversion recovery (FLAIR) magnetic resonance imaging showed a fresh hematoma in the right subdural space with a midline shift of 15 mm. FLAIR and diffusion-weighted imaging showed a hyperintense area in the right paraventricular white matter compressed by the hematoma. Apparent diffusion coefficients (ADCs) corresponding to the hyperintense area in the central area of the affected cerebral hemisphere on FLAIR images were measured before and one month after the operation. The motion probing gradient was applied in the right-left direction to the body axis. Since the central area in the cerebrum includes nerve fibers perpendicular to the direction of the gradient, the measured ADC appeared to be anisotropic. Preoperative ADC in the right paraventricular white matter was anisotropic and greater than in age-matched normal subjects, so the edema was identified as the vasogenic type. The edema in the right paraventricular white matter resolved promptly with improvement of the midline shift and normalization of the ADC.- - - - - - - - - - ranking = 3.0145249644001keywords = hemiparesis, paresis (Clic here for more details about this article) |
7/89. Combined motor disturbances following severe traumatic brain injury: an integrative long-term treatment approach.patients surviving severe traumatic brain injury (TBI) often suffer from residual impairments in motor control, communication skills, cognition and social behaviour. These distinctly hamper their capability to return to their 'pre-trauma' activity. Comprehensive and integrated rehabilitation programmes initiate, during the acute phase, a prolonged treatment process which starts at the most sophisticated medical systems. There is no clear end point for the treatment of these patients, since the recovery process and the rehabilitation activity may continue for years, even after patients return home to live with their families. The inherent inability to make a firm early prediction regarding outcome of patients and the late appearance of additional symptoms stress the need for a comprehensive close long-term follow-up. The following presentation concerns the description of the treatment strategy and long-term improvement of a 22-year-old male who suffered from very severe TBI. On admission to the emergency room, he was in the decerebrated position and his glasgow coma scale (GCS) was at the lowest (3). The focus of this presentation is on the recovery of motor function. The initial motor disabilities included weakness in all four limbs, in particular left hemiplegia, and right hemiparesis with severe bilateral ataxic elements and a marked tremor of the right arm. Range of motion was limited in hips, and he suffered from stiff trunk and neck. goals of physiotherapy were directed towards improving range of motion (ROM) and active movement. Casting, use of orthoses, biofeedback, hydrotherapy, hippotherapy, medication and nerve blocks for reducing spasticity were timely applied during the process. The motor improvement in this very severe TBI patient who is now over 3 years post-injury still continues and has a functional meaning. He has succeeded in being able to stand up by himself from a chair and is able to walk unaided and without orthoses for very short distances--up to five steps. He is able to drink soup without assistance and play a few notes on the piano. Marked cognitive improvement occurred as well. It is concluded that motor improvement may be evident over long periods of time and various timely interventions may assist in the process.- - - - - - - - - - ranking = 3.0145249644001keywords = hemiparesis, paresis (Clic here for more details about this article) |
8/89. Delayed, transient neurological deterioration after mild head injury--case report.A 16-year-old boy presented with delayed, transient neurological deterioration 18 days after mild head injury. Left hemiparesis and left homonymous hemianopsia appeared after right frontal contusional and mild subdural hematomas subsided. neuroimaging examinations including cerebral angiography, magnetic resonance imaging, and single photon emission computed tomography showed vasodilation and hyperemia in the right cerebral hemisphere. The present case is not typical of acute "juvenile head trauma syndrome," but may represent a possible pathophysiology of the delayed type of transient neurological deterioration after mild head injury.- - - - - - - - - - ranking = 3.0145249644001keywords = hemiparesis, paresis (Clic here for more details about this article) |
9/89. Vertex epidural hematoma with communicating bifrontal subgaleal hematomas treated by percutaneous needle aspiration.The case of an 11-year-old boy is presented who suffered a bicycle accident with a parasagittal skull fracture, a small vertex epidural hematoma, frontal contusions and a frontal subgaleal hematoma. Enlargement of the vertex epidural hematoma was diagnosed after development of a slight paraparesis on day 11 with the aid of MRI. Three percutaneous needle aspirations of the subgaleal hematoma with a total of 59 ml being evacuated led to quick recovery and disappearance of the subgaleal as well as the vertex epidural hematoma. It is speculated that both hematomas communicated via the skull fracture thus making the evacuation of the epidural hematoma by subgaleal punctures possible.- - - - - - - - - - ranking = 1keywords = paresis (Clic here for more details about this article) |
10/89. Epileptic seizures after treatment with thiocolchicoside.PURPOSE: To report the occurrence of epileptic seizures in humans, closely related to the use of the centrally acting muscle relaxant thiocolchicoside. methods: Description of three case histories. RESULTS: Two patients, affected with complex-partial seizures, sometimes secondarily generalized, receiving antiepileptic therapy, were seizure free for 7 and 9 years, respectively. They had the reappearance of tonic-clonic seizures few days after the continued use of thiocolchicoside, at a cumulative dose of the drug of 52 mg and 76 mg, respectively. The third patient was brain damaged and without a history of seizures. He had a sudden, convulsive seizure a few minutes after 4 mg intramuscular thiocolchicoside. CONCLUSIONS: Our case histories indicate that thiocolchicoside has a powerful epileptogenic activity. This drug should be avoided in patients with epilepsy or acute brain injury and possible disruption of the blood-brain barrier.- - - - - - - - - - ranking = 0.026636703453186keywords = muscle (Clic here for more details about this article) |
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