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)

Blood brain barrier disruption enhances drug delivery in primary central nervous system lymphoma. In this study, we report adverse events that were encountered intraoperatively and in the postoperative period in these patients. A retrospective analysis of 17 patients documenting demographic data, preprocedure medical history, intraoperative, and postoperative anesthetic complications was conducted between January 2002 and December 2004. Seventeen patients underwent 210 treatments under general anesthesia with a mean of 12.4+/-7.2 treatments per patient. Focal seizures occurred in 13% of patients. Generalized motor seizures occurred in 4 treatment sessions in 2 different patients. The incidence of seizures was significantly higher when the internal carotid artery was used for injection, as opposed to the vertebral artery (20.8% and 6.02%, respectively, P=0.0034). Tachycardia associated with ST segment depression occurred 9 times (4.3%) in 3 patients. One patient had significant ST segment elevation (more than 1.5 mm). Transient cerebral vasospasm after methotrexate injection occurred in 9% of patients. Postoperative nausea and vomiting were observed in 11.9% of patients. After emergence, lethargy and obtundation occurred in 7.6% of the cases. The incidence of postoperative headache and reversible motor deficits was 6% and 3.8%, respectively. Our review highlights the problems that were encountered during blood brain barrier disruption under anesthesia and in the postoperative period. Further prospective studies are required for comprehensive evaluation of intraprocedure and postprocedure complications that will allow development of an optimal anesthetic plan and will improve patient outcome by preventing potential complications.
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PMID:Perioperative complications of blood brain barrier disruption under general anesthesia: a retrospective review. 1815 25

A 66-year-old male presented with acute cephalalgia, disorientation, and lethargy. The patient was evaluated in the ER and admitted with probable hydrocephalus. Brain-MRI revealed multiple nonspecific brain lesions, predominantly involving the right temporal lobe, which on biopsy proved a diagnosis of Primary Central Nervous System Lymphoma (PCNSL). Subsequent laboratory studies demonstrated active HIV infection with a CD4 count of 21 cells/ microliter and HIV viral load (VL) of greater than 400,000 copies/milliliter. The patient was eventually initiated on highly active antiretroviral therapy (HAART). He declined palliative whole-brain radiotherapy (WBRT) but was amenable to Gamma Knife Radiosurgery (GKRS) for treatment of right temporal brain lesions. Three months later, the patient's neurological symptoms improved; similarly, his CD4 count increased to 176 cells/mL and his HIV VL was less than 90 copies/mL. By 12-month follow-up, patient was asymptomatic and at 36-months, Brain MRI demonstrated total remission (CR) without new brain lesions. The gold standard treatment of newly diagnosed PCNSL remains high-dose chemotherapy in conjunction with palliative WBRT, however there may be a role for novel, combined approaches utilizing chemotherapy, HAART, and GKRS to positively impact survival rates of PCNSL related to AIDS.
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PMID:Highly Active Antiretroviral Therapy and Gamma Knife Radiosurgery for the Treatment of AIDS-Related Primary Central Nervous System Lymphoma: A Case Report. 3065 58

A 31-year-old man presented with seizures and cerebellar symptoms on a background of weight loss and lethargy. He was found to be infected with human immunodeficiency virus (HIV) and following radiological imaging, was commenced on treatment for presumed cerebral toxoplasmosis. Due to a lack of response, both clinically and on interval imaging, a positron-emission tomography-computed tomography and brain biopsy were undertaken, which demonstrated high-grade primary central nervous system lymphoma (PCNSL). Awareness amongst both clinicians and radiologists of the multifarious patterns of intra-cranial involvement in patients with HIV is, therefore, of utmost importance, as the treatment and prognosis of these entities are entirely different.
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PMID:Primary central nervous system lymphoma presenting as multiple space-occupying lesions in advanced human immunodeficiency virus infection. 3175 81