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Query: UMLS:C0085584 (encephalopathy)
 18,178 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Although the occurrence of Wernicke's encephalopathy (WE) in patients on dialysis is frequently alluded to, review of the literature reveals only 3 described cases. We describe 5 patients on dialysis who developed WE in the absence of alcoholism or other predisposing factors. The clinical diagnoses included uremic encephalopathy (2 patients), dysequilibrium syndrome (1), dialysis dementia (1), and brainstem hemorrhage (1). At postmortem examination, classic findings of WE were evident. The rarity of WE in patients on dialysis may in part be explained by studies indicating a genetic defect in transketolase activity. Patients on dialysis are also potentially at risk for thiamine deficiency because of anorexia, vomiting, and intravenous alimentation. Other factors altering thiamine requirements, such as glucose load or infections, may also contribute. Preventable and potentially curable, WE should be suspected in all patients on dialysis who have an unexplained neurological picture.
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PMID:Wernicke's encephalopathy in patients on peritoneal dialysis or hemodialysis. 382 16

The present study, conducted between January 1975 and June 1983, includes 282 adult patients admitted for status epilepticus (SE) in 2 intensive care units (3.5% of all admissions). In their great majority, i.e., 201, patients had no previous history of epilepsy, and initiated the SE during the course of recent affections such as brain or systemic diseases. In 81 patients with previous seizure, epilepsy was idiopathic in 20, and symptomatic in 61, the 3 main causes being cranial traumatism, cerebrovascular accident and chronic alcoholism. SE was of various causes. The most frequent were cerebro-vascular disease, post-anoxic encephalopathy, intoxication, bacterial or viral meningo-encephalitis. In some patients, SE was preceded by manifestations such as convulsions, behavorial disturbances or conscience impairment. One should be aware of these facts and undertake or increase an anticonvulsivant medication at their onset. Duration of SE, when clearly established, was highly variable but had no apparent correlation to sequelae or death occurrences. SE itself was directly related to death in only 2 cases; in all other instances death was the consequence of the primary disease. These results are consistent with previous reports: presently SE occurs more frequently in the course of other affections than in prior epileptic patients. The better vital prognosis of SE is due to the simultaneous conjunction of new anticonvulsivant medication and supportive care associated with the cure of the causative disease.
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PMID:[Status epilepticus in the adult. Epidemiologic and clinical study in an intensive care unit]. 402 53

The authors studied 286 patients with epilepsy with disease onset past the age of 20 years (176 males, 110 females) from the urban and rural populations. In 57% of cases the aetiology of epilepsy was undetermined. Among the known aetiological factors head trauma accounted for 15.5% of cases, inflammatory processes in the central nervous system for 4.5%, alcoholism for 7%, vascular lesions for 6%, tumours for 5.2%, degenerative and atrophic changes for 1.5%. Over 40% of patients had had attacks for up to 15 years and over 18% for over 20 years. In 80% of cases grand mal seizures occurred, and in 33% of these cases more than 12 attacks occurred annually. Six cases of status epilepticus were observed with 2 deaths. The attacks were precipitated by menstruation, alcohol abuse, infection, stressed, television watching. Among the signs accompanying or following the seizures tongue biting and urination prevailed. Neurological signs were demonstrated in 21% of cases, encephalopathy in 65%, other psychic disturbances in 9.5%. Systematic treatment was received by 75% of the patients (over 80% in urban population), and therapy with multiple drugs was most frequent. Drug-resistant epilepsy was found in 34% of cases. The patients from the rural population had a lower educational level and had more children. About 70% of the patients were in employment.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Analysis of clinico-social features of epilepsy]. 404 96

The potential for hepatic injury associated with the therapeutic use of salicylates and acetaminophen has recently attracted considerable attention. About 300 cases have been reported in which elevated transaminase levels or other evidence of hepatic injury developed following treatment with salicylates. Review of the spectrum of abnormalities reveals a group of patients (4 percent) with symptomatic liver damage in whom progressive or chronic liver disease is a possibility with continued use of the drug. In a few patients in this group, jaundice developed; several had abnormal prothrombin times; 11 (70 percent) had transaminase values in excess of 500 units; and five patients (30 percent) had encephalopathy and/or Reye's syndrome. In several reports liver damage has also been associated with the use of acetaminophen in therapeutic or near-therapeutic dosages. Of 18 patients, nine appeared to have ingested acetaminophen in amounts approaching overdose. Of the remaining nine patients, six were alcoholics. In the entire group, only five patients did not have a history of alcohol abuse; in three, glutathione depletion was suggested as a possible explanation for hepatotoxicity. The association with alcoholism or glutathione depletion suggests that host susceptibility may play a critical role. In two patients, long-term use of acetaminophen resulted in liver injury suggestive of chronic active hepatitis, possibly on the basis of an idiosyncratic reaction. In a study of chronic liver disease, acetaminophen half-life was prolonged (168 percent) without accumulation at 4 g a day over five days. In a double-blind, two-week, cross-over study, no clinical or laboratory evidence of adverse effects was found. There is, therefore, no evidence that chronic liver disease increases the risk of hepatotoxicity following the administration of acetaminophen in therapeutic doses. Thus, acetaminophen is the preferred antipyretic analgesic in patients with liver disease. Salicylates should be avoided since many of the adverse effects associated with these drugs are similar to the complications of chronic liver disease.
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PMID:Hepatotoxicity following the therapeutic use of antipyretic analgesics. 635 71

In Japan Wernicke's encephalopathy is not rare, but only one case of Marchiafava-Bignami disease has been reported. In our case, Wernicke lesions were found in the mamillary bodies, septal nuclei, and periventricular regions. Involvement of the septal nuclei is rare in this encephalopathy. A characteristic Marchiafava-Bignami lesion was observed only in the anterior part of the corpus callosum. From the clinicopathologic viewpoint, Wernicke's encephalopathy might have preceded Marchiafava-Bignami disease in our case. To our knowledge, only two cases without a history of alcoholism and both suffering from Wernicke's encephalopathy and Marchiafava-Bignami disease have been documented. However, in both cases Wernicke lesions were atypical, since characteristic lesions were absent in the mamillary bodies and in the regions surrounding the third ventricle and the aqueduct. Ours appears to be the first report on a non-alcoholic patient with typical lesions of both diseases.
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PMID:A non-alcoholic Japanese patient with Wernicke's encephalopathy and Marchiafava-Bignami disease. 644 Jul 23

The authors studied the brain and heart of 40 patients (30 males and 10 females) who were hospitalized with the clinical diagnosis of alcoholic delirium, Gaye-Wernike's encephalopathy, and acute alcoholic intoxication due to chronic alcoholism. The morphological alterations in the brain and heart were as follows: compromised vascular permeability, dystrophic changes in the neurons and cardiomyocytes, proliferative reaction of microgliocytes and the development of small cardiosclerosis. Such disorders can be defined as an exacerbation of chronic alcoholic encephalopathy and cardiomyodystrophy. Alcoholic damage to the heart seems to be one of the additional factors that disrupt cerebral hemodynamics which results in hypoxia of the cerebral tissue and is accompanied by impairment of the central regulation of cardiac activity and progression of cerebral changes, i. e. the pathological process develops according to the vicious circle principle.
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PMID:[Morphology of the brain and heart in alcoholic psychoses]. 662 25

A prospective study of the development of encephalopathy was undertaken in 180 patients undergoing emergency portacaval shunt for bleeding esophageal varices between 1963 and 1978. The incidence of preoperative encephalopathy was 32 percent. Postoperatively, encephalopathy developed in 31.5 percent of 95 survivors and was severe in 7 percent of those survivors. Encephalopathy developed in most patients in the first and second follow-up years; in 10 year survivors, encephalopathy was virtually absent. Encephalopathy was more likely to occur in patients with encephalopathy at the time of shunt and in those who returned to alcoholism after shunt. Most encephalopathic episodes were precipitated by dietary indiscretion, often associated with alcoholism. Careful follow-up with attention to dietary compliance and abstinence from alcohol should make the risk of encephalopathy acceptable in relation to the unquestionable benefits of portacaval shunt in reducing the risk of variceal hemorrhage.
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PMID:Prospective study of portasystemic encephalopathy after emergency portacaval shunt for bleeding varices. 697 88

A series of 45 mesocaval interposition shunt operations for bleeding oesophageal varices in Child's class B and C cirrhotics is presented. Twelve operations were carried out electively and 33 as emergencies. The primary mortality rates were 8% and 48% in these groups, respectively. Eleven (39%) of the 28 survivors died during a follow-up of 5 months to 4 years. Cumulative overall survival was 48% at one year and 33% at four years. Mortality was influenced more by surgery if performed as an emergency than the functional reserve of the liver. Continued alcoholism after surgery correlated with late mortality. Two cases of variceal rebleeding occurred in the primary survivor group (7%); both of them had shunt occlusion. Shunt patency rate was 89%. All patients had some degree of encephalopathy before surgery, but severe or chronic cases were not observed during the follow-up. Ascites when present preoperatively always disappeared after shunt. As a technically relatively simple procedure, mesocaval interposition shunt effectively prevents variceal rebleeding and ascites formation, thus offering improvement also in the quality of life. In elective cases an acceptably low mortality is achieved even in poor risk patients. In emergency cases mesocaval shunt provides about 50% chance of survival, if conservative methods to stop the bleeding fail.
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PMID:Interposition mesocaval shunt for bleeding oesophageal varices in moderate and poor risk cirrhotics. 697 49

A subacute form of encephalopathy was observed in 7 patients with a history of severe chronic alcoholism. These episodes lasted about 1 to 6 weeks and were characterized by epileptic seizures (grand mal, focal motor), prominent EEG abnormalities with focal features (slowing, spiking, "PLEDs") and neurological deficits such as hemianopsia or hemiparesis. These changes resolved with symptomatic (mainly anticonvulsive) treatment but recurrences occurred in 3 cases. The clinical picture does not fit any of the known CNS complications of chronic alcoholism and there seems to be no relationship to alcohol withdrawal. Impressive EEG abnormalities strongly differ from the mild abnormalities or normal tracings found in other CNS complications of alcoholism. The pathogenetic mechanisms are essentially obscure; vascular changes might play a contributory role in some of the cases.
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PMID:Subacute encephalopathy with seizures in alcoholics: a clinical-electroencephalographic study. 727 27

Pathological findings from two patients with clinical symptoms of diffuse encephalopathy who died due to a bronchopneumonia are studied. Postmortem examination of the central nervous system revealed neuronal changes which suggested the diagnosis of pellagroid encephalopathy. The differential diagnosis between several diseases characterized by encephalopathy, alcohol ingestion and malnutrition are discussed (chronic alcoholism, acquired hepatocerebral degeneration, Marchiafava-Bignami's syndrome, Morel's lamilar sclerosis, Wernicke-Korsakoff's syndrome and pellagroid encephalopathy). Alcoholic encephalopathy should be considered a medical emergency, which requires early correction of the basal parameters and prompt administration of thiamin and nicotinamide-nicotinic acid in doses of 500 mg per day i.v. followed by 200-300 mg per day of niacinamide by mouth.
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PMID:[Pellagroid encephalopathy in chronic alcoholism. Clinicopathological study (author's transl)]. 741 37


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