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

All patients who presented to the emergency department as a result of cocaine intoxication during a one-year period were reviewed retrospectively. One hundred thirty-seven cases were reviewed. Patients presented with a wide variety of chief complaints including altered mental status (40%), chest pain (21%), syncope (19%), suicide attempt (13%), palpitations (12%), and seizures (12%), as well as numerous other complaints. There was only one death. Few patients required treatment within the ED; sixteen required hospitalization.
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PMID:Emergency department presentation of cocaine intoxication. 291 84

The mean age of the 13 patients studied (9 women, 7 men) was 50.5 +/- 15.7 years. The disease was discovered on account of malaise (3 cases), behavioural disorders (4 cases), coma (3 cases), syncope (1 case) or right hemiparesis (1 case) or in the course of systematic examination (1 case). Eleven patients consulted for evaluation of hypoglycaemia and 2 for behavioural disorders. The history was characteristic, with malaise, loss of consciousness, severe neurological disorders (seizures, hemiparesis, hemiplegia or coma) and psychiatric disorders. These symptoms typically occurred in the morning before breakfast or between meals in 9 patients, and atypically at any point of time or after meals in 4 patients. Their hypoglycaemic nature was demonstrated by blood glucose determination in 11/13 cases and by response to ingestion of sugar in 12/13 cases. The mean period elapsed between the initial symptoms and the final diagnosis was 20.3 +/- 17.3 months. Inappropriate insulin secretion was elicited a.m. before breakfast, during Conn's diet or fasting test, or by calculating the blood insulin/glucose ratio or Turner's coefficient. Prior to surgery, the insulinoma was located by ultrasonography in 3/8 cases, by computerized tomography in 2/6 cases, by selective arteriography in 6/11 cases, and by phlebography with spleno-portal catheterization and staged sampling for insulin and C-peptide assays in 8/9 cases. Histological examination after surgery (11 cases) or necropsy (1 case) showed an adenoma without evidence of malignancy.
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PMID:[Insulinoma: diagnostic elements. 13 cases]. 299 55

Case report of a 35 years old patient, who, without previous history of epilepsy, within two years experienced two long-lasting psychotic episodes due to non-convulsive status epilepticus with complex partial seizures. During the second psychotic episode she developed ictal vegetative phenomena such as profuse sweating, flush, apnoea, and, above all and most alarming, periods of severe bradycardia and asystolia with clinical signs of syncope. Ictal asystolia, though being an uncommon sing of epileptic seizures, may be one cause of sudden unexpected death in epileptics.
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PMID:[Epileptic psychosis and nonconvulsive status epilepticus with ictal bradycardia and asystole]. 309 May 78

Three hundred fifty patients in an observation unit attached to an emergency department received diagnostic workup of nine critical diagnostic syndromes (abdominal pain, flank pain, headache, possible cerebrovascular accident, chest pain, dizziness or syncope, head injury, seizure, multiple trauma). The decision to hospitalize for acute care after observation for 11.1 +/- 3.9 hours was examined. The objective diagnosis-related group (DRG) criteria for admission were compared retrospectively with the physician's clinical judgment of need for hospitalization. Clinical outcome was used to establish the correctness of the decision to hospitalize. Clinical judgment was compared with objective DRG criteria for reliability in predicting the presence of serious pathology necessitating acute care hospitalization; respective values were sensitivity, 100% vs 76%; specificity, 86% vs 80%; positive predictive value, 75% vs 62%; and negative predictive value, 100% vs 89%. The difference between the sensitivity of the two admission criteria was highly significant (P less than 10(-8); chi 2, 26.12). We conclude that the physician's clinical judgment outperforms DRG objective criteria in identifying which patients with critical diagnostic syndromes need acute care hospitalization for emergency medical or surgical therapy.
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PMID:Decision to hospitalize: objective diagnosis-related group criteria versus clinical judgment. 313 51

The value of echocardiography in the evaluation of dizziness was studied in 151 consecutive patients. Twenty-two patients, on further review, were found to have related complaints, seizures and syncope mainly, but not dizziness. Twenty-four patients had vertigo, 67 had nonvertiginous dizziness, and in 38 patients, there was insufficient information to categorize the dizziness as being vertigo or nonvertiginous dizziness. When the 22 nondizzy patients were compared with the 129 dizzy patients, the only statistically significant differences were that there were more blacks in the nondizzy group and that the aortic root dimension was, on average, 0.4 cm larger in the nondizzy group. These findings, although statistically significant, appeared to be clinically insignificant. There was, however, a high prevalence of valvular heart disease in both the nondizzy and two of the three dizzy subgroups. In most cases, the valvular abnormality had not been suspected clinically. But in no case was significant information added by echocardiography that helped in patient management. Thus, in the dizzy patient, echocardiography should be reserved for specific cardiac indications and not used as a routine screening test.
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PMID:Should echocardiography be used to screen dizzy patients? 317 55

Medical emergencies at a major metropolitan airport have a significant impact on prehospital care capabilities for the rest of the community in which the airport is located. Stapleton International Airport in Denver, Colorado, is a facility that in 1985 had 14.4 million passengers and a static employee population of 12,000 to 15,000. In 1981, there were 1,182 ambulance trips to the airport, 40.4% of which did not result in the transport of a patient. The expense of sending an ambulance and fire engine out on such calls was great, and paramedics were out of service for approximately 300 hours on these nontransport cases. In order to improve prehospital services to the airport and the city, a paramedic has been stationed in the concourse at the airport 16 hours a day since 1982. The records for airport paramedic services for the 12 months ending September 1985 were reviewed. Paramedic services were requested for 1,952 patients. Of these, 696 (35.7%) were transported to hospital by ambulance; 115 (5.9%) went by private car; 284 (14.6%) refused any paramedic care or transport; and 857 (43.9%) were released, after base station contact, with instructions to seek definitive care at the final destination. Presenting complaints were classified into 55 categories and the frequencies and dispositions are described. The most common presentations resulting in transport were chest pain, 110 (5.6%); syncope, 60 (3.1%); psychiatric, 57 (2.9%); abdominal pain, 49 (2.5%); seizure, 36 (1.8%); fracture, 31 (1.6%); and cardiac arrest, 29 (1.5%).(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Prehospital care at a major international airport. 210 61

The most important neurological disorders leading to syncope and/or drop attack are presented. With respect to epilepsy it is important to consider generalized absence seizures (petit mal), generalized tonic-clonic seizures (grand mal) and some types of complex partial seizures. Additionally, some sleep and arousal disorders must be mentioned, such as narcolepsy, disorders of excessive somnolence associated with sleep-induced respiratory impairment, as well as the Kleine-Levin-Critchley syndrome. Vagotonic, asympathicotonic, sympathicotonic and central autonomic disorders are comprised in the group of autonomic attacks. Among other brain diseases manifesting syncope and/or drop attack, cerebrovascular disorders are of major importance in view of their high incidence. Psychogenic seizures also have to be taken into account in the differential diagnosis.
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PMID:[Syncopal consciousness disorders and drop attacks from the neurologic viewpoint]. 328 7

In a 7-year prospective follow-up of 104 children with enuresis in 32 cases (19 boys and 13 girls) coexistence of common migraine was found. Twenty-two children had various other seizure-like disorders, particularly tics, febrile convulsions, pavor nocturnus and fainting, and three had absence attacks. In 20 cases vasomotor disturbances and in 17 abnormal Schellong's test were found. The IQ was normal or high in all cases. Emotional disorders were observed in nearly half the cases. The water-salt test of Decourt was done in 9 cases and it was abnormal in 8 cases. At least two abnormal EEG records were obtained in 26 cases, and in 24 of them seizure activity was demonstrated in the EEG. In the period of follow-up disappearance or very marked improvement of enuresis occurred in all cases and migrainous attacks became less frequent and intense in 27 cases, while in 5 the severity of migraine increased. The author discusses the pathological mechanism of these disturbances calling attention to less good efficiency of the regulatory functions of the centrencephalic activating system and hypothalamus connected with biochemical and bioelectric immaturity.
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PMID:[Coexistence of idiopathic spontaneous nocturnal enuresis and migraine in children]. 344 4

Our recommendations for the evaluation of the patient with suspected cardiogenic syncope are as follows: An initial thorough history and physical examination of the patient will suggest the diagnosis of cardiogenic syncope in at least 50 per cent of patients. A sudden occurrence of syncope, or "drop attack", is most suggestive of an arrhythmic cause for syncope. If there is no evidence of neurologic, metabolic, or obvious cardiac (for example, aortic stenosis) cause for syncope, a 24-hour ambulatory ECG should be performed. If the patient has had repeated syncopal episodes or if the patient has had seizures that are difficult to control with anticonvulsant therapy, ambulatory ECG monitoring may reveal an arrhythmia in these preselected patients. If the initial 24-hour ambulatory ECG is negative and if the patient has had multiple episodes of syncope, multiple days of recording will be necessary before typical symptoms occur that correlate with arrhythmias. Seventy-two hours of ambulatory ECG monitoring should be sufficient in most instances to establish an arrhythmic cause for syncope. Echocardiography and exercise stress testing are not routinely indicated in the evaluation of syncope unless the clinical history and examination suggest valvular or coronary disease. Rarely, an atrial myxoma will be visualized by echocardiography that is not apparent clinically. Those patients who still have unexplained recurrent syncopal episodes, despite all noninvasive studies, can benefit from invasive electrophysiologic studies, although the expected yield from electrophysiologic testing is low.
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PMID:Cardiogenic syncope. Seizure versus syncope. 352 10

An analysis of the clinical features of patients having evidence of a syncopal onset to convulsive episodes is reported. The range of convulsive phenomena was quite wide and did not appear to differentiate the syndrome from primary epilepsy in terms of seizure morphology, occurrence of incontinence or pattern of post-ictal recovery. It is therefore suggested that the premonitory and precipitating features are more specific in the diagnosis of convulsive syncope. Skin pallor was often reported during attacks. Although EEG abnormalities were seen in some cases, the follow-up results indicate a low incidence of unprovoked convulsions in patients with this condition without anticonvulsant treatment.
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PMID:A clinical study of convulsive syncope. 358 11


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