Gene/Protein Disease Symptom Drug Enzyme Compound
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 21,692 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A patient with severe liver disease and mildly obnormal but stable renal function was given cimetidine on two occasions for gastrointestinal hemorrhage. In each course, dosing was initiated at half the recommended dosage of 600 mg daily, and mental status deteriorated shortly after dosing began. A further dosage decrease to 300 mg daily allowed continuation of cimetidine therapy in absence of mental status alterations. In this patient, mental status changes occurred at lower serum concentrations than we have previously reported. This discrepancy was explained by analysis of cimetidine CSF concentrations, as this patient had abnormally high cimetidine blood to CSF permeability. Although the cause of increased CSF concentrations is unclear, cimetidine-associated mental confusion was dose related and completely reversible upon a decrease in dosage. Patients who develop cimetidine-associated mental status changes and who cannot have treatment stopped may be safely treated by individualizing the dosing rate.
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PMID:Dose and serum concentration relationships in cimetidine-associated mental confusion. 696 83

Two cases of acute bacterial meningitis occurred with an absent CSF WBC response. To determine the incidence and clinical characteristics of such patients, 50 consecutive cases of meningitis were reviewed retrospectively. In addition to the two initially noted cases, five additional cases were found. In the seven cases, there were six or fewer cells, but bacteria were detected in the CSF. A distinctive clinical and laboratory syndrome emerged. All seven patients were either old or had Hodgkin's disease or severe alcoholism. All patients had evidence of an overwhelming infection with confusion or nuchal rigidity. As compared with the remaining 45 patients with meningitis and CSF pleocytosis, no fever (less than 38 degrees C), a lower peripheral WBC count, and near-normal CSF glucose and protein concentrations were common. Organisms involved were EScherichia coli in three patients, Pneumococcus in three patients, and mixed anaerobes in patient. A fatal outcome ensued in six of seven patients. Despite the correct choice of an antibacterial agent, doses were late and suboptimal for meningitis. This syndrome is surprisingly common in host-defective cases, has an ominous prognosis, and must be treated expectantly with antimicrobial agents that enter the CSF.
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PMID:Bacterial meningitis in the absence of CSF pleocytosis. 702 10

A patient is described who was diagnosed in an outpatient department as having paranoid psychosis and later chronic schizophrenia, which was treated with chlorpromazine. Two years later, the patient was admitted to hospital because of increasing confusion, disorganization, and numerous manic symptoms. Physical examination and serologic examination of blood and CSF confirmed the diagnosis of general paresis. Correct treatment led to the eventual discontinuation of neuroleptics and the cessation of paranoid and manic symptoms.
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PMID:Reversible neurosyphilis presenting as chronic mania. 709 76

A 19-year-old boy suffered from headache and intermittent CSF rhinorrhea, was admitted to Matsuyama Shimin Hospital on June 1, 1979. Two months prior to admission he had had a frontal head injury with confusion and the right nasal bleeding. Plain skully x-ray films and biplane (axial & coronal) CT revealed intracerebral pneumocephalus in the right frontal lobe with depressed basal skull fracture into the right ethmoid sinus. Clinical conservative courses of intermittent CSF rhinorrhea, headache and vomiting were related to the changes of the air shadow on plain skull films. Preoperative metrizamide CT Cisternography was done on July 5. Sequential CT cisternograms demonstrated ventricular reflux at 1 hr and partial obstruction of the basal cistern and supratentorial subarachnoid space at 3 hr, which attributed to the mass effect of the air cysts. They also demonstrated an interesting finding, the accumulation of metrizamide into the intracerebral air cyst at 3 hr, suggesting transependymal penetration of contrast medium. At 24 hr, the air cyst decreased in size and the metrizamide disappeared. CT cisternograms 8 months after the surgery showed no evidence of air cyst but remained a low dense porencephalic cyst. Ventricular reflux was seen at 3 and 6 hr but there was no accumulation of metrizamide into the cyst at any hr. Filling patterns of the basal cistern and supratentorial subarachnoid space returned normal except the defect in the anterior interhemispheric cistern. Transependymal penetration of metrizamide in this case can be explained by the mechanism of pressure gradient between the ventricle and the air cyst. Thus the postoperative CT cisternograms showed no penetration because of the absence of pressure gradient, whereas the ventricular reflux and the same ependymal septum still remained. No mention has been made about the CSF flow dynamics in intracerebral pneumocephalus and their relation to the CSF rhinorrhea in previous literature. Intermittent CSF rhinorrhea of this case will attribute to the CSF accumulated in the air cyst as mentioned above.
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PMID:[A case report of traumatic intracerebral pneumocephalus with interesting CT cisternographic findings (author's transl)]. 711 May 20

We report a case of serious mental confusion, hallucinations, and agitation in a 65 year old man, occurring in close relationship to the intravenous administration of metronidazole. The patient was treated twice, but at different dosages. The confusion and hallucinations occurred at the recommended daily dose of 2.0 g, but did not return at a daily dose of 500 mg. Metronidazole serum concentrations were obtained throughout both courses of therapy; CSF and tissue concentrations were obtained at autopsy. The mental confusion was associated with peak serum concentrations of approximately 40 micrograms/ml. Symptoms resolved within 24-48 hr after stopping metronidazole, and resolution was consistent with a metronidazole half life of 14 hr. We conclude that metronidazole can be associated with a dose- and serum concentration-related mental confusion state, and that this side effect appears completely reversible upon discontinuing the drug.
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PMID:Mental confusion in a patient treated with metronidazole--a concentration-related effect? 716 92

The myelographic contrast agent, metrizamide, causes a temporary confusional state in many patients. Since metrizamide is a 2-deoxyglucose analogue, it was tested for inhibitory effects on glucose metabolism. The Michaelis constant (Km) of human brain hexokinase for glucose rose from 0.039 to 0.24 and 0.47 mM with final metrizamide concentrations of 0, 16 and 32 mM, respectively. The maximal velocity did not change. Since metrizamide is injected into the human CSF in concentrations of up to 780 mM, impairment of brain glucose metabolism can be expected. These effects could be largely counteracted if metrizamide were injected in a 100 mM glucose solution.
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PMID:Metrizamide inhibits human brain hexokinase. 720 85

During the past 48 months, seven children with infected ventriculoperitoneal shunts with acute abdominal emergencies in the absence of neurological signs or symptoms were encountered. Initial confusion in the correct diagnosis led to unnecessary laparatomy in three children and a dangerous delay in the initiation of appropriate treatment in all seven patients. The correct diagnosis was made by analysis of ventricular fluid obtained from the shunt reservoir. Diversion of infected CSF from the inflamed peritoneal cavity combined with intravenous and intraventricular antibiotics resulted in prompt resolution of abdominal signs and successful sterilization of the CSF. Total shunt replacement in uncontaminated CSF followed by postoperative antibiotic therapy administered intravenously effected complete cures in all patients. Awareness of this syndrome and its proper management is of paramount importance.
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PMID:Acute abdomen in children with infected ventriculoperitoneal shunts. 735 85

Several pedigrees of which some members showed a clinical syndrome consisting of mental changes, choreatic involuntary movements, limb muscles atrophy, and acanthocytosis have been reported in the United States and the United Kingdom. Such a case and some of the family members who had such abnormalities as acanthocytosis, hypo-beta-lipoproteinemia, convulsions, and confusion was observed. Results of biochemical analysis of catecholamines and their metabolites in CSF and urine showed an elevated value of norepinephrine in CSF and increased urinary secretion of DOPAC. The authors propose to designate this syndrome an amyotrophic chorea with acanthocytosis.
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PMID:A pedigree of amyotrophic chorea with acanthocytosis. 741 43

Children with partially treated (PT) meningitis present diagnostic and therapeutic dilemmas. Since the approach to these children is not uniform, both in the literature and in daily practice, we conducted a survey among leading Israeli pediatricians from various hospitals to learn about their opinions and practices relating to this problem. Twenty-eight of 30 senior pediatricians responded to a questionnaire encompassing the various aspects of PT meningitis. The results of the survey highlighted the confusion and lack of clear policy regarding the definition, diagnostic approach and treatment of these children. Fifty percent of the pediatricians stated that even one dose of an antimicrobial agent, regardless of the type of drug, is sufficient for the definition of PT meningitis; 43% of the responders did not require any threshold parameter in CSF findings for the definition of probable bacterial meningitis among PT children and 52% did not think that a second lumbar puncture was useful as a diagnostic aid in PT meningitis. Epidemiological circumstances played a role in the diagnostic and therapeutic approach of infectious disease specialists mainly, but less so in the other groups of pediatricians. Finally, more than half the responders did not use throat cultures to identify potential carriers among PT meningitis patients and did not consider the use of prophylactic treatment in close contacts. These data clearly indicate the need for guidelines regarding the various aspects of PT meningitis.
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PMID:A survey of current Israeli practices and approach to partially treated meningitis in children. 759 92

The value of the PCR for CMV in the CSF was evaluated. 23 samples from 20 patients were examined for CMV DNA, of which 11 were positive and 12 were negative for CMV. The clinical spectrum of the patients with positive samples included encephalitis, encephalitis, and polyradiculopathy, or isolated polyradiculopathy. The main symptoms were fever, confusion, lethargy, cognitive disturbance, cranial neuropathy, weakness of the legs, and incontinence. The laboratory evaluation showed a low CD4 lymphocyte count, a slightly increased blood sedimentation rate and a large variation of CSF patterns. The CMV early antigen tests were negative in all cases. In 4 cases the neuroradiological examination was compatible with CMV infection. 8 patients were treated with ganciclovir or foscarnet. Improvement of symptoms was observed in 2 cases and stabilization in 2 others. However, the CMV infection was rapidly progressive and 9 out of 10 patients died after a mean of 53 days after diagnosis.
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PMID:[Clinical value of a polymerase chain reaction on cytomegalovirus DNA in cerebrospinal fluid in HIV patients with neurological symptoms]. 774 Feb 95


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