1/10. Traumatic asphyxia complicated by unwitnessed cardiac arrest.We report a case of traumatic asphyxia complicated by unwitnessed cardiac arrest in which the patient has made a good, functional recovery. Traumatic asphyxia is an uncommon clinical syndrome usually occurring after chest compression. Associated physical findings include subconjunctival hemorrhage and purple-blue neck and face discoloration. These facial changes can mimic those seen with massive closed head injury; however, cerebral injury after traumatic asphyxia usually occurs due to cerebral hypoxia. When such features are observed, the diagnosis of traumatic asphyxia should be considered. Prompt treatment with attention to the reestablishment of oxygenation and perfusion may result in good outcomes.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
2/10. 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) |
3/10. Neuropsychological deficits of a U.S. Army pilot following an anoxic event as a function of cardiac arrest.Anoxic encephalopathy occurs as a result of cardiac arrest, respiratory distress, or carbon monoxide poisoning. This is a case report on the neuropsychological deficits of anoxia in an otherwise previously healthy 36-year-old male pilot. The patient was taking an over-the-counter supplement that included an herb called Ma Huang on the day of his cardiac arrest. Ma Huang is reported to potentially present an increased risk of cardiac infarctions and central nervous system dysfunctions. Several instances of death have been linked to Ma Huang. The patient produced a neuropsychological profile that evidenced impairments in executive functioning, memory, language, attention, intellectual and academic functioning, as well as motor speed and coordination, all of which are consistent with diffuse brain damage. This case adds to the body of literature documenting the physical and neuropsychological effects of anoxia, as well as the effects of ephedrine-based supplements, such as Ma Huang.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
4/10. Delayed postanoxic encephalopathy: a case report and literature review.Delayed postanoxic encephalopathy is a rare condition in which patients appear to make a complete clinical recovery after an episode of anoxia or hypoxia but then develop a relapse characterized by apathy, confusion, agitation, and/or progressive neurologic deficits. The incidence of delayed postanoxic encephalopathy is unclear but has been reported to range from less than 1 to 28 per 1000 in patients who have suffered hypoxic or anoxic events. The exact pathogenesis remains unknown. We describe a case of an independently living 51-year-old woman admitted to an inpatient rehabilitation unit 11 days after a respiratory arrest. At admission, she exhibited cognitive and visual deficits that were relatively mild but prevented a safe return to independent living. Two days later, she developed the sudden onset and rapid worsening of parkinsonian symptoms and excruciating bilateral lower-extremity pain. The pain was intractable, and over the next 2 days she progressed to being unable to walk or perform her activities of daily living without maximum assistance. A diagnosis of delayed postanoxic encephalopathy was made, and the patient responded to a trial of carbidopa and levodopa as well as redirection of her physical and occupational therapy programs. This case illustrates the unusual presentation of delayed postanoxic encephalopathy during inpatient rehabilitation and suggests that this condition should be considered if patients who have suffered an anoxic or hypoxic event show a sudden neurologic deterioration.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
5/10. Identification of hypometabolic areas in the brain using brain imaging and hyperbaric oxygen.Current neurologic assessments consider idling neurons and ischemic penumbras to be metabolically lethargic and electrically nonfunctional or nonviable. diagnosis, prognosis, and therapeutics of central nervous system dysfunctions require differentiation between viable and nonviable neurons. It is necessary to develop and document efficacious and safe techniques for reactivating idling neurons. The authors present a case study of a near drowning 12 years earlier. Areas of cortical hypometabolism were identified by using SPECT imaging in conjunction with hyperbaric oxygen therapy (HBOT). Delayed imaging after HBOT (1 hour, 1.5 atm abs) suggested viable but metabolically lethargic neurons. After HBOT (80 1-hour treatments, monoplace chamber, 1.5 atm abs), marked improvements in cognitive and motor functioning were demonstrated. The data support the hypothesis that idling neurons and ischemic penumbras, when given sufficient oxygen, are capable of reactivation. Thus, changes in tracer distribution after a single exposure to HBOT may be a good prognostic indicator of viable neurons. HBOT may be valuable not only in recovery from anoxic encephalopathy but also from other traumatic and nontraumatic dysfunctions of the central nervous system, including stroke. HBOT in conjunction with physical and rehabilitative therapy may help reactivated idling neurons to remain permanently active.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
6/10. Postural hallucinations? An unusual presentation of anaemia.The case of a 14 year old girl is reported, referred to child psychiatry with tearfulness and possible auditory hallucinations. Closer questioning revealed a history of low energy, sleeping excessively without refreshment, exertional dyspnoea, and poor growth. Psychologically, there was no evidence of low mood or negative cognitions despite the inexplicable tearfulness. Detailed enquiry revealed the "hallucinations" to be "whooshing" noises in her ears precipitated by standing. She was found to have a haemoglobin level of 55 g/l, attributed to a combination of poor diet and menorrhagia.Periodic, anaemic, cerebral hypoxia could be proposed to be the root of most, if not all, of the symptoms, illustrating the importance of marrying physical and psychological history taking with suitable investigations for an eminently treatable condition.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
7/10. Systems model guided balance rehabilitation in an individual with declarative memory deficits and a total knee arthroplasty: a case report.BACKGROUND AND PURPOSE: The clinical management of functional mobility problems of individuals with primary musculoskeletal impairments is complicated by the concurrent presence of neurologic diagnoses. There are few case descriptions present in the literature of clinical decision making in the context of combined musculoskeletal and neurologic impairments. The purpose of this case report is to describe the application and use of a systems model of motor control for defining the appropriate rehabilitation program for an individual with both orthopedic and neurologic impairments leading to complaints of frequent losses of balance and falls during community mobility. DESCRIPTION: RG was a 67-year-old male referred to physical therapy because of balance problems. review of his previous medical history revealed that he had suffered an anoxic brain injury 5 years earlier but had recovered full independence in activities of daily living (ADLs) with shortterm memory deficits being the primary residual effect of the brain injury. His balance problems developed only after having undergone a unilateral total knee arthroplasty 4 months prior to his initial physical therapy examination. Through examination and evaluation, RG's problems were determined to be consistent with postsurgery induced deconditioning coupled with anoxic brain injury related motor and cognitive deficits. INTERVENTION AND OUTCOMES: Physical therapy intervention focused on increasing RG's strength, decreasing the range of motion limitations in his lower extremities, balance exercises specific to his dynamic balance deficits, as well as increased amounts of practice to maximize procedural learning. Upon completion of his initial episode of care, RG's musculoskeletal impairments had improved; his scores on balance tests had increased, and his frequency of falls had decreased. Following his discharge, RG continued with a physical therapist designed secondary prevention program. DISCUSSION: This case report describes the successful rehabilitation of an individual with concurrent orthopedic and neurologic diagnoses. Important components of this rehabilitation course include: (1) the application of a systems model of motor control to guide clinical interventions, (2) the consideration of the effects of memory deficits on rehabilitation outcomes, and (3) the utilization of a secondary prevention program to prevent reoccurrence of balance problems.- - - - - - - - - - ranking = 3keywords = physical (Clic here for more details about this article) |
8/10. Action myoclonus following acute cerebral anoxia.Action myoclonus secondary to posthypoxic encephalopathy is being seen increasingly with improved resuscitation techniques. A case report describes 5 specific physical and occupational therapeutic techniques for achieving independence in ambulation, transfers and self-care: (1) analysis and segmentation of complex motions into small steps; (2) controlled progression of training; (3) voluntary cessation of abnormal activity (pacing); (4) progressive densensitization to external stimuli; and (5) quantification of progress. literature review suggests that posthypoxic action myoclonus is secondary to a loss of inhibitory synapses in the brainstem reticular formation due to low serotonin levels. The proposed therapeutic effect of clonazepam, the drug used in this patient, is decreased serotinin degredation. L-5-hydroxytryptamine, an investigative drug, is also therapeutic, for it stimulates increased serotonin production.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
9/10. Trifocal independent periodic lateralized epileptiform discharges.The EEG of a 2 1/2-year-old female with a severe cerebral insult showed trifocal periodic lateralized epileptiform discharges (TRIPLEDs). We believe this is the first such record reported. As with BIPLEDs, the physical findings associated with this EEG appear to represent a diffuse cerebral insult. The most frequent causes of BIPLEDs are diffuse anoxic encephalopathy and CNS infection. In this patient, the TRIPLEDs are apparently due to a severe anoxic insult suffered in utero. As is true with BIPLEDs, the presence of TRIPLEDs represents a poor prognosis.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
10/10. Old warp, new weft: weaving a new life fabric after anoxia.A young New Zealander reweaves a new life after a severe anoxic brain injury. His mother, a teacher, works from an educational perspective to construct an individualized lifestyle plan (ILP), implemented in the community by a team of support workers. This approach to learning is holistic and encompasses the physical, cognitive, emotional and spiritual dimensions of human healing. This article, part of the requirements for a Master's degree in Special education, recounts part of the new journey, which is described in the language of capacity, achievement and love, rather than that of dysfunction, disability and disappointment.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
| | Next -> |