11/37. Acute pancreatic damage associated with convulsive status epilepticus: a report of three cases.Three cases involving a previously unreported association of acute pancreatic damage following convulsive status epilepticus (SE) are presented. A review of literature failed to reveal a similar association between SE and acute pancreatic damage. As possible pathophysiological mechanisms of this so far unknown sequel of SE, increased intraduodenal pressure during SE leading to the reflux of the duodenal contents into the pancreatic duct, along with altered metabolism of oxygen-derived free radicals during a prolonged seizure with hypoxia and ischemia resulting in acinar cell injury are suggested. We believe that SE should be considered as an additional risk factor of acute pancreatitis and that pancreatic enzymes should be monitored in patients who have prolonged seizures.- - - - - - - - - - ranking = 1keywords = injury (Clic here for more details about this article) |
12/37. Effects of acute hypoxemia/ischemia on EEG and evoked responses at normothermia and hypothermia in humans.BACKGROUND: hypothermia is used clinically to prevent neurologic injury but the degree of protection which it affords at various levels of the nervous system in humans is difficult to establish. MATERIAL/methods: The temporal changes in EEG amplitude and somatosensory evoked potential (SEP) amplitudes in a patient experiencing acute normothermic hypoxemia, a patient experiencing acute circulatory arrest at moderate hypothermia and a collection of patients undergoing deep hypothermic circulatory arrest were analyzed to determine the rate at which changes occur during acute lack of oxygen delivery at various temperatures. RESULTS: In each case, it was found that more rostrally generated potentials disappeared more quickly than more peripheral potentials. All potentials decayed more slowly during acute normothermic hypoxemia than during circulatory arrest. During circulatory arrest at 14.4 degrees C, the amplitude of the Erb's point, N13 and N18 potentials in the SEP took 5 times longer to drop to 50% of their value at the onset of ischemia than with circulatory arrest at 30.9 degrees C. CONCLUSIONS: The longer times to disappearance of the SEP potentials during deep hypothermia compared to moderate hypothermia was consistent with the predicted 3.5-6.5 fold reduction in metabolic activity at deep hypothermia compared to moderate hypothermia. The prolonged time to disappearance of the SEP during normothermic hypoxemia demonstrates that even with reduced oxygen delivery the continued delivery of metabolic substrate can be critical to neural function.- - - - - - - - - - ranking = 1keywords = injury (Clic here for more details about this article) |
13/37. diffusion MRI in three types of anoxic encephalopathy.We report the clinical and diffusion-weighted MRI (DWI) features of three patients with different types of anoxic brain injury: attempted hanging (hypoxic hypoxia), carbon monoxide poisoning (histotoxic hypoxia), and hanging with cardiac arrest (hypoxic-ischemic encephalopathy, HIE). The first two patients, but not the third, recovered substantial neurological function. The distribution of DWI abnormalities was different and correlated well with the distinct neuropathological features of these entities. The prognosis after anoxic encephalopathy depends on the underlying mechanism and its severity, which may be reflected by DWI abnormalities.- - - - - - - - - - ranking = 143.10943427693keywords = brain injury, brain, injury (Clic here for more details about this article) |
14/37. Confounding factors in diagnosing brain death: a case report.BACKGROUND: brain death is strictly defined medically and legally. This diagnosis depends on three cardinal neurological features: coma, absent brainstem reflexes, and apnea. The diagnosis can only be made, however, in the absence of intoxication, hypothermia, or certain medical illnesses. CASE PRESENTATION: A patient with severe hypoxic-ischemic brain injury met the three cardinal neurological features of brain death but concurrent profound hypothyroidism precluded the diagnosis. Our clinical and ethical decisions were further challenged by another facet of this complex case. Although her brain damage indicated a hopeless prognosis, we could not discontinue care based on futility because the only known surrogate was mentally retarded and unable to participate in medical planning. CONCLUSION: The presence of certain medical conditions prohibits a diagnosis of brain death, which is a medicolegal diagnosis of death, not a prediction or forecast of future outcome. While prognostication is important in deciding to withdraw care, it is not a component in diagnosing brain death.- - - - - - - - - - ranking = 410.62495271283keywords = brain injury, brain, injury (Clic here for more details about this article) |
15/37. Unilateral schizencephaly and contralateral polymicrogyria associated with umbilical cord mass.We report a 6-month-old boy with diffuse hypertonia and developmental delay who had unilateral separated-lip schizencephaly and contralateral polymicrogyria. The contralateral polymicrogyria was associated with an incomplete clefting in that hemisphere. An umbilical cord hamartoma is presumed to have caused hypoperfusion to the early developing brain, resulting in bilateral lesions.- - - - - - - - - - ranking = 29.723946492878keywords = brain (Clic here for more details about this article) |
16/37. Cortical hypoxic-ischemic brain damage in shaken-baby (shaken impact) syndrome: value of diffusion-weighted MRI.Shaken-baby syndrome (SBS) is a type of child abuse caused by violent shaking of an infant, with or without impact, and characterized by subdural hematomas, retinal hemorrhages, and occult bone fractures. Parenchymal brain lesions in SBS may be missed or underestimated on CT scans, but can be detected at an earlier stage with diffusion-weighted MRI (DW-MRI) as areas of restricted diffusion. We demonstrate the value of DW-MRI in a 2-month-old baby boy with suspected SBS. The pattern of diffusion abnormalities indicates that the neuropathology of parenchymal lesions in SBS is due to hypoxic-ischemic brain injuries, and not to diffuse axonal injury.- - - - - - - - - - ranking = 179.34367895727keywords = brain, injury (Clic here for more details about this article) |
17/37. Hyper-IgM syndrome: a case report.Hyperimmunoglobulin M syndrome is a rare primary immunodeficiency disorder. We report a case of a 6-month-old boy who suffered from developmental delays, frequent respiratory tract infection, and unusual fungal and bacterial infection. X-linked hyperimmunoglobulin M syndrome was ultimately diagnosed with decreasing immunoglobulin-G, A, and E (immunoglobulin g = 51.3 mg/dL, immunoglobulin a = 8.32 mg/dL, immunoglobulin e <17.5 mg/dL), elevating immunoglobulin m (immunoglobulin m = 140 mg/dL), and decreasing T-cell expression of the cd40 ligand over flow cytometry. Seizure episodes and hypotonia developed with greater signal intensity at the putamen in a brain magnetic resonance imaging, which is compatible with hypoxic ischemic encephalopathy. This is the youngest proven case of hyper-IgM syndrome in taiwan ever reported.- - - - - - - - - - ranking = 29.723946492878keywords = brain (Clic here for more details about this article) |
18/37. Prenatal magnetic resonance imaging evaluation of ischemic brain lesions in the survivors of monochorionic twin pregnancies: report of 3 cases.The death of 1 twin of monochorionic pairs is associated with a significant risk of brain hypoxic-ischemic damage in the survivor. Ultrasound may diagnose cerebral anomalies only a few weeks after the event. We report 3 cases of single survivors of monochorionic-twin pregnancies in which prenatal magnetic resonance imaging detected brain changes earlier and with better definition of the brain abnormalities than ultrasound.- - - - - - - - - - ranking = 208.06762545015keywords = brain (Clic here for more details about this article) |
19/37. Using EEG in a consultative role.The electroencephalogram (EEG) is a long-used tool assisting health care providers with the diagnosis, management, and treatment of various neurological disorders. This article highlights several scenarios in which a consultant may utilize the routine EEG in managing specific neurological cases. Eight case scenarios from a tertiary referral hospital are presented for the reader's consideration. Scenarios selected are new-onset seizures, encephalopathy, syncope, dementia, brain death, hypoxic-ischemic encephalopathy, status epilepticus, and migraine. A history in each condition is presented and is followed by a discussion of how useful an EEG may be in these specific situations. These eight cases highlight specific learning points where the EEG may be useful and how it can be practically incorporated into care of patients. Understanding how the EEG may be useful in the presented cases will allow the efficient and effective use of the EEG in similar clinical scenarios.- - - - - - - - - - ranking = 29.723946492878keywords = brain (Clic here for more details about this article) |
20/37. Anoxic-ischemic alpha coma: prognostic significance of the incomplete variant.The prognostic significance of post-anoxic-ischemic alpha coma (AC) is controversial. We recorded somatosensory evoked potentials (SEPs) and performed serial electroencephalography (EEG) in a 60-year-old woman in coma after cardiac arrest. The first EEG was recorded after 48 hours (GCS=5; E1-V1-M3); brain-stem reflexes were preserved. The EEG pattern showed monotonous alpha frequencies (10-11 Hz) with posterior predominance; acoustic and noxious stimuli evoked EEG reactivity. Early cortical SEPs (72 h) were normal. On the fifth day (GCS=8; E4-V1-M3), the EEG alpha pattern was replaced by a diffuse delta activity; rhythmic theta changes appeared spontaneously or in response to stimuli. The patient regained consciousness on the tenth day and EEG showed posterior theta activity (6-7 c/s) partially reactive to stimuli. At the 6-month follow-up, cognitive evaluation showed mild dementia. Recent studies identified two forms of AC. patients with complete AC have an outcome that is almost invariably poor. Conversely, incomplete AC (posteriorly accentuated alpha frequency, reactive and with SEPs mostly normal) reflects a less severe degree of anoxic-ischemic encephalopathy. The case we report should be classified, according to the SEPs and EEG features, as incomplete AC. The fact that the patient has regained consciousness, even if with residual cognitive impairment, confirms the need to distinguish this variant from complete AC.- - - - - - - - - - ranking = 29.723946492878keywords = brain (Clic here for more details about this article) |
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