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The paper describes the psychiatric status on the basis of 76 patients with acquired immune deficiency syndrome. There is considerable difference between the different stages of the disease. The disorders are divided into groups following the German and French psychopathological tradition, where the incidence is dependent on the underlying complaint. 50% of the patients suffered from chronic psychoorganic disorders (34% organic personality disorders, 16% dementia). 9% suffered from an acute psychosis caused by complications and founded on substantial physical illness. 3 patients showed symptoms of a (under given circumstances) hitherto unknown endoform psychosis. In 9% of the patients, psychoreactive disturbances (anxiety and reactive depression) were observed. Two infants had congenital development deficiencies. 25% of the patients were without any psychopathology. Patients showing organic personality disorders mostly resemble each other to such a degree as to form a separate group. We suggest to name this group according to the most prominent psychopathology as "AIDS-lethargy". This status is characterised by a specific apathy, tiredness and indolence of the patients combined with the lack of emotional participation related to their own destiny. AIDS-lethargy is the first manifestation in appearance of the HIV infection of the brain itself. Another sequel of the brain infection is AIDS dementia which can be classified as "subcortical dementia" and differs from the more current forms of dementia clinically. Affected are mainly neuropsychologic functions like arousal, attention, mood and motivation, whereas the hallmarks of cortical involvement-aphasia, agnosia and apraxia-are not present. Supplementary findings (EEG, CCT, CSF): The group of patients with chronic psychoorganic disorders differs significantly from the group with psychoreactive disorders and normals. Pathological EEG and CCT are more frequent in psychoorganic disorders. CSF-test-including the intrathecally synthesized antibodies against HIV-does not show traceable variation in either group. There are four problems which may be combined in a given acute psychopathological HIV-syndrome: 1. Being member of a risk group with its reactive, psychosocial and personality problems. 2. Individual mental and emotional reaction to the fact of infection 3. Chronic psychoorganic disturbances. 4. Acute organic psychoses as a result of complications and other physical illness.
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PMID:[Psychopathologic pictures in HIV infection: AIDS lethargy and AIDS dementia]. 340 94

A 44-year-old man with a documented 12-year history of progressive sensorineural hearing loss developed a generalized tonic-clonic seizure followed by a visual field deficit and apraxia. Six months later he developed a peripheral neuropathy and muscle fatigue followed by a slowly progressive aphasia and cortical blindness as well as increased seizure activity. A computed tomography scan showed bilateral basal ganglion calcification. The serum lactate level was elevated at 3.4 mEq/dL. A muscle biopsy enabled the diagnosis of mitochondrial myopathy. This disorder is presented as an unusual cause of progressive sensorineural hearing loss in adults.
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PMID:Mitochondrial encephalomyopathy: a rare genetic cause of sensorineural hearing loss. 757 56

In the years 1982-1985 in the Dept. of Neurosurgery of the Jagiellonian University, 197 patients with anterior communicating artery aneurysms were operated on. Excluding multiple aneurysms (9), and taking into account early surgical losses (16), 172 patients were supposed to undergo late medical examinations. The patients were examined by means of questionnaires at least five years after surgery. 43 patients out of the 123 (71.5%) who handed in filled-in questionnaires, underwent psychological examination. Preliminary analysis of the late results of surgery indicates maintenance of the neurological disorders and symptoms. Within the group of examined patients (a neuropsychological examination, Wechsler Scale) it was found that 33 patients had considerable morbid decline in their mental condition and 4 patients moderate. 6 patients were not examined with Wechsler Scale because of aphasia (5 patients) and considerable deterioration of visual acquity (1 patient). The results of the neuropsychological examination showed that the symptoms that predominated were: short memory disorder, a slowdown in psychical and motor functions, conscious concentration disorder, elements of dynamic apraxia and increased tiredness as far as psychical process was concerned. 14 patients (32.6%) resumed work on their former posts, among them the 4 patients who had moderate morbid decline in their mental condition.
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PMID:[Neuropsychological disorders after subarachnoid hemorrhage and surgery in anterior communicating artery brain aneurysms]. 1080 May 85

In August 2002, 65 cases of Loa-associated neurological Serious Adverse Events were reported after ivermectin treatment. The first signs, occurring within the 12-24 hours following treatment, included fatigue, generalized arthralgia, and sometimes agitation, mutism, and incontinence. Disorders of consciousness, including coma, generally appeared between 24 and 72 hours, and showed a rapid variation with time. The most frequent objective neurological signs were extrapyramidal. The patients presented with haemorrhages of the conjunctiva and of the retina. Biological examinations showed a massive Loa microfilaruria, the passage of Loa microfilariae into the cerebrospinal fluid, haematuria, and an increase in the C-reactive protein, all of which have been correlated with the high intensity of the initial Loa microfilaraemia. Eosinophil counts decreased dramatically within the first 24 hours, and then rose again rapidly. Electroencephalograms suggested the existence of a diffuse pathological process within the first weeks; the abnormalities disappearing after 3-6 months. Death may occur when patients are not properly managed, i.e. in the absence of good nursing. However, some patients who recovered showed sequelae such as aphasia, episodic amnesia, or extrapyramidal signs. The main risk factor for these encephalopathies is the intensity of the initial Loa microfilaraemia. The disorders of consciousness may occur when there are >50,000 Loa microfilariae per ml. The possible roles of co-factors, such as Loa strains, genetic predisposition of individuals, co-infestations with other parasites, or alcohol consumption, seem to be minor but they should be considered. The mechanisms of the post-ivermectin Loa-related encephalopathies should be investigated to improve the management of patients developing the condition.
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PMID:Clinical picture, epidemiology and outcome of Loa-associated serious adverse events related to mass ivermectin treatment of onchocerciasis in Cameroon. 1497 61

Patients with an untreated myocardial infarction may present with serious late complications. 3 patients are described. A 63-year-old woman became progressively more short of breath 4 days after an acute episode of chest pain accompanied by nausea and sweating. It proved to be a cardiogenic shock following a rupture of a papillary muscle. A man aged 65 collapsed 5 days after an episode of back pain and nausea. This was a cardiac tamponade due to rupture of the left ventricle. A woman aged 74 had transient aphasia and during investigations for this was seen to have anomalies on ECG. She had cerebral emboli and a cardiac aneurysm with associated thrombus. All 3 patients recovered following mitral-valve replacement, repair of the rupture and medicinal treatment for the clot, respectively. Around one-third of patients who have a myocardial infarction do not have chest pain but experience shortness of breath, autonomic nervous symptoms (sweating, nausea, vomiting), extreme and inexplicable tiredness and fainting. These atypical symptoms should suggest myocardial infarction. In order to avoid high morbidity and death from complications such as arrhythmias, heart failure, rupture and aneurysm formation it is important that a patient who has had a myocardial infarction should be treated as soon as possible, preferably by reperfusion therapy.
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PMID:[Complications of an unrecognized myocardial infarction]. 1635 69

As with eye movements in locked-in syndrome, severe motor dysfunction should be coped with by an agreed system of interpretation to express feelings and needs. However, it is possible that such patients might make errors in the agreed system of interpretation through fatigue, which would cause misunderstandings. We report here a new questioning and verifying strategy for an agreed system of interpretation. Our questioning strategy is characterized by repeating questions in different forms, specifically by affirmative and negative sentences (Double-Checked agreed system of interpretation). When the patient wants to express "Yes", a single movement is required for an affirmative question and no movement is required for a negative one. When the patient wants to express "No", no movement is required for an affirmative question and one movement is required for a negative one. The Double-Checked agreed system of interpretation can help patients to cope with fatigability and can also help to prevent misunderstandings. If the same responses to both affirmative and negative questions are given, we can consider that those answers reflect fatigue. In addition, we have developed a strategy to evaluate the patient's understanding of the Double-Checked agreed system of interpretation by modifying the Western Aphasia Battery. This report describes how to apply the Double-Checked agreed system of interpretation, using the example of a 48-year-old brain-injured man with minimal motor function and severe fatigability.
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PMID:A new procedure for communication with a patient with minimal motor function and fatigability. 1735 4

The famous Swiss writer Charles-Ferdinand Ramuz suffered a stroke at 65 years, which he called 'the adventure' or 'the accident'. He developed language disturbances suggesting crossed aphasia in a right hander with left hemiparesis. This uncommon pattern allowed him to continue to write his diary and to report his disturbances, with a unique depth and precision, especially for cognitive-emotional changes. Language and motor dysfunction recovered within a few weeks, but Ramuz complained of persisting emotional flattening alternating with irritability, fatigue, depression, anxiety, and concentration difficulty, which gave him the feeling to have become another person and to be inhabited by a stranger, whom he compared with devils. Ramuz fought several months to resume his literary activity, having the impression to have lost inspiration and creativity. However, the novels he wrote less than 6 months after stroke show no stylistic changes and have been found to be of the same quality as his previous production. Ramuz even 'used' his stroke experience in his work, in particular in a novel depicting an old man who has a stroke and dies of it. Ramuz's diary, with his own daily description of stroke features and consequences during acute and recovery phases, is a unique document in a writer of his importance, and provides invaluable information on subjective emotional and cognitive experience of stroke.
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PMID:'The Adventure': Charles-Ferdinand Ramuz's extraordinary stroke diary. 1909 49

The famous Swiss writer Charles-Ferdinand Ramuz suffered a stroke at 65 years, which he called 'the adventure' or 'the accident'. He developed language disturbances suggesting crossed aphasia in a right hander with left hemiparesis. This uncommon pattern allowed him to continue to write his diary and to report his disturbances, with a unique depth and precision, especially for cognitive-emotional changes. Language and motor dysfunction recovered within a few weeks, but Ramuz complained of persisting emotional flattening alternating with irritability, fatigue, depression, anxiety, and concentration difficulty, which gave him the feeling to have become another person and to be inhabited by a stranger, whom he compared with devils. Ramuz fought several months to resume his literary activity, having the impression to have lost inspiration and creativity. However, the novels he wrote less than 6 months after stroke show no stylistic changes and have been found to be of the same quality as his previous production. Ramuz even 'used' his stroke experience in his work, in particular in a novel depicting an old man who has a stroke and dies of it. Ramuz's diary, with his own daily description of stroke features and consequences during acute and recovery phases, is a unique document in a writer of his importance, and provides invaluable information on subjective emotional and cognitive experience of stroke.
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PMID:'The adventure': Charles-Ferdinand Ramuz's extraordinary stroke diary. 2037 32

Traumatic brain injury (TBI) may be defined as any extracranial mechanical force to the brain that results in any period of loss of consciousness, any loss of memory for events immediately before or after the event, or any alteration in mental status at the time of the event. The major causes are automobile accidents, falls, sporting injuries, and assaults. Many soldiers returning from combat in Afghanistan and Iraq have also experienced TBI. This article provides an overview of the neuropsychiatric complications of TBI, including impairment of consciousness, posttraumatic amnesia, cognitive disorders and dementia, posttraumatic epilepsy, aphasia, depression, mania, psychosis, anxiety disorders, personality changes, aggression, behavioral dyscontrol, fatigue/apathy, and increased risk of suicide. Discussion will focus primarily on issues affecting mental health clinicians. Because mental health providers are more involved in care of chronic issues related to TBI, these issues will be discussed in more detail, although acute neuropsychiatric complications of TBI will be briefly explained.
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PMID:Neuropsychiatric complications of traumatic brain injury. 2132 64

Stroke, Multiple Sclerosis (MS), traumatic brain injuries (TBI) and neuropathies are the most important diseases in neurological rehabilitation financed by the German Pension Insurance. The primary goal is vocational (re)integration. Driven by multiple findings of neuroscience research the traditional holistic approach with mainly empirically derived strategies was developed further and improved by new evidence-based interventions. This process had been, and continues to be, necessary to meet the health-economic pressures for ever shorter and more efficient rehab measures. Evidence-based interventions refer to symptom-oriented measures, to team-management concepts, as well as to education and psychosocial interventions. Drug therapy and/or neurophysiological measures can be added to increase neuroregeneration and neuroplasticity. Evidence-based aftercare concepts support sustainability and steadiness of rehab results.Mirror therapy, robot-assisted training, mental training, task-specific training, and above all constraint-induced movement therapy (CIMT) can restore motor arm and hand functions. Treadmill training and robot-assisted training improve stance and gait. Botulinum toxine injections in combination with physical and redressing methods are superior in managing spasticity. Guideline-oriented management of associated pain syndromes (myofascial, neuropathic, complex-regional=dystrophic) improve primary outcome and quality of life. Drug therapy with so-called co-analgetics and physical therapy play an important role in pain management. Swallowing disorders lead to higher mortality and morbidity in the acute phase; stepwise diagnostics (screening, endoscopy, radiology) and specific swallowing therapy can reduce these risks and frequently can restore normal eating und drinking.In our modern industrial societies communicative and cognitive disturbances are more impairing than the above mentioned disorders. Speech and language therapy (SLT) is dominant in communicative disorders; the therapists use communicative and/or linguistics-oriented strategies. SLT must begin early after disease onset and with high frequency to elicit good results. PC-assisted (self-)training, possibly telemedically applied, can increase training frequency and time and, hence, improve outcome in aphasia. High-frequency and task-specific training, often PC-assisted, were found to be relevant for improving cognitive functions in all dimensions. Several strategies seem to be efficient in neglect. Visual field deficits can be treated restitutively and compensatingly by PC-assisted training. Attention, memory and executive dysfunctions each require multimodal specific treatment strategies, performed in single and group therapy and in PC-assisted training. Also, education of patients to cope with their impairments and disabilities is another important part. Combined medically and vocationally oriented rehabilitation settings are necessary for raising the rate of return-to-work, especially in patients with motor hand impairments or cognitive disorders. Education of patients and relatives to cope with the chronic neurological diseases and disablements highly improve the sustainability of rehab results and can, in the long run, also reduce mortality and admission to nursing homes. Appropriate physical activity and sports are relevant in the phase of aftercare, by stabilizing both motor coordination and cognitive factors; in MS patients fatigue can be diminished effectively.The main mental comorbidities are anxiety and depression. Pharmacological and psychological treatments have been found to be equally important in this context. Frequently, these mental disorders appear in the phase of aftercare and long-term course only, then worsening outcome sustainability. Efficient concepts to deal with this aspect are still missing. The ambulatory health care system can not cope with it until now.The multitude of evidence-based interventions have over the last 20 years after the Rehab Commission of the Federation of the German Pension Insurance Institutes contributed decisively to even improving primary outcomes and quality of life of neurological patients in spite of shortened length of stay and other restrictions. Neurorehabilitative research, especially the clinically oriented part, had a major influence on the process of professionalization of all members in the neurorehabilitative team. This fact enables new and more efficient organizational structures and working processes within the team; the discussion on this topic has however only just started.
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PMID:[DGRW-update: neurology--from empirical strategies towards evidence based interventions]. 2213 65


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