Improving the clinical assessment of consciousness with advances in electrophysiological and neuroimaging techniques. (73/148)

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Jimsonweed poisoning associated with a homemade stew - Maryland, 2008. (74/148)

In the early morning hours of July 9, 2008, six adult family members were admitted to a hospital emergency department in Maryland with hallucinations, confusion, mydriasis, and tachycardia of approximately 3-4 hours duration. Approximately 4-5 hours earlier, all six family members had shared a meal of homemade stew and bread. Subsequent investigation by the Montgomery County Department of Health and Human Services (MCDHHS) and the Maryland Department of Health and Mental Hygiene (MDHMH) determined that the stew contained jimsonweed (Datura stramonium), a plant in the nightshade family that contains atropine and scopolamine and has been associated with anticholinergic-type poisoning. This report describes the poisoning incident, which resulted in six hospitalizations, and the subsequent multidisciplinary investigation. Health-care providers and public health officials should be aware that jimsonweed poisoning can occur among many age groups, including younger persons, who typically consume the plant material for recreational purposes, or persons of any age group who might unknowingly ingest the plant. A prompt diagnosis of jimsonweed poisoning is complicated by the difficulties in eliciting exposure histories in persons with altered mental status and the variable presentations of affected persons. Consultation with horticulturalists, poison control centers, and specialized laboratories might be necessary to investigate cases and outbreaks.  (+info)

Intracranial transthecal subarachnoid fat emboli and subarachnoid haemorrhage arising from a sacral fracture and dural tear. (75/148)

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Prognosis for recovery from prolonged posttraumatic unawareness: logistic analysis. (76/148)

This study reviews the course and outcome of 130 patients who remained in a state of prolonged unawareness 30 days after severe cranio-cerebral trauma. Prognostic indicators and outcome were fitted by a logistic model. The significant prognostic factors observable in the first week after trauma were found to be ventilatory status, motor reactivity and significant extraneural trauma. The significant prognostic factors after the first month of unawareness were early ventilatory status, early motor reactivity, late epilepsy and hydrocephalus. The estimated probability of recovery of awareness (that is, consciousness) ranged from 0.94 in patients with early decorticate posturing in the absence of both extraneural trauma and ventilatory disturbance to 0.06 in patients with flaccidity, extraneural trauma and ventilatory disturbance in the first week after injury.  (+info)

Descriptive study of acute disseminated encephalomyelitis and evaluation of functional outcome predictors. (77/148)

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Is elevated pre-ictal heart rate associated with secondary generalization in partial epilepsy? (78/148)

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Inter-rater reliability of the Full Outline of UnResponsiveness score and the Glasgow Coma Scale in critically ill patients: a prospective observational study. (79/148)

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Acute propafenone toxicity after two exposures at standard dosing. (80/148)

A 72-year-old woman presented with a decreased level of consciousness and hypotension. The initial electrocardiogram demonstrated atrial fibrillation with a wide QRS complex. Her medical history revealed that she had just been started on propafenone. A diagnosis of propafenone toxicity was made and sodium bicarbonate was administered. A rare phenomenon in which toxicity occurred at therapeutic dosing is reported. Acute propafenone toxicity manifests in a wide range of organ systems; in particular, cardiovascular compromise in the form of hypotension, bradycardia and QRS widening can occur. Sodium bicarbonate therapy is advocated to directly counteract the toxic effects of propafenone. In the case described, this treatment resulted in rapid normalization of the QRS duration and stabilization of the hemodynamic profile.  (+info)