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Query: UMLS:C0036572 (seizures)
 80,221 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Common causes of coma in falciparum malaria are cerebral malaria, hypoglycaemia and electrolyte disturbances. Focal deficits due to arterial infarcts may sometimes occur in children, but are rare in adults. Three adults with falciparum malaria who had fever, altered consciousness and focal neurological deficits (one of whom also had seizures) are being reported here. CT scan of the brain revealed haemorrhagic infarction of the cerebral cortex and subcortical white matter with surrounding oedema suggestive of venous infarction in all three patients. The diagnosis of cerebral venous thrombosis was missed in the first patient, and was detected only at autopsy. In the next two patients, superior sagittal sinus thrombosis was confirmed angiographically. Only one patient survived; the other two died of increased intracranial pressure. Two of the three patients also had Plasmodium vivax co-infection. A hypercoagulable state resulting from severe malaria may be responsible for this rare and potentially fatal complication. Cerebral malaria may be associated with raised intracranial pressure due to cerebral oedema. Cerebral venous thrombosis may worsen this and adversely affect outcome. This diagnosis should be suspected in patients with severe malaria who develop focal neurological deficits and confirmed by appropriate imaging; judicious use of local thrombolytic therapy may help improve outcome.
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PMID:Cerebral venous and dural sinus thrombosis in severe falciparum malaria. 1466 96

Haemangioma calcificans is a relatively rare intracranial tumour, which is characterized by the presence of a calcified nodule in or near the brain. The patient is most often an adult of either sex, who develops seizures. The lesion can be large enough to produce raised intracranial pressure. The location of tumour is subcortical and often in the temporal lobe. It is usually solitary and benign in nature. Microscopically, there are thin-walled blood vessels separated by dense fibrous bands containing deposits of haemosiderin and calcium. On electron microscopy, tubular structures limited by a wall of electrodense material and irregular calcium deposits within them are prominent features. Four cases of haemangioma calcificans are described here with review of literature.
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PMID:Haemangioma calcificans. 1475 89

Plasmodium falciparum is the most common cause of severe and life-threatening malaria. Falciparum malaria causes over one million deaths every year. In Africa, a vast majority of these deaths occur in children under five years of age. The presentation of severe malaria varies with age and geographical distribution. The mortality rate is higher in adults than in children but African children develop neuro-cognitive sequelae following severe malaria more frequently. The management of severe malaria includes prompt administration of appropriate parenteral anti-malarial agents and early recognition and treatment of the complications. In children, the complications include metabolic acidosis (often caused by hypovolaemia), hypoglycaemia, hyperlacticacidaemia, severe anaemia, seizures and raised intracranial pressure. In adults, renal failure and pulmonary oedema are more common causes of death. In contrast, concomitant bacterial infections occur more frequently in children and are associated with mortality in children. Admission to critical or intensive care units may help reduce the mortality, and the frequency and severity of sequelae related to severe malaria.
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PMID:Management of severe falciparum malaria. 1504 99

In view of very limited availability of paediatric intensive care (PIC) facilities in developing countries, it is important to define priorities and recognise children who might benefit most from PIC. The objective of this retrospective, descriptive analysis was to identify the clinical indicators for intensive care in children with acute bacterial meningitis (ABM). The study included 220 children aged between 1 month and 12 years with ABM admitted to the paediatric services of an urban, tertiary-care, teaching hospital in northern India from July 1993 to December 1996. Of these, 88 were transferred to the PICU by the primary physician, 59% were comatose (Glasgow coma score <8), 44% had raised intracranial pressure (ICP), 24% were in shock and 42% had respiratory distress/failure. Seizures occurred during their illness in 64 children, 34 of whom had refractory status epilepticus. Endotracheal intubation was needed in 29 and ventilatory support in 19 children. Most of the life support measures were required during the initial 48 hours. Nineteen (22%) children died, 16 of whom were comatose on admission. Multiple system involvement was associated with higher mortality. There were no deaths among the children who were not transferred to the PICU. Children with ABM who have a Glasgow coma score <8, clinical signs of raised ICP, refractory status epilepticus, shock and/or respiratory compromise should be prioritised to receive PIC.
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PMID:Intensive care needs of children with acute bacterial meningitis: a developing country perspective. 1518 41

Choroid plexus carcinoma is a rare intracranial neoplasm, affecting mainly very young children. The commonest site is within the lateral ventricles and the prognosis is very poor. We report a seven month old baby boy who presented with raised intracranial pressure and seizures. Brain CT scan showed large intraventricular mass with calcification and hydrocephalus. Total macroscopic resection of the tumour was performed and diagnosis of choroid plexus carcinoma was made. However, the patient died 11 days after the tumour excision. The histopathology of this rare childhood neoplasm is discussed.
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PMID:Choroid plexus carcinoma in an infant. 1519 Jun 65

A 28-year-old man presented with history of raised intracranial pressure and one episode of generalized tonic clonic seizures. Computed Tomogram revealed multiple contrast enhancing intracranial lesions. Biopsy of one of the lesions was reported as metastatic alveolar soft part sarcoma. He was advised whole brain radiotherapy.
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PMID:Alveolar soft-part sarcoma presenting with multiple intracranial metastases. 1526 87

Intracranial schwannoma not related to cranial nerves are unusual and rarely found in the subfrontal region. We report a case of cystic olfactory groove schwannoma in a 55-year- old male, who presented with late onset seizure without raised intracranial pressure. The tumor was excised completely.
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PMID:Cystic olfactory groove schwannoma. 1526 89

Electroconvulsive therapy (ECT) is a safe and efficient procedure performed for the treatment of drug resistant depression and other psychiatric disorders. Nowadays, its administration under general anaesthesia is a worldwide process. Anaesthetic management generally involves a short acting barbiturate such as thiopental in induction followed by a muscle relaxant. Succinylcholine is the drug of choice for muscle relaxation. This approach prevents patients from suffering hazardous orthopaedic injuries due to confusion. The effectiveness of ECT depends on an adequate seizure, and so the anaesthetist should be aware of the factors that influence the duration of seizures as well as concomitant diseases and potential adverse antidepressive drug reactions. An acute haemodynamic response due to sympathetic discharge in the course of the seizure provokes abrupt cardiovascular and cerebrovascular changes such as bradycardia, tachycardia, hypertension and raised intracranial pressure. The control of responses by b-blockers and similar agents is especially important in patients with cardiac or intracerebral problems. ECT is applicable in nearly all age groups and even in pregnant subjects. The aim of this article is to review the aspects of anaesthetic management of safe and effective ECT.
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PMID:[Anaesthesia in electroconvulsive therapy]. 1536 7

Eclampsia continues to be a significant cause of maternal and fetal death throughout the world. Neurologists have a specific role to play in the diagnosis and management of patients who have eclampsia, especially those who have recurrent seizures, raised intracranial pressure, and coma. Postpartum patients may be admitted to a neurology service when they present to the emergency department with seizures. The cornerstone of treatment has been blood pressure control and magnesium sulfate with its antivasospastic effect. Should this fail, antiepileptic drugs of proved efficacy, such as diazepam and phenytoin, can be used. Recent studies reveal genetic and mitochondrial defects in eclampsia, but further investigation is warranted to determine the complex underlying pathophysiologic interplay and the optimum prophylactic and therapeutic management.
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PMID:Neurologic aspects of eclampsia. 1547 70

Acute liver failure (ALF) is an uncommon medical emergency whose rapid progression and high mortality demand early diagnosis and expert management, including immediate transfer of any potential case to facilities for intensive care and orthotopic liver transplantation (OLT). All patients with ALF must be screened aggressively for acetaminophen toxicity (history, serum levels, "hyperacute" presentation with renal failure), for other drugs, and viral hepatitis; rare causes of ALF should also be considered. After an acetaminophen overdose, N-acetylcysteine must be given as early as possible, preferably in the emergency room, but any patient with ALF should promptly receive N-acetylcysteine if there is suspicion of acetaminophen toxicity irrespective of the time of ingestion. Supportive care for all patients with ALF includes adequate enteral nutrition, aggressive screening and treatment of infection, prophylactic broad-spectrum antibiotics, and antifungal agents. Sedation with propofol is given for severe agitation or mechanical ventilation. With advanced coma grades, intensive care is needed with hemodynamic monitoring, ventilatory support, continuous renal replacement for renal failure, and intracranial pressure monitoring. Intracranial hypertension is treated with mannitol and/or acute short-term hyperventilation, but if the patient is refractory to treatment, mild-moderate hypothermia is achieved by a cooling blanket that is continued throughout OLT. Barbiturate coma is only used in refractory cases as the last treatment modality. Seizures are aggressively treated with phenytoin, with additional diazepam as needed. Candidacy and activation for OLT should be completed as early as possible in the course of ALF, especially in "hyperacute" cases such as acetaminophen toxicity. The final decision to proceed with OLT is made when a donor organ becomes available. King's College Hospital criteria for OLT are still the best prognostic assessment for fatal outcome in ALF, but the criteria fail to identify some patients who will die.
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PMID:Acute Liver Failure. 1552 12


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