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

Spontaneous rupture of the diaphragm during normal labour is extremely rare. It requires emergency surgical correction. The authors report what they believe is only the second reported case. Eleven hours after delivery of a male infant, a 27-year-old woman experienced severe epigastric pain, vomiting and dyspnea, followed by cardiopulmonary arrest. Although the ruptured diaphragm was diagnosed and repaired, she suffered severe anoxic encephalopathy and died 3 weeks after operation without regaining consciousness. Clinicians must be aware of the existence of this rare condition because failure to diagnose and treat the ruptured diaphragm will almost certainly lead to the patient's death.
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PMID:Spontaneous rupture of the diaphragm in labour: a case report. 276 35

Between July 1983 and February 1984, eight children with adenovirus Type 3 infection, proven by virus isolation from sputum, stool or nasopharyngeal swabs and a fourfold increase in complement fixation antibody titers against the virus, were treated in our department. All eight patients had fever lasting at least 7 days, hepatomegaly, diffuse pulmonary infiltrates and abnormal liver function tests. Seven of the patients exhibited dyspnea and pulmonary wheezing. Six of the patients developed changes in state of consciousness, and three had repeated convulsions. EEG patterns in three of the patients were compatible with encephalopathy. Other clinical manifestations included: follicular tonsillitis in two patients, diarrhea in two, pneumothorax in one, and shock with disseminated intravascular coagulation in one. The spectrum of adenovirus Type 3 infection reported here has been described previously only in the viral hemorrhagic fevers. This adenovirus Type 3 infection shares the potential for disseminated disease that has been described previously for Type 7, simulating Reye's syndrome.
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PMID:Adenovirus type 3 infection with systemic manifestation in apparently normal children. 302 30

Noninvasive mechanical ventilation (NMV) now represents the first step in the management of acute on chronic respiratory failure (A/CRF). During the last 5 yrs, many studies have confirmed the feasibility of NMV in an acute setting, either by facial or nasal interface, used in addition to volumetric or barometric respirators, to manage A/CRF. The best indications for NMV are slowly progressive A/CRF, frequently represented by chronic obstructive pulmonary disease (COPD), or restrictive pulmonary disease. The criteria to initiate NMV in such patients are worsening of respiratory status and arterial blood gas (ABG) values, with increased hypoxia, hypercapnia and respiratory acidosis, despite optimal management with medication, physiotherapy and oxygen therapy. Respiratory encephalopathy is not an absolute contraindication; however, bronchial hypersecretion indicates that care is needed under NMV. Invasive mechanical ventilation with endotracheal (ET) intubation is discussed in the case of failure of NMV, when clinical status and ABG values worsen in spite of it. The signal for ET intubation is then obvious, represented by severe dyspnoea leading to respiratory pauses or arrest, severe cyanosis, and signs of haemodynamic instability. Despite immediate evidence of ominous cardiorespiratory inefficiency, ET intubation may be delayed and often avoided with the help of NMV. Criteria should be studied to identify guidelines for cessation of NMV, in order not to continue with the technique too long considering the safety of the patient. Indications for NMV in other kinds of ARF have received less study and are more controversial.
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PMID:Noninvasive mechanical ventilation and acute respiratory failure: indications and limitations. 915 23

The incidence of liver metastasis is quite frequent in patients with advanced cancer. Some patients are asintomatic, but more often a correlation can be present between the clinical observation and the anatomic and functional alteration of the liver provoked by metastasis. Hepatomegaly may cause pain, dyspnea, hiccup. Biliary obstruction generates jaundice and itching. Portal hypertension may cause ascitis, encephalopathy, varices of the esophagus. Hepatic failure may produce symptoms like sopor, dysrasic oedema, coagulation problems, jaundice. The treatment of the symptoms listed above is crucial for the quality of life of these patients, and must be the mainstay of the therapeutic approach. This paper describes the palliative treatment of the clinical complications related to liver metastasis.
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PMID:[Clinical features and symptomatic treatment of liver metastasis in the terminally ill patient]. 921 73

Upper airway obstruction is a frequent cause of admission to the emergency department and the intensive care unit. Symptoms are mainly represented by dyspnea and stridor. Severity must be rapidly assessed to allow adapted treatment and avoid cardiac arrest and hypoxic encephalopathy. The possible etiologies are numerous, with acquired and congenital ones, but the majority is represented by laryngitis, lymphoid hypertrophy and laryngotracheomalacia. In case of respiratory failure, treatment must first establish airway patency with bag and mask ventilation, and then intubation. If vital prognosis is not threatened, biologic, radiologic or endoscopic examination can be performed to identify the cause of the obstruction and treat it.
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PMID:[Upper airway obstruction (foreign bodies excluded)]. 1079 42

In this report we describe the respiratory patterns of six patients with Leigh syndrome, including two individual cases with accompanying clinical phenotypes of Alpers disease and mitochondrial encephalopathy with ragged red fibers. In five cases where sleep apnea was monitored, each one showed isolated or post-sigh central apnea, hiccup, apneusis-like breathing and obstructive apnea in various combinations. The remaining patient with Alpers/Leigh overlap syndrome showed an apneusis-like pattern of dyspnea. The sleep structure was examined in three patients. Two patients with brainstem lesions showed a decrease in the deep sleep stages and an absence of REM sleep. Medullary lesions were found in four patients by magnetic resonance imaging or at autopsy and involved predominantly the dorsal respiratory group (DRG) of medullary neurons. The role of DRG lesions in the pathophysiology of respiratory symptoms in Leigh syndrome is discussed.
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PMID:Characteristics of breathing abnormality in Leigh and its overlap syndromes. 1187 May 85

We report an adult autologous stem cell transplant (ASCT) patient who developed transplant-associated thrombotic microangiopathy (TMA) due to human herpesvirus-6 (HHV-6) reactivation. A 58-year-old female with Stage IIIA IgGkappa multiple myeloma received a melphalan (200 mg/m2) ASCT with discharge home after resolution of ASCT-related toxicities. She presented on D+20 with dyspnea, rash, and fever to 105 degrees F, followed by worsening dyspnea, hypotension, and capillary leak. Mental status (MS) changes were noted on D+23, but head CT and EEG were unremarkable. On D+29, a generalized seizure occurred with decline in platelet count and haptoglobin. TMA was noted on peripheral blood smear and therapeutic plasma exchange (TPE) was initiated on D+31. Lumbar puncture (LP) revealed CSF protein 74 mg/dL and white blood count 7,000/mm3 with 74% lymphocytosis. TPE was continued without improvement in her MS or thrombocytopenia despite improvement in microangiopathy. An MRI of the brain showed a left hippocampus abnormality, and an EEG was consistent with encephalopathy. Serum polymerase chain regimen (PCR) was negative for CMV, HSV1, and HSV2 but was strongly positive for HHV-6. Repeat LP protein was 597 mg/dL. Foscarnet was initiated, and cerebrospinal fluid (CSF) PCR for HHV-6 revealed 1,400 DNA copies/mL. Her MS greatly improved within 48 hr of antiviral therapy, serum HHV-6 became negative, and TPE was tapered without recurrence of her TMA. TMA with HHV-6 reactivation is likely an underdiagnosed entity. Given its fulminant course and favorable response to therapy, HHV-6 reactivation should be considered a potential etiology in patients with TMA after ASCT.
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PMID:Thrombotic microangiopathy (TMA) and stroke due to human herpesvirus-6 (HHV-6) reactivation in an adult receiving high-dose melphalan with autologous peripheral stem cell transplantation. 1516 83

The aim of this study was to analyze the clinical spectrum and seek potential curable causes of spontaneous pneumomediastinum (SPM) in children in order to minimize respiratory morbidity. Medical records from 1986 to 2003 were retrospectively reviewed at a tertiary pediatric facility in northern Taiwan. Sixteen cases of SPM were identified. There were eleven boys and five girls (M:F = 2.2:1) and ages ranged from 2 to 17 years (average, 10 years). Cough (81%), dyspnea (75%) and chest pain (56%) were the predominant symptoms and expiratory wheezing (63%) and neck crepitus (50%) were the most common physical findings. The specific sign of Hamman's crunch was noted in only one child initially. A coughing-related Valsalva maneuver (13 patients/81%) was the most common cause of pneumomediastinum in these children. The most common underlying medical causes were asthma (8 patients/50%) and idiopathic origin (5 patients/31%). Acute gastroenteritis, foreign body aspiration and mycoplasmal pneumonia were each found in one patient respectively. All patients had subcutaneous emphysema on initial chest radiographs. Two patients were complicated by pneumothorax and required intensive respiratory therapy. The average hospital stay was 4 days (range 1-9 days). Rapid resolution of symptoms without long-term sequelae was common except for one patient who had hypoxic-ischemic encephalopathy with epilepsy after foreign body removal. We conclude that in young teenagers, who suffer from cough, dyspnea, chest pain and associated discomfort of throat or neck, the diagnosis of SPM should be considered and chest radiography including posterior-anterior and lateral projections should be performed to verify the diagnosis. Because of the high prevalence of asthma related SPM, children of idiopathic SPM should undergo diagnostic pulmonary function tests after the acute episode, to establish whether the child has asthma. Targeted investigations of the underlying causes of SPM might decrease respiratory morbidity and avoid further complications.
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PMID:Asthmatic versus non-asthmatic spontaneous pneumomediastinum in children. 1599 70

We reported a 67-year-old woman with unilateral laminar necrosis caused by hypoxic encephalopathy. She presented with sudden onset of dyspnea, unconsciousness and left hemiplegia. Although diffusion-weighted MRI image of the brain 14 hours after onset was indistinct, MRI on the 4th day showed right laminar necrosis. Cerebral angiography demonstrated complete obstruction of the right proximal common carotid artery and severe stenosis of the left internal carotid artery. We speculate that chronic ipsilateral obstruction of the internal carotid artery may modify the unique distribution of laminar necrosis. As shown in this case, laminar necrosis can be demonstrated only on subsequent MRI. If clinical suspicion of hypoxic encephalopathy is high, repeated MRI may be appropriate.
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PMID:[A case of hypoxic encephalopathy with unilateral laminar necrosis]. 1688 3

Although linked with cardiac dysfunction, the association of MELAS (mitochondrial myopathy, encephalopathy, lactic acidosis, and stroke-like episodes) and pulmonary artery hypertension (PAH) has not been previously described. PAH and right ventricular heart failure were identified by echocardiography in a 3-year-old boy with a history of hypotonia, microcephaly and developmental delay. He initially presented with a 10-day history of dyspnoea, dependent oedema and reduced oral intake. Lactic acidosis was noted on serial arterial blood sampling and cerebrospinal fluid. Muscle biopsy demonstrated cytochrome-c oxidase-positive 'ragged-red' fibres consistent with MELAS; subsequent analyses revealed the m.3243A>G point mutation most commonly associated with MELAS. The mutation was heteroplasmic, representing 92% of the total mtDNA from a lung sample. Nitric oxide and epoprostenol were administered without significant clinical or echocardiographic improvement of his PAH. A 'mitochondrial cocktail' including biotin, riboflavin, carnitine and coenzyme Q10 also was provided. Five months after presentation, he developed seizures; MRI imaging of his brain demonstrated multiple focal lesions. His clinical status worsened with increasing cardiopulmonary failure. He died two months later. Although therapy for both MELAS and PAH remains limited, recent investigations suggest a beneficial role for l-arginine in both conditions, implying a possible common pathophysiology. Mitochondrial diseases such as MELAS should be considered in cases of idiopathic PAH, particularly when associated with multisystem involvement including short stature, hearing loss, renal dysfunction, retinopathy, diabetes mellitus, migraines, seizures, ophthalmoplegia, fatigability and weakness.
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PMID:Pulmonary artery hypertension in a child with MELAS due to a point mutation of the mitochondrial tRNA((Leu)) gene (m.3243A>G). 1818 Oct 29


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