1/11. The neurological complications of cardiac transplantation.review of the neurological complications encountered in 83 patients who received cardiac homografts over a seven-year period leads to the following conclusions: (1) Neurological disorders are common in transplant recipients, occurring in over 50 per cent of patients. (2) infection was the single most frequent cause of the neurological dysfunction, being responsible for one-third of all CNS complications. (3) The infective organisms were typically those considered to be usually of low pathogenicity: fungi, viruses, protozoa and an uncommon bacterial strain. (4) Other clinical neurological syndromes were related to vascular lesions, often apparently from cerebral ischaemia or infarction occurring during the surgical procedure, metabolic encephalopathies, cerebral microglioma, acute psychotic episodes and back pain from vertebral compression fractures. (5) The infectious complications and probably the development of neoplasms de novo, are related to immunosuppressive therapy which impairs virtually all host defence mechanisms and alters the nature of the host's response to infective agents or other foreign antigens. (6) Because neurological symptoms and signs were usually those of behavioural changes or deterioration in intellectual performance, the neurological examination was often of little value in diagnosing the nature or even the anatomical site of the neuropathological process. (7) The possibility of an infectious origin of the neurological manifestations must be aggressively pursued even in the absence of fever and a significantly abnormal spinal fluid examination. The diagnostic error made most frequently was to ascribe neurological symptoms erroneously to metabolic disturbances or to "intensive care unit psychosis" when they were in fact due to unrecognized CNS infection. (8) maintenance of mean cardiopulmonary bypass pressures above 70 mmHg, particularly in patients with known arteriosclerosis, may reduce operative morbidity. (9) Though increased diagnostic accuracy is possible with routine use of a variety of radiological and laboratory techniques, two further requirements probably must be met before a significant reduction in the frequency of neurological complications will occur: the advent of greater immunospecificity in suppressing rejection of the grafted organ while preserving defences against infection; and a more effective armamentarium of antiviral and antifungal drugs.- - - - - - - - - - ranking = 1keywords = behaviour (Clic here for more details about this article) |
2/11. Modification of severe behaviour problems following herpes simplex encephalitis.Violent and sexually disinhibited behaviour together with poor self-care developed in a 38-year-old teacher following herpes simplex encephalitis. These behaviours were sufficiently severe to make rehabilitation difficult and return to the community impossible. Initially, only violent behaviour was treated, both by medication and a behaviour programme, and sexual disinhibition subsequently by the latter. In order to implement the programme a special (psychiatric) nurse was required on a 24 h basis. The incidence of violent behaviour was reduced from up to 55 times per day to zero over a period of 2 months. Whether this was affected by medication or behaviour management, or by spontaneous recovery, is discussed. Sexual disinhibition was eliminated in supervised settings, but continued to occur if left unsupervised and this improvement resulted from behaviour management. Poor personal hygiene also improved markedly over the 6-month period. The goal of returning the patient home to live with her family was achieved and she remained there at follow-up. This intervention was carried out in a rehabilitation unit that does not specialize in the treatment of such cases; clearly this has implications for cost and quality of care.- - - - - - - - - - ranking = 11keywords = behaviour (Clic here for more details about this article) |
3/11. rabies presenting with myocarditis and encephalitis.We report a case of rabies acquired in zambia by a 45-year-old woman who presented with a history of an influenza-like illness, abnormal behaviour and signs of myocarditis. A provisional diagnosis of systemic viral infection was made. Within 12 h of admission the patient developed features of rabies that included hydrophobia. She was artificially paralysed and ventilated electively. Empirical antibiotic therapy was given also. Signs of myocarditis and fever disappeared within 48 h. Her clinical condition remained stable but she required heavy sedation. On the ninth day after admission the patient developed features of inappropriate secretion of antidiuretic hormone and gradually became water-logged. Intake of fluid was therefore restricted. Her level of consciousness deteriorated progressively to the point where sedation was no longer required. brain death was diagnosed 14 days after admission.- - - - - - - - - - ranking = 1keywords = behaviour (Clic here for more details about this article) |
4/11. limbic encephalitis associated with malignant thymoma.A case of limbic encephalitis associated with recurrent malignant thymoma in a 41-year-old male is described. The patient presented with confusion, loss of memory, hallucinations, abnormal behaviour, tachycardia and profuse sweating. Investigations were unrewarding and the patient's clinical state deteriorated until his death 1 month after presentation. The diagnosis was made at autopsy when bilateral extensive neuronal loss with reactive gliosis, confined to the medial temporal cortex and Ammon's horn, was revealed.- - - - - - - - - - ranking = 1keywords = behaviour (Clic here for more details about this article) |
5/11. Behaviour disturbances during recovery from herpes simplex encephalitis.Bizarre behaviour disturbances in four patients occurring during incomplete recovery from herpes simplex encephalitis are described. Some aspects of their behaviour were similar to that originally described by Kluver and Bucy in monkeys following bilateral temporal lobectomy. Previous reports of behavioural disturbances in man after herpes simplex encephalitis are reviewed and attention drawn to the aggressive and disruptive behaviour that is often seen. With the reduced mortality in herpes simplex encephalitis in recent years it is possible that behaviour disturbances such as those described here will be seen more frequently.- - - - - - - - - - ranking = 5keywords = behaviour (Clic here for more details about this article) |
6/11. limbic encephalitis: a case report.We report a case of a 24 year old patient, who presented with simple and complex partial epileptic seizures, progressive changes in behaviour and affect including marked aggression, and a decline in memory to the point of inability to learn. Extensive work-up resulted in a final diagnosis of limbic encephalitis. This diagnosis was supported by a number of investigations performed during the follow-up of 6 years and ranging from the basic EEG to the more sophisticated investigations of magnetic resonance tomography, magnetoencephalography and positron emission tomography.- - - - - - - - - - ranking = 1keywords = behaviour (Clic here for more details about this article) |
7/11. Support for carers of people with learning disabilities.The current rhetoric associated with the provision of community care might lead some to conclude that services for people with a learning disability and their families has improved significantly. However, a recent interview with a mother who has a young son with a profound learning disability and associated behavioural problems, questions such assumptions.- - - - - - - - - - ranking = 1keywords = behaviour (Clic here for more details about this article) |
8/11. transvestism in a person with learning disabilities presenting with behavioural problems.A case of transvestism is reported in a 47-year-old man with learning disabilities. He had developed encephalitis in childhood, which had resulted in moderate learning disabilities and epilepsy, and had been living in institutions from the age of six. He did not have any chance to express his sexual desire and this frustration manifested as aggressive behaviour. Recently, he moved to a community home and his deviant sexual behaviour became apparent. Management of his problems involves organizing a behavioural programme linking his cross dressing with aggressive behaviour.- - - - - - - - - - ranking = 8keywords = behaviour (Clic here for more details about this article) |
9/11. Behavioural and electrophysiological chromatic and achromatic contrast sensitivity in an achromatopsic patient.OBJECTIVES--In cases of incomplete achromatopsia it is unclear whether residual visual function is mediated by intact striate cortex or results from incomplete lesions to extrastriate cortical visual areas. A patient with complete cerebral achromatopsia was tested to establish the nature of his residual vision and to determine the integrity of striate cortex function. methods--Behavioural contrast sensitivity, using the method of adjustment, and averaged visually evoked cortical potentials were measured to sinusoidally modulated chromatic and achromatic gratings in an achromatopsic patient and a normal observer. eye movements were measured in the patient using a Skalar infrared monitoring system. RESULTS--The patient's chromatic contrast sensitivity was normal, indicating that despite his dense colour blindness his occipital cortex still processed information about spatial variations in hue. His sensitivity to achromatic gratings was depressed particularly at high spatial frequencies, possibly because of his jerk nystagmus. These behavioural results were reinforced by the nature of visually evoked responses to chromatic and achromatic gratings, in which total colour blindness coexisted with an almost normal cortical potential to isoluminant chromatic gratings. CONCLUSIONS--The results show that information about chromatic contrast is present in some cortical areas, and coded in a colour-opponent fashion, in the absence of any perceptual experience of colour.- - - - - - - - - - ranking = 1keywords = behaviour (Clic here for more details about this article) |
10/11. Epileptic akinetic mutism: following temporal lobectomy for Rasmussen's syndrome.A girl aged 9 years with Rasmussen's encephalitis previously treated by left temporal lobectomy suddenly developed prolonged attacks of extremely rapid respirations associated with poverty of body movements and greatly reduced facial movements with loss of speech. Her comprehension appeared intact and she responded to certain requests. Her eye gaze behaviour suggested a high degree of vigilance. The attacks would last from minutes to hours and were repeated up to a dozen times daily. In the context of the stress generated by the illness and other family problems the attacks had been mistaken for an hysterical elaboration. Their ictal nature was confirmed by EEG/video monitoring. Possible links with other developmental language disorders associated with epilepsy are discussed, including a model of autism.- - - - - - - - - - ranking = 1keywords = behaviour (Clic here for more details about this article) |
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