Disturbance Of Cerebral Function Research Articles

Diagnosis of cerebral function disorders and subsequent brain damage in newborn infants under intensive care

Possibilities of recognizing cerebral function disturbances in newborns as early as the acute phase of the condition, and of prognosticating permanent brain damage are described. Clinical findings such as lethargy or spasms in the second and third weeks of life following hypoxia indicate severe function disturbances with poor prognosis. In contrast, the same symptoms in the first week after a hypoxia or following a cerebral hemorrhage are only of relatively slight prognostic significance. Metabolic parameters such as lactate, hypoxanthine, CK-BB, and ammoniemia are elevated in the first few hours and days after a perinatal hypoxia and correlate with the current disturbances in the central nervous system. However, they are not indicative of a possible occurrence of later brain damage. Cerebral sonography furnishes excellent information concerning gross structural changes and cerebral hemorrhages. The extent of the hemorrhages, classified in 4 stages, correlates well with the later development. Less severe functional disturbances can also be identified by electroencephalography together with observation of behavior (polygraphy). Here also, findings correlate well with the children's subsequent development. The combination of sonographic findings and neurophysiological diagnosis is at present the best source of information concerning the later occurrence of brain damage.

Postoperative pain control with intrathecal morphine.

A clinical study of the use of intrathecal morphine in two groups of surgical patients, 32 in all, showed that the morphine provided very powerful and prolonged analgesia with little disturbance of cerebral function. When combined with a spinal block it did not interfere with the action of the spinal anaesthetic. When combined with a relaxant technique of anaesthesia some persistent curarisation was seen. The only complication to emerge from the study was respiratory depression which could be very delayed in its offset. The depression was sufficient to induce carbon dioxide narcosis in two patients. It is suggested that the dose of intrathecal morphine in the very elderly should be very severely restricted as they appeared to be unduly sensitive to the respiratory depressant effect of morphine when given intrathecally.

EEG Examination during Delirium tremens

In 30 male patients several EEG examinations could be carried out during delirium tremens (d.t.) or shortly thereafter. Most of the patients showed a normal EEG or changes which can be explained with regard to sedation through medication. 1 patient showed generalized paroxysmal spike wave bursts. On account of experimental results, we may assume that a transitory cerebral excitibality change occures in d.t. This pathophysiological basis explains the normal EEGs and paroxysmal bursts during d.t. 4 cases showed passages of pronounced diffuse slow activity during d.t. partly accompanied by thythmic bilateral slow waves. These changes point to a complication of d.t. that occurs because of another disease which results in cerebral functional disturbances as in other organic psychoses.

Überlebenszeit, Handlungsfähigkeit und röntgenologische Diagnostik bei Schußverletzungen des Schädels

Three cases of suicidal temporal gunshots. Different circumstances in the clinical course and in the ability of action.--In one case there was a bullet tract in the lower temporal region with considerable destruction of the base of the skull, followed by immediate inability of action and early death. Another case with a transtemporal gunshot without radiological signs of a laceration of the base of skull showed severe disturbance of cerebral functions for some days and remaining blindness. In the third case there was a pistol shot in the temporal region with retained missile, full ability of acting and undisturbed consciousness. Causative for the differences in the effect of the gunshots are differences of weapons and amunition and the anatomical position of the wound track in the temporal region. Discussion about the role of concussion of the brain by different rate of transgression of energy from the missile to the skull. Reference to the importance of X-ray analysis and to a radiographic documentation of the findings in such cases.

Xerodermic idiocy in identical twins

Identical twin girls with the xerodermic idiocy syndrome (xeroderma pigmentosum, neurological complications, and mental retardation) are described. Monozygosity was established by clinical features, blood types, and dermatoglyphics. Biochemical studies were normal but an electroencephalogram showed diffuse disturbance of cerebral function in both twins. Their bone age was retarded by about two years. A skin biopsy showed hyperkeratosis, atrophy of the rete ridges and hyperpigmentation of the basal cells, but no malignant change. The absence of malignant change was thought to be due to avoidance of sunlight. Neither consanguinity nor clinical evidence of the disease was present in the parents. A mutant gene of large effect is thought to be the cause of the syndrome. The underlying pathogenesis of the skin lesion is briefly discussed.

The Effect of Cyclandelate on Mental Function in Patients with Arteriosclerotic Brain Disease

The manifestations of the chronic brain syndrome associated with cerebral arteriosclerosis are notoriously diverse, ranging from disturbance of cerebral functions which can be recognized by physical examination to those which can be identified by examination of the patient's mental state. With widespread arteriosclerotic involvement of the cerebral circulation there are important alterations in the individual's thinking and behaviour. There is disturbance of memory, accompanied by disorientation, at first in time and place and later as to person; and intellectual functions including comprehension, problem solving, learning, and judgement are also impaired.

The average visual response in patients with cerebrovascular disease

The average visual response (AVR) was recorded in thirty patients after a cerebrovascular accident and in fourteen control subjects from the same age group. The AVR was obtained with the aid of a 16-channel EEG machine, a Computer of Average Transients and a tape recorder with 13 FM channels. This made it possible to study different periods after the stimuli and to study the potential distribution of the various components. Primary and secondary parts of the response and the rhythmic response were considered separately and the AVR was also considered as a whole. There were large inter-individual differences in both the patients and the controls. Therefore no general criteria of abnormality of the AVR could be established from the control subjects; criteria of abnormality of the degree of asymmetry between the AVR from the affected and unaffected sides were defined. The absence of waves I or II could not be considered pathological. In our series wave III (peak latency approximately 80 msec) was not infrequently surface positive in the occipital region. The presence of such a positive wave III correlated with the age of the subject both in the patient group and in the group of controls. The primary and secondary responses and the AVR as a whole, recorded from the parietooccipital derivation, were more frequently abnormal in patients with severe cerebral pathology than in those with moderate pathology. Such a correlation could not be found for the AVR recorded from the occipital-to-ear derivation. Similar findings were obtained, independent of the degree of cerebral pathology, for the patients with a disturbance of the visual system. An abnormal asymmetry of the amplitude of the secondary response only occurred in patients with disturbance of the visual system. The amplitude of the rhythmic response was correlated with the amplitude of the alpha rhythm; such a correlation could not be demonstrated for the other components of the AVR. A normal AVR was found more often in controls and in patients with a normal EEG than in patients with moderate or severe EEG disturbances. Determination of the potential field of the AVR with the aid of multi-channel recording did not appear to furnish significantly more information for diagnostic purposes than recording from both parieto-occipital areas. The AVR from the parieto-occipital derivation appeared to provide a better picture of the disturbances of cerebral function than did the occipital-to-ear derivation.

Memory loss due to hippocampal lesions. Report of a case.

MEMORY has been defined as that property of the nervous system whereby it is effective both in the storage and the retrieval of information. 1 Instances of pure memory loss without associated impairment of other intellectual functions and not complicated by the presence of other neurologic signs or symptoms or by clouded or altered states of consciousness are rarely encountered in neurologic practice or reported in the neurologic literature. Memory loss is most frequently found in association with widespread disturbance of cerebral function in conditions such as senile brain disease, the presenile and other organic psychoses, toxic and deficiency states, encephalitis, posttraumatic and postanoxic sequelae, and after electroshock therapy and status epilepticus. 2 In all of these, however, there are usually other associated neurologic abnormalities as well as disturbances of other intellectual functions and of consciousness. Even in those conditions in which the lesions are somewhat localized (Korsakoff-Wernicke encephalopathy,

The differential diagnosis of "little strokes".

Summary Transient focal disturbances of cerebral function are often indicative of atherosclerosis. They may occur, however, in association with a number of other conditions which are illustrated by fourteen brief case histories.

HOMICIDE, TEMPORAL LOBE EPILEPSY AND DEPRESSION: A CASE REPORT.

It is well recognized that the depressed person occasionally commits murder as a consequence of the mood disorder (Mayer-Gross, Slater and Roth, 1960). Despite the popular view to the contrary, there is much evidence that murders are rarely committed in or after epileptic seizures. Alström (1950), in a study of the frequency of criminality in 345 adult male epileptics, did not find any cases of homicide. In a 10-year period, crimes of violence were recorded for 17 per cent of the patient series and 11 per cent. of a control group. All these crimes, however, were minor, usually a complication of the abuse of alcohol. Neither severe bodily injury to others, nor a crime committed during a psychomotor seizure were encountered. He also made the important observation that, while mentally normal patients with idiopathic epilepsy had an incidence of criminality similar to that of the general population, those epileptics displaying mental disorder in addition to fits had twice this frequency of criminal records. Hill and Pond (1952) state that, from their experience in an epilepsy ward and clinic, violent or dangerous behaviour during epileptic or post-epileptic automatisms is rarely seen in any patient. Levin (1952), who studied 52 cases of epileptic clouded state admitted to the Boston Psychopathic Hospital, concurs with this view. He comments that these patients are often potentially aggressive, but their intellectual faculties are so disorganized that they are unable to carry out well-planned integrated behaviour of any kind, including aggressive acts. However, in a clinical and EEG study of 100 prisoners awaiting trial for murder, Hill and Pond, in 1952, found 18 cases of epilepsy, an incidence of epilepsy thirty-two times that of the general population. In all these cases, careful examination of the circumstances of each crime excluded the occurrence of a seizure beforehand with a high degree of probability. They concluded that a relationship exists between epilepsy and murder, although it is not directly a result of the seizure or of its immediate sequelae. In some cases, at least, the common factor may be a mental illness in the epileptic, in which the epilepsy plays an important causative role. Pathogenic factors in such cases include the disturbance of cerebral function by the seizure discharges and also the difficulties in psychosocial adjustment caused by the fits themselves or the underlying organic brain disease causing them.

ONLY HALF AWARE: A REVIEW

This review was designed to stimulate thinking of the symptoms of mental illness in a physiological frame of reference. If the activity of the cerebral cortex is balanced between mechanisms of reaching out and avoiding, this balance may be disturbed by genetic factors or circumstances developing during life, thus altering the mental set of the individual. Disturbances of cerebral function lead to changes in personality which are related rather specifically to the areas involved. Obsessive, catatonic and oral behavior may be considered as release phenomena. Unilateral injury of the parietal lobe may lead to symptoms of apraxia and agnosia confined to the opposite side of the body. Different types of sensory stimuli are related rather specifically to certain types of motor response.

Cerebral metabolic disturbance and delirium in pernicious anemia; clinical and electroencephalographic studies.

IT IS THE purpose of this paper to discuss the disturbance in cerebral function which occurs in pernicious anemia patients. This aspect of the disease process, while noted since the earliest descriptions of the disease, has remained poorly understood because of the lack of tools for proper study of such cerebral processes. HISTORICAL REVIEW In his classical description of pernicious anemia in 1849, Addison 1 may have recognized disturbance in cerebral function in the disease process, for he wrote as follows: Its approach is first indicated by a certain amount of languor and restlessness, to which presently succeed a manifest paleness of countenance, loss of muscular strength, general relaxation or feebleness of the whole frame, and indisposition to, or incapacity for, bodily or mental exertion. Lichtheim 2 in 1887 first called attention to neurodegenerative changes in pernicious anemia and ascribed them to some blood-circulating toxin. In a poorly received paper,