Sick sinus syndrome. Symptomatic cases in children.
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In 20 children needing treatment for symptomatic sick sinus syndrome, the average age at presentation was 7.1 years and ranged from 9 months to 18 years. Symptoms were never precise but, in retrospect, 5 children had syncope, 7 had a rapid heart action, 6 had dyspnoea or tachypnoea, 2 had nonspecific chest pains, 2 had pale spells, and 1 had a sudden hemiplegia. Symptoms followed cardiac surgery in 15 cases and were related to unoperated congenital heart disease in 2 and to myocarditis in 2. The aetiology was unknown in 1 case. The type of cardiac surgery resulting in the development of the sick sinus syndrome was predominantly related to atrial suturing. Both tachy- and bradydysrhythmias were found, including wandering atrial pacemaker (9 cases), junctional rhythm (19 cases), supraventricular tachycardia (9 cases), atrial flutter (11 cases), and atrial fibrillation (2 cases). Both atrial (8 cases) and ventricular (7 cases) premature beats were seen. All patients were given trials of drug therapy but difficulties were encountered. Cardioversion was used for tachyarrhythmias in 11 cases without serious problems. Six children had permanent cardiac pacemakers inserted with good results. Recognition of the sick sinus syndrome in childhood is important and treatment must be regulated by the severity of symptoms. (+info)
Release of fatty acid amides in a patient with hemispheric stroke: a microdialysis study.
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BACKGROUND: Excitotoxic insults such as stroke may induce release of fatty acid ethanolamides (FAEs), contributing to the downstream events in the ischemic cascade. We therefore studied release of FAEs such as anandamide, palmitylethanolamide (PEA), and oleylethanolamide (OEA) in the brain of a patient suffering from malignant hemispheric infarction treated with hypothermia. CASE DESCRIPTION: A patient with life-threatening hemispheric stroke was treated with moderate hypothermia (33 degrees C) that was maintained for 3 days, followed by a 3-day rewarming period. Microdialysis was applied to measure glutamate, lactate, and glycerol by using a microdialysis analyzer. FAEs were measured by microdialysis coupled with high-performance liquid chromatography/mass spectrometry. Release of neuroprotective fatty amides occurred within the first day after ischemia and reached high concentrations for all 3 substances in tissue surrounding the primary ischemic lesion: anandamide up to 42 pmol/mL, PEA up to 120 pmol/mL, and OEA up to 242 pmol/mL. There was a significant correlation with elevation of lactate as early marker for the hypoxic insult. CONCLUSIONS: This is the first report demonstrating release of FAEs in vivo during human stroke and may suggest contribution of the FAE signaling system to the pathophysiological events after ischemia. (+info)
Perception of verticality after recent cerebral hemispheric stroke.
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BACKGROUND AND PURPOSE: Perception of the subjective visual vertical (SVV) is affected by cerebral hemispheric lesions. Knowledge of this disturbance is of interest for the study of its possible relation to balance disturbances. There is still uncertainty about the possible effects of a visual field defect and of the side and site of the lesion. This study was conducted to assess SVV with the head upright or tilted and to explore its relation to a visual field defect, visuospatial neglect, and the site of lesion. METHODS: Forty patients with hemiplegia after a recent hemispheric stroke (20 with left and 20 with right stroke) were studied. The site of the lesion was determined on CT scan, with special attention focused on the vestibular cortex. A neurological examination with determination of the visual field and visual neglect was conducted before SVV was tested. Subjects sat in a dark room and adjusted a luminous rod to the vertical position. Measures were repeated with binocular and monocular vision and with the head upright or tilted to the right or left. RESULTS: SVV was abnormally deviated in 23 of 40 patients (57%). The deviation was significantly greater among patients with a right or left hemispheric lesion than among healthy controls (-2.2 degrees and 1.5 degrees versus 0.2 degrees ); the same applied to the range of uncertainty (7.6 degrees and 4.7 degrees versus 1.9 degrees ). SVV deviation was not significantly related to the location of the lesion but was closely related to visuospatial neglect. The "E" effect observed in controls with the head tilted, ie, an SVV shift in the direction opposite to the head tilt, was not observed in hemiplegic patients with the head tilted toward the nonparetic side. CONCLUSIONS: Recent hemispheric stroke affects SVV perception, which is closely correlated to visuospatial neglect. It is suggested that the E effect might be mediated by the stretching of the somatosensory structure of the neck. (+info)
Ectopic calcification around joints of paralysed limbs in hemiplegia, diffuse brain damage, and other neurological diseases.
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Mechanical deformity associated, with neurological disease is commonly encountered in the form of contractures, or pre-existing arthritis. Less common is the occurrence of ectopic calcification around the joints of a paralysed limb. Two forms of this are presented in a series of twenty patients. Para-articular calcification with the appearance of myositis ossificans around large joints of the affected limbs occurred most often. The interior of the joints was not affected, nor was there evidence of bony injury. In some cases, however, the excessive outgrowth of bone around the joint eventually resulted in a functional ankylosis by a uniting bar of bone outside the joint. The second form of calcification was periosteal, which unlike the first type was resorbed and left an area of cortical bony thickening. (+info)
Nervous system involvement in systemic lupus erythematosus.
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In a retrospective analysis of 80 patients with systemic lupus erythematosus (SLE) seen over a 10-year period, 41 (51%) exhibited neurological manifestations. Nervous system involvement was characterized by a significantly greater involvement of black patients (P less than 0-02), a higher incidence of renal failure after the first appearance of neurological features (P less than 0-05), and a significantly worse 10-year survival rate (P less than 0-05). Specific neurological investigations were generally unhelpful in diagnosis. The finding of hypoglycorrhachia in 4 patients was striking and may have pathogenetic significance. The lack of a specific diagnostic test for central nervous system involvement may have hindered recognition of a cerebral abscess in one patient. Treatment with massive doses of corticosteroids was not obviously more effective than treatment with smaller doses. Autopsy findings showed scattered small cerebral infarcts but vasculitis was apparent in only one case. (+info)
Varicella-zoster virus: atypical presentations and unusual complications.
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Varicella-zoster virus (VZV) is the etiologic agent of varicella (primary infection) and herpes zoster (reactivation of latent infection). Although varicella is most often a relatively benign and self-limited childhood illness, the disease can be associated with a variety of serious and potentially lethal complications in both immunocompetent and immunocompromised persons. One complication of varicella that appears to be increasing in frequency is serious bacterial soft tissue infections caused by group A streptococci. Issues related to management of varicella become especially complex when varicella involves pregnant women or susceptible neonates. Herpes zoster can be associated with a variety of neurologic complications, including a syndrome of delayed contralateral hemiparesis. Neurologic complications of herpes zoster, including chronic encephalitis, occur with increased frequency in AIDS patients. VZV retinitis is a potentially sight-threatening complication that occurs in both immunocompetent and immunocompromised persons. Current knowledge regarding pathogenesis and antiviral therapy is reviewed. (+info)
The vulpius procedure for correction of equinus deformity in patients with hemiplegia.
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Spasm or contracture of gastrocnemius causes an equinus deformity of the ankle in both cerebral palsy and hemiplegia. Its release is therefore required in the treatment of those patients who do not respond to conservative measures. The Vulpius procedure is a simple and effective method for the release of gastrocnemius and is particularly indicated when long periods of immobilisation of the foot and ankle are not desirable. We have used this procedure with good results to correct an equinus deformity in 230 adults with a cerebrovascular accident and various associated medical conditions. It is not only effective in cerebral palsy, but should be considered at an early stage in all adult patients with deformity of the ankle and foot in whom spasm of gastrocnemius is the major cause. (+info)
Use of a static adjustable ankle-foot orthosis following tibial nerve block to reduce plantar-flexion contracture in an individual with brain injury.
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BACKGROUND AND PURPOSE: Ankle plantar-flexion contractures are a common complication of brain injuries and can lead to secondary limitations in mobility. CASE DESCRIPTION: The patient was a 44-year-old woman with left hemiplegia following a right frontal arteriovenous malformation resection. She had a left ankle plantar-flexion contracture of -31 degrees from neutral. After a tibial nerve block, an adjustable ankle-foot orthosis was applied 23 hours a day for 27 days. Adjustments of the orthosis were made as the contracture was reduced. The patient received physical therapy during the 27-day period for functional mobility activities and stretching the plantar flexors outside of the orthosis. OUTCOMES: The patient's dorsiflexion passive range of motion increased from -31 degrees to +10 degrees. DISCUSSION: The application of an adjustable ankle-foot orthosis following a tibial nerve block, as an addition to a physical therapy regimen of stretching and mobility training, may reduce plantar-flexion contractures in patients with brain injury. (+info)