1/13. Constructing Alzheimer's: narratives of lost identities, confusion and loneliness in old age.This paper is a qualitative study based on retrospective, unstructured, qualitative interviews with Mrs. Jones and other African-American, Chinese-American, Irish-American and Latino family caregivers in the boston area. A narrative approach is used to show how family caregivers draw on their cultural and personal resources to create stories about the nature and meaning of illness and to ask how ethnic identity may influence the kinds of stories family caregivers tell. Three different story types are identified and described, each with a distinctive configuration of illness meanings and overarching theme, or storyline: a subset of African-American, Irish-American, and Chinese-American caregivers told us stories about Alzheimer's as a disease that erodes the core identity of a loved one and deteriorates their minds; a subset of Chinese caregivers narrated stories that emphasized how families managed confusion and disabilities, changes ultimately construed as an expected part of growing old; a subset of Puerto Rican and Dominican families, while using the biomedical label of Alzheimer's disease or dementia, placed the elder's illness in stories about tragic losses, loneliness, and family responsibility. To construct their stories, caregivers drew upon both biomedical explanations and other cultural meanings of behavioral and cognitive changes in old age. Their stories challenge us to move beyond the sharp contrast between ethnic minority and non-ethnic minority views of dementia-related changes, to local clinics and hospitals as sites where biomedical knowledge is interpreted, communicated, discussed, and adapted to the perspectives and lived realities of families.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
2/13. Isolated and focal retrograde amnesia: a hiatus in the past.Two cases of isolated retrograde amnesia were reported. Both showed the same clinical pattern in development and resolution of amnesia despite of different etiologies. Sudden insult to the brain (trauma in Case 1 and viral encephalitis in Case 2) caused concurrent antero- and retrograde amnesia. Fortunately both recovered from the anterograde amnesia completely. However, both were left with a period of postictal amnesia of a few months and retrograde amnesia of up to 14 months' duration. The analysis of their pattern of temporal evolution and dissolution of amnesia support the hypothesis that recently acquired episodic information requires a certain amount of constant activation for a certain period of time in order to be organized into a durable memory. The nature of this activation as well as its origin remains to be solved.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
3/13. Acute confusion and blindness from quinine toxicity.quinine is widely used for nocturnal leg cramps, despite limited evidence of its clinical efficacy in this condition. Accidental overdose is associated with serious ocular complications and can potentially be fatal. We report the case of a 57-year-old man who presented with acute confusion and bilateral blindness after consuming approximately 7.2 g quinine sulphate along with an unknown quantity of alcohol. He was treated with general supportive measures and nitrates, with an apparent initial recovery, but visual field defects persisted. This case highlights the potential toxic effects of quinine, the dangers of its bulk prescription, and the lack of strict guidelines with regard to its prescription. We suggest that restricted prescribing for leg cramps, better patient education about the toxic nature of the drug, and clear labelling of this hazard on the dispensing bottles might lead to a reduction in the cases of quinine poisoning.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
4/13. Acute confusion--an unusual form of cerebral herpes simplex virus infection?herpes simplex virus (HSV) infections are common and, if afflicting the central nervous system, may cause death or severe sequelae. Since specific therapy is now available there is an increasing demand for the recognition of the various ways in which cerebral HSV-infections may be manifested. This report describes a 15-year-old boy who presented acutely with mental symptoms of confusion, hallucinations and sleep disturbance. Simultaneously, but without any increase in cerebrospinal fluid cell or protein content, an intrathecal production of HSV-antibodies of transient nature was detected. These findings suggest that the patient may have suffered from an unusual form of herpes infection in the central nervous system. We suggest that similar cases should be thoroughly explored for possible herpes etiology as early as possible during the acute phase of the disease.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
5/13. Acute confusional state in childhood.Acute confusional state (ACS) relates to a sudden alteration of the mental status. The impairment may be global or confined to a specific faculty of higher cortical function. Such specificity does not depend on the nature of the pathological process, but rather on the anatomical location of the area of the brain which is involved. In the absence of relevant medical history and associated signs and symptoms, the differential diagnosis of ACS may be difficult. Two case reports of unusual causes of ACS are presented: basilar migraine manifesting as transient global amnesia, and absence status. These are followed by a brief review of etiological causes of ACS commonly encountered in the pediatric practice, and a more detailed review of rare causes, such as non-convulsive epilepsy and migraine. A list of auxiliary tests for cases which are not readily diagnosed is presented.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
6/13. Neurological aspects of insulinomas.Neurological involvement occurred in every one of a series of 30 patients with an insulinoma. The episodic nature of the hypoglycaemia caused symptoms and signs to fluctuate and often led to delay in diagnosis (mean length of history was 3 years). The commonest feature at first presentation was confusion (20 instances), but as the illness evolved, coma (16 instances) and convulsions (8 instances) became more frequent. Objective weakness was found in 7 patients, with 3 examples of hemiparesis and 2 each of paraparesis and monoparesis; in all, the weakness resolved over a period of 1 hr to 3 days when normoglycaemia was maintained. Other neurological features included subjective visual disturbances, headache, dysarthria and ataxia. 220 patients with an insulinoma from 7 series in the literature were reviewed. The high incidence of neurological features was confirmed, with confusion (152 cases), coma (82 cases) and convulsions (58 cases) predominating. Visual disturbances were common, though not accurately quantified in some series. Objective evidence of weakness on the other hand was reported in only 6 of the 222 patients. Other less common symptoms included headache (18 instances) and peripheral paraesthesiae (14 instances). In the 7 series reviewed, as in our own, it was found that in any one patient, each episode of hypoglycaemia was accompanied by the same symptom complex. The presence of an insulinoma should be considered in any patient with unusual, or inexplicable neurological features, particularly when they are intermittent. The diagnosis can be confirmed by demonstrating an inappropriately high circulating insulin level, for the ambient blood glucose concentration.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
7/13. Temporary neurological deterioration after extracranial-intracranial bypass.Five patients who experienced temporary neurological deterioration after extracranial to intracranial bypass procedures are reported in detail. These patients suffered transient ischemic attacks or more prolonged deficits usually of a different nature than the preoperative symptoms. All patients had a good outcome and the spells ceased; the neurological deficits improved within a maximum of 2 weeks. Obvious causes of deterioration such as intra- or extracerebral hematomas, occlusion of a previously stenotic vessel, or graft occlusion were ruled out by computed tomography and angiography in each case. Intraoperative causes of neurological deterioration such as anesthetic effect, hypotension, and temporary occlusion of the cortical vessel or sacrifice of its small branches were not likely to be the cause of the deficits because in each case, the patient awoke satisfactorily and deterioration occurred hours to days later. In each case, postoperative angiography showed good perfusion of at least one major division of the middle cerebral territory. Anticoagulation with heparin in three patients did not change the clinical course. In one patient who was not anticoagulated, embolism could have been responsible for a single prolonged ischemic event, but in the other patients thromboembolism does not seem likely to have been responsible for the deficits. The cause of the deterioration in these patients remains unexplained. We speculate that hyperperfusion of chronically ischemic brain tissue and shifts in the watershed region resulting from the new flow pattern after bypass grafting are two mechanisms that may have been of importance in the etiology of these deficits.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
8/13. Diagnostic dilemma of the aged.The complexity of symptoms seen in the elderly patient derives from the nature of age-related psychological and physiological changes and the variety of medical illnesses and psychiatric disorders common in advanced age. Without using differential diagnosis, the changes in mental status are too often ascribed to manifestation of senile decay, resulting in overdiagnosis of senile dementia. There is an interrelationship between somatic and psychiatric disorders and unusual appearances of many clinical entities common in the elderly. A review of pertinent literature and related clinical examples illustrate the common symptom complexes, including psychosomatic and somatopsychic disorders, seen in aged patients.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
9/13. Subarachnoid-pleural fistula after resection of a pancoast tumor with hyponatremia.Resection of superior sulcus neoplasms is associated with a number of complications resulting from the extensive nature of the resection and the necessity to sacrifice certain adjacent structures. One of the complications of resection is the development of subarachnoid-pleural fistula, with the subsequent appearance of air in the cerebrospinal fluid circulation. We report a case in which a subarachnoid-pleural fistula led to persistent pneumocephaly in a patient who exhibited postoperative hyponatremia, confusion, and gait disturbance.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
10/13. Clinical features of leuko-araiosis.OBJECTIVE: To study the clinical features of leuko-araiosis. methods: Age matched groups of patients with a CT finding of pure leukoaraiosis (n = 26) and a control group with a normal CT finding (n = 26) were formed (mean ages 78.6 (SD 3.3) v 76.5 (SD 4.6) years; NS). RESULTS: dementia, vascular dementia, central brain atrophy on CT, disability in activities of daily living and instrumental activities of daily living, urinary incontinence, gait disorder (assistance needed), personality change, and night time confusion were found to be more commonly present in leuko-araiosis positive patients than in controls, whereas focal neurological symptoms and signs were not associated with leuko-araiosis. The occurrences of heart failure and systolic hypotension-but not hypertension-were higher in the leuko-araiosis positive group than in the controls. Leuko-araiosis was also found to be related to a less sudden onset of symptoms and a lower Hachinski score than true brain infarction(s). CONCLUSIONS: Leuko-araiosis on CT in these elderly patients seems to be a vascular disorder aetiologically different from brain infarction, with clinical manifestations of subtle onset and general disabling nature and no prominent focal neurological signs or symptoms.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
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