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Query: UMLS:C0015672 (fatigue)
 51,768 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A 38-year-old layer of parquet flooring was referred because of memory impairment, tiredness and diffuse headaches. His work involved using several neurotoxic organic solvents. Extensive laboratory, neuropsychological, clinical neurophysiological, neuroadiological, magnetic resonance (MR) imaging and spectroscopy studies were performed. The neuropsychological and behavioural assessments showed an organic brain syndrome. MR imaging and CT scanning of the brain revealed enlarged ventricles and generalized atrophy. 31P and 1H MR spectroscopic measurements did not show any abnormalities. Owing to recent improvements regarding sensitivity and facilitated assignment, MR spectroscopy may provide in the near future significant additional information on brain metabolism in patients with brain dysfunction presumably induced by organic solvents.
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PMID:Magnetic resonance studies on brain dysfunction induced by organic solvents. 144 99

Sixty-two patients with chronic toxic encephalopathy diagnosed in 1976-1981 were considered for reexamination in 1983-1984. Thirteen were found to have other diseases that might contribute to brain dysfunction. Seventeen were unwilling or unable to participate. The final group consisted of 32 men 33 to 63 (median 55) years of age who were physically and psychometrically reexamined with the same methods used in the initial investigation. The interval between the first and present examination was 21-88 (median 48) months, and exposure to solvents had ceased. The subjects reported some improvement in their neurasthenic problems. In particular they suffered less from fatigue, headache, and dizziness. When diagnosed they had an average of seven out of ten typical neurasthenic symptoms included in the toxic encephalopathy syndrome. At the time of the follow-up the mean number of symptoms had decreased significantly to five. The psychometric retesting showed significant deterioration in verbal memory, improvement in visual memory, and unchanged results on the other tests. In conclusion, these toxic encephalopathy patients improved subjectively when exposure stopped. Psychometrically they performed very close to the initial testing, which excluded progressive brain disease or subacute pharmacological solvent intoxication.
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PMID:Prospective clinical and psychometric investigation of patients with chronic toxic encephalopathy induced by solvents. 335 95

The incidence and extent of cerebral damage following open-heart surgery were prospectively investigated in 103 patients, using clinical assessment, psychometry, adenylate kinase analysis in cerebrospinal fluid (CSF-AK) and computed tomography (CT) of the brain. The surgical mortality was 1.9%. Clinically there was obvious cerebral dysfunction in four cases, subtle evidence of brain damage (mainly undue fatigue) in 16 and no evidence in 81 cases. In the 16 patients the mean CSF-AK was substantially increased (0.122 U/l) and the psychometric performance distinctly impaired (-12 points) postoperatively; in the 81 patients the figures were 0.55 U/l and -3.4. Psychometrically, 60% of the patients showed cerebral dysfunction, which was pronounced in 16%. CSF-AK analysis indicated cerebral damage as absent or trival in 45%, moderate in 33% and marked in 22%. CT revealed postoperative cerebral infarction in two cases. Results from the various methods showed reasonable correlation, but also considerable overlap. Open-heart surgery thus can cause brain damage additional to that neurologically discernible. Fatigue is an important sign in this context. In research on postoperative brain damage, the relative insensitivity of routine neurologic investigation calls for supplementary, refined methods.
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PMID:Cerebral damage during open-heart surgery. Clinical, psychometric, biochemical and CT data. 349 46

The association between lead absorption and objective psychological performance tests in five groups with different levels of lead absorption was studied in the following groups: (1) a control, non-lead-exposed group; (2) cable splicers, (3) cable manufactures, and (4) secondary lead smelter workers. The following performance tests were used: Block Design, Digit Symbol, and Embedded Figures. Age-corrected performance test scores and the average of three test scores (INDEX) were used throughout. A significant association between performance tests scores and increased lead absorption was found. Zinc protoporphyrin level was a more "powerful" (in the statistical sense) indicator of lead-induced CNS effects than blood lead levels. This study provides additional evidence that neurotoxic effects associated with occupational exposure to lead can be demonstrated by means of performance tests. It has been known and widely accepted that increased lead absorption is associated with "non-specific" subjective symptoms: tiredness, sleep disturbance, irritability, etc. Psychometric techniques (including an appropriate statistical analysis strategy) are highly sensitive for the early detection of CNS neurotoxicity, such as metal toxicity. Moreover, even in lead-exposed but asymptomatic individuals, a significant correlation (negative) between test scores and levels of lead absorption could be detected. It is concluded that workers exposed to lead at levels considered "safe" might be at risk of developing brain dysfunction with long term exposure.
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PMID:Lead exposure and behavioral changes: comparisons of four occupational groups with different levels of lead absorption. 734 80

One of the best methods for studying subtle lateralizing signs of brain dysfunction is the use of psychometrically matched tasks. The current study reports the development and psychometric matching of two pairs of measures of language and visual-spatial functioning. We expanded and modified four existing neuropsychological measures in order to develop tasks with a wide range of item difficulty that could be administered to subjects with impaired attention or extreme fatigue. Using 413 subjects, a Word Finding and a Dot Localization task were matched on their distribution of item difficulty and item-scale correlations. Measures of Similarities and Line Orientation were matched similarly. The psychometric matching for both pairs of tests was cross-validated using an additional 413 subjects. The matched measures of Word Finding and Dot Localization have been used in several studies to date and have proven valuable for identifying subtle lateralized impairment that might otherwise be obscured by psychometric artifacts.
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PMID:Psychometrically matched tasks for assessment of hemispheric asymmetries of function. 754 65

Major surgery is still associated with undesirable sequelae such as pain, cardiopulmonary, infective and thromboembolic complications, cerebral dysfunction, nausea and gastrointestinal paralysis, fatigue and prolonged convalescence. The key pathogenic factor in postoperative morbidity, excluding failures of surgical and anaesthetic technique, is the surgical stress response with subsequent increased demands on organ function. These changes in organ function are thought to be mediated by trauma-induced endocrine metabolic changes and activation of several biological cascade systems (cytokines, complement, arachidonic acid metabolites, nitric oxide, free oxygen radicals, etc). To understand postoperative morbidity it is therefore necessary to understand the pathophysiological role of the various components of the surgical stress response and to determine if modification of such responses may improve surgical outcome. While no single technique or drug regimen has been shown to eliminate postoperative morbidity and mortality, multimodal interventions may lead to a major reduction in the undesirable sequelae of surgical injury with improved recovery and reduction in postoperative morbidity and overall costs.
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PMID:Multimodal approach to control postoperative pathophysiology and rehabilitation. 917 83

Chronic fatigue and chronic fatigue syndrome (CFS) have become increasingly recognized as a common clinical problem, yet one that physicians often find difficult to manage. In this review we suggest a practical, pragmatic, evidence-based approach to the assessment and initial management of the patient whose presentation suggests this diagnosis. The basic principles are simple and for each aspect of management we point out both potential pitfalls and strategies to overcome them. The first, and most important task is to develop mutual trust and collaboration. The second is to complete an adequate assessment, the aim of which is either to make a diagnosis of CFS or to identify an alternative cause for the patient's symptoms. The history is most important and should include a detailed account of the symptoms, the associated disability, the choice of coping strategies, and importantly, the patient's own understanding of his/her illness. The assessment of possible comorbid psychiatric disorders such as depression or anxiety is mandatory. When the physician is satisfied that no alternative physical or psychiatric disorder can be found to explain symptoms, we suggest that a firm and positive diagnosis of CFS be made. The treatment of CFS requires that the patient is given a positive explanation of the cause of his symptoms, emphasizing the distinction among factors that may have predisposed them to develop the illness (lifestyle, work stress, personality), triggered the illness (viral infection, life events) and perpetuated the illness (cerebral dysfunction, sleep disorder, depression, inconsistent activity, and misunderstanding of the illness and fear of making it worse). Interventions are then aimed to overcoming these illness-perpetuating factors. The role of antidepressants remains uncertain but may be tried on a pragmatic basis. Other medications should be avoided. The only treatment strategies of proven efficacy are cognitive behavioral ones. The most important starting point is to promote a consistent pattern of activity, rest, and sleep, followed by a gradual return to normal activity; ongoing review of any 'catastrophic' misinterpretation of symptoms and the problem solving of current life difficulties. We regard chronic fatigue syndrome as important not only because it represents potentially treatable disability and suffering but also because it provides an example for the positive management of medically unexplained illness in general.
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PMID:Chronic fatigue syndrome. A practical guide to assessment and management. 921 87

A 21 year old patient reported a relatively rapid onset of serious chronic fatigue syndrome (CFS), with her worst symptoms being cognitive impairments. Congruent with research on rapid onset CFS, she had no psychiatric history and specialized testing did not suggest that somatization was likely. Neuroimaging and EEG research has documented brain dysfunction in cases of CFS. Therefore, a quantitative EEG was done, comparing her to a normative data base. This revealed excessive left frontal theta brainwave activity in an area previously implicated in SPECT research. Therefore, a novel treatment approach was utilized consisting of a combination of EEG neurofeedback and self-hypnosis training, both of which seemed very beneficial. She experienced considerable improvement in fatigue, vigor, and confusion as measured pre-post with the Profile of Mood States and through collaborative interviews with both parents. Most of the changes were maintained at 5, 7, and 9 month follow-up testing.
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PMID:Treatment of chronic fatigue with neurofeedback and self-hypnosis. 1179 Sep 17

Many anecdotal cases and some clinical studies have demonstrated that formaldehyde exposure can cause multiple health-related problems and cerebral dysfunction. The U.S. Consumer Product Safety Commission has documented multiple hazards related to formaldehyde exposure. Some of this research has suggested that low levels of exposure can be very hazardous to one's health and can potentially result in heightened chemical sensitivities, seizures, and cognitive decline. Some research suggests that exposure results in long-term immunological changes, cell neurofilament protein changes, and demyelination. Symptomatically, exposure has been associated with respiratory problems, excessive fatigue, headaches, mood changes, and impaired attention, concentration, and memory functioning. This article outlines the case of a biology teacher whose chronic formaldehyde exposure resulted in heightened sensitivity to formaldehyde, three tonic-clonic seizures, and dramatic amnesia as well as other cognitive dysfunction.
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PMID:A case of claimed persistent neuropsychological sequelae of chronic formaldehyde exposure: clinical, psychometric, and functional findings. 1459 Jan 91

The evidence regarding the co-morbidity of chronic hepatitis C, psychiatric illness and intravenous drug abuse is reviewed from the literature. Also the occurrence and the treatment of psychiatric side effects during treatment with interferon in patients with a history of drug abuse are reviewed. There is insufficient evidence for a specific hepatitis C induced depression or fatigue, but a direct link between hepatitis C and cerebral dysfunction is not excluded. Immune system activation rather than drug use may explain cerebral symptoms. In HCV positive substance users anxiety and depression are more prevalent than in HCV negative substance users. During treatment with regular or pegylated (PEG) interferon depression is a frequent side effect (ca 30%) and occurs independently from pre-existing psychiatric disorders or drug abuse. A history of drug abuse per se does not increase the risk of depression as a side effect of interferon treatment. It is extremely important to monitor symptoms of depression in the early weeks of treatment and to start antidepressant treatment as early as possible. Antidepressants should be continued throughout the interferon treatment period. There are insufficient data to assess these situations in which preventive antidepressant treatment should be started before interferon treatment. Clinical judgement can, however, lead to preventive antidepressant treatment, even at subclinical levels of depression. A cut off score of > 10 on the Beck Depression Inventory before interferon treatment is associated with a higher risk of depression during treatment. Both selective serotonin reuptake inhibitors and other classes of antidepressants can be used.
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PMID:Hepatitis C, interferon alpha and psychiatric co-morbidity in intravenous drug users (IVDU) : guidelines for clinical practice. 1583 90


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