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)

To determine whether treatment with hyperbaric oxygen (HBO) or dimethyl sulfoxide (DMSO) could mitigate the fatal effects of cerebral ischemia, we anesthetized 68 gerbils with ketamine, ligated the right carotid artery (CA), and placed a snare occluder around the left CA. After 48 hours, 30 gerbils that were neurologically normal or had suffered only mild deficits were subjected to left CA occlusion without anesthesia for periods of 2 to 60 minutes. The onset of circling, posturing, falling, and lethargy began immediately; seizures and coma ensued 4 to 5 minutes later and persisted until release of the left CA occluder. All gerbils recovered after 2-minute staged bilateral CA occlusions. The mortality rate was 33% after both 5- and 10-minute occlusions and 100% after 20- and 60-minute bilateral occlusions. Twelve gerbils were placed in an HBO chamber (100% oxygen at 1.5 atmospheres) for 15 minutes during 20-minute bilateral occlusion; only 2 died (16% mortality rate). Thus, HBO therapy conferred significant protection against death from untreated ischemia (P less than 0.001). Histological examination showed that the extent of patchy bilateral ischemic neuronal damage was much less in surviving gerbils that received HBO therapy than in those that died after 20-minute occlusions. Fourteen gerbils were treated with DMSO, 2.5 g/kg intraperitoneally, during 5- or 10-minute bilateral CA occlusion; 12 died (86% mortality rate). Thus, DMSO provided no protection against fatal cerebral infarction; in fact, the results in the 10-minute reperfusion group suggest that DMSO may have a deleterious effect.
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PMID:Effect of hyperbaric oxygen therapy or dimethyl sulfoxide on cerebral ischemia in unanesthetized gerbils. 371 99

Histopathological study on 723 brains from routine necropsies was performed. Ten brains (1.38 percent) were found to have histological lesions of disseminated intravascular coagulation (DIC) with multiple fresh fibrin and/or platelet thrombi in the cerebral microcirculation. Among them, premortem diagnosis was made in only one case, and only two cases also showed evidence of visceral involvement. Microthrombi were found most frequently in the cerebral cortex and hypothalamic region and in the cerebral white matter, brain stem, and cerebellum, in descending order. Neurological symptoms and signs, including lethargy, coma and seizure, were detected in all cases. The abnormal body temperature and/or urinary output observed in most patients appeared to be related to the frequent hypothalamic involvement by DIC. The exclusive or predominant involvement of the brain by multiple microthrombi may be considered as a localized form of DIC. It is probably related to cerebral ischemia since severe acute neuronal ischemic changes also were noted in most brains.
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PMID:Disseminated intravascular coagulation involving the brain: a topographical study. 712 Apr 79

A 3-year-old Chinese girl with alternating hemiplegia syndrome failed to respond to anticonvulsants, antimigrainous drugs, and calcium channel blockers. She made a complete remission with a 4-week course of steroid, and relapsed after steroid withdrawal. Electroencephalogram and brain mapping during the hemiplegic attack showed unilateral high-voltage sharp slow-wave discharges in the temporo-occipital region contralateral to the hemiplegic side and diffuse high-voltage slowing during attacks of quadriplegia or other clinical manifestation such as dullness, lethargy, or yawning. Brain perfusion single photon emission computed tomographic (SPECT) scan study during the attack showed decreased uptake in the temporoparietal region contralateral to the hemiplegic side and in the ipsilateral basal ganglia, whereas the perfusion was normal between attacks. Electroencephalogram background activity was improved while the child was in clinical remission with steroid treatment. Computed tomographic and magnetic resonance imaging scans of the brain were normal. Carotid angiogram failed to show any structural or dynamic changes of the carotid arteries. The possible mechanism underlying alternating hemiplegia syndrome might be transient and reversible cerebral ischemia with high-voltage slow-wave discharges shown in the electroencephalogram and decreased perfusion in SPECT scan.
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PMID:Alternating hemiplegia syndrome: electroencephalogram, brain mapping, and brain perfusion SPECT scan study in a Chinese girl. 840 62

Although hypercalcemia may cause drowsiness, lethargy, weakness, confusion and coma it rarely causes seizures or cerebral infarction. The patient presented had a clinical evolution from hallucinosis to a generalized tonic-clonic seizure, and subsequent cortical blindness with occipital cerebral ischemia as evidenced by SPECT and MRI scans. EEG revealed occipital PLEDs. With reversal of hypercalcemia, there was a return of vision, resolution of EEG epileptiform activity, although with some residual occipital infarction. This case, in concert with a literature review of hypercalcemia, reveals examples of occipital and watershed ischemia, blindness, seizures and hypertension, a pattern markedly similar to that of eclampsia. Furthermore, medications such as magnesium sulfate, believed to reverse cerebrovasospasm responsible for the eclamptic neurologic findings, may counter the effects of hypercalcemia at a cellular level, lending support to a calcium-mediated injury in eclampsia.
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PMID:Reversible hypercalcemic cerebral vasoconstriction with seizures and blindness: a paradigm for eclampsia? 966 11

A 27-year-old female motorcycle passenger was admitted with bruises and concussion after a motor-vehicle accident. After a lucid interval of several hours she became stuporous and progressed to an acute comatose state. Computed tomography demonstrated extensive cerebral ischaemia in the territory of the right middle cerebral artery. Angiography after transfer to the authors' hospital revealed dissections of both carotid arteries and of the right vertebral artery. The patient underwent surgical reconstruction of the left internal carotid artery with saphenous vein. The management of this patient is discussed and the literature reviewed.
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PMID:Complex traumatic dissection of right vertebral and bilateral carotid arteries: a case report and literature review. 1066 7

Patients with subarachnoid hemorrhage (SAH) are at risk for seizures and delayed cerebral ischemia, both of which can be detected with continuous EEG monitoring (cEEG). Ischemia can be detected with EEG at a reversible stage. CEEG may be most useful in patients with poor grade SAH, as the neurological exam is of limited utility in these stuporous or comatose patients. Seizures have been detected in 19% of SAH patients undergoing cEEG, with the vast majority (95%) of these seizures being nonconvulsive and without any detectable clinical correlate. Applying quantitative analysis to the cEEG (relative alpha variability, post-stimulation alpha/delta ratio) allows reliable detection of ischemia from vasospasm, with EEG changes often preceding changes in the clinical exam and other non-continuous monitoring techniques by up to two days. In patients at risk for developing vasospasm, cEEG monitoring, preferably with quantitative EEG analysis, should be started as early as possible and carried out for up to 14 days after the SAH. CEEG findings may lead to therapeutic (e.g., antiepileptic medication, hypertensive therapy, angioplasty) or additional diagnostic interventions such as angiography, CT or MRI.
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PMID:Continuous EEG monitoring in patients with subarachnoid hemorrhage. 1580 8

The hyperdense vessel sign is a debated topic in terms of its sensitivity and specificity for acute cerebral ischemia. Bilateral, hyperdense middle cerebral artery signs are rare presentations of bilateral cerebral infarction. We describe a 17-year-old boy with a history of cerebral palsy and a repaired atrial septal defect, presenting with lethargy and respiratory failure. Noncontrast computed tomography of the brain revealed bilateral, hyperdense middle cerebral artery signs, and he subsequently demonstrated bilateral cerebral infarctions in the distributions of the middle cerebral arteries. Hyperdense artery signs must alert physicians to evaluate patients for stroke, with an especially high index of suspicion for pediatric patients with hyperdense vessels, who are less likely to present with atherosclerotic disease causing vascular calcifications; rather, hyperdense artery signs could be an early sign of large-vessel thrombosis and cerebral infarction.
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PMID:Bilateral, hyperdense middle cerebral arteries predict bihemispheric stroke. 1894 May 62