1/10. Amnesic syndrome and severe ataxia following the recreational use of 3,4-methylene-dioxymethamphetamine (MDMA, 'ecstasy') and other substances.A 26-year-old woman suffered disseminated intravascular coagulation (DIC) and a brief respiratory arrest following recreational use of 3,4-methylene-dioxymethamphetamine (MDMA; 'ecstasy'), together with amyl nitrate, lysergic acid (LSD), cannabis and alcohol. She was left with residual cognitive and physical deficits, particularly severe anterograde memory disorder, mental slowness, severe ataxia and dysarthria. Follow-up investigations have shown that these have persisted, although there has been some improvement in verbal recognition memory and in social functioning. magnetic resonance imaging and quantified positron emission tomography investigations have revealed: (i) severe cerebellar atrophy and hypometabolism accounting for the ataxia and dysarthria; (ii) thalamic, retrosplenial and left medial temporal hypometabolism to which the anterograde amnesia can be attributed; and (iii) some degree of fronto-temporal-parietal hypometabolism, possibly accounting for the cognitive slowness. The putative relationship of these abnormalities to the direct and indirect effects of MDMA toxicity, hypoxia and ischaemia is considered.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
2/10. Cognitive presentation of multiple sclerosis: evidence for a cortical variant.BACKGROUND: Although neuropsychiatric complications are well recognised, the presentation of multiple sclerosis with cognitive or neuropsychiatric symptoms has generally been considered a rare occurrence and to reflect subcortical pathology. OBJECTIVES: To document the clinical, neuropsychological, and radiological features of six cases of cognitive presentation of multiple sclerosis, to review the relevant literature, and to propose a possible cortical basis for this clinical presentation. SUBJECTS: Six patients (five women; age range 38 to 60 years) presented to the memory and cognitive disorders clinic in Cambridge with an initially undiagnosed cognitive/neuropsychiatric syndrome. All underwent neuropsychological evaluation, brain imaging, and ancillary investigations to establish a diagnosis of multiple sclerosis. RESULTS: The six cases all had a progressive dementia syndrome with prominent amnesia, often accompanied by classic cortical features including dysphasia, dysgraphia, or dyslexia. Mood disturbance was ubiquitous and in three patients there was a long history of preceding severe depression. All six developed characteristic physical signs on follow up, with marked disabilities. A review of 17 previously reported cases highlighted the prominence of memory impairment and depression in the early stages. CONCLUSIONS: On clinical, pathological, and radiological grounds, the neuropsychiatric presentation of multiple sclerosis may represent a clinicopathological entity of "cortical multiple sclerosis." Failure to recognise this will delay diagnosis and may expose patients to potentially dangerous and invasive investigation. Because the neuropsychiatric features of cortical multiple sclerosis are a major cause of handicap, their early recognition may be particularly important in view of emerging treatments.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
3/10. association between delayed sleep phase and hypernyctohemeral syndromes: a case study.STUDY OBJECTIVE: We investigated whether the hypernyctohemeral syndrome (non-24-hour sleep-wake syndrome) may show a clinical association with the delayed sleep phase syndrome (DSPS) in a 39-year-old woman who developed sleep disturbances following a traumatic brain injury. MEASUREMENTS AND RESULTS: sleep-wake log documentation and wrist-activity recordings for more than 6 consecutive months confirmed the patient's tendency to live on longer-than-24-hour "days." Episodes of relative coordination to the 24-hour day were also noted, suggesting that the patient was transiently in and out of phase with environmental synchronizers too weak to fully entrain her to the geophysical environment. Interestingly, we noted a tendency to initiate sleep between 3:00 am and 5:00 am and wake up from sleep between noon and 1:00 pm. CONCLUSIONS: These results support an association between the hypernyctohemeral syndrome and the DSPS. This association may carry implications for the treatment of circadian rhythms disorders.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
4/10. Delayed neuropsychiatric impairment after carbon monoxide poisoning from burning charcoal.Poisoning by carbon monoxide from burning charcoal has become one of the popular and lethal ways of attempting suicide in hong kong. survivors of the carbon monoxide poisoning often face acute and delayed adverse problems in both their physical and mental health. We report two cases of delayed onset neuropsychiatric complications caused by carbon monoxide poisoning from burning charcoal. These symptoms were characterised by a latent period, followed by an abrupt and profound deterioration in the neurocognitive function with a seemingly reversible course. The literature is reviewed regarding the aetiology, pathophysiology, and management of this condition. Regular monitoring of their neurocognitive function and forewarning of this potential complication to the survivors of carbon monoxide poisoning and their families should be essential.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
5/10. Environmental reduplicative paramnesia in a case of atypical Alzheimer's disease.A 79-year-old patient with neuropathologically confirmed Alzheimer's disease (AD) presented with a selective environmental reduplicative paramnesia (RP), the belief that one or more environments exist simultaneously in two or more physical locations. Clinical presentation and neuropathological examination revealed an atypical form of AD. High neurofibrillary tangle densities were observed in the frontal and temporal association cortex, whereas the parietal and entorhinal cortex, as well as the hippocampus, were nearly spared. These findings are compared to those reported in frontal and frontotemporal variants of AD and discussed in the light of current anatomoclinical models for environmental RP.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
6/10. Pure amnestic seizures in temporal lobe epilepsy. Definition, clinical symptomatology and functional anatomical considerations.Pure amnestic seizures (PAS) sometimes occur in patients with temporal lobe epilepsy. They never represent the only type of seizures in these patients. Pure amnestic seizures are defined as seizures during which the only clinical manifestation is the patients' inability to retain in memory what occurs during the seizure coupled with the preservation of other cognitive functions and the ability to interact normally with their physical and social environment. It is postulated that PAS result from selective ictal inactivation of mesial temporal (MT) structures without isocortical involvement. This occurs most often in patients with neuropsychological and electroencephalographic (EEG) evidence of bilateral dysfunction of MT structures (six out of eight patients in this study). In the few patients without such evidence as well as in some with bilateral MT dysfunction, PAS may result from seizure discharge limited to the MT structures of both temporal lobes. In the light of current anatomical knowledge, contralateral spread of seizure discharge from the MT structures of one side to those of the other through the dorsal hippocampal commissure is the only likely explanation for this situation. One observation with depth electrode stimulation of MT structures supports this view. In patients with evidence for bilateral MT dysfunction, a unilateral seizure may presumably suffice to induce a PAS, the contralateral MT structures being unable to ensure normal memory function. In most instances PAS can be distinguished from episodes of transient global amnesia on clinical grounds.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
7/10. Too shameful to remember: a 17-year-old Chinese boy with psychogenic amnesia.A case of psychogenic amnesia in a 17-year-old Chinese boy is presented. The case is unusual in that the amnesia lasted as long as six weeks without any pseudodementia or fugue. The patient can be best understood from the abnormal sick role and the communication models of hysteria. The family was preoccupied with physical illness and relied on non-verbal rather than verbal language in communicating distress and negative emotions. shame was the central psychodynamic aetiology; it was too shameful for the patient to talk about or withdraw himself from the predicaments in which he was trapped. Preceding the onset of amnesia he had suffered from multiple conversion symptoms for seven months. His message and predicaments not understood, he was unnecessarily investigated and treated by numerous doctors, making matters much worse. The prices paid included five hospital admissions, countless consultations at accident and emergency departments and with general practitioners, and an appendectomy for a normal appendix.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
8/10. Facilitating telephone number recall in a case of psychogenic amnesia.In the present case study, a middle-aged woman was admitted to the hospital with no identification and no recollection of her identity. Attempts by social and police agencies to recognize, or discover some clue about the patient, were unsuccessful. The behavioral interventions of modeling, reinforcement, and progressive relaxation were designed to induce telephone dialing behavior and telephone number recall. The positive outcome of the case is discussed in terms of spontaneous remission, and the effects of relaxation therapy, a physical-motoric non-verbal procedure on the recollection process of the amnesia victim.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
9/10. Selective impairments within episodic memories.We report the case of a patient (T.R.) who developed a severe and selective amnesia for names and dates associated with events. His amnesia was temporally limited, affecting only the last two to three decades of his life. When recalling an event he was able to evoke both its content and place, while he could not provide any information about people (names or their physical features) and the time (date/period) of its occurrence. His performance on event-memory tests was consistent across the type of material used (personal and public events) or the period of life investigated. These results suggest that knowledge of an episode is specified across multiple representations.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
10/10. Transient global amnesia: a complication of incremental exercise testing.Incremental exercise testing is routinely used for diagnosis, rehabilitation, health screening, and research. We report the case of a 71-yr-old patient with chronic obstructive pulmonary disease (COPD) who suffered an episode of transient global amnesia (TGA) several minutes after successfully completing an incremental exercise test on a cycle ergometer. TGA, which is known to be precipitated by physical or emotional stress in about one-third of cases, is a transient neurological disorder in which memory impairment is the prominent deficit. TGA has a benign course and requires no treatment although 24-h observation is recommended. Recognition of TGA as a potential complication of incremental graded exercise testing is important to both aid diagnosis of the amnesia and to spare a patient unnecessary evaluation.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
| | Next -> |