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

Severe conjugate downward eye deviation of several days' duration in a lethargic patient with subarachnoid hemorrhage and of several weeks' duration in a comatose patient with hypoxic encephalopathy occurred in the absence of structural pretectal lesions. Persisting downgaze in a stuporous or comatose patient does not necessarily indicate anatomic pretectal damage.
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PMID:Sustained downgaze deviation. Two cases without structural pretectal lesions. 94 4

As a causative factor in spontaneous subarachnoid hemorrhage, vascular anomalies, especially aneurysm or arteriovenous malformation, have been generally recognized. On the other hand, subarachnoid hemorrhage from brain tumor and cryptic vascular malformation are rare. We experienced two cases showing subarachnoid hemorrhage from angioblastic meningioma and vascular hamartoma as an initial symptom. Case 1: A 48-year-old woman, who complained of severe headache and vomiting on Feb. 10th, 1972, gradually became lethargic. Lumbar puncture revealed moderately hemorrhagic C.S.F.. On the fifth day after the onset, she was admitted to our hospital. On admission she showed disorientation and disturbance of resent memory. Aphasia and agnosia were slightly observed. On ophthalmologic examination right homonymous lower quadrant hemianopsia was observed. The carotid angiogram showed slight square shift of the anterior cerebral artery to the right side, elevation of the middle serebral artery and a homogeneous tumor stain in the occipital region in capillary phase. A walnut sized tumor invading the middle portion of the left lateral sinus and showing firm adhesion to the tentrium was found. There was an intracerebral hematoma behined the tumor. The tumor, the tentrium and the lateral sinus were extirpated en bloc and the intracerebral hematoma was aspirated. Histologically, the tumor was angioblastic meningioma. Case 2: A 7-year-old boy, who complained of severe abrupt headache, nuchal pain and vomiting on Sept. 17th, 1972, became gradually lethargic. Lumbar puncture revealed hemorrhagic C.S.F., On the tenth day after the onset, he was admitted to our hospital. He showed confusion and agitation. The carotid angiogram showed an unrolling of the pericallosal artery, but no findings of space taking lesions. An air study indicated a globular filling defect protruding into the anterior horn of the right lateral ventricle. The tumor located in the laterobasal wall of the anterior horn was removed picemiel by transventricular approach. Histologically, the tumor was vascular hamartoma. Furthermore, we discussed various brain tumors showing subarachnoid hemorrhage as an initial symptom, its frequency and bleeding mechanism on the literature.
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PMID:[Two cases showing subarachnoid hemorrhage from angioblastic meningioma and vascular hamartoma (author's transl)]. 98 94

A case of generalized choreic movement associated with subarachnoid hemorrhage is reported. A 71 year-old hypertensive woman suddenly developed severe headache 14 days before admission. Consciousness disturbance and involuntary movement involving the face and upper extremities appeared about 8 days after onset. The involuntary motion was diagnosed as generalized choreic movement. CT scans showed subarachnoid hemorrhage with ventricular dilatation and periventricular lucency involving bilateral caudate nuclei. On admission the patient was stuporous with Hunt & Kosnik Grade 4. She showed involuntary choreic movement in both arms, trunk and face; hemiparenis and hyperreflexia were absent. An angiography revealed a right internal carotid-anterior choroidal artery aneurysm with vasospasm. After clipping the aneurysm in the following day, the consciousness disturbance and choreic movement gradually improved. By eight days after operation, the choreic movement completely disappeared. An MRI showed lacunar infarcts in the bilateral basal ganglia, predominantly in the caudate nuclei. In our case, the choreic movement is supposed to have been caused by impaired circulation in the bilateral corpora striata due to vasospasm and hydrocephalus after subarachnoid hemorrhage, in addition to the preexisting lacunar infarcts in the basal ganglia. This is claimed to be the first reported case of generalized choreic movement in associated with subarachnoid hemorrhage, which improved after surgery.
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PMID:[Generalized choreic movement associated with subarachnoid hemorrhage]. 174 95

A case of falx dural arteriovenous malformation was reported. A 62 year old man was admitted to Nakamura City Hospital on August 15, 1989, with severe headache as his chief complaint. On admission, his consciousness was lethargic. CT scan showed subarachnoid hemorrhage with ventricular perforation and hematoma of the corpus callosum. Angiograms demonstrated a dural arteriovenous malformation (DAVM) in the frontal falx, which was fed by bilateral middle meningeal arteries and the left anterior falx artery and drained into the superior sagittal sinus via the dural vein. Bifrontal craniotomy was performed. At first, bilateral middle meningeal arteries were coagulated, and the frontoparietal dura was excised widely. Then, the falx was cut at the crista galli. The DAVM was found in the falx, including a vascular sac embedded in the brain tissue. The DAVM was coagulated as much as possible. Carotid angiograms revealed complete disappearance of the DAVM, 4 months after the operation. Although angiograms performed after only one month still showed a small residual DAVM. On reviewing the literature we found only 5 patients with the DAVM in the falx. In 6 cases including our own, intracranial hemorrhage occurred in 4 cases (3 cases were subarachnoid hemorrhage). Vascular sacs were seen in 4 cases, and drainage to the pial vein was noted in 3 cases. It seemed to be rare that the DAVM drained into the dural vein. In our particular case, operative findings showed the DAVM drained into the dural vein without the pial vein, and intracranial hemorrhage was attributed to rupture of the vascular sac.
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PMID:[Dural arteriovenous malformation in the falx with subarachnoid hemorrhage]. 194 92

A case of intrasellar and suprasellar meningioma with hypopituitarism is reported. A-64-year-old woman was admitted to our hospital with chief complaints of reduced consciousness and inactivity. She had a history of subarachnoid hemorrhage 20 years previously, and developed right third nerve palsy. Physical examination demonstrated that, in consciousness, she was stuporous, and she had impaired visual acuity and palsy in the right third nerve. An X-ray film of the sella turcica showed enlargement and intrasellar calcification. A CT scan with contrast enhancement revealed a homogenously enhanced mass in the sella and suprasellar region. A cerebral angiogram showed elevation of the bilateral A1 portion of the anterior cerebral artery. No tumor blush was evident. Endocrinologic function tests confirmed impaired anterior lobe hormones and hypothyroidism. Preoperative diagnosis was pituitary adenoma. The tumor was subtotally removed by using the transsphenoidal approach and right frontotemporal craniotomy was carried out using microsurgery in a two staged operation. The tumor was yellowish-grey, partly firm in consistency, and it had a soft elasticity. Operative findings showed that the dura matter of the tuberculum sella, the anterior and posterior clinoid process, the medial sphenoidal ridge, and the wall of the cavernous sinus were intact, which was confirmed at autopsy, later. Microscopical examination revealed a mixed meningothelial and fibroblastic meningioma with papillary component and psammomatous bodies. The tumor was thought to originate in the diaphragma sella, and to extend in intrasellar and suprasellar directions. The patient died of basilar artery thrombosis. In clinical and radiological examination, there is no definite difference between pituitary adenoma and intrasellar meningioma.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[A case of intrasellar and suprasellar meningioma with hypopituitarism]. 220 90

Two cases treating aneurysms of the distal PICA were reported, and 36 cases with 39 aneurysms in the literatures in Japan were reviewed concerning the distribution of aneurysms and their findings on CT. Case 1; a 68-year-old female suffered from sudden onset of severe headache and nausea. On admission, it was found she was lethargic. However, her consciousness deteriorated down to semicoma with tetraparetic condition soon after. CT revealed subarachnoid hemorrhage in the basal, quadrigeminal and supravermian cisterns and blood clots in the entire ventricle. Cerebral angiography demonstrated an aneurysm located at the distal segment of the left PICA. She was initially treated conservatively because of being in Hunt and Kosnik Grade 5, and then, 3 weeks after onset, suboccipital craniectomy was performed and the aneurysm was clipped successfully. Case 2; a 60-year-old, female, suddenly experienced severe suboccipitalgia and vomiting. CT revealed subarachnoid hemorrhage in the entire subarachnoid space and intraventricular hemorrhages in the 4th, 3rd and lateral ventricles. Subsequently cerebral angiography was performed and left VAG demonstrated an aneurysm at the left A2-A3 junction. She underwent bifrontal craniotomy and the aneurysm was clipped via the interhemispheric approach. Her postoperative course was uneventful. Postoperative left CAG showed successful clipping of the aneurysm. However, left VAG suggested an aneurysm-like shadow in the right PICA. Right BAG carried out one week later demonstrated an aneurysm at the distal segment of the right PICA. This aneurysm was then clipped successfully under suboccipital craniectomy.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Distal aneurysm of posterior inferior cerebellar artery: report of two cases--pitfall in diagnosis]. 228 Aug 14

Twenty-four patients with caudate hemorrhage, in whom such definite organic lesions as arteriovenous malformations or ruptured cerebral aneurysms could not be proved, were analyzed. These cases comprise 2.0% of 1202 cases of hypertensive intracerebral hemorrhage diagnosed by computed tomography and experienced from 1976 through 1987. Thirteen patients were male and 11 were female. Their average age was 61 years. Headache (67%) and nausea and vomiting (50%), which were often the initial symptoms, were similar to those of subarachnoid hemorrhage. The main clinical symptoms were signs of meningeal irritation. Ten patients (42%) had transient disturbance of consciousness, and nine (38%) of these were somnolent; only one patient, who had a massive hematoma, was stuporous. When the hematoma extended to the internal capsule, the patient showed motor disturbance (38%). Two patients (8%) had Horner's sign, five (21%) exhibited diminished activity, and one (4%) suffered anosognosia. The volume of the intracerebral hematoma averaged 4.7 ml and was less than 5 ml in 17 patients (71%). In 20 patients (83%), the hematoma was confined to the head of the caudate nucleus. The hemorrhage tended to rupture into the anterior horn of the lateral ventricle, and in nearly all cases (96%), intraventricular hematoma was observed. Seventeen patients (71%) underwent cerebral angiography. There were no instances of dilation of the recurrent artery of Heubner. Twenty patients (83%) were treated conservatively. Continuous ventricular drainage was employed in four patients (17%), and ventriculoperitoneal shunting in three (13%). However, it was judged retrospectively that continuous ventricular drainage had been necessary in only two cases in which disturbance of consciousness was progressed due to acute hydrocephalus.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Clinical analysis of 24 cases of caudate hemorrhage]. 248 89

Anterior communicating artery aneurysm was shown in a 48-year-old man who had suffered from subarachnoid hemorrhage (SAH) by cerebral angiography. Right pterional approach was performed on the 40th day after SAH. Premature ruptured occurred during aneurysmal manipulation and temporary clip (Scoville clip) was placed at the middle of the right A1 segment for fifteen minutes. the anterior communicating artery aneurysm was successfully clipped and postoperative course was uneventful. But, four days after the operation, the patient fell into coma following generalized tonic convulsion. Lumbar puncture showed fresh SAH. Consciousness recovered gradually to a lethargic state. A newly formed berry aneurysm was revealed on the righ A1 segment at the site of the temporary clip application by cerebral angiography performed on the seventh day after aneurysmal surgery. Second attack occurred on the 12th postoperative day and the patient died on the 16th day after the operation. Postmortem findings disclosed massive subarachnoid and intraventricular hemorrhage from the ruptured aneurysm at the right A1 segment. Microscopic examination of the aneurysm and the right A1 segment. microscopic examination of the aneurysm and the right A1 segment showed the extensive destruction of the artery and massive proliferation of aspergillus in the arterial wall which was prominent of its outer layer. The mechanism of the formation of the new aneurysm in this case was considered as follows: the arterial wall was primarily damaged by the temporary clip and was weakened rapidly by the invasion of aspergillus, probably producing thrombosis of the vast vasorum, hemorrhage, and necrosis in it.
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PMID:[A rare case of cerebral aspergillus aneurysm at the site of temporary clip application]. 320 69

Traumatic acute subdural hematomas over the convexity of the cerebral hemispheres are often encountered, but acute interhemispheric subdural hematomas are rare. Fourty-eight cases of acute subdural hematomas was admitted to our hospital between 1977 and 1986, and three cases of them (6%) were located in the interhemispheric subdural space. In this paper, these three cases are reported with 20 documented cases. Case 1: an 81-year-old female was admitted to our hospital because of headache, nausea and vomiting. She hit her occiput a week ago. CT scan demonstrated contusion in the right frontal lobe and a high density in the interhemispheric space of the right frontal region. Her complaints disappeared gradually by conservative therapy and she returned to her social life. Case 2: a 50-year-old male fell downstairs and hit his vertex. As he lost consciousness, he was admitted to our hospital. He was stuporous and had left-hemiparesis. Skull X-ray film showed fracture line extending from the right temporal bone to the left parietal bone across the midline. CT scan revealed intracerebral hematoma in both frontal lobe and right parietal lobe and subarachnoid hemorrhage in the basal cistern and Sylvian fissure of the right side. And interhemispheric subdural hematoma in the right parietal region was visualized. Angiography demonstrated a lateral displacement of the right callosomarginal artery and an avascular area between the falx and the callosomarginal artery. After admission his consciousness recovered and convulsion was controlled by drug. Left-hemiparesis was improved by conservative therapy and he was discharged on foot.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Three cases of acute interhemispheric subdural hematoma]. 328 92

A case of an aneurysm on the persistent primitive trigeminal artery (PPTA) is reported. A seventy-five-year-old woman with subarachnoid hemorrhage was admitted to the Hospital six hours after the onset. She was lethargic and had stiffness of her neck with severe headache and vomiting. Computed tomographic examination showed marked subarachnoid hemorrhage in the basal cisterns, especially in the ambient cistern on the right side. Cerebral angiogram revealed the right PPTA having a saccular aneurysm on the trunk. Her advanced age and the special location of the aneurysm did not allow direct operation in the acute stage. She died of rebleeding of the aneurysm thirty days after admission. Pathological study showed that the PPTA was originated from the cavernous portion of the right internal carotid artery and joined to the cephalad portion of the basilar artery. The aneurysm, 10 X 7 mm in size, was located at the curved midportion of PPTA, 9 mm proximal to the basilar artery. The proximal portion of the PPTA to the aneurysm had severe arteriosclerosis, whereas the distal portion showed less sclerotic change. However, there were no evidences of developmental anomaly in the wall of the PPTA. Eighteen cases of PPTA with the aneurysm arisen from PPTA itself or at its junction with internal carotid artery have been previously reported. PPTA in any case has not been examined pathologically. It has been speculated that dysplasia of the PPTA wall contributes to initiating the aneurysm on the PPTA. However our histopathological examination of the PPTA revealed no evidence of dysplasia in the PPTA wall.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[An autopsy case of a persistent primitive trigeminal artery aneurysm]. 328 32


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