1/16. An unusual presentation of inhalant abuse with dissociative amnesia.A 38-y-old male with occult inhalant abuse underwent an 18-mo evaluation for presumed seizure disorder. Although past medical history was significant for alcohol abuse, his wife confirmed a 6-y histoy of abstinence. His seizures were characterized as episodes of unconsciousness preceded by a feeling of "things slowing down". No muscular activity was witnessed during these episodes, and upon regaining consciousness the patient had slurred speech, disorientation, dissociative amnesia, and bizarre behavior that resolved spontaneously. Despite 4 emergency department visits, 4 hospital admissions, 5 neurologic and 7 psychiatric outpatient evaluations, extensive work-up was non-diagnostic. These episodes recurred until his wife found him huffing trichloroethylene. Questioning of the patient revealed that huffing always preceded these episodes and that he started huffing after discontinuing alcohol. The patient underwent addiction treatment. Toxic inhalants should be suspected as a substitute drug of abuse in patients attempting abstention. Disorientation clinically similar to dissociative amnesia can occur following loss of consciousness during an episode of trichloroethylene use.- - - - - - - - - - ranking = 1keywords = consciousness (Clic here for more details about this article) |
2/16. Dissociative amnesia after general anesthesia--a case report.Psychogenic unconsciousness is a rare cause of failure of prompt recovery from general anesthesia. The diagnosis is only made by exclusion of other conditions. We describe a young, healthy female who failed to wake up promptly after total intravenous anesthesia with alfentanil and propofol. She regained consciousness 24 hours later without any specific treatment. However she sustained amnesia for a period of 48 hours. Dissociative disorder was diagnosed after an extensive workup. This case report emphasizes the importance of inclusion of psychiatric disorder in the differential diagnosis should unexplainable delayed emergence from general anesthesia occur.- - - - - - - - - - ranking = 0.66666666666667keywords = consciousness (Clic here for more details about this article) |
3/16. An endocrinopathy characterized by dysfunction of the pituitary-adrenal axis and alopecia universalis: supporting the entity of a triple H syndrome.We demonstrate the rare disorder of triple H syndrome in a 25-year-old man. He was pointed out as having short stature, at -5.9 s.d., and diagnosed as GH deficient at 6 years old. Approximately a year ago, he noticed systematic hair loss. He lost body weight by 7 kg during the last half year. He was admitted to Jichi Medical School Hospital because of unconsciousness. Physical findings showed disturbance of consciousness with japan coma Scale I-3. He had emaciation and alopecia universalis. Laboratory findings showed plasma glucose was as low as 1.11 mmol/l. GH and ACTH deficiency with hypoadrenocorticism were clarified. His intelligence was in the low normal range with a WAIS IQ of 70, and anterograde amnesia was suggested in the presence of a little, but not significant, morphological change in the hippocampus on a magnetic resonance imaging scan. Replacement by a physiological dose of hydrocortisone normalized plasma glucose, and restored body weight and growth of hair during the 7 month therapeutic period. The present finding strongly supports a clinical entity of triple H syndrome, including ACTH deficiency, alopecia universalis and anterograde amnesia, and that there may be some variation of the triad among the subjects.- - - - - - - - - - ranking = 0.66666666666667keywords = consciousness (Clic here for more details about this article) |
4/16. Transformations of consciousness. A cartography. I. The perception-hallucination continuum.Self-awareness emerges from the evolutionary transformation of material structures into magical, mythical and mental structures of consciousness. Western varieties of conscious states may be mapped on a perception-hallucination continuum of increasing ergotropic or hyper-arousal. These levels of subcortical arousal are cortically or cognitively interpreted as normal, creative, hyperhrenic, cataleptic and ecstatic states. During increasing hyper-arousal (characterized by EEG desynchronization): (1) the variability of the EEG amplitude decreases in introverts whereas in extroverts, it increases; (2) exteroception is transformed into an experience of interoception, while willed motor activity becomes increasingly impaired and ultimately inhibited, and (3) information processing during these hallucinatory states is preferentially shifted from the speech dominant and motor-coordinating or "major" toward the nonverbal, gestalt-perceiving, the non-dominant or "minor" cortical hemisphere.- - - - - - - - - - ranking = 1.6666666666667keywords = consciousness (Clic here for more details about this article) |
5/16. Transient aphasia and persistent amnesia after surgery for internal carotid artery--posterior communicating artery aneurysm.We report a case of transient aphasia and persistent amnesia after clipping of a ruptured cerebral aneurysm to treat a subarachnoid hemorrhage. Postoperatively, aphasia was identified and magnetic resonance imaging (MRI) showed an abnormal intensity area in the left anterior thalamus. Single photon emission computed tomography (SPECT) revealed a wider area of low perfusion surrounding the left thalamus and left frontotemporal lobe than that shown by the MRI. His aphasia resolved over the subsequent 12-week period. He was left with an isolated disturbance of memory; in the absence of any dementia, aphasia or disturbance of consciousness, his condition was classified as one of amnesia. SPECT 14 weeks after admission revealed an area of low perfusion limited to the left thalamus. These findings suggest that the persistence of amnesia in this case was caused by the infarction of the mammillothalamic tract, and the recovery from aphasia may have resulted from the disappearance of surrounding edema.- - - - - - - - - - ranking = 0.33333333333333keywords = consciousness (Clic here for more details about this article) |
6/16. Anterograde amnesia in triazolam overdose despite flumazenil treatment: a case report.Anterograde amnesia, possibly accompanied by acute brain syndrome, is a potential side-effect of certain benzodiazepines, particularly triazolam. flumazenil is a benzodiazepine antagonist that is highly effective in reversing the central nervous system effects of benzodiazepine overdose. We report a case of triazolam overdose resulting in anterograde amnesia after flumazenil administration had restored clear consciousness. The defect in memory may have been due to too little flumazenil being given or failure of memory consolidation affected by the character of triazolam during the induced lucent period. We feel that physicians should be aware of the potential occurrence of acute brain syndrome in patients with benzodiazepine overdose despite treatment with flumazenil.- - - - - - - - - - ranking = 0.33333333333333keywords = consciousness (Clic here for more details about this article) |
7/16. Concussion in sports. Guidelines for the prevention of catastrophic outcome.Concussion (defined as a traumatically induced alteration in mental status, not necessarily with loss of consciousness) is a common form of sports-related injury too often dismissed as trivial by physicians, athletic trainers, coaches, sports reporters, and athletes themselves. While head injuries can occur in virtually any form of athletic activity, they occur most frequently in contact sports, such as football, boxing, and martial arts competition, or from high-velocity collisions or falls in basketball, soccer, and ice hockey. The pathophysiology of concussion is less well understood than that of severe head injury, and it has received less attention as a result. We describe a high school football player who died of diffuse brain swelling after repeated concussions without loss of consciousness. Guidelines have been developed to reduce the risk of such serious catastrophic outcomes after concussion in sports.- - - - - - - - - - ranking = 0.66666666666667keywords = consciousness (Clic here for more details about this article) |
8/16. Neuropsychological assessment and brain imaging technologies in evaluation of the sequelae of blunt head injury.A 43 year old man with a traumatic amnesic syndrome experienced only a brief, if any, loss of consciousness following an injury to the head. Four years after this injury, his results on standard psychometric assessment were normal. Long-latency evoked response potentials results were normal, and the neurological examination and computed tomography scans were unhelpful in explaining his amnesic symptoms. He had no history of alcohol abuse, yet his neuropsychological profile was that of a Korsakoff-like amnesia with frontal lobe features. Magnetic-resonance images demonstrated evidence of extensive frontal lobe damage, while cerebral blood flow studies provided additional evidence of bilateral frontal lobe dysfunction. The case highlights the need for those giving opinions in medico-legal head trauma cases to go beyond a reliance on routine indicators, such as duration of coma, results of standard psychometric assessment and computed tomography scans, to more specialised neuropsychological evaluations and magnetic-resonance imaging scans.- - - - - - - - - - ranking = 0.33333333333333keywords = consciousness (Clic here for more details about this article) |
9/16. Negative hallucinations, other irretrievable experiences and two functions of consciousness.After providing a psychodynamic exploration of negative hallucinations in four clinical cases, the focus of this paper was broadened in an attempt to understand the mechanism of negative hallucination. To this end, after defining the term 'irretrievable experiences', two other examples--preconscious perceptions and infantile amnesia, both analogues to negative hallucination--were examined. A discussion followed concerning two types of 'consciousness': 'consciousness' as a synonym for 'awareness' and 'consciousness' as a distinct psychological state. Next, the role of different functions of each sort of consciousness in the processes of conferring, fixing and retrieving mental contents within particular categories of experience was taken up. Finally, integrating developmental aspects of these same functions, explanations were offered regarding the mechanisms involved in preconscious perception, infantile amnesia and negative hallucinations.- - - - - - - - - - ranking = 2.6666666666667keywords = consciousness (Clic here for more details about this article) |
10/16. Hypothalamic and basal forebrain germinoma presenting with amnesia and hyperphagia.patients harboring primary intracranial germinomas usually have had Parinaud's syndrome and hydrocephalus (with pineal tumors) or hypopituitarism, visual loss, and diabetes insipidus (with suprasellar tumors) at presentation. The few reported cases of verified intraparenchymal hypothalamic germinomas all have been in prepubertal males with progressive neurologic deficits, altered levels of consciousness, or clinically apparent panhypopituitarism. The subject of this report was an endocrinologically normal, primiparous 24-year-old woman who presented with hydrocephalus followed by worsening anterograde amnesia and hyperphagia despite having a functioning ventriculoatrial shunt. Computed tomography scanning and magnetic resonance imaging demonstrated an anterior hypothalamic, thalamic, and basal forebrain mass, which stereotactic biopsy proved to be a germinoma. Intraaxial germinomas restricted to the anterior hypothalamus or thalamus rarely have been reported. The clinical features of the current patient may be unique.- - - - - - - - - - ranking = 0.33333333333333keywords = consciousness (Clic here for more details about this article) |
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