Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0030552 (paresis)
 5,831 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A 62-year-old man developed man-in-the-barrel syndrome (MIBS) after emergency four-vessel coronary artery bypass surgery. MIBS refers to the clinical syndrome of bilateral upper extremity paresis with intact motor functioning of the lower extremities, giving the appearance of being confined within a barrel. The pathogenesis of MIBS is believed to be cerebral hypoperfusion leading to border zone infarctions between the territories of the anterior and middle cerebral arteries. Physical examination revealed bibrachial paresis, decreased upper extremity tone, mild left central VII palsy, flat affect, mild cognitive deficits, and poor balance while ambulating. An EMG showing poor motor unit recruitment and slow-firing motor units, and abnormal SSEPs indicated an upper motor neuron lesion. There was good progress in physical and occupational therapy, and good return of upper extremity function in four months. Only 11 cases of MIBS have been reported, all of whom were comatose; ten died. Our patient was never comatose and had good functional recovery.
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PMID:Man-in-the-barrel syndrome in a noncomatose patient: a case report. 195 15

Hydrogen peroxide is used as a preserver in milk industry. Three cases of accidental ingestion of 60% hydrogen peroxide (oxygenated water 200 volumes). The patients were male stockbreeders aged 30, 45 and 62 years, respectively, who stored that powerful oxidizing agent in commercial drink containers without adequate labeling. One of them was admitted comatose and required assisted ventilation. After recovering consciousness migratory paresis of right limbs and of the VI cranial nerve were observed, which were reversed after ten days, and left hemiparesia that persisted for two months. Upper gastrointestinal tract lesions, particularly in stomach, were detected in all. The endoscopic and pathological findings are described in detail. The outcome was satisfactory in the three patients, with complete remission of the lesions. There appears to be a direct relationship between the severity of symptoms and the amount of ingested peroxide, dependent on the diameter of the opening of the container. Only five reports have been identified related to the oral poisoning by this substance.
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PMID:[Ingestion of hydrogen peroxide. Apropos of 3 cases]. 204 3

A 67-years old woman developed sudden headache and transient vertigo. One week later, left arm paresis appeared and the patient became comatose. Investigations showed thrombocytopenia with hemolytic anemia and the presence of numerous irregularly contracted red cells (schizocytes). This was consistent with the diagnosis of thrombotic thrombocytopenic purpura. As focal neurological manifestations and widespread mental changes were still present when she emerged from coma, magnetic resonance imaging was performed showing numerous small infarcts in the white and grey matters.
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PMID:[Thrombotic thrombocytopenic purpura. A case diagnosed by MRI]. 206 82

We report three patients who lapsed into coma and subsequently manifested hypersomnolence, amnesia and vertical gaze paresis. Computed tomography revealed bilateral paramedian thalamic infarcts. This clinical symptomatology comprises the paramedian diencephalic syndrome.
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PMID:Paramedian diencephalic syndrome. Report of 3 cases. 226 88

The purpose of this study was to determine the effectiveness and associated problems of emergency intubation in 605 injured infants and children admitted to the Children's Hospital of Pittsburgh in 1987. We identified 63 patients (10.4%) undergoing endotracheal intubation at the scene of injury, at a referring hospital or in our emergency department. Injuries were to the head (90.5%), abdomen (12.7%), face (11.1%), chest (6.3%), neck (3.2%); or were orthopedic (19%) or multiple (39.7%). Indications for intubation included coma (74.6%), shock (28.6%), apnea (22.2%), and airway obstruction (3.2%). Of 16 complications (25.4%), 13 were immediately life threatening: right mainstem intubation (5), massive barotrauma (2), failure of adequate preoxygenation (2), esophageal intubation (1), attempt at nasotracheal intubation in an open facial fracture (1), and extubation during transport (1). Three were late complications: vocal cord paresis (2) and subglottic stenosis (1). Airway complications led to PO2 less than 90 mm Hg in 7 of 12 on first ABG, compared to 9 of 44 in uncomplicated cases (p less than 0.05). Intubation attempts at the scene of injury were more often multiple, unsuccessful, and associated with airway complications. All four complication-associated fatalities were life-threatening scene complications. Nearly one half (44.4%, 28 of 63) had one of the following problems in respiratory management: major airway complication, PaO2 less than 90, or PaCO2 greater than 45 on either the first or second ABG after arrival at our emergency department. Head injury with coma is the most common setting for emergency intubation. Airway complications are common, and are more frequent in treatment attempt at the scene. Despite endotracheal intubation, injured children in our series remain at high risk for hypoxemia, elevated arterial PCO2, and major airway complications, all of which contribute to secondary brain injury.
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PMID:Emergency endotracheal intubation in pediatric trauma. 230 99

A 91-year-old man presented with the sudden onset of coma, vertical gaze paresis, and transient disturbance of horizontal gaze, with fixed but unequal pupils. Both cranial computed tomography and postmortem study documented infarction of the paramedian thalamus bilaterally and of the ventral mesencephalon, accounted for by presumably embolic occlusion of a single artery. This artery arose as an unpaired perforating artery originating from the proximal segment of one posterior cerebral artery and thus conformed to the variant anatomic configuration associated with such infarcts as described by Percheron.
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PMID:Neuro-ophthalmological findings with neuropathological correlation in bilateral thalamic-mesencephalic infarction. 293 25

Clinical and laboratory data on 46 patients with acute bacterial meningitis were analyzed in a retrospective survey. The incidence of bacterial meningitis in hospital admissions was 1.3% and the mortality 33%. Streptococcus pneumoniae was the most frequent etiologic agent. Mortality was highest for pneumococcal meningitis and was higher in patients over 50 years of age (83% vs 25%, p less than 0.05). The initial stage of consciousness was prognostically important. All awake patients survived, while the more impaired the consciousness (from lethargy to coma), the higher the mortality (19%, 25%, and 78% respectively). Seizures and paresis of the third cranial nerve were significantly higher in lethal cases. Brain edema was the leading cause of death (60%). The interval between hospital admission and start of antibiotic treatment was crucial for prognosis. Patients who received the first dose of antibiotics within 3 hours after admission had a mortality of 13%, while a delay of 6-24 hours increased the mortality to 3/3.
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PMID:[Prognostic factors in bacterial meningitis in adults. Retrospective analysis of 46 patients]. 311 39

A retrospective study of 75 consecutive cases of spontaneous cerebellar haemorrhage was undertaken in order to evaluate the clinical features and natural history of this condition. A wide spectrum of clinical findings contributed to the poor clinical diagnostic accuracy of 23 per cent, with common misdiagnoses including brainstem stroke and vestibular or labyrinthine disturbance. Presentation with, or the later development of stupor or coma strongly correlated with poor outcome (severe disability or death; p = 0.002). The characteristics of conscious patients who remained stable were compared with those who subsequently deteriorated. The initial conscious state (alert, drowsy or confused), severity of symptoms and ataxia, and the size of haemorrhage on CT scan were not reliable prognostic indicators. However, the presence of bilateral gaze paresis, anarthria (present in eight cases), limb weakness, a systolic blood pressure above 200 mmHg and moderate hydrocephalus significantly correlated with a poor outcome. The presence of these signs warrants consideration of urgent surgical intervention at the time of diagnosis. Since no clinical or radiological findings excluded the possibility of further deterioration, careful monitoring in an intensive care unit is necessary within the first 48 h in those conscious patients who are likely to remain stable. Guidelines for making the clinical diagnosis and for selecting those patients who will require transfer to adequately equipped centres are suggested.
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PMID:Cerebellar haemorrhage--diagnosis and treatment: a study of 75 consecutive cases. 344 85

Cerebral symptoms were registered in a multicenter study including 64 patients with severe hypertension, diastolic blood pressure (DBP) greater than or equal to 135 mmHg, and more or less pronounced hypertensive encephalopathy. The symptoms were: headache (70%), dizziness (35%), consciousness disturbances (28%), nausea (27%), paresis (23%), blurred vision (22%), paraesthesia (21%) and vomiting (14%). None had convulsions or coma. Initial treatment was furosemide i.v., and if DBP was greater than or equal to 125 mmHg after one hour, patients were randomized to treatment with either i.v. diazoxide (bolus injections of 75-150 mg) or i.m. dihydralazine (bolus injections of 6-12.5 mg). A gradual fall in blood pressure (BP) was obtained in all three groups. Along with BP reduction a substantial regression of neurological symptoms was registered. After 5 hours only minor cerebral symptoms were present without significant difference between diazoxide and dihydralazine. None developed cerebral complications. The study failed to show a significant correlation between BP reduction and regression of neurological symptoms graded semiquantitatively. Reduction of BP by titration using small repeated bolus injections is recommended, but oral treatment should be considered in the patients who are able to ingest peroral medication in spite of neurological symptoms.
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PMID:Reversibility of cerebral symptoms in severe hypertension in relation to acute antihypertensive therapy. Danish Multicenter Study. 353 94

A case of transient complete bilateral paresis of abduction is reported without esotropia. Loss of vestibular ocular reflex (VOR) responses of the abducting eye and intactness of all other slow VOR reactions were the leading symptoms. Since bilateral lesions of the pontine gaze centers in this initially comatose patient without signs of increased intracranial pressure were excluded, bilateral lesions of the abducens nerves appeared improbable. In view of normal function of the ascending tract of Deiters bilateral paramedian lesions between the vestibular and abducens nuclei appeared to be more likely. Clinical course with relatively rapid recovery after administration of thiamine, theoretical considerations, and some earlier reports led to the conclusion that in some metabolic-toxic disorders--apparently in this case of Wernicke's encephalopathy--intrapontine connections in the paraabducens area may be selectively vulnerable. A similar effect on oligosynaptic connections to the medial rectus nucleus could lead to a disordered inhibition of this muscle. The term "posterior INO of Lutz" should no longer be used because of the lack of any anatomical and physiological evidence for its existence.
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PMID:Isolated ophthalmoplegia of abduction. 366 51


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