Disorientation For Place Research Articles

Difficulties in diagnosing rabies using the example of a clinical case in the Omsk region

Rabies is the deadliest zoonotic disease caused by the rabies virus, a member of the genus Lyssavirus. The disease occurs after a bite from a wild or domestic animal. The paper presents a clinical case of rabies with early diagnostic difficulties, particularlyclinical, epidemiological, and laboratory diagnostic features, in a patient suffering from alcoholism. The victim sought medical help 20 days after the dog bite. On day 29, a hydrophobia clinic was observed. The patient exhibited signs of visual and auditory hallucinations, aggressiveness, and disorientation in place and time, which resembled the development of alcoholic psychosis. Saliva samples were collected on day 3 of the disease, and its polymerase chain reaction test was negative for rabies virus. On day 29, the patient died. The diagnosis of rabies was confirmed antemortem and posthumously. The virus was detected in the saliva on day 9 of the disease and posthumously in the cerebral cortex, medulla oblongata, cerebellum, and salivary glands. Histologically, Babesh–Negri bodies were found in the brain tissue. Necessary preventive measures were implemented. The unfavorable outcome in the described case of rabies emphasizes the lack of awareness of the population (especially rural) about the risk of contracting rabies infection through contact with animals and the importance of timely post-exposure prophylaxis. Timely anti-rabies care remains the only effective means of preventing related deaths.

Особенности проведения анестезии при офтальмологических вмешательствах у детей с перинатальными поражениями центральной нервной системы

Purpose. To study the frequency and severity of hypertensive-hydrocephalic syndrome in children planning to undergo ophthalmic surgery, to assess the adequacy of the anesthesia performed. Material and methods. The clinical material was selected by the method of continuous sampling from 4 637 children. Of these, two age groups were formed. The 1st group consisted of 220 children under the age of 6 years, to whom the induction of anesthesia was carried out with the drug «Sevoran». Group 2 included 56 older children (from 7 to 17 years old), who received anesthesia induction with propofol or sodium thiopental. Both groups were comparable in terms of the severity of the hypertensive-hydrocephalic syndrome. Results. Throughout the entire operating period, no complications arose in any case. Within 1–3 hours after waking up, 32 children of the 1st group and 6 children of the 2nd group complained of an isolated headache. Postoperative nausea and vomiting were observed in 22 children of the 1st group and 6 children of the 2nd group. In 30% of cases in children of the 1st group, postoperative reactions were expressed by aggressive behavior, disorientation in place and time, violation of behavioral reactions. In group 2, such reactions were detected only in 10% of cases. All negative manifestations were arrested by parenteral administration of midazolam at a dose of 3–5 mg. Conclusion. For the induction of anesthesia in young children with the presence of hypertensive-hydrocephalic syndrome, the optimal use of the drug «Sevoran». The drugs of choice for anesthesia in children over 6 years of age are propofol and sodium thiopental. The use of artificial ventilation in a moderate hyperventilation mode avoids an increase in intracranial pressure. Adequate analgesia avoids many adverse reactions. Keywords: hypertensive-hydrocephalic syndrome, general inhalation anesthesia, ophthalmic surgery.

Flashback psychopathology in combatants with PTSD

Flashback psychopathology in combatants with PTSD

30 year old woman with possible Creutzfeldt-Jakob Disease initially presenting with psychiatric symptoms: a case report

Results The patient's problems had begun six months prior to hospital admission with symptoms of disorientation in place and time and behavioral disturbances. She was treated initially as a psychiatric outpatient receiving medication. After 4 months of unsuccessful treatment she was hospitalized and subjected to 16 E.C.T. sessions. About 2 months after E.C.T., the patient was admitted to our hospital with neurological symtomatology (gait and speech disturbances). Biochemical examination, E.E.G and lumbar puncture (including protein 14-3-3 assay) were inconclusive, while brain MRI revealed brain atrophy and high signal intensity in the region of basal ganglia, imaging suggestive of Creutzfeldt-Jakob Disease. 22 months after initial presentation the patient is in a state of akinetic mutism. Conclusions To our knowledge this is the first report presenting in Greece concerning possible Creutzfeldt-Jakob Disease in such a young person. The initial presentation with pure psychiatric symptoms is also of interest, while the time elapsed since the presentation of neurological symtomatology is considered to be quite long.

ＯＰＬＬを合併した淡蒼球黒質ルイ体変性症の１剖検例

Clinical and neuropathological studies of a case of pallido-nigro-luysian atrophy with thalamic degeneration and ossification of the posterior longitudinal ligament (OPLL) is reported. The patient was a 72-year-old man, suffering from gait disturbance caused by OPLL for about 3 years. The clinical features were characterized by gradual development of disorientation in place, time and person, memory disturbance, vertical gaze palsy and rigidity of extremities. Dysarthria, dysphagia, bradykinesia, masked face and neck dystonia appeared at the advanced stage of his illness. There was no tremor or other involuntary movements. A clinical diagnosis of parkinsonism was suspected. The main neuropathological findings were neuronal loss and gliosis in globus pallidus, substantia nigra, subthalamic nucleus and thalamus. In addition, neuronal loss of the anterior horn of the cervical spinal cord due to compression by OPLL (C4-C7) was recognized. The neuropathological findings of the present case were consistent with systemic degenerative disorder of the nervous system affecting the pallido-nigro-luysian tract. This rare disorder should be considered in the differential diagnosis of parkinsonism in old people.

Confabulation Following Brain Injury

MANY ELEMENTS of the Korsakow psychosis or amnestic confabulatory state appear during the process of recovery from brain injuries such as those resulting from acute head injuries and ruptured intracranial aneurysms. After emergence from coma and the return of verbal responsiveness, amnesia, confabulation, disorientation for place and time, reduplicative delusions (reduplicative paramnesia), and misidentification of persons and objects are commonly expressed. These phenomena have been variously defined, classified, and interpreted. (In this paper, confabulation is defined as the fictitious narrative of some past event or events. Reduplication for place is the statement that there are two or more places, usually the hospital, of the same or similar names, although only one exists. Reduplication for person is the attributing of two or more identities to a single person, such as claiming that a ward attendant is also a classmate or that a nurse

Changes in symbolic expression with amytal sodium.

1. Attitudes toward and recognition of illness and hospitalization were studied before and during the intravenous administration of amobarbital sodium. Changes in language patterns and nonverbal aspects of behavior were compared in 50 patients with pre-existing brain disease and a like number of normal subjects with comparable disabilities. 2. Prior to receiving the drug, all patients expressed awareness of illness, were completely oriented for place, and identified the examiners correctly. With the drug, explicit denial of illness, disorientation for place, and gross misidentification of the examiners occurred only in some of the patients with brain damage. In the normal group, subjects talked of illness in terms of a third person, used more "concrete" symbols, selectively misinterpreted questions about illness and misnamed the examiners in "paraphasic" fashion. 3. Amobarbital sodium did not necessarily make patients more communicative. Thirty patients in both groups showed no changes in verbal or nonverbal behavior. Some talked more, others less. 4. Euphoria was noted in II patients in the normal group and in 17 with brain disease. The euphoria frequently alternated with paranoid and depressed attitudes. It was not related to the dosage of the drug and in some instances came on after the interview was terminated. Ludicrous aspects of behavior were prominent. 5. The euphoria, drowsiness, dysarthria, and dystaxia produced, unlike the nystagmus, cannot be explained in terms of any particular neurophysiologic mechanism of action of barbiturates but must be considered in symbolic as well as physiological concepts. 6. Amobarbital sodium, given under the conditions described, appeared to provide a milieu of brain function in which not new motivations but new symbolic forms for their expression could be evolved and maintained. These are best interpreted not in terms of "release of repressed material" but as an adaptive, more effective defense in a situation of greater stress. 7. The productions of patients under the influence of amobarbital sodium should be interpreted not only in a factual referential context but as a symbolic representation of wishes and feelings expressed in personal, spatial, and temporal terms. 8. The observed behavior could not be explained in physiological or psychophysiological terms as "cortical depression" or "release of inhibition." It is suggested that much of the behavior ascribed to such mechanisms may be largely manifestations of a particular observer-subject relationship.