1/3. Behavioural disturbances following Japanese B encephalitis.Clinically, Japanese B encephalitis (JBE) is often overlooked as its occurrence in Western countries is rare. However, its neurological, cognitive and psychiatric sequelae constitute a major public health problem in the far east where JBE is endemic. European and American subjects may however experience the JBE when returning from a far east journey. In such cases, misdiagnosis is frequent because of the unawareness of psychiatrists and physicians. The present review, therefore, documents the behavioural and cognitive sequelae of JBE. This reactivates the debate concerning the vaccination against the virus all the more that the literature enlightens the importance of the vaccination for those who undertake frequent and extensive tourist excursions to the Orient but still discusses it for occasional travellers. Following is a case-report of a young western European post-graduate student who has contracted JBE by experiencing an acute febrile delirium during an unusual short stay in South East asia. Pyramidal syndrome, Parkinsonism and amnesia were the prominent acute deficits. Whereas these faded in great part during convalescence, emotional and behavioural instability associated with affective involvement, obsessive-compulsive symptoms and cognitive impairments appeared. A partial recovery was however obtained with neuroleptics, lithium and following electro-convulsive therapy. Organic personality syndrome was persistent and thereafter constituted the main sequelae syndrome. Hypersomnia and several enuretic episodes persisted.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/3. Approach to diagnosis of parkinson disease.OBJECTIVE: To review the clinical features of parkinson disease (PD) and other causes of motor parkinsonism with an emphasis on diagnosis in elderly patients. SOURCES OF INFORMATION medline: and Google Scholar were searched for original research articles describing clinical diagnosis of parkinsonism. consensus statements and articles summarizing diagnostic criteria for parkinsonian syndromes were also reviewed. Most evidence was levels II or III. MAIN MESSAGE: diagnosis of PD is made clinically and can be challenging. In older patients, PD can present with general functional decline and nonspecific symptoms. Clinical criteria for diagnosing PD and the TRAP mnemonic can be helpful. A 2-week trial of levodopa-carbidopa treatment can be considered. Specific signs and a minimal response to levodopa treatment suggest other causes of parkinsonism. Clinical features of other causes of parkinsonism are reviewed in the article. CONCLUSION: Parkinsonism and PD are common in older patients. family physicians should consider parkinsonism in the differential diagnosis of patients who have falls and exhibit general functional decline.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
3/3. Parkinsonism induced by sepsis: a case report.BACKGROUND: Parkinson's disease (PD) is a slowly progressive neurodegenerative disease that appears essentially as a sporadic condition with no identifiable cause. Parkinsonism is used for syndromes where the aetiolobgy is known such as Parkinsonism due to stroke, infection, neuroleptic drugs and toxic agents. Parkinson's disease and Parkinsonism present with the tetrad of tremor at rest, slowness of voluntary movement (bradykinesia), rigidity and a characteristic disturbance of gait and posture. A report of Parkinsonism induced by sepsis is rare. This report aims to create awareness of Parkinsonism as a manifestation of sepsis. METHOD: The case note of a patient with Parkinsonism induced by sepsis managed in the medical unit of the University of Port Harcourt teaching Hospital and a review of the literature on the subject with medline search was used. RESULT: A 71-year-old Nigerian male presented with Parkinsonism on a background of Gram negative sepsis which resolved with antibiotic therapy. Antiparkinoinian drugs were not used. CONCLUSION: Parkinsonism is a rarely reported neurological complication of sepsis. There is a need for physicians to be aware of this clinical manifestation.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |