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Severe closed head-injury results in a multitude of long-lasting cognitive deficits. ERPs can effectively complement the more traditional behavioural measures to provide information that is not available through any other means. It is now fairly clear that a late positive wave, P3, associated with contextual updating is attenuated and prolonged in a variety of conditions in the head-injured. It is also possible that measures of selective attention such as the processing negativity may be abnormal in this group. A more definitive statement will, however, have to wait the results of further investigations. A number of investigators have now indicated that cognitive processing is slowed in the head-injured. Again, ERPs have been instrumental in explaining why it is slowed. Decision-making time as measured by RT is generally longer than P3 latency. Because P3 latency is delayed in the head-injured, the time required for evaluation of the stimulus (recognition and classification) is slowed in the head-injured. The additional delay in RT must, however, be explained by other processes, most probably a response bias that perhaps emphasizes accuracy at a cost of speed. Such a strategy can be manipulated if the patient is provided with cues about their speed of responding. Finally, ERPs have been instrumental in explaining possible reasons for cognitive slowing. A powerful CNV technique may permit the categorization of the head-injured into at least 2 distinctive groups: those that tend to underprocess information (perhaps as a result of apathy or a lack of motivation) and those that tend to overprocess (perhaps as a result of an inefficient and needless processing of irrelevant information resulting in fatigue). The extent to which the different modes of information processing are related to the site of brain injury and possible personality change remains an issue of speculation.
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PMID:Electrophysiological assessment of cognitive disorder in closed head-injured outpatients. 228 30

Some aircraft personel and airline industry workers are exposed to jet fuel, a mixture of aliphatic hydrocarbons (petroleum 80%) and some organic solvents (petroleum 80%) and some organic solvents (aromatic hydrocarbons 20%). In order to evaluate the possible neuropsychiatric sequeale of such long-term occupational exposure, we examined 30 workers exposed at about 250 mg/m3 for 4-32 years at a jet motor factory. They were compared with two control groups (2 x 30) of matched non-exposed workers. The medical history was first assessed by standardized interviews and examination of medical records kept by the factory physician. The exposed subjects had, after their employment, much more often sought medical advice because of emotional dysfunctions, such as depression and anxiety, than had the control groups (P less than 0.005). When the prevalent mental symptoms, indicative of brain lesion, later were rated by psychiatrists, the exposed workers scored higher than did the controls (P less than 0.001). 14 subjects showing most symptoms were then selected for a thorough neuropsychiatric clinical investigation comprising psychosocial inquiries, psychological testing, personality assessment and neurological/neurophysiological examination. Seven were judged to suffer from mild organic brain syndrome (i.e. "organic neurasthenia") of which one subject was a severe case. The subjects had all undergone a slow but steady personality change over the years--starting from an ordinary strength without neurotic traits and moving towards an asthenic state with fatigue, anxiety and vegetative hyperreactivity. No other cause for this change could be identified as an alternative to the occupational exposure to jet fuel. It is concluded that personality changes and emotional dysfunctions are the foremost effects of such long-term exposure to petroleum products.
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PMID:Neuropsychiatric symptoms in workers occupationally exposed to jet fuel--a combined epidemiological and casuistic study. 657 84

The estuarine dinoflagellate Pfiesteria piscicida gen. et sp. nov. produces exotoxin(s) that can be absorbed from water or fine aerosols. Culture filtrate (0.22 microns porosity filters, > 250 toxic flagellated cells/ml) induces formation of open ulcerative sores, hemorrhaging, and death of finfish and shellfish. Human exposure to aerosols from ichthyotoxic cultures (> or = 2000 cells/ml) has been associated with narcosis, respiratory distress with asthma-like symptoms, severe stomach cramping, nausea, vomiting, and eye irritation with reddening and blurred vision (hours to days); autonomic nervous system dysfunction [localized sweating, erratic heart beat (weeks)]; central nervous system dysfunction [sudden rages and personality change (hours to days), and reversible cognitive impairment and short-term memory loss (weeks)]; and chronic effects including asthma-like symptoms, exercise fatigue, and sensory symptoms (tingling or numbness in lips, hands, and feet; months to years). Elevated hepatic enzyme levels and high phosphorus excretion in one human exposure suggested hepatic and renal dysfunction (weeks); easy infection and low counts of several T-cell types may indicate immune system suppression (months to years). Pfiesteria piscicida is euryhaline and eurythermal, and in bioassays a nontoxic flagellated stage has increased under P enrichment (> or = 100 micrograms SRP/L), suggesting a stimulatory role of nutrients. Pfiesteria-like dinoflagellates have been tracked to fish kill sites in eutrophic estuaries from Delaware Bay through the Gulf Coast. Our data point to a critical need to characterize their chronic effects on human health as well as fish recruitment, disease resistance, and survival.
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PMID:Insidious effects of a toxic estuarine dinoflagellate on fish survival and human health. 852 74

Medical issues in sport diving include illnesses that are caused by diving, and medical disorders that compromise safety. Cerebral air embolism and decompression sickness of the brain and spinal cord can result from diving. Sport divers may manifest a spectrum of symptoms from air embolism, which can range from unconsciousness to minimal symptoms, which include fatigue, personality change, poor concentration, irritability, and changes in vision. The physician must search for these minor symptoms in divers who are suspected of pulmonary barotrauma. Medical disorders of concern in diving include diseases of the lungs, the heart, the brain, and the endocrine system, particularly diabetes. Other factors involved in diving safety are exercise capacity and training. Clinical practice standards usually prohibit diving by individuals who have a seizure disorder that requires continuous medication. In the United States, we will not approve diving for individuals who have insulin-dependent diabetes or severe asthma. Some divers can return to diving after myocardial infarction or bypass surgery if they demonstrate good exercise tolerance and no ischemia on a graded exercise test, which simulates the physical activity needed for safe diving.
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PMID:Medical aspects of sport diving. 914 89

There are only a few reported cases of psychiatric disorders presenting a s decompression sickness (DCS). Previous reports indicate that DCS can result in personality change, depression, Munchausen's syndrome, and pseudo stroke. We report two cases of acute psychoses that occurred following diving as suspected DCS and were treated with hyperbaric oxygen, which did not improve the psychotic features. One patient had symptoms of DCS including myalgias, weakness, and fatigue; however the symptoms were inconsistent. The symptom onset and nitrogen loading from his dive profiles made the diagnosis of DCS unlikely. The second patient exhibited mild joint pain, fatigue, and psychosis that was temporally associated with diving but no other symptoms of DCS. Following a detailed medical evaluation we determined that these two patients did not have DCS or arterial gas embolism (AGE). Although it is highly unlikely that a pure psychotic episode will arise as a result of DCS, physicians caring for divers with symptoms of DCS or AGE and acute psychosis may consider a trial of recompression therapy while completing the medical evaluation. Divers with acute psychosis without signs and symptoms and benign dive profiles are unlikely to have DCS or AGE.
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PMID:Acute psychosis associated with diving. 1206 50

A 13-year-old girl presented to our emergency with a one week history of fever and skin rash and new onset of chorea for the last three days. There was a long standing history of right predominant headache; followed by personality change, fatigue, arthralgia and weight loss over the last few months. Previous investigations by head CT and ophthalmological examination did not explain the symptoms. Further investigations revealed peri- and pancarditis with aortic insufficiency, a renal involvement with elevated creatinin, protein- and hematuria and a hemolytic anemia. Diagnosis of lupus eythematodes was confirmed by high ANA, anti-dsDNS and Anticardiolipin antibodies. Within the first 48 hours after admission there was significant deterioration with reduced vigilance and dysarthria. MRI of the brain and dopplersonography of cerebral vessels showed a complete thrombosis of the right medial cerebral artery with a small net of collaterals, irregularities of the left cerebral artery due to vasculitis and several subacute leftsided ischemias. Immunosuppressive therapy with high-dose corticosteroids and cyclophosphamid together with antithrombotic therapy induced an improvement of neurologic, renal and cardiac function.
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PMID:[Vasculitis as a reason of chronic headache]. 1854 40

The aim of this descriptive, cross-sectional study was to determine information requirements of patients with typical meningiomas after surgery. The study sample consisted of 20 patients who underwent surgery for brain tumours in neurosurgery clinics of a university hospital. Permission to conduct research was obtained from all patients and from the hospital. Before the surgery, a booklet was given to patients for training. Patients were followed up one, three, six and 12 months later by the phone after the surgery and asked to report their problems. All questions were recorded and answered. Data were collected by the socio-demographic, patient symptom and health status questionnaire. Descriptive data were analyzed using percentage and arithmetic averages. Comparative statistics were evaluated using chi-square. Patients wanted information about diet, physical therapy and rehabilitation, quick thinking difficulties, fasting, headache, irritability, personality change, fatigue, driving, deep vein thrombosis during the follow up. There was a significant difference between their health status and fear of seizures and recurrent tumor, forgetfulness, lack of concentration (p < 0.05). Although they received health education and booklet, patients needed more information during the 12 months after surgery. Therefore it suggested that monitoring the patient's needs is necessary.
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PMID:Information needs of patients with meningiomas. 2154 9

The non-motor symptoms of Parkinson's disease (PD) have been attracting increasing attention due to their ubiquitous nature and their often devastating effects on the quality of life. Behavioral problems in PD include dementia, depression, apathy, fatigue, anxiety, psychosis, akathisia, personality change, sleep disorders and impulse control disorders. Some of these are intrinsic to the neuropathology while others occur as an interplay between pathology, psychology and pharmacology. While few data exist for guiding therapy, enough is known to guide therapy in a rational manner.
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PMID:Recognition and treatment of neuropsychiatric disturbances in Parkinson's disease. 2628 91