1/30. stroke--a medical emergency.Acute ischaemic stroke as an urgent-to-treat condition has gained a more prominent role in the consciousness of emergency physicians and neurologists over the past decade. This is mainly due to an increasing insight into the pathophysiological mechanism of ischaemia, the definition of therapeutical goals, such as reperfusion or neuroprotection, and the recent application of respective treatment strategies in large multicentre studies. This review article will focus on the emergency assessment of stroke patients, on general treatment strategies, and particularly on specific measures of intensive care therapy of stroke including thrombolysis, decompressive surgery, hypothermia and treatment of brain oedema.- - - - - - - - - - ranking = 1keywords = consciousness (Clic here for more details about this article) |
2/30. Cerebral and coronary gas embolism from the inhalation of pressurized helium.OBJECTIVE: inhalation of helium, which produces a change in the voice, is frequently used among young rock singers to improve their performance. DESIGN: A case report. SETTINGS: adult medical intensive care unit in a university hospital. PATIENT: A 23-yr-old singer, who accidentally inhaled helium from a high pressurized tank without pressure reduction, presented with transient loss of consciousness and chest pain. INTERVENTIONS: Electrocardiogram, chest radiograph, biochemical and toxicological analyses, echocardiography, coronary angiography were performed. MEASUREMENTS AND MAIN RESULTS: At admission, the patient slowly regained consciousness. An electrocardiogram showed significant ST elevations in leads I, aVL, and V4-V6. The chest radiograph was consistent with pulmonary congestion and pneumomediastinum. The echocardiogram showed normal sized heart chambers with hypokinesis of the left ventricular lateral wall. ethanol and urine cannabinoids were present in low concentrations, but no presence of opiates, methadone, cocaine, or amphetamines was documented. troponin t was positive. Elevation of ST segments gradually disappeared within 30 mins, the drowsiness within 10 hrs, and the thoracic pain within 24 hrs. coronary angiography showed normal coronary arteries. The patient was discharged on day 3 without any symptoms and with normal electrocardiogram and chest radiograph. CONCLUSION: Accidental inhalation of helium under high pressure can cause symptomatic cerebral and coronary artery gas embolism.- - - - - - - - - - ranking = 2keywords = consciousness (Clic here for more details about this article) |
3/30. Obliteration of bilateral dissecting aneurysms of the vertebral arteries following repeated subarachnoid hemorrhage: a case report.A 51-year-old man presented with loss of consciousness when he underwent urological examination at another hospital. CT scans showed subarachnoid hemorrhage, and cerebral angiography showed bilateral dissecting aneurysms of the vertebral arteries. Following ventricular drainage, the lesion was managed conservatively with blood pressure control but again ruptured on day 8. Cerebral angiography revealed narrowing of both the dissecting aneurysms. On day 11, the right vertebral artery had been spontaneously obliterated and the right dissecting aneurysm was filled in a retrograde fashion via the left vertebral artery. Proximal occlusion of the right vertebral artery was performed to prevent recanalization. Two months later, cerebral angiography revealed that both vertebral arteries were obliterated and the basilar artery and right posterior inferior cerebellar artery were filled via the right posterior communicating artery. The present case demonstrated that the hemodynamic status of bilateral dissecting aneurysms of the vertebral artery changed variably indicating the necessity of careful angiographic observation.- - - - - - - - - - ranking = 1keywords = consciousness (Clic here for more details about this article) |
4/30. stroke associated with addiction to heroin.During a five year period at the Harlem Hospital Center nine heroin addicts were seen with strokes. Four occurred after loss of consciousness following intravenous heroin. Two occurred in patients using heroin at the time, but were not related to overdose or to a particular recent injection. The youth of these patients and lack of other predisposing factors suggests that heroin played a role in their strokes. In the other three patients, the relationships of stroke to heroin is less persuasive. There are several possible mechanisms by which heroin abuse could lead to stroke.- - - - - - - - - - ranking = 1keywords = consciousness (Clic here for more details about this article) |
5/30. Cerebrovascular complications in patients with malignancy: report of three cases and review of the literature.A cerebrovascular thromboembolic event may precede the identification of cancer, and be the first clinical evidence of an underlying malignancy. The malignancy can cause either nonbacterial thrombotic endocarditis or hypercoagulable state, both of which may have clinical manifestions such as thrombotic or embolic occlusion of multiple major cerebral vessels. We present three cases with unusual cerebrovascular events. The first case is a 62-year-old woman who was admitted due to acute left limbs weakness and consciousness disturbance. Brain computed tomographic (CT) scan showed right middle cerebral artery (MCA) and posterior cerebral artery (PCA) infarctions with uncal herniation. The second case is a 44-year-old woman who was hospitalized due to acute bilateral limb weakness and consciousness disturbance. Bilateral MCA, left PCA, anterior cerebral artery (ACA) infarctions and deep vein thrombosis in the left leg were diagnosed. The third case is a 63-year-old man who developed sudden onset of right hemiplegia and consciousness disturbance. Brain CT scan showed bilateral MCA and left ACA infarction. The results of a series of examinations including biochemistry, lipid profile, carotid duplex, and transthoracic and transesophageal echocardiography were unremarkable. All patients had positive disseminated intravascular coagulation (DIC) tests with elevated D-dimers and fibrinogen degradation products (FDP). Further systemic evaluation for malignancy revealed ovarian cancer in the first patient, endometrial carcinoma in the second patient, and adenocarcinoma of lung in the third patient. They all died of the underlying malignancy. Because the hemostatic system can be altered by malignancy, intravascular coagulation abnormalities of these malignancy-related strokes may be disclosed by laboratory assays of hemostasis.- - - - - - - - - - ranking = 3keywords = consciousness (Clic here for more details about this article) |
6/30. Rare fatal vascular complication of transsphenoidal surgery.We report the case of a 61-year-old man, who underwent transsphenoidal surgery for a pituitary macroadenoma. The presence of tough fibrous septa dividing the tumour permitted only a partial resection. Progressive loss of consciousness soon after surgery occurred, an emergency CT scan showed no evidence of haemorrhage. Twenty hours later, MRI revealed compression of both internal carotid arteries with arrest of arterial flow resulting in stroke by an enlarged haemorrhagic mass consistent with a pituitary apoplexy. On the second postoperative day, the patient died as a result of this extensive stroke. The mechanisms of this rare complication after transsphenoidal surgery are theorized and the sensitivity of imaging methods is discussed.- - - - - - - - - - ranking = 1keywords = consciousness (Clic here for more details about this article) |
7/30. Effect of pyritinol on EEG and SSEP in comatose patients in the acute phase of intensive care therapy.The extent and duration of acute disturbances of consciousness depend on the severity and localization of the underlying cerebral dysfunction. The glasgow coma scale (GCS) permits a relevant statement to be made on the course and recovery tendency of functional damage patterns in cerebral, mesencephalic, and brain stem structures. Therapy is directed at exerting a beneficial effect on the disturbed cerebral metabolism by administration of centrally active substances and at utilizing the available reserve plasticity of the brain for any possible recovery of mental performance. The bioavailability and profile of action of pyritinol have been well documented in animal experiments. We have studied the question as to the extent to which the substance influences the depth of coma in patients receiving acute intensive care therapy, and how this can be objectified electrophysiologically in the form of a specific central effect on basal brain structures. In a phase-II pilot study over five days the acute effect of intravenous 60-min. administration of 1,000 mg pyritinol on the depth of coma, the central conduction time (CCT) and the primary complex amplitude (N20/P25) of the SSEP, and on vigilance behavior (spectral edge frequencies and power) was investigated for 90 minutes in each case under intensive-medical steady-state conditions in 10 comatose patients. Because of the differences in the underlying brain damage, the primary depth of coma, age (30-89 years), sex (two female, eight male), as well as previous treatment (surgery, conservative), the significance of the results could not be evaluated by confirmatory statistical analysis.(ABSTRACT TRUNCATED AT 250 WORDS)- - - - - - - - - - ranking = 1keywords = consciousness (Clic here for more details about this article) |
8/30. Misleading presentation of epilepsy in elderly people.Four elderly patients with epilepsy are described. The seizures took the form of abrupt loss of consciousness without tonic/clonic movements, followed by prolonged loss of consciousness or drowsiness. In three cases, there had been a long history of blackouts before the diagnosis was made. The diagnosis of epilepsy in these cases was made on clinical grounds. In each case, the event was either witnessed by medical observers or an eye-witness account was obtained. In every case, there had been repeated, and apparently precisely similar, transient disturbances of consciousness, with complete recovery in the intervals. All of the patients had abnormal EEGs.- - - - - - - - - - ranking = 3keywords = consciousness (Clic here for more details about this article) |
9/30. Lone bilateral blindness: a transient ischaemic attack.In the Oxfordshire Community stroke Project 14 patients were notified with lone bilateral blindness, defined as rapid onset of dimming or loss of vision over all of both visual fields simultaneously, lasting under 24 hours, without associated symptoms of focal cerebral ischaemia, epilepsy, or reduction in consciousness. The age of these patients was close to that of the 184 patients who presented with transient ischaemic attacks and they had a similar high prevalence of vascular risk factors. During a mean follow-up of 2.4 years, 5 of the 14 had a first-ever stroke (0.31 expected). In view of their 16 times (95% CI 7-39 times) excess risk of stroke such patients should be included, for practical purposes, under the diagnostic heading of transient ischaemic attack.- - - - - - - - - - ranking = 1keywords = consciousness (Clic here for more details about this article) |
10/30. High altitude cerebral oedema.High altitude cerebral oedema is a severe form of acute mountain sickness occurring at heights above 4500 metres. The clinical features are of headache, impairment of consciousness and a variety of neurological signs. The condition occurs during acclimatisation and also at extreme altitudes above 7500 metres when it is often fatal. Case histories of cerebral oedema patients, pathological findings and treatment are reviewed. Other forms of altitude-related illness are also reviewed, including stroke and retinal haemorrhage.- - - - - - - - - - ranking = 1keywords = consciousness (Clic here for more details about this article) |
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