1/7. The minimally conscious state in children.The minimally conscious state (MCS) is a condition of severely altered consciousness in which minimal but definite behavioral evidence of self- or environmental awareness is shown. Diagnostic criteria recently have been proposed for entry into and emergence from the MCS. We present clinical and neuroimaging data on 5 children diagnosed with MCS and discuss the limited information available concerning its epidemiology, etiology, pathology, and prognosis. Issues related to the evaluation and care of children suspected of having MCS are also reviewed as well as current ethical and legal controversies.- - - - - - - - - - ranking = 1keywords = environment (Clic here for more details about this article) |
2/7. Misdiagnosing the vegetative state after severe brain injury: the influence of medication.patients who suffer severe brain damage may be left unaware of self and of the environment and in a permanent vegetative state (PVS). The difficulties in correctly ascertaining unawareness after brain injury have been emphasized by a number of authors. It is well recognized that toxic-metabolic and drug-induced cerebral depression occurs acutely after brain injury. However, less attention has been drawn to the effects of medication months after brain injury and the way in which medication may confound assessment of awareness and, thus, the reliable assessment of long-term prognosis. This paper describes two patients who sustained a severe and well-documented structural brain injury, one hypoxic and one traumatic. Both were unaware when first seen at 3 months post-injury, but both have made useful functional recovery. The paper discusses their progress and how the early prescription of large doses of anti-epileptic drugs, sedatives and anti-spastic agents in these circumstances may result in an initial misdiagnosis of the vegetative state.- - - - - - - - - - ranking = 1keywords = environment (Clic here for more details about this article) |
3/7. Percutaneous dilatational tracheostomy for emergent airway access.The study objective of this article was to evaluate percutaneous dilatational tracheostomy (PDT) for emergent airway access. This is a case series of 9 patients who presented over a 58-month period. All patients were in severe respiratory difficulty where intubation by conventional means was unsuccessful. All 9 patients were successfully intubated using PDT technique. No technical complications were noted, specifically bleeding, extratracheal placement, or prolonged procedure time. Six patients ultimately died, 2 from anoxic encephalopathy due to failed resuscitation and 4 from comorbid illness. Three patients ultimately survived to hospital discharge. The authors conclude that PDT can effectively establish a surgical airway in an emergent setting. The major advantage of this technique is the ability to gain and maintain competence in an elective, controlled environment. The authors believe that PDT may play a role in the management of the emergent surgical airway.- - - - - - - - - - ranking = 1keywords = environment (Clic here for more details about this article) |
4/7. Cerebral support for near-drowned children in a temperate environment.The case histories of three children who were admitted to Modbury Hospital after immersion accidents in the northeastern suburbs of Adelaide during the period from November, 1978, to March, 1979, are presented. hypothermia of moderate degree was found in one child. A Canadian treatment regimen is reviewed, and a plea made for a more vigorous management of the near-drowned victims of immersion accidents.- - - - - - - - - - ranking = 4keywords = environment (Clic here for more details about this article) |
5/7. Dense retrograde amnesia, intact learning capability and abnormal forgetting rate: a consolidation deficit?Following a thoracic trauma, which caused brain hypoxia, a 24-year-old man presented with a dense retrograde amnesia for events, persons and environments that spanned his whole life before injury. knowledge acquired at school or through the media were equally lost, with the exception of arithmetical skills and some geographical knowledge. No deficit was apparent in language, object recognition, motor skills and intellectual tests. Anterograde memory was marked by very efficient learning capacity, an almost perfect retention of information at delay interval of 4 hours and pathologically rapid forgetting at longer delays. Informal observations agreed with test performance in showing that he could relearn facts of the past and easily acquire new information, but tended to lose these memories if the information was not frequently rehearsed. PET showed a hypometabolism of the posterior temporal lobes. Though some points remain obscure, we propose that a consolidation deficit hypothesis provides the most sensible interpretation of this peculiar pattern of memory deficit.- - - - - - - - - - ranking = 1keywords = environment (Clic here for more details about this article) |
6/7. Modification of perseverative behaviour in an adult with anoxic brain damage.A single-case study is reported of an adult female exhibiting perseverative behaviour on the ward, following anoxic brain damage subsequent to an attempted suicide by hanging. Her behaviour consisted of excessive requests to use the telephone, and was accompanied by a lack of insight, impaired memory and blunted affect, with no evidence of anxiety when prevented from using the telephone. Treatment to reduce the persistent requests was given in two stages, and consisted of feedback, and feedback plus extinction. Results indicated a marked reduction in the perseverative behaviour, though it appeared that this did not generalize to the home environment following the woman's discharge from hospital.- - - - - - - - - - ranking = 1keywords = environment (Clic here for more details about this article) |
7/7. Sniffing behaviour, or recognizing a lily by smell, but not recognizing a sock on sight.We report a 65-year-old man with a post-anoxic encephalopathy who showed compulsive sniffing at available objects. This stereotyped environment-driven behaviour has not been previously described. Other compulsive environment-driven responses, such as manipulation and utilization of tools and hyperlexia, were also present. The disorder shared several features with the kluver-bucy syndrome where mouthing of objects, rather than smelling them, is common. The patient had a severe dementia, with amnesia, anomia, apraxia, and visual agnosia. Whereas he could not recognize very familiar objects on sight, he could in contrast correctly identify several familiar odours. Although sniffing was a compulsive and purposeless environment-driven behaviour, the question may be asked whether a relatively preserved olfactory recognition, in the presence of a severe disorder of visual recognition and knowledge, could have favoured a stereotyped exploration of objects by smelling.- - - - - - - - - - ranking = 3keywords = environment (Clic here for more details about this article) |