Gene/Protein Disease Symptom Drug Enzyme Compound
Pivot Concepts:   Target Concepts:
Query: UMLS:C0023380 (lethargy)
 5,697 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Disproportionate enlargement or isolation of the fourth ventricle are rare complications of ventriculo-peritoneal shunt for post-haemorrhagic hydrocephalus. Obvious features such as ataxia may indicate raised intracranial pressure in the posterior fossa. The child may, however, present with less specific signs of vomiting, anorexia, and lethargy and these symptoms may be misinterpreted as secondary to dilation of the lateral ventricular system due to malfunction of the ventriculo-peritoneal shunt. Two children with disproportionate enlargement of the fourth ventricle and two children with isolation of the fourth ventricle are described to illustrate the wide variations in clinical presentation. These rare complications can be diagnosed by real time ultrasound examination of the brain or computed tomography of the head. They should be considered in the differential diagnosis of a child who deteriorates after lateral ventriculo-peritoneal shunting for post-haemorrhagic hydrocephalus, and dealt with specifically to avoid the risk of upward herniation of the enlarged fourth ventricle.
 ...
PMID:Specific enlargement of the fourth ventricle after ventriculo-peritoneal shunt for post-haemorrhagic hydrocephalus. 349 66

This report concerns 60 children with documented Staphylococcus epidermidis sepsis. There were 34 boys and 26 girls, ages 2 weeks to 15 years. The primary diagnosis included malignancy (13), congenital (13) or acquired (11) gastrointestinal disorders, prematurity (7), cardiac defect (5), hydrocephalus (2) and miscellaneous (9). Clinical presentation included fever (54), tachycardia (15), lethargy (20), hypotension (8), irritability (6), increased gastric residuals (6) and apnea/bradycardia (3). A documented source of sepsis was noted in 56 patients, including percutaneous central venous catheters (23), Broviac catheters (17), umbilical arterial catheters (6), wound (3), V-P shunt (2), cardiac defect (2), cholangitis (1), chest tube (1) and peripheral arterial line (1). There were six sepsis-related deaths, four in premature infants. Two of six infected subclavian catheters were treated successfully with vancomycin. Infection was successfully cleared in 20 of 23 infected Broviac catheters with vancomycin through the line. However, six were eventually removed for tract infection (1), persistent fever (2), and Candida sp. infection (3). Although once considered a non-pathogenic skin contaminant, S. epidermidis has emerged as a serious pathogen in hospitalized, immunosuppressed, premature and malnourished pediatric patients. Indwelling catheters enhance the likelihood of infection in these patients. Aggressive antimicrobial therapy is vital in this potentially lethal infection. Vancomycin proved efficacious in this series.
 ...
PMID:Staphylococcus epidermidis sepsis in pediatric patients: clinical and therapeutic considerations. 648 77

A 19 years' old white male presented with a stuporous state, initially suspected to be of a toxic origin. It appeared soon that the patient had a left oedematous cerebellar infarction with obstructive hydrocephalus. The angiographic study has shown an occlusion of the left vertebral artery at the level of C2. After reviewing the literature about the different etiologies of vertebral occlusions in the young people, it appeared likewise that, in this case, it was the result of a traumatic compression due to an alcoholic coma. Despite an external ventricular drainage, the neurological state worsened. After a left suboccipital craniotomy and resection of the external part of the cerebellar hemisphere, the state of the patient improved quickly, and he was discharged from hospital with a light cerebellar syndrome.
 ...
PMID:[Edematous cerebellar infarction in the young subject]. 666 5

Computed tomography in a 3 1/2-year-old boy with ataxia, lethargy, fever, vomiting, and increasing irritability revealed moderate hydrocephalus and a blood density mass lesion lying superior and posterior to the 3rd ventricle. On several of the sections, the blood density was greater in the dependent than in the superior portion of the mass. The average attenuation number within the mass was 40 EMI units. The infusion of contrast agent demonstrated capsular enhancement (a target sign), which was also demonstrated by angiography. The diagnosis, which was confirmed at operation, was thrombosis of an aneurysm of the vein of Galen. The massive thrombus was resected, but the aneurysm was not excised. The patient's recovery was uneventful.
 ...
PMID:Thrombosed aneurysm of the vein of Galen. 720 47

We represent a case of cystic dilatation of the fourth ventricle resulted from obstruction of the foramina of Luschka and Magendie and of the aqueduct of Sylvius which developed after a surgery of AVM. A 42-year-old woman was admitted to our clinic for the operation of AVM located at the trigone of lateral ventricle and the lateral wall of midbrain. VPS had been performed previously because of acute hydrocephalus resulted from several attacks of ventricular hemorrhage. Total removal of the AVM was performed. The patient was stuporous after the surgery, and CT scan showed marked distension of the fourth ventricle with shifted third ventricle and slightly dilated supra-tentorial ventricular system. Although a revision of the abdominal side of VPs performed and the lateral and the third ventricles were shunted effectively, the fourth ventricle continued to show remarkable distension. Since it was considered that the occlusion of the foramina of Luschka and magendie due to previous episodes of ventricular hemorrhage and the blockage of the aqueduct of Sylvius 'trapped' the fourth ventricle, suboccipital craniotomy and re-opening of the foramen of Magendie was performed. The arachnoid membrane around the cisterna magna was strongly adhered to the dura mater. When incision was made on the arachnoid membrane between the cerebellar tonsils, slightly turbid and xanthochromic CSF spurted out and some old clots were also aspirated from the opened fourth ventricle. The size of the fourth ventricle returned normal on CT scan ten days after the operation, and the patient recovered progressively afterwards.
 ...
PMID:[A case of trapped fourth ventricle which developed after a surgery of AVM (author's transl)]. 727 34

A 21-year-old male, who had undergone a ventriculoatrial shunt for hydrocephalus 5 years previously, became stuporous. A roentgenogram revealed that the distal segment of the broken atrial catheter had migrated and become lodged in the heart. Because the fragment had not adhered to the myocardium, it was easily retrieved by the transvenous approach with a retriever catheter. If the migrated catheter does not adhere to the myocardium, transvenous catheter retrieval is absolutely necessary. If, however, the migrated catheter adheres to the myocardium, an open thoracotomy would be required for retrieval, or the alternative of warfarin administration without retrieval may be the treatment of choice, as long as other problems do not occur.
 ...
PMID:Management of a broken atrial catheter migrated into the heart: a rare complication of ventriculoatrial shunt--case report. 750 2

Neurological examination of a lethargic, ataxic 12-week-old dobermann revealed decreased conscious proprioception in all its limbs. Haematological examination revealed a low platelet count. Cytological examination of a sample of cerebrospinal fluid revealed evidence of haemorrhage and chronic inflammation. The levels of von Willebrand's factor antigen were extremely low. Skull radiographs were consistent with mild hydrocephalus. Treatment resulted in little clinical improvement and the animal was euthanased. Post mortem examination of the brain revealed an internal hydrocephalus with haemorrhage into the ventricles. It was considered that the animal had suffered severe intracranial haemorrhage as a result of its low level of von Willebrand's factor antigen and that the bleeding may have been potentiated by the low platelet count.
 ...
PMID:Intracranial haemorrhage in a dobermann puppy with von Willebrand's disease. 757 Dec 71

The neuronal metabolic state that forms the cellular basis for cognitive functioning and motor behavior is dependent on cerebral perfusion. As intracerebral pressure increases, cerebral perfusion is compromised. The management of acute hydrocephalus after head trauma has been extensively described. In this article, we present evidence of clinical, cerebral perfusion, and neurophysiologic improvement in a 19-year-old patient with chronic post-traumatic hydrocephalus. Lethargy, gaze palsy, torticollis, and triplegia were noted 2 years postinjury in a neurologically stable patient. Computed axial tomography (CAT) scan confirmed marked enlargement of the third and fourth ventricles with a prominent subgaleal fluid collection. Intraoperative cerebral spinal fluid pressure was 26cm H2O despite hyperventilation. A ventriculo-peritoneal shunt was placed. Postoperatively, marked improvement in clinical exam, cerebral perfusion (SPECT scan), and evoked potentials correlated with the reemergence of the cerebral mantle on CAT scan and magnetic resonance imaging (MRI). Chronic obstructive hydrocephalus should be suspected and aggressively pursued in chronic head injury.
 ...
PMID:Shunting in chronic post-traumatic hydrocephalus: demonstration of neurophysiologic improvement. 812 89

A 67-year-old woman presented with a 1-year history of gradual weight loss, reduced mental activity, muscle weakness, and urinary dysfunction. Neurological examination revealed mild lethargy, severe muscular atrophy, and diminished deep tendon reflexes in the extremities. The levels of vitamin B1 and folate in blood were low: 1.9 micrograms/dl (normal range 2.0-7.2) and 0.7 ng/ml (normal range 4.0-12.0). respectively. A lumbar puncture was done. The pressure of the cerebrospinal fluid was within normal limits, the level of protein was very high (467 mg/dl), and only a few lymphocytes were seen. A nerve-conduction study showed low amplitudes of action potentials and slow conduction velocities in both the motor and sensory nerves. Myelin irregularity, "onion bulb formation", and axonal atrophy were seen in a specimen obtained by sural nerve biopsy. A T2-weighted magnetic resonance image of the brain showed ventricular dilatation, high-intensity signals around the lateral ventricles, and a flow-void sign of the cerebral aqueduct. Radioisotope cisternography (111In-DTPA) disclosed ventricular reflux and slow clearance of the tracer from the ventricles. These findings indicated the presence of chronic inflammatory demyelinating polyneuropathy, nutritional polyneuropathy, vitamin B1 deficiency, folate deficiency, and normal pressure hydrocephalus. In this patient, the high level of protein in the cerebrospinal fluid may have caused the hydrocephalus.
 ...
PMID:[Chronic neuropathy, a high level of protein in cerebrospinal fluid, and vitamin B1 and folate deficiency in a patient with normal-pressure hydrocephalus]. 930 Dec 70

Mice with the Otx2+/- mutation often die during the postneonatal period. Before death these animals, generated from TT2 ES cells and crossed with CBA mice, develop a dome-shaped head, weakness of the limbs, kyphosis, lethargy, drowsiness, and emaciation. Autopsy of these mice revealed eminent dilatation of lateral ventricles and a ballooned cerebrum. Histological analysis shows edematous change of the periventricular white matter. These results suggest that Otx2 functions as a head organizer, and a mutation of this gene is a likely cause of hydrocephalus in mammals. Additionally, craniobasal skeletal anomaly in half of the heterozygotes and dwarfism in some of the female heterozygotes are described.
 ...
PMID:Hydrocephalus in the Otx2+/- mutant mouse. 939 63


<< Previous 1 2 3 4 5 6 7 8 Next >>