Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0038220 (status epilepticus)
 7,272 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A 51-year-old housewife developed symptoms of a cold followed by high fever, delirium, coma, rigidity of extremity muscles, positive Babinski sign and generalized convulsions, while complement-fixing antibody titre to herpes simplex virus in the sera raised over 128 X and declined to 8 X in the course. She finally expired of bronchopneumonia following status epilepticus after 94 days of illness. Severe necrosis with extensive hemorrhage in the white matter was predominant in the temporal, insular and orbitofrontal cortex, thalamus and globus pallidus. Focal rarefaction of the cerebral cortex with a very few eosinophilic intranuclear inclusions in the oligodendroglia and nerve cells, nerve cell destruction in the substantia nigra with glial nodules and perivascular inflammatory cell cuffs were observed. Abundant cytomegalic inclusion cells, originating from hypertrophic astrocytes, were present in the necrotic areas of cerebrum as well as in the rarefied tissue in the subependymal layers of the brainstem and cerebellum. Electron-microscopic study of the cytomegalic cells demonstrated the presence of numerous virions in both nucleus and cytoplasm. Fortuitour infection of the brain by cytomegalovirus with necrotizing encephalitis by herpes simplex virus is unique. The cause of double viral infections and severe lesions by less virulent strains is discussed.
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PMID:Double encephalitis with herpes simplex virus and cytomegalovirus in an adult. 17 28

The EEG is a useful and, at times, an essential test in the evaluation of delirium. In most patients with delirium, the EEG will show diffuse slowing and thus is helpful in differentiating organic etiologies from functional, psychiatric disorders. The degree of the EEG changes correlates with the severity of the encephalopathy so that the EEG may be used to help monitor therapy. In some delirious patients, the EEG may indicate whether the patient is suffering from focal, rather than global, impairment. Furthermore, the EEG is the only test that can identify an ongoing epileptic state (e.g., nonconvulsive status epilepticus) as being responsible for the clinical picture of confusion. Other electrophysiological tests that may prove helpful in the evaluation of delirium, such as computerized EEG spectral analysis, topographic brain mapping, and sleep studies, are briefly reviewed.
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PMID:Utility of EEG in delirium: past views and current practice. 181 75

In recent years, polymerase chain reaction (PCR) has been under study as a potential technique to improve the accuracy of diagnosis of suspected central nervous system viral infections. We describe a case of severe encephalitis in a previously healthy 20-year-old woman from New York who presented with headache, fever, and photophobia. Her illness was characterized by progressive worsening of her neurological status, leading to confusion, delirium, and status epilepticus. The diagnosis of Jamestown Canyon encephalitis was established by positive reverse transcriptase (RT)-PCR and nucleic acid sequencing of the band from both cerebrospinal fluid and brain tissue. The nucleotide sequence and the deduced amino acid sequence of the Jamestown Canyon virus from this patient were very similar to Jamestown Canyon virus isolates from mosquito pools in New York. This report suggests that RT-PCR assays could be important tools in the diagnostic workup of cases of encephalitis.
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PMID:Diagnosis of Jamestown Canyon encephalitis by polymerase chain reaction. 1045 Nov 69

The relationship of epilepsy with psychosis is intriguing to neurologists and psychiatrists alike. This review highlights these relationships, including (a) interictal psychosis, in which the presence of psychotic episodes is not temporally related to the occurrence of seizures, (b) postictal psychosis, characterized by an increased number of seizures followed by a period of lucidity and subsequent psychotic symptoms, and (c) ictal psychosis, in which psychotic symptoms occur in association with ictal discharges on EEG. Also discussed are other kinds of episodic symptoms that may mimic psychosis, including nonconvulsive status epilepticus, postictal delirium, and peri-ictal aggressive behavior. The controversial concept of "forced normalization," which proposes an antagonistic relationship between seizures and psychosis, is also explored. Finally, the potential contribution of antiepileptic drugs to psychotic symptomatology and the effects of antipsychotic agents on seizure threshold are examined.
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PMID:Psychosis and peri-ictal confusional states. 1049 32

The alcohol withdrawal syndrome occurs in the hours or days after the cessation of alcohol drinking in an alcohol dependent patient. The alcohol withdrawal syndrome is produced by the emergence of the biological mechanism of neurological tolerance to ethanol. The clinical manifestations of the alcohol withdrawal syndrome are due to the hyperexcitability of the central nervous system: agitation, excitability, tremor, convulsions, status epilepticus, delirium, sympathetic hyperactivity. Usually benign, the alcohol withdrawal syndrome is frequently manageable on an ambulatory basis, as long as no clinical counter-indication is present such as a serious previous alcohol withdrawal syndrome, previous withdrawal convulsions, a significant medical or psychiatric comorbidity, a high level of alcohol consumption, a pregnancy, or the lack of an effective familial or social support. The ambulatory management of the alcohol withdrawal syndrome requires frequently the use of a sedative drug. Benzodiazepines used orally for a duration of 3 to 5 days are actually considered a first choice. Inability to work and drive is frequently present for several days.
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PMID:[Ambulatory management of alcohol withdrawal syndrome]. 1057 35

The induction of a delirium by medical illness, somatic treatments, or experimental drugs occasionally relieves psychotic, excited, and manic states. An induced delirium is a feature of modern electroconvulsive therapy (ECT), and was a feature of insulin coma therapy and psychosurgery. Case material explores the relationship between psychosis, mania, seizures, and electroencephalogram. From our understanding of the mechanism of ECT in relieving intractable status epilepticus, we suggest a hypothesis for the beneficial interaction between delirium and ECT.
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PMID:The interaction of delirium and seizures. 1083 98

Sedatives continue to be used on a routine basis in critically ill patients. Although many agents are available and some approach an ideal, none are perfect. Patients require continuous reassessment of their pain and need for sedation. Pathophysiologic abnormalities that cause agitation, confusion, or delirium must be identified and treated before unilateral administration of potent sedative agents that may mask potentially lethal insufficiencies. The routine use of standardized and validated sedation scales and monitors is needed. It is hoped that reliable objective monitors of patients' level of consciousness and comfort will be forthcoming. Each sedative agent discussed in this article seems to have a place in the ICU pharmacologic armamentarium to ensure the safe and comfortable delivery of care. Etomidate is an attractive agent for short-term use to provide the rapid onset and offset of sedation in critically ill patients who are at risk for hemodynamic instability but seem to need sedation or anesthesia to perform a procedure or manipulate the airway. Ketamine administered through intramuscular injection or intravenous infusion provides quick, intense analgesia and anesthesia and allows patients to tolerate limited but painful procedures. The risk/benefit ratio associated with the use of this neuroleptic agent must be weighed carefully. Ketamine is contraindicated in patients who lack normal intracranial compliance or who have significant myocardial ischemia. Barbiturates are reserved mainly to induce coma in patients at risk for severe CNS ischemia, which frequently is associated with refractory intracranial hypertension, or in patients with status epilepticus. When administered in high doses, these drugs have prolonged sedative and depressant effects. Judicious hemodynamic monitoring is required when barbiturate coma is induced. Haloperidol is indicated in the treatment of delirium. Patients should be monitored for extrapyramidal side effects and, when they require higher doses, for potential electrocardiographic prolongation of the QT interval. Dexmedetomidine may evolve into an agent with qualities comparable with midazolam and propofol, and it may even become a drug of choice in select patients. Further study is required, however. Propofol has many of the qualities of an ideal sedative agent. Benzodiazepines and narcotics often are used in concert with propofol to provide reliable amnesia and to relieve pain, respectively. Propofol frequently causes hypotension when administered as a bolus or infusion, particularly in patients with limited cardiac reserve or hypovolemia. More data must be obtained to identify potential deleterious effects of hypertriglyceridemia, and further evaluation of the potential benefits in certain patient populations, such as neurosurgical patients, is needed.
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PMID:Use of propofol and other nonbenzodiazepine sedatives in the intensive care unit. 1176 65

The outcome of nonepileptic seizures (NES) is usually poor. The early recognition suggests better prognosis. This study is undertaken to examine the value of neuropsychiatric method for making accurate diagnosis of the psychiatric disorder that underlies psychogenic NES. Multidisciplinary approach to clinical assessment of such patients with chronic or resistant course of seizure disorder was used. Out of 6 patients, who went through the neuropsychiatric evaluation, two were admitted with a diagnosis of status epilepticus, three--with acute episodes of repetitive seizures and one--with diagnoses of bettolepsy. The results demonstrated that in four cases seizures were the manifestation of dissociative disorder (F 44), in one--of somatic form autonomic dysfunction (F 45.3) and the last patient had delirium due to epilepsy. All of the four patients with the past history of epilepsy were treated with antiepileptic drugs (AED). In two cases diagnosis of epilepsy and AED therapy were withdrawn. In the remaining cases we supposed the coexistence of epilepsy and NES. Our data suggests that incorporating of neuropsychiatric methods into the diagnostic battery for people with suspected and/or intractable epilepsy help in distinguishing NES and epilepsy as well as in revealing the underlying psychic disorder, which leads to formulation specific treatment program.
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PMID:[Neuropsychiatric aspects of diagnostics of nonepileptic seizures]. 1657 33

This article describes the diary of a man from 19th-century England (1829-1834) that documents the onset and course of his wife's epilepsy after a stroke. Her stroke produced aphasia and right hemiparesis, but her epilepsy was the diary's focus and caused the greatest concern. The diary documents the history of her epilepsy in detail. In addition to tonic-clonic seizures, she experienced frequent bouts of status epilepticus and complex partial seizures. The diary contains some of the earliest recorded descriptions of status epilepticus and its aftermath of delirium, mood disorder, and hysteria. It also offers some of the earliest and most detailed accounts of complex partial seizures. Bleeding by cupping was the only symptomatic or prophylactic treatment recorded. These aspects of the diary are presented, as are the historical perspectives on epilepsy, including early beliefs and stigmas, therapeutic remedies, and early European views of epilepsy.
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PMID:A diary of epilepsy in the early 1800s. 1726 88

Providing adequate sedation in the neurologic intensive care unit (ICU) depends on determination of proper goals for sedation, adequate assessment of the level of sedation, and appropriate choice of drug based on the patient's physiology. The management of sedation in the ICU will influence long-term outcome. Delirium, anxiety, and pain must be identified and treated separately. The use of protocols can improve compliance with published evidence-based recommendations. Propofol and dexmedetomidine may be used for rapidly titratable sedation, benzodiazepines for anxiolysis, neuroleptics for treatment of delirium, and opiates for analgesia. Unique aspects of patients with acute brain disease, such as elevated intracranial pressure or status epilepticus, require adaptation of sedative regimens. Processed EEG monitoring and volatile anesthetic agents have not yet proven beneficial or practical for use in the ICU.
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PMID:Sedation in the neurologic intensive care unit. 1833 34


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