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)

Beagle dogs inoculated with the agent of Rocky Mountain spotted fever, Rickettsia rickettsii, developed a clinical syndrome that extended from febrile exanthema to death and appeared to be dose related. Infected dogs were anorectic and lethargic and developed cutaneous lesions characteristic of Rocky Mountain spotted fever, including petechia, ecchymosis, edema, and necrosis. Hematologic changes after inoculation included anemia, leukopenia proceeding to leukocytosis, and thrombocytopenia. Changes in blood chemistry values included increases in serum alkaline phosphatase and cholesterol, and hyponatremia and hypochloremia. The prominent histopathologic change was necrotizing vasculitis. The canine disease is comparable with human Rocky Mountain spotted fever on a clinical, hematologic, biochemical, and pathologic basis, and may provide a model system for this disease in man. The results suggest the dog may be involved in the epidemiology of R rickettsii infections.
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PMID:Studies on the pathogenesis of Rickettsia rickettsii in the dog: clinical and clinicopathologic changes of experimental infection. 87 82

A 36 year old white man was diagnosed as having Whipple's disease after a prolonged illness of lethargy, night sweats, and weight loss associated with lymphadenopathy and splenomegaly. Biopsy specimen of an inguinal lymph node confirmed the presence of periodic acid Schiff positive macrophages and culture gave a pure growth of Corynebacterium jeikeium. Twelve hours after the introduction of oral co-trimoxazole and streptomycin the patient's condition deteriorated. He became confused, feverish, and developed florid retinal vasculitis with associated visual impairment. Both the systemic symptoms and the retinal vasculitis responded to treatment with corticosteroids and his vision returned to normal. We think this was a Jarisch-Herxheimer reaction not previously described in Whipple's disease and advise inspection of the fundi of such patients before starting treatment.
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PMID:Whipple's disease complicated by a retinal Jarisch-Herxheimer reaction: a case report. 137 Dec 61

Dissemination of tumor to the leptomeninges and cerebrospinal fluid represents a common pattern of metastasis for many cancers; however, few chemotherapeutic agents are available for intrathecal (i.t.) use and treatment results are often poor. We studied the neurotoxicity and pharmacokinetics of i.t. 4-hydroperoxycyclophosphamide (4-HC) in the rabbit and the activity of i.t. 4-HC in a VX2 rabbit model of leptomeningeal carcinomatosis to evaluate the potential use of 4-HC in the treatment of leptomeningeal tumors. Toxicity studies examined 4-HC doses ranging from 0.5 to 6.0 mumol administered by intraventricular injection weekly for 4 to 8 weeks. Clinical or histological neurotoxicity was not observed in rabbits treated with < 1.0 mumol 4-HC for 4 weeks. Clinical toxicity, characterized by lethargy, weight loss, seizures, or death, was apparent at doses > 2.0 mumol. Vasculitis of superficial arteries was observed in rabbits treated with > 1.0 mumol 4-HC. In cerebrospinal fluid pharmacokinetic studies, the mean drug half-life after intraventricular or intralumbar administration was 24.3 and 18.2 min. Regional inequities in drug exposure were apparent as area under the clearance curve values for cerebrospinal fluid distant from the injection site were lower than those of proximate sites (P < 0.001). Weekly intraventricular treatment of VX2 leptomeningeal tumor-bearing rabbits with 0.5 or 1.0 mumol of 4-HC resulted in an increased life span of 22.5 and 35%, respectively. These results indicate that i.t. 4-HC, at doses lower than those producing neurotoxicity in the rabbit, is effective treatment for VX2 leptomeningeal carcinomatosis.
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PMID:Intrathecal 4-hydroperoxycyclophosphamide: neurotoxicity, cerebrospinal fluid pharmacokinetics, and antitumor activity in a rabbit model of VX2 leptomeningeal carcinomatosis. 142 60

In 1987, a 69-year-old female suffering from epilepsy and right hemiparesis was admitted to the hospital and given conservative therapy. During the next three weeks she became a stuporous state. Steroids were then prescribed, and she made a complete recovery. Following hormonal and immunological investigations, a diagnosis of Hashimoto's disease with hypothyroidism was made. Following her discharge, thyroxin and anticonvulsant treatments continued. On May 30, 1989, at the age of seventy-one, the patient was found lying unconscious at home, and taken to our hospital. She had signs of a confused state, and seizures of her right arm on admission. Cranial computed tomography (CT) revealed a low density area in the left parieto-occipital lobe, which was heterogeneously enhanced by contrast medium. Magnetic resonance imaging (MRI) showed a lesion of low signal intensity in T1-weighted images and high signal intensity in T2-weighted images, which was homogeneously enhanced by Gd DTPA. Cerebral angiography disclosed no abnormality. Two weeks later, follow-up CT showed that the lesion had become larger and markedly enhanced. A brain tumor, probably malignant lymphoma, was suspected. On June 14, stereotaxic biopsy of the enhanced lesion was performed. Histopathological examination disclosed dense infiltration of the entire walls of many small parenchymal vessels, both arterioles and venules, by lymphocytes. Treatment for angiitis (betamethasone 16 mg daily) was started on June 20, then gradually tapered, and the lesion diminished on CT. Our case has some features of both isolated angiitis of the central nervous system and encephalopathy in compensated Hashimoto's disease. It is suggested that some common base of the autoimmune diseases exists in this case.
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PMID:[Isolated angiitis of the CNS associated with Hashimoto's disease]. 161 79

Isolated cerebral angiitis was confirmed by brain parenchyma biopsy in a 31-year-old man with a rapidly progressive encephalopathy and normal cerebral angiography and magnetic resonance imaging. Presenting features of aphasia, hemiparesis, and lethargy resembled herpes simplex encephalitis. Severe neurologic deficits rapidly resolved with steroids plus cyclophosphamide, and he remains in remission after two years. This case illustrates potentially misleading early manifestations of isolated cerebral angiitis, diagnostic limitations of angiography, the value of biopsy that includes both brain parenchyma and leptomeninges, and the potential efficacy of steroid and cyclophosphamide therapy in small-vessel disease. Clinical features and response to treatment vary widely in reported cases, suggesting that isolated cerebral angiitis may have diverse etiologies.
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PMID:Isolated small-vessel angiitis of the central nervous system. 336 77

A 15 year old female began to suffer from a headache 12 hours prior to admission to a hospital in Broken Hill, N.S.W., Australia. Several hours after the onset of the headache, she had a generalized tonic-clonic seizure. Upon arrival at the hospital, she was lethargic, but did respond to commands. Her speech was slurred and the right side of her body was paralyzed. She had no fever and blood pressure was normal. Despite attempts to treat her with intravenous dexamethasone, she slipped into an unconscious state. A CT scan uncovered a left parietal hypodense lesion. Her pupils quickly dilated the next day. The right pupil did respond slightly to light, however. Physicians made a burr hole in the parietal area of her skull which exposed underlying necrotic tissue. After the operation, her brain stem failed to function. She died the following day, 3 days after the symptoms began. Other than a febrile convulsion at 10 months, she had been in good health. She had been taking a combined oral contraceptive (COC) made of 125mcg levonorgestrel and 50mcg ethinyl estradiol for 2 weeks. Pathologists found an area of necrosis in the left temporo-parietal region of the brain and an occlusive thrombosis near the left middle cerebral artery. Further, a pronounced segmental necrotizing vasculitis of the left middle cerebral and right posterior cerebral arteries existed. Based on other documented cases and this case, the physicians point to evidence that vessel size in vasculitis has an effect on the severity of the disease. Vasculitis in small vessels has a tendency to cause a gradual progression of the disease, while this disease in medium and large vessels may cause a rapid progression of the disease, as in this case. The researchers suspect that the COC may have precipitated the disease.
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PMID:Isolated angiitis of the brain in a young female on the contraceptive pill. 345 Dec 35

Kawasaky's disease is a multisystem widespread vasculitis. Besides the mucocutaneous patterns, symptoms related to various organs have been observed in the medical literature. Lethargy, irritability, meningism and cranial nerves paralysis occur in the acute phase of central nervous system involvement. The A.A. report a rare cerebellar syndrome caused by vasculitis in a seven years old girl's cerebellum. Surveillance of tardive complications must be undertaken in patients affected by Kawasaky's disease.
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PMID:[Cerebellar syndrome in a case of Kawasaki disease]. 378 6

A 73 year-old man experienced left monocular blindness and transient right hand clumsiness. A left carotid arteriogram was performed 4 days after admission. Immediately following arteriography, there was a right hemiparesia and dysphasia. After 24 hours, the abnormalities resolved. The patient was treated with heparin. During the following weeks, he became gradually drowsy and confused. Pseudo-bulbar palsy and astasia appeared after a fluctuating but progressive neurological course. The combination of systemic symptoms, high sedimentation rate, renal failure, livedo reticularis and purple toes suggested necrotizing angiitis. With corticosteroid treatment, there was a slight improvement of systemic symptoms. Cholesterol emboli were seen in both fundi. Cholesterol embolization was proved by identifying the biconcave cholesterol crystal clefts in muscle and skin biopsies. The subsequent course was marqued by continuous neurological deterioration. The patient became stuporous and died 7 months after admission. Despite the lack of central nervous system pathological study, the clinical picture was highly suggestive of cerebral cholesterol embolism. A few cases have been reported, with only eight well-documented clinical descriptions. Clinical signs and symptoms were closely similar to those of the present case. Anticoagulant therapy of cholesterol emboli has been unsuccessful. In the present case, the onset of embolization was temporally related to anticoagulation.
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PMID:[Retinal, muscular and cutaneous cholesterol emboli. Progressive encephalopathy]. 408 20

An epizootic of encephalomyelitis attributable to western equine encephalitis virus was identified in emus (Dromaius novaehollandiae) from several flocks in western Texas in July 1992. Affected emus ranged from 3 months to 3 years old. Morbidity of emus in 8 flocks ranged from 15 to 50%, and 17 of 193 (8.8%) emus died. The diagnosis was confirmed by isolation and characterization of the causative virus and detection of antibody to the virus in emus that were currently ill and emus that had been ill but recovered. Clinical signs varied from mild to severe and included anorexia, lethargy with sternal recumbency, ataxia, muscle tremors, head tilt, unnatural positioning of the head on the back, acute onset of paralysis, and lateral recumbency with paddling. A few emus died without prior evidence of clinical disease. Post-mortem examination revealed 3 to 5 ml of clear pale-yellow pericardial fluid that contained a fibrin clot. Volume of the contents of the proventriculus and ventriculus were less than anticipated. Microscopic examination of numerous tissues revealed multifocal vasculitis with infiltration of plasmacytes, lymphocytes, and a few heterophilic leukocytes. The epizootic developed during a period of unseasonably heavy rainfall that resulted in higher numbers of mosquitoes than was typical for that season of year. A concurrent increase in the number of horses with encephalomyelitis attributable to western equine encephalities virus was not reported.
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PMID:An epizootic attributable to western equine encephalitis virus infection in emus in Texas. 796 Oct 99

From August 1990 to June 1991, a moderate die-off of 4- to 5-year-old green sea turtles (Chelonia mydas) occurred at Cayman Turtle Farm, Grand Cayman, British West Indies. Clinical signs included lethargy, anorexia, and inability to dive. Many of the ill turtles floated on the surface of their tanks. There was no apparent sex predilection. Complete necropsies, including histopathologic examination of tissues, were performed on eight turtles. Necropsies revealed multiple irregular discrete to patchy 1-10 mm pale gray foci throughout the hearts of four turtles. By light microscopic examination, the most severe and consistent lesions were necrotizing myocarditis, histiocytic to fibrinous splenitis, and hepatic lipidosis and necrosis. A mixed leukocytic infiltrate of acidophils, macrophages, and lymphocytes was present in affected areas of the heart. Other lesions included lymphocytic/plasmacytic interstitial nephritis, subacute interstitial pneumonia, subacute mesenteric vasculitis, chronic/active enteritis of the small intestine, and occasional granulomas associated with spirorchid trematode ova. Chlamydiae could be demonstrated in macrophages in sections of paraffin-embedded heart, liver, and spleen and in myocardial fibers and hepatocytes using a modified Macchiavello's stain. Chlamydial antigen was detected by light microscopic examination in the cytoplasm of myocardial fibers and in occasional hepatocytes using a commercially available genus-specific antichlamydial monoclonal antibody and the avidin biotin peroxidase complex staining method. Electron microscopic examination of the heart of the most severely affected turtle revealed developmental stages of chlamydial organisms. A suspension of heart from this turtle was inoculated into the yolk sacs of chicken embryos.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Chlamydiosis in mariculture-reared green sea turtles (Chelonia mydas). 814 Jul 12


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