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The hypertensive encephalopathy is a syndrome consisting of a sudden elevation of arterial pressure usually preceded by severe headache and followed by convulsions, coma or a variety of transitory cerebral phenomena. The syndrome may complicate acute glomerulonephritis, toxemia of pregnancy and essential or malignant hypertension. Two syndromes must be differentiated from true hypertensive encephalopathy: 1. acute anxiety state with labile hypertension and 2. acute pulmonary edema due to hypertensive heart disease. At least in patients with acute anxiety states, the use of antihypertensive agents is usually not indicated. Since encephalopathy is always accompanied by increased vascular resistance and since clinical experience has demonstrated clearing of the sensorium, cessation of convulsions and release of vasoconstriction following reduction of blood pressure, the primary aim of therapy should be prompt lowering of arterial pressure. The two agents of choice are diazoxide and sodium nitroprusside. Stroke is differentiated from encephalopathy by the persistence of lateralizing signs. The aggressiveness of antihypertensive therapy in this situation depends on the severity of the hypertensive process. Rapid reduction of blood pressure is indicated in patients found to have accelerated hypertension while a more gradual lowering of pressure appears warranted for patients with chronic arterial hypertension and evidence of generalized arteriosclerosis.
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PMID:Management of hypertensive encephalopathy. 72 Oct 56

Jurors on criminal trials carry a considerable burden of responsibility. They determine the defendant's fate. Additionally, during trials they can be exposed to stressful, frightening, and sordid aspects of life. The stressfulness varies depending upon the nature of the trial, its length, the nature of the testimony and evidence, the jurors' interpersonal relationships, the difficulty establishing guilt or innocence, the public's attitude, etc. These experiences can create psychological and/or physical discomfort that can be transient and mildly or moderately intense, or more serious and constitute illness. The authors have studied juries of four criminal trials--two murder cases, one child abuse case, and one obscenity case. Forty jurors were interviewed. Twenty-seven had one or more discomforting physical and/or physiological symptoms. These involved gastrointestinal distress (10 jurors); generalized nervousness (4 jurors); heart palpitation (6 jurors); headaches (4 jurors); sexual inhibitions (4 jurors); depression (4 jurors); anorexia (4 jurors); faintness (2 jurors); and numbness, lump in throat, chest pain, hives, and flu (1 juror each). Seven of the jurors became clearly ill. Illnesses included: peptic ulcer reactivation and hives, phobic reaction, anxiety state and increased alcohol use, hypertensive episode and visual scotomata, sexual inhibition, chills, fever, and depression, and post-traumatic stress disorder.
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PMID:The occupational hazards of jury duty. 142 62

An acute epidemic of headache, mucosal irritation, fatigue, odd taste, and dizziness involving several hundred state government employees occurred in June 1986 in an office building in Missouri that housed 2,500 employees. A survey of 305 ill and 131 well employees demonstrated that ill employees were more likely to have perceived unusual odors and inadequate air flow in their work areas. The building has eight floors, seven of which are divided in half by an atrium, and 17 separate air handling systems. A total of 87% of the ill employees were concentrated in only three of the "half floors." Extensive investigation revealed no toxic substances or other direct causes for the illnesses, but several factors were identified that may have reduced air quality in the affected areas. These included a low proportion of outside air, associated with crowding, blocked vents, smoking, and use of office chemicals. This pattern of illness suggests epidemic anxiety state triggered by poor air quality.
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PMID:Report of an illness outbreak at the Harry S Truman State Office Building. 291 48

Two hundred patients clinically certified as suffering from anxiety state were investigated with a view to understanding the clinical manifestation of the condition in Nigeria. We found that 67 symptoms were manifested by those patients, but only 15 symptoms were presented by about 10% of the sample. These common symptoms were: frequent headaches, difficulty in falling asleep, flushing, difficulty in concentrating, rapid or irregular heart beating, weakness, hot flashes, dizziness, feeling of something crawling in the head, heaviness of the head, nervousness, poor appetite, poor sight, nightmares, and chest pain. The five major precipitating factors were physical ailments, studying and examinations, use of drugs, psychological phenomona, pregnancy and childbirth, in decreasing order of magnitude. The most vulnerable age group was between 18 and 23 years old. The first born children account for the highest number of anxiety patients, but as the number of siblings increases, the vulnerability of the last-born increases. Anxiety neurosis as seen here is predominantly a problem of single males and females with secondary school education.
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PMID:Clinical anxiety in Nigeria. 340 42

The 5-HT3 receptor antagonists are a novel therapy for patients suffering from fibromyalgia, although the optimal duration of treatment is still unclear. The objective of this phase II study was to evaluate whether prolonging treatment with tropisetron to 4 weeks is tolerable and correlated with an improved clinical benefit. Thirty female patients with fibromyalgia received oral tropisetron (5 mg) daily for 28 days in an open-label fashion. Treatment resulted in significantly decreased pain as measured by visual analog scale (VAS), with a mean reduction of 59.7% and an absolute median change of -25.0 from baseline to day 28 (p<0.0001). A similar, significant reduction of 55.7% and absolute median change of -31.0 was observed in the painscore (p<0.0001). The response rate with patients showing a > or = 35% reduction in individual pain scores was 72.4% at day 28. The pressure tolerance of tender-points was slightly increased at the end of the treatment period. In addition, significant improvements were observed in the State-Trait-Anxiety-Inventory (STAI), scales of von Zerssen (Bf-S) and Beck Depression Index (BDI). Functional symptoms were compared with the results from a 10-day, randomized, double-blind phase III study of tropisetron in 418 fibromyalgia patients. In both studies several functional symptoms such as sleep disturbances and dizziness improved significantly (p<0.05). In the 28 days study, the number and extent of improvement in functional symptoms was increased compared with the shorter trial. Tolerability and safety of tropisetron was good, and typically for 5-HT3-receptor antagonists, gastrointestinal symptoms and headache were the most frequently reported events. In conclusion, 28 days treatment of fibromyalgia patients with 5 mg tropisetron resulted in significant pain reduction, which was most pronounced after 10 days with a further reduction up to day 28. Psychometric tests showed significant improvements in depression and anxiety state scores, while functional symptoms improved with extended tropisetron treatment.
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PMID:Oral treatment of fibromyalgia with tropisetron given over 28 days: influence on functional and vegetative symptoms, psychometric parameters and pain. 1102 33

A 68-year-old female referred for excessive daytime sleepiness, strong morning headaches, snoring and suspected chronic fatigue syndrome. The polyMESAM examination was performed with following results: Respiratory Disturbances Index--RDI (average number of apnoeas and hypopnoeas in one hour of registration) 26, Oxygen Desaturation Index--ODI (average number of oxygen haemoglobin saturation drops in one hour) 51, basal oxygen haemoglobin saturation 90% and average oxygen haemoglobin saturation minimas 82%. Her condition was rated as grave OSAS. CPAP therapy was, however, impeded by anxiety state caused by claustrophobia. Analysis of lateral cephalogram proved significant constriction of the retrolingual posterior airway space to 6 mm (the bottom standard limit for women is 12 mm), with a relatively good position of the hyoid bone. The genioglossus advancement surgery was therefore performed on the patient as the only causational therapy. Then the patient referred improvement of sleepiness, snoring, fatigue and morning headache. PolyMESAM recorded two months after the surgery showed a strong improvement of OSAS: RDI 11, ODI 14, basal oxygen haemoglobin saturation 93% and average oxygen haemoglobin saturation minimas 89%.
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PMID:[Genioglossal advancement in the surgical treatment of obstructive sleep apnea syndrome in adults]. 1170 82

The authors report the unusual case of a 58-year-old woman (MJP) suffering from left temporal throbbing headache, associated with confusion. Magnetic resonance imaging showed a 5 x 3 x 2 cm hematoma at the left posterior temporal--parietal junction (PTPJ). Repeated MRI of MJP's brain performed during a 4-month follow-up period showed decrease in hematoma size (2.3 x 1.5 x 1) with evidence for development of encephalomalacia and resorption of blood products involving the area of hemorrhage. MJP had mild transcortical sensory aphasia characterized by difficulty with reading and processing, with semantic paraphasic errors while speaking and some difficulty with repetition. MJP had remained normotensive and seizure free, on Vasotec therapy and Dilantin prophylaxis. An in vivo proton magnetic resonance spectroscopy (1H-MRS) performed during an 8-month follow-up period showed reduced concentration for N-acetyl aspartate (NAA) by 19.3% (F=4.09, P<0.04), and myo-inositol by 32.0% (F=5.16, P<0.02) in the left orbital frontal cortex (OFC) as compared with 16 healthy subjects (age- and sex-matched). Cognitive tests (the Wechsler abbreviated scale of intelligence (WASI) and the Stroop color--word interference) showed a significant impairment suggesting involvement of higher-order cognitive functioning (memory, learning, and general intelligence) and attentional system. The Spielberger state-trait anxiety inventory (STAI) showed increased anxiety at the moment of the current examination and decreased tendency to be anxious over a long period of time. The Beck Anxiety and Depression Inventory revealed minimal anxiety and mild to moderate levels of depression. It is hypothesized that the PTPJ hematoma triggered long-distance pathways linking PTPJ area and frontal lobe, including OFC, which resulted in abnormal chemical changes in the left OFC and in cognitive tests impairment, and in long-term anxiety state changes.
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PMID:Effect of posterior temporal-parietal hematoma on orbital frontal chemistry in relation to a cognitive and anxiety state: a combined 1H-MRS and neuropsychological study of an unusual case as compared with 16 healthy subjects. 1186 Nov 28

Sixty patients with chloroquine induced psychiatric complications are reported in the present series. Psychosis was the most common complication followed by anxiety state and seizures. The maximum number of patients were between the ages of 6 and 10 years and females (70.0%) outnumbered the males (30.0%). Headache and sleeplessness were found to be more common amongpatients developing psychiatric complications of chloroquine. The symptoms disappeared within 2 to 21 days after the discontinuation of chloroquine.
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PMID:Psychiatric complications of chloroquine. 2174 75