1/22. Opisthotonic posturing with neuromuscular irritability attributable to 4-aminopyridine ingestion by a healthy pediatric patient.INTRODUCTION: 4-aminopyridine (4-AP) is a potassium channel blocker used to increase muscle strength in the treatment of demyelinating diseases such as multiple sclerosis. We describe a case of ingestion by an 8-month-old child that resulted in severe but transient symptoms. CASE REPORT: An 8-month-old boy was found with greenish saliva, and a capsule with green 4-AP powder was missing. On arrival to an emergency department, he was jittery, tachycardic, and tachypneic. Activated charcoal, a cathartic, and midazolam (0.5 mg/kg) were administered before transfer to a tertiary pediatric hospital. On arrival, the infant remained tachycardic and tachypneic. His eyes deviated upward and he was noted to have 3 deep tendon reflexes bilaterally. He was administered 0.9% normal saline (20 mL/kg) for a wide pulse pressure with low diastolic blood pressure. The patient developed dramatic opisthotonic posturing and vermiform tongue fasciculations. The symptoms responded well to repeated intravenous doses of benzodiazepines. In this case, we used 2 doses of lorazepam (0.05 mg/kg each). During opisthotonic posturing, an electroencephalogram performed in the intensive care unit revealed no evidence of seizure activity. Within 20 hours after admission, the patient became asymptomatic. CONCLUSION: This case is, to our knowledge, the first documented pediatric 4-AP ingestion. Clinical signs and symptoms are described as well as the response to therapy with benzodiazepines. The electroencephalogram performed while the patient was symptomatic was negative for seizures.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
2/22. Hypocalcemic generalised seizures as a manifestation of iatrogenic hypoparathyroidism months to years after thyroid surgery.hypoparathyroidism is a relatively common side effect of a thyroidectomy and leads to hypocalcemia. Carpopedal spasm and tetany are typical manifestations and usually occur within weeks after surgery. The first signs can be less typical and include movement disorders such as chorea, as well as symptoms of increased intracranial pressure or epileptic seizures. We describe two cases with generalised tonic-clonic seizures as the first manifestation of postoperative hypoparathyroidism, appearing months and years after thyroidectomy. Iatrogenic hypoparathyroidism needs to be considered in the differential diagnosis of adult-onset, generalised, tonic-clonic seizures even if the thyroidectomy was performed years earlier.- - - - - - - - - - ranking = 0.5keywords = pressure (Clic here for more details about this article) |
3/22. Large-cell medulloblastoma in aicardi syndrome. Case report and literature review.An eight-year-old girl with aicardi syndrome (AIC) developed signs of increased intracranial pressure. A clinical and radiological investigation revealed a tumor in the posterior fossa, which was resected. The histopathological diagnosis was large-cell medulloblastoma. Eight months later, she died of a local recurrence, despite treatment with chemotherapy and radiotherapy according to a PNET protocol. In addition to the growth of a large-cell medulloblastoma at the location of the primary tumor and the meningeal spread of the tumor, the autopsy revealed major cortical and subcortical malformations of the brain. Various benign (e.g., plexus papillomas) and malignant tumors (angiosarcoma, embryonic carcinoma, and hepatoblastoma) have been reported in connection with aicardi syndrome. A genetic analysis of AIC suggests that the mutation is localized on the distal part of the short arm of the x chromosome, an area that may be of importance for tumor development. This is the first report of a primary malignant brain tumor -- large-cell medulloblastoma -- in a patient with aicardi syndrome.- - - - - - - - - - ranking = 0.5keywords = pressure (Clic here for more details about this article) |
4/22. Spasm of accommodation in a patient with increased intracranial pressure and pineal cyst.BACKGROUND: In the setting of a normal neurological examination, accommodation spasm is frequently attributed to a non-organic etiology. Occasionally, organic disorders are associated. In particular, central lesions involving the dorsal midbrain and quadrigeminal plate have been described with disorders of accommodation. history AND SIGNS: A 36-year-old woman with idiopathic intracranial hypertension (IIH) had visual blur from pseudo-myopia due to accommodative spasm. magnetic resonance imaging (MRI) revealed a pineal cyst that was reported to be an incidental finding. The patient had persistent papilledema and recurrent episodes of unilateral and bilateral visual blur from accommodative spasm despite medical management. THERAPY AND OUTCOME: A lumboperitoneal shunt effectively lowered her intracranial pressure (ICP). Thereafter, all symptoms of increased ICP, accommodative spasm and papilledema resolved. A functional, non-organic cause for accommodation spasm was not suspected. CONCLUSIONS: To our knowledge, this is the first report of isolated accommodative spasm as a presenting symptom in a patient with IIH. The patient's accommodative spasm resolved with lowering of the ICP. It remains speculative whether her pineal cyst played a role in triggering the accommodative spasm.- - - - - - - - - - ranking = 2.5keywords = pressure (Clic here for more details about this article) |
5/22. Obstetrical anaesthesia and analgesia in chronic spinal cord-injured women.Improved acute and rehabilitative care and emphasis on integrating patients into society after spinal cord injury is likely to result in increasing numbers of cord-injured women presenting for obstetrical care. Anaesthetists providing care to these women should be familiar with the complications resulting from chronic cord injury and aware that many may be aggravated by the physiological changes of normal pregnancy. These complications include reduced respiratory volumes and reserve, decreased blood pressure and an increased incidence of thromboembolic phenomena, anaemia and recurrent urinary tract infections. patients with cord lesions above the T5 spinal level are at risk for the life-threatening complication of autonomic hyperreflexia (AH) which results from the loss of central regulation of the sympathetic nervous system below the level of the lesion. Sympathetic hyperactivity and hypertension result in response to noxious stimuli entering the cord below the level of the lesion. Labour appears to be a particularly noxious stimulus and patients with injuries above T5 are at risk for AH during labour even if they have not had previous AH episodes. morbidity is related to the degree of hypertension and intracranial haemorrhage has been reported during labour and attributed to AH. We report our experience in providing care to three parturients with spinal cord injuries. Two patients had high cervical lesions, one of whom experienced AH during labour and was treated with an epidural block. The second was at risk for AH having had episodes in the past and received an epidural block to provide prophylaxis for AH. In both cases epidural blockade provided effective treatment and prophylaxis for AH.(ABSTRACT TRUNCATED AT 250 WORDS)- - - - - - - - - - ranking = 0.5keywords = pressure (Clic here for more details about this article) |
6/22. Severe hypertension during postpartum haemorrhage after i.v. administration of prostaglandin E2.Severe hypertension with arterial spasm was observed after i.v. administration of prostaglandin E2 (PGE2) during uterine exploration under general anaesthesia for control of postpartum haemorrhage. This hypertension was exceptional because PGE2 is known to cause a decrease in systemic arterial pressure. Different hypotheses for this paradoxical hypertensive crisis after PGE2 administration are discussed.- - - - - - - - - - ranking = 0.5keywords = pressure (Clic here for more details about this article) |
7/22. Microvascular decompression for hypertension--clinical and experimental study.Balloon compression of the left IXth and Xth cranial nerves and ventrolateral medulla oblongata in dogs resulted in statistically significant increases in blood pressure without obvious changes in cardiac output. Five of 21 hypertensive patients with trigeminal neuralgia or hemifacial spasm demonstrated normalized blood pressure following microvascular decompression for arterial compression of the brainstem in the area of the IXth and Xth cranial nerves on the left. Our experimental and clinical results suggest that neurogenic hypertension caused by the vascular compression of the medulla oblongata can be relieved by microvascular decompression.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
8/22. Isolated fracture of the medial portion of the lateral mass of the atlas: a previously undescribed entity.Four cases of fracture of the medial aspect of the lateral mass of the atlas are presented. Unlike most cases of atlantal fracture, definite history of a blow to the vertex could not be established. While the exact mechanism of injury is unknown, it is postulated that the bone fragment is produced by a combination of stretching the ligamentum transversarium and pressure on the lateral mass due to contraction of the neck muscles. All four patients were neurologically intact and complained of pain in the distribution of the greater occipital nerve. It is suggested that this fracture might be identified more often in patients with similar histories and complaints by use of laminagraphy, since part or all of the atlas is frequently obscured on routine open mouth roentgenograms of the upper cervical spine.- - - - - - - - - - ranking = 0.5keywords = pressure (Clic here for more details about this article) |
9/22. Visual loss following intranasal anesthetic injection.Four patients had visual loss after nasal surgery. There was one instance each of branch retinal artery occlusion, central retinal artery occlusion, anterior ischemic optic neuropathy, and posterior ischemic optic neuropathy. The postulated mechanism is vasospasm. The submucosal injection, under pressure, of an anesthetic with epinephrine is deemed to be causative.- - - - - - - - - - ranking = 0.5keywords = pressure (Clic here for more details about this article) |
10/22. Duchenne muscular dystrophy and malignant hyperthermia--two case reports.The case histories are presented including the anaesthetic and postoperative management, of two children, a two-year-old with undiagnosed Duchenne muscular dystrophy (DMD) and a three-year-old with known DMD. The child with undiagnosed DMD had no symptoms of DMD and had received halothane twice before, without succinylcholine, with no apparent difficulty. Following an uneventful induction of anaesthesia with halothane, nitrous oxide and O2, succinylcholine resulted in bilateral masseter muscle spasm and then, in rapid sequence, ventricular tachycardia and cardiac arrest. resuscitation was difficult, prolonged and associated with hyperkalaemia (K = 12.57 mEq X L-1), severe metabolic and respiratory acidosis, high peripheral venous pressure and massive hepatosplenomegaly, but not hyperthermia. The patient was finally resuscitated but died two days later. Skeletal muscle biopsy results were consistent with malignant hyperthermia. The second patient was known to have DMD but did not receive prophylactic or intraoperative dantrolene nor have his anaesthetic machine flushed with oxygen for an extended period prior to induction of anaesthesia. This child was anaesthetized with fentanyl and N2O and, with the exception of a high intraoperative heart rate (155-160 beats X min-1), had an uncomplicated anaesthetic and operation (intraoperative axillary temperatures ranged between 36.8-37.9 degrees C). Postoperatively his temperature rapidly increased to 38.8 degrees C and then 40.3 degrees C and he became metabolically acidotic. Intravenous administration of dantrolene for 48 hours reduced the temperature and allowed normal recovery and discharge. A postoperative muscle biopsy was consistent with DMD.(ABSTRACT TRUNCATED AT 250 WORDS)- - - - - - - - - - ranking = 0.5keywords = pressure (Clic here for more details about this article) |
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