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Query: UMLS:C0030552 (paresis)
 5,831 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

We report a case of protracted intraoperative cardiac arrest (15 minutes), occurring in a patient with haemorrhagic shock in consequence of a bullet wound to the right hemithorax; external cardiac massage was immediately started and carried on until the restoration of spontaneous cardiac activity. In the immediate postoperative period, the patient presented seizure activity, treated with TPS in continuous infusion (2 mg/kg/h) and DPH (250 mg/die). Anticonvulsant therapy didn't allow a correct neurologic evaluation of the patient; that was possible only when treatment was suspended (4 days after ICU admission). Neurophysiological investigations (EEG and Somato-Sensorial Evoked Potentials) were undertaken; particularly SSEPs recorded no pathologic alteration of the cortical response. At the discharge from ICU the patient was completely awake after coma, a residual paresis of the right lower limb was present. We suggest that in post-anoxic coma, when anticonvulsant therapy is required, neurophysiological investigations improve the accuracy of early outcome prediction.
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PMID:[Complete neurological recovery following prolonged cardiac arrest. Description of a clinical case]. 780 53

We analysed 27 complex partial seizures arising from the temporal lobes recorded on videotape simultaneously with the EEG emphasizing the motor manifestations specially dystonic posturing, ictal paresis and head and eye forced deviation (version). The temporal lobe origin of the seizures was based on the agreement of many scalp-sphenoidal or zygomatic interictal and ictal EEG recordings, CT and MRI findings, interictal and, in some patients, ictal SPECT studies. 8 patients had surgery. In 5 from 7 patients who had temporal lobectomy, mesial temporal sclerosis was the anatomopathological finding and in one patient who had selective amigdalohippocampectomy, hemosiderosis and gliosis probably due to bleeding of a posterior cerebral artery giant aneurysm was found. All patients have been seizure free after surgery. While dystonic posturing and ictal paresis, present in 18 seizures (66.6%), were excellent as lateralizing seizure signs, since they were always contralateral to the ictal onset, contralateral and ipsilateral versive head and eye movements were observed.
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PMID:[Clinical manifestations in complex partial crisis of the temporal lobe: a video-electroencephalographic study]. 782 40

We conducted a longitudinal self-controlled study of 131 patients aged 4-60 treated with resective surgery for medically uncontrolled partial epilepsy from 1949 to 1988. Using multivariate logistic regression, we showed that pre- and perioperative variables can be used to predict "success" or "failure" of surgical resective treatment in approximately 79% of cases. If the predicted probability is > 0.75 or < 0.25, the model predicts a correct result in 87% of cases. Eight predictive factors emerged with a backward multivariate logistic regression model with the likelihood-ratio (LR) test to exclude variables from the equation: (a) the influence of the surgical team and surgical procedure, (b) the presence of paresis preoperatively, (c) duration of disease, (d) age at treatment, (e) positive neuroradiologic findings in preoperative investigations, (f) preoperative complex partial seizures (CPS), (g) nonepileptic EEG abnormalities, and (h) generalized spike activity in EEG preoperatively. Sex, age at first seizure, area of resection, presence of simple or generalized seizures preoperatively, preoperative seizure frequency, tissue pathology, use of computed tomography/nuclear magnetic resonance (CT/NMR) in preoperative investigations, degree of preoperative neurologic deficit, perioperative electrocorticographic results, and bilateral EEG spikes did not have predictive value in the model.
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PMID:Predictive factors for success in surgical treatment for partial epilepsy: a multivariate analysis. 802 2

Sixteen patients (8 female, 8 male) with primary angiitis of the CNS (PACNS), were followed prospectively in a vasculitis clinic. Diagnosis was by angiography in patients without underlying disease. Median age at diagnosis was 36.5 years, and median duration of follow-up was 28 months. Onset was acute in 14 patients (88%), with 3.5 weeks (median) from onset symptoms to diagnosis. Three women developed symptoms within 3 weeks postpartum. The most frequent symptoms were severe headaches (12, 75%), stroke (6, 30%), transient ischaemic attack (TIA) (4, 28%), seizures (7, 44%), visual aberration (3, 19%), and cognitive impairment (5, 31%). Laboratory data included high ESR (2, 13%), leucocytosis (8, 80%), thrombocytosis (1, 6%), positive antinuclear antibody titre (3, 15%), and high levels of complement (5, 31%). Lumbar puncture was performed in 12 patients (75%). CSF analysis was abnormal in five patients (42%). EEG was abnormal in 5/9 patients. The major CT/MRI scan findings were cerebral haemorrhage (4, 25%), brain infarcts (5, 31%), brain atrophy (2, 13%) and non-specific lesions (2, 13%). Four patients had normal studies. All patients received corticosteroids (CS), and five were treated with oral cyclophosphamide. Two patients relapsed despite CS and cyclophosphamide therapy. All patients are alive, and at the last assessment, eight had a permanent neurological deficit, which included paresis (3, 19%), neurocognitive abnormalities (2, 13%), visual loss (2, 13%) and seizure activity (5, 31%). Our data suggest a non-progressive, non-fatal course in those PACNS patients diagnosed angiographically and treated with CS with or without cyclophosphamide.
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PMID:Primary angiitis of the CNS diagnosed by angiography. 804 67

In a population based register of stroke (n = 536) compiled in Perth, Western Australia during an 18 month period in 1989-90, 60 cases (11%) of primary intracerebral haemorrhage were identified among 56 persons (52% men). The mean age of these patients was 68 (range 23-93) and 46 (77%) events were first ever strokes. The crude annual incidence was 35 per 100,000, with a peak in the eighth decade, and a male predominance. Deep and lobar haemorrhages each accounted for almost one third of all cases. The clinical presentations included sudden coma (12%), headache (8%), seizures (8%), and pure sensory-motor stroke (3%). Primary intracerebral haemorrhage was the first presentation of leukaemia in two cases (both fatal) and it followed an alcoholic binge in four cases. 55% had a history of hypertension. 16 (27%) patients, half of whom had a history of hypertension, were taking antiplatelet agents, and one patient was taking warfarin. There were only two confirmed cases of amyloid angiopathy. The overall 28 day case fatality was 35%, but this varied from 100% for haemorrhages in the brainstem to 22% for those in the basal ganglionic or thalamic region. Other predictors of early death were intraventricular extension of blood, volume of haematoma, mass effect, and coma and severe paresis at onset. Although based on small numbers, these data confirm the heterogeneous nature of primary intracerebral haemorrhage, but they also suggest a different clinical spectrum of this type of stroke in the community compared with the experience of specialist neurological units.
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PMID:Spectrum of primary intracerebral haemorrhage in Perth, Western Australia, 1989-90: incidence and outcome. 805 17

The presented patient was injured while repairing a car. When the motor was running a metal blade of the fan broke off and struck him on the right side of his forehead. The blade sticking in the bone was removed surgically, and after 17 days he was discharged home without neurological deficit. After 60 days paresis of the left upper extremity and rhinorrhoea developed, and the patient had a second operation. Four months after the injury the first seizure appeared, provoked by discontinuation of anticonvulsants.
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PMID:[Craniocerebral injury with foreign body penetration complicated with rhinorrhea, intracranial pneumatocele and early epilepsy]. 816 88

Forty-two cats underwent craniotomy for removal of a meningioma between 1985 and 1991. Median duration of clinical signs before examination was 1.25 months. All cats had inappropriate demeanor: 48% were dull and 38% were lethargic. Neurological deficits included impaired vision in 93%, paresis in 83%, and seizures in 19%. Computed tomography (CT) showed solitary masses in 86% and multiple masses in 14%. Intraoperative complications included hemorrhage and difficulty excising deep or adherent masses. Anemia in 13 of 42 cats was the most common immediate postoperative complication. Ten of 42 cats had no improvement or a more severe neurological status after surgery. Eight of 42 cats died immediately after surgery; 6 of these were anemic. Of the cats that survived the immediate postoperative period, evaluation 10 to 14 days after surgery showed that 97% (33 of 34) were alert and 79% (27 of 34) had returned to normal behavior. Neurological deficits, except for vision impairment, had resolved in most cats. The duration of follow-up varied from 1.3 months to 55.1 months. Ten cats developed neurological abnormalities from 1 month to 44.2 months after surgery; of these, 6 had tumor recurrence or new growth confirmed by CT scan or necropsy. Overall survival was 71% at 6 months, 66% at 1 year, and 50% at 2 years. Age of cat and location of tumor did not significantly affect survival (P = .1034 and .1851, respectively). There were too few precise measurements of tumor size to make a valid statistical comparison of the effect of size on survival. Location or presence of multiple tumors did not affect final outcome.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Results of craniotomy for the treatment of cerebral meningioma in 42 cats. 819 79

Gaucher disease is the most prevalent hereditary metabolic storage disorder, and the most common genetic disease in individuals of Ashkenazic Jewish ancestry. Patients with Gaucher disease have been classified into three clinical phenotypes. Patients with type 1 disease exhibit markedly variable hepatosplenomegaly, anemia, thrombocytopenia, skeletal, and, to a lesser extent, pulmonary and kidney involvement. The central nervous system does not appear to be involved. In patients with type 2 Gaucher disease, hepatosplenomegaly and extensive central nervous system damage are apparent in infancy. These patients usually die between 1 and 2 years of age. Patients with type 3 Gaucher disease have been subclassified into types 3a and 3b. Type 3a patients exhibit mild-to-moderate hepatosplenomegaly and slowly progressive neurologic deterioration. Recurrent myoclonic seizures are common. Patients with type 3b Gaucher disease exhibit splenomegaly along with extensive hepatomegaly that is frequently accompanied by esophageal varices. Horizontal supranuclear gaze paresis is the major neurologic sign. Excessive quantities of glucocerebroside accumulate in the organs of patients with Gaucher disease because of a deficiency of the enzyme glucocerebrosidase. In the vast majority of patients, the reduction of glucocerebrosidase activity is caused by mutations in the gene that codes for glucocerebrosidase. In a few instances, glucocerebroside accumulates due to a lack of saposin C, a cohydrolase that is required in addition to glucocerebrosidase for the catabolism of glucocerebroside. Mutations in the glucocerebrosidase gene are discussed in the context of the severity of disease and the presence or absence of nervous system involvement. Enzyme replacement therapy is highly beneficial for patients with type 1 Gaucher disease. Enzyme replacement is also being investigated for patients with type 3b Gaucher disease. Novel procedures must be developed to deliver glucocerebrosidase to the nervous system so that patients with type 2 and type 3a Gaucher disease can be helped. Exploration of gene therapy for Gaucher disease is under way.
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PMID:The role of neurogenetics in Gaucher disease. 821 80

The effects of procaine injected into the substantia innominata (SI) and the amygdala (AM) were compared in AM-kindled rats. Intra-SI injection of procaine (ipsilateral to the kindled AM) caused immediate contralateral hemiparesis lasting for about 30 min, associated with EEG amplitude reduction. When the kindled AM was stimulated at the previously established generalized seizure triggering threshold (GST), 8/15 animals had ipsilateral hemiconvulsive seizure 5 min after the injection. In all the animals, afterdischarge was readily produced with a significant reduction in its duration. When procaine was injected into the kindled AM, there was no paresis or EEG change. AM stimulation at the GST did not evoke afterdischarge 5 min after the injection, although the kindled seizure was reactivated by a more intense stimulus. After 24 hr, all the animals, regardless of the site of procaine injection, responded to GST stimulation with a kindled seizure. The data suggest that: (1) the effect of intra-SI procaine is not due to drug diffusion to the kindled AM, and (2) the kindled AM can gain access to the contralateral hemispheric motor mechanism without participation of the ipsilateral SI.
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PMID:Ipsilateral hemiconvulsive seizure after unilateral injection of procaine into the substantia innominata of amygdaloid-kindled rats. 831 95

Electrical stimulation of the vagus nerve has shown efficacy in controlling seizures in experimental models, and early clinical trials have suggested possible benefit in humans. Eleven patients with complex partial seizures were subjected to implantation of vagus nerve stimulators. Electrode contacts embedded in silicone rubber spirals were placed on the left vagus nerve in the low cervical area. A transcutaneously programmable stimulator module was placed in an infraclavicular subcutaneous pocket and connected to the electrode. One patient required replacement of the system due to electrode fracture. Another patient developed delayed ipsilateral vocal-cord paralysis; the technique was then modified to allow more tolerance for postoperative nerve edema. A third patient showed asymptomatic vocal-cord paresis on immediate postoperative laryngoscopy. Vagus nerve stimulation produces transient vocal-cord dysfunction while the current is on. Nine patients were randomly assigned to receive either high- or low-current stimulation, and seizure frequency was recorded. The high-current stimulation group showed a median reduction in seizure frequency of 27.7% compared to the preimplantation baseline, while the low-current stimulation group showed a median increase of 6.3%. This difference approached statistical significance. The entire population then received maximally tolerable stimulation. The high-current stimulation group showed a further 14.3% reduction, while the low-current stimulation group showed a 25.4% reduction compared to the blinded period. The efficacy of vagus nerve stimulation seemed to depend on stimulus parameters, and a cumulative effect was evident. These results are encouraging, and further study of this modality as an adjunct treatment for epilepsy is warranted.
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PMID:Vagus nerve stimulation for complex partial seizures: surgical technique, safety, and efficacy. 841 Feb 39


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