Impaired Level Of Consciousness Research Articles

Central Pontine Myelinolysis<subtitle>TWO CASES WITH ASSOCIATED ELECTROLYTE DISTURBANCE</subtitle>

Two patients with central pontine myelinolysis are described. Both were middle aged women presenting with a history of protracted vomiting and drowsiness. Hyponatraemia (serum sodium 96 to 100 mmol/L) was a feature in both patients. No underlying malignancy, alcoholism, malnutrition or other serious disease was identified. Correction of electrolyte abnormalities was accompanied by deterioration in level of consciousness and development of a neurological syndrome characterized by quadriparesis, dysphasia and mutism. Death followed and histopathological examination confirmed classical myelinolysis in the central pons and extensive similar, though not identical, lesions in the cerebral hemispheres in both cases. The pathophysiological basis of the lesions is likely to be a special metabolic susceptibility of oligodendroglial cells in areas where neurones, glial cells and myelin sheaths lie in close proximity to one another.

Intracranial suppurative disease. Early presumptive diagnosis and successful treatment without surgery.

The limiting factor in the prognosis of patients with intracranial abscess is the irreversible damage done before treatment is instituted. Six cases of documented focal intracranial infection in which abscess development was either aborted or reversed stress the feasibility of early diagnosis and appropriate antibiotic therapy without surgery. Early diagnosis is based on severe headache, with or without focal neurologic symptoms, in patients with extracranial suppurative focuses, and is confirmed by focal electroencephalographic changes. Even without bacteriologic examination of cranial contents, penicillin G potassium and tetracycline hydrochloride or chloramphenicol sodium succinate can confidently be used, unless a resistant bacterium has been identified in the blood or extracranial focus. Focal signs appearing early in treatment do not necessarily presage failure, but deterioration in level of consciousness probably indicates the need for surgical decompression. Long-term prognosis following nonsurgical treatment is good.

Intracranial Suppurative Disease

The limiting factor in the prognosis of patients with intracranial abscess is the irreversible damage done before treatment is instituted. Six cases of documented focal intracranial infection in which abscess development was either aborted or reversed stress the feasibility of early diagnosis and appropriate antibiotic therapy without surgery. Early diagnosis is based on severe headache, with or without focal neurologic symptoms, in patients with extracranial suppurative focuses, and is confirmed by focal electroencephalographic changes. Even without bacteriologic examination of cranial contents, penicillin G potassium and tetracycline hydrochloride or chloramphenicol sodium succinate can confidently be used, unless a resistant bacterium has been identified in the blood or extracranial focus. Focal signs appearing early in treatment do not necessarily presage failure, but deterioration in level of consciousness probably indicates the need for surgical decompression. Long-term prognosis following nonsurgical treatment is good.

Clinical and electroencephalographic assessment of diazepam in liver disease.

The effects of 5 mg of diazepam intravenously were assessed in 23 patients with liver disease, 10 of whom had clinical evidence either in the past or at the time of study of hepatic encephalopathy. Transient drowsiness occurred in all patients, but prolonged deterioration in conscious level was not observed. Serial electroencephalographic recordings showed the development of activity at faster frequencies, similar to that found in normal subjects, a change which is different from that usually observed in cirrhotic patients after administration of chlorpromazine and morphine when slow-wave activity is increased.

Central Pontine Myelinolysis

Two patients with central pontine myelinolysis are described. Both were middle aged women presenting with a history of protracted vomiting and drowsiness. Hypo-natraemia (serum sodium 96 to 100 mmol/L) was a feature in both patients. No underlying malignaney, alcoholism, malnutrition or other serious disease was identified. Correction of electrolyte abnormalities was accompanied by deterioration in level of consciousness and development of a neurological syndrome characterized by quadriparesis, dysphasia and mutism. Death followed and histopathological examination confirmed classical myelinolysis in the central pons and extensive similar, though not identical, lesions in the cerebral bemispheres in both cases. The pathophysiological basis of the lesions is likely to be a special metabolic susceptibility of oligodendroglial cells in areas where neurones, glial cells and myelin sheaths lie in close proximity to one another.