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

The authors describe their experience with four cases of dural arteriovenous malformation (AVM) which led them to analyze the clinical aspects of these lesions in an attempt to understand their pathophysiology. An additional 191 previously reported cases of dural AVM's were reviewed with special attention to the mechanism of intradural, central, and peripheral nervous system manifestations. Apart from the peripheral cranial nerve symptoms, which are most likely due to arterial steal, the central nervous system (CNS) symptoms appear to be related to passive venous hypertension and/or congestion. Generalized CNS symptoms can be related to cerebrospinal fluid malabsorption due either to increased pressure in the superior sagittal sinus, to venous sinus thrombosis, or to meningeal reaction resulting from minimal subarachnoid hemorrhages. These phenomena are not related to the anatomical type of venous drainage. On the other hand, focal CNS symptoms are specifically indicative of cortical venous drainage. Seizures, transient ischemic attacks, motor weakness, and brain-stem and cerebellar symptoms can be encountered depending on the territory of the draining vein or veins. Therefore, the localizing value of focal CNS symptomatology relates to the venous territory and not to the nidus or to the arterial supply characteristics of dural AVM's. Furthermore, the venous patterns of various dural AVM's at the base of the skull are expressed by differences in their clinical presentation. Dural AVM's of the floor of the anterior cranial fossa and of the tentorium are almost always drained by the cortical veins and, therefore, have a high risk of intradural bleeding. The remarkable similarities in the manifestations of dural and brain AVM's and the differences in the manifestations of dural and spinal dural AMV's are pointed out. High-quality angiograms and a multidisciplinary approach to the study of dural AVM's will provide the best understanding of their symptoms and, therefore, the most appropriate treatment strategy.
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PMID:Neurological manifestations of intracranial dural arteriovenous malformations. 370 21

Male Fischer rats received daily intraperitoneal injections of cyclosporine (IV preparation containing CsA + cremophor) diluted in NaCl or in NaCl + cremophor. At the dose of 100 mg and 50 mg/kg/day the animals developed seizures, motor weakness and died at 4-7 days. Light microscopy at 7 days in these rats showed diffuse vacuolization of all segments of the proximal tubules which was very extensive in the outer stripe. At the dose of 25 mg and 15 mg/kg/day animals were free of symptoms and were sacrificed at day 15 for functional and histological studies. Light and electron microscopy showed cytoplasmic vacuolization in all segments of the proximal tubules. Crystal structures were observed in the experimental animals as well as in the control group that received cremophor + NaCl. The CsA blood levels were at the range of 134-236 ng/ml. Reduction of the glomerular filtration rate was observed in experimental animals as compared with the controls. We concluded that CsA is not the cause of an interstitial nephritis in the Fischer rats and that CsA is nephrotoxic to all segments of the proximal tubules. The cremophor is the cause of the crystal structures seen in the proximal tubules.
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PMID:Cyclosporine nephrotoxicity in the Fischer rat. 370 42

Brain metastases are rare in well-differentiated thyroid carcinoma but when present they can lead to the patient's death. Iodine-131 therapy for intracerebral thyroid carcinoma metastases causes radiation-induced acute cerebral edema that can lead to CNS complications and even death. We present a case in which a patient with intracerebral 131I uptake developed seizures, slurred speech, and muscle weakness 12 hr following 131I therapy. The patient's CT scan, post-therapy, confirmed an intracranial metastasis with a significant amount of surrounding edema. Radiotherapists, when using external beam radiation to treat intracerebral metastases, commonly place these patients on steroids, glycerol, or mannitol prior to instituting therapy, to prevent complications from radiation-induced cerebral edema. This technique could be applied to 131I therapy of intracranial thyroid carcinoma metastases as well.
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PMID:Cerebral edema following iodine-131 therapy for thyroid carcinoma metastatic to the brain. 371 81

The subjects were 42 alcoholic patients (33 males and 9 females) who were treated with lithium orotate during an alcohol rehabilitation program in a private clinical setting for at least six months. They derive from a total number of 105 patients who received this treatment initially, while the remainder discontinued the treatment within six months. The data were collected from a private practice record and the follow-up varied between six months and 10 years. The 42 patients studied displayed a multitude of complaints in addition to chronic alcoholism. These included liver dysfunction, seizure disorders, headaches, hyperthyroidism, affective disorders. Meniere's syndrome, liver and lung cancers. Thirty-six of the 42 patients studied had been hospitalized at least once for the management of their alcoholism. Lithium orotate was given, 150 mg daily, with a diet low in simple carbohydrates and containing moderate amounts of protein and fat. In addition, calcium orotate (for hepatic involvement), magnesium orotate, bromelaine, and essential phospholipids (for cardiac problems), and supportive measures were instituted, if required. Lithium orotate proved useful as the main pharmacologic agent for the treatment of alcoholism. Ten of the patients had no relapse for over three and up to 10 years, 13 patients remained without relapse for 1 to 3 years, and the remaining 12 had relapses between 6 to 12 months. Lithium orotate therapy was safe and the adverse side effects noted were minor, i.e., eight patients developed muscle weakness, loss of appetite or mild apathy. For these patients, the symptoms subsided when the daily dose was given 4 to 5 times weekly.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Lithium orotate in the treatment of alcoholism and related conditions. 371 72

We describe a case of granulomatous encephalitis caused by Bipolaris (Drechslera) hawaiiensis in an immunocompetent patient. An 18-year-old man with a seven-month history of seizures and right leg weakness was found by computed tomographic scan to have a left frontoparietal enhancing lesion. Biopsy of the lesion revealed granulomatous inflammation and numerous septate hyphae. Culture of the biopsy specimen yielded a pure culture of B hawaiiensis in four days. Susceptibility studies revealed the organism to be sensitive to amphotericin B (minimal inhibitory concentration [MIC] equals 0.25 mg/L) and miconazole lactate (MIC equals 0.064 mg/L), but resistant to flucytosine (MIC greater than 100 mg/L). No synergy was demonstrated with amphotericin B and flucytosine in vitro. The patient was successfully treated with surgery and systemic and intrathecal amphotericin B therapy, and a negative culture was obtained from a repeated brain biopsy six weeks later.
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PMID:Granulomatous encephalitis caused by Bipolaris hawaiiensis. 377 50

The clinical features of 66 patients with histologically defined mitochondrial myopathy are described. The age of onset of symptoms ranged from birth to 68 years, but was before 20 years in 61%. Nineteen patients had similarly affected relatives. Three groups of cases could be identified clinically: a combination of progressive external ophthalmoplegia and weakness of the limbs induced or increased by exertion (55%); such limb weakness alone (18%); and those with clinical features, such as ataxia, dementia, deafness, involuntary movements and seizures, predominantly or exclusively arising from the CNS (27%). There was considerable overlap between these groups, and pigmentary retinopathy, present in 36% of patients, occurred in all three. At a mean disease duration of twenty years, 9 patients (all from Group 3) were severely disabled but 42 were still able to work. In vitro studies of mitochondrial metabolism, performed in 33 cases, most commonly showed deficiencies of the mitochondrial respiratory chain localized to complex I (18 patients) or complex III (9). No typical clinical picture emerged for any of the identifiable biochemical defects.
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PMID:The clinical features of mitochondrial myopathy. 377 73

Of 68 patients with unclippable aneurysms treated by proximal artery occlusion with detachable balloons, permanent occlusion was achieved in 65; of these patients, 37 had carotid artery aneurysms below the origin of the ophthalmic artery, 21 had aneurysms arising from the supraclinoid portion of the carotid artery, six had basilar trunk aneurysms, and one had a distal vertebral aneurysm. Examination for treatment selection included assessment of the circle of Willis by compression angiography and xenon blood flow studies, with the ultimate evaluation being test occlusion under systemic heparinization with the balloon temporarily placed in the desired position. Of 67 patients who underwent a formal occlusion test, eight with carotid artery aneurysms did not initially tolerate the occlusion test, and ischemic signs disappeared instantaneously with deflation and removal of the balloon. During test occlusion, two additional patients had ischemic events that proved to be embolic; these reversed immediately upon balloon deflation. Of the 65 patients in whom permanent occlusion was effected by detachable balloon, there were nine instances of delayed cerebral events. One of these was a seizure leading to respiratory arrest and resuscitation 3 days following occlusion in a patient who had presented with seizures. The other eight cases were delayed ischemic events; seven were completely reversed and one patient had residual weakness in one leg (1.5% permanent morbidity). Extracranial-intracranial bypass procedures were performed in 25 of the 65 cases. All aneurysms of the carotid artery below the level of the ophthalmic artery presented angiographic proof of complete thrombosis. Ten of 21 aneurysms arising from the supraclinoid portion of the carotid artery were completely thrombosed by proximal occlusion alone, without additional trapping procedures. Similarly, in three of six basilar trunk aneurysms, proximal occlusion alone initiated complete aneurysm thrombosis without trapping. The conclusion is that proximal balloon occlusion for unclippable cerebral aneurysms is a convenient, safe, and effective way of producing arterial occlusion in these cases.
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PMID:Use of detachable balloons for proximal artery occlusion in the treatment of unclippable cerebral aneurysms. 378 58

Incontinentia pigmenti (IP) has been associated with CNS involvement, including seizures, retardation, motor abnormalities, and malformations in greater than 30% of patients. Motor symptoms include spasticity and hyperreflexia; however, weakness and flaccidity have also been described. Peripheral nervous system neuropathology in patients with IP has not previously been reported. The infant with IP in this report showed generalized weakness due to anterior horn cell degeneration. The neuropathologic findings in both the central and peripheral nervous systems will be reviewed and contrasted to previous reports. Patients with IP and weakness should undergo neurodiagnostic evaluation of peripheral nervous system function.
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PMID:Incontinentia pigmenti: association with anterior horn cell degeneration. 382 37

An 8 1/2-year-old girl presented with a long history of seizures, growth retardation, muscle weakness, gait disturbance, and hearing loss. Her evaluation revealed chronic moderate renal failure (serum creatinine 2.2 mg/dL), severe hypocalcemia (5 mg/dL), hyperphosphatemia (8.1 mg/dL), hypomagnesemia (1.5 mg/dL), increased urinary magnesium excretion (2 mg/kg/d), high fractional excretion of magnesium (21.7%), hypokalemia (3.2 mEq/L), and hyperkaliuria (26 mEq/L). Low circulating immunoreactive parathyroid hormone levels for the degree of the hypocalcemia (serum N-parathyroid hormone 212 pg/mL) and severe rickets without evidence of osteitis fibrosa cystica were found. The patient probably has primary renal leak hypomagnesemia (magnesuric hypomagnesemia) which caused impaired secretion of immunoreactive parathyroid hormone leading to severe hypocalcemia and calcium deficiency rickets. Treatment with magnesium and calcium supplements, calcitriol, and aluminum hydroxide resulted in marked clinical, biochemical, and radiologic improvement. Calcium deficiency rickets due to primary or secondary renal magnesium wasting in conjunction with moderate renal failure represents a largely unrecognized metabolic bone disease.
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PMID:Severe renal osteodystrophy without elevated serum immunoreactive parathyroid hormone concentrations in hypomagnesemia due to renal magnesium wasting. 382 40

Alprazolam treatment was tapered in 17 panic patients at a rate of 10% of the starting dose every 3 days. Only four subjects completed withdrawal on schedule (4-5 weeks); four additional subjects discontinued treatment in 7-13 weeks. During withdrawal 15 patients had recurrent or increased panic attacks and nine had significant new withdrawal symptoms. Most common among the latter were malaise, weakness, insomnia, tachycardia, lightheadedness, and dizziness. None had seizures, psychosis, or significant neurological or EEG abnormalities. Results indicate that relapse and withdrawal are important considerations in the choice of alprazolam treatment for panic attacks.
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PMID:Discontinuation of alprazolam treatment in panic patients. 382 28


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