RESUMO
We longitudinally evaluated the neuropsychological functions, rate of progression, and waking EEG findings in 17 patients with probable Alzheimer's disease (AD) with delusions and hallucinations, and compared them with those of matched AD patients without delusions and hallucinations. AD patients with delusions and hallucinations had a more rapid rate of decline, as measured by the Mini-Mental State Examination, a specific defect in receptive language, and a greater frequency of aggression and hostility. Visual EEG analysis showed that these patients had a significantly greater proportion of moderately abnormal EEGs, and spectral analysis confirmed the increased amount of delta and theta activity. These data demonstrate that AD patients with delusions and hallucinations have a greater degree of cerebral dysfunction and a relatively focal neuropsychological defect, which may indicate a localized pathologic abnormality.
Assuntos
Doença de Alzheimer/complicações , Delusões/complicações , Alucinações/complicações , Idoso , Doença de Alzheimer/tratamento farmacológico , Doença de Alzheimer/fisiopatologia , Doença de Alzheimer/psicologia , Análise de Variância , Comportamento/fisiologia , Delusões/tratamento farmacológico , Delusões/fisiopatologia , Depressão/fisiopatologia , Depressão/psicologia , Eletroencefalografia , Feminino , Alucinações/tratamento farmacológico , Alucinações/fisiopatologia , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Testes Neuropsicológicos , Escalas de Graduação Psiquiátrica , Psicotrópicos/uso terapêuticoRESUMO
Depressive illness with initial onset after age 60 has different clinical and prognostic features compared to depression beginning at a younger age. We evaluated waking electroencephalograms (EEGs) in 61 elderly depressed patients (32 early onset, 29 late onset) without cognitive impairment and not receiving psychotropic medications. The groups were comparable for age, severity of Hamilton depression score, education, and Folstein Mini-Mental State scores. Conventional visual EEG analysis revealed no significant differences in the mean alpha rhythm, incidence of abnormal records, or types of EEG abnormalities. Computerized spectral EEG analysis was also performed in 48 patients (23 early onset, 25 late onset). There were no significant differences in the pooled parasagittal mean frequency, theta--beta difference, combined delta and theta percentage, or relative power of the frequency bands. Thus, waking EEGs do not differentiate between elderly patients with the initial onset of the depression before or after age 60.
Assuntos
Transtorno Depressivo/fisiopatologia , Eletroencefalografia , Vigília/fisiologia , Fatores Etários , Idoso , Córtex Cerebral/fisiopatologia , Demência/diagnóstico , Demência/fisiopatologia , Demência/psicologia , Transtorno Depressivo/diagnóstico , Transtorno Depressivo/psicologia , Diagnóstico Diferencial , Feminino , Humanos , Masculino , Testes de PersonalidadeRESUMO
We reviewed the clinical features and ictal EEGs in 23 adults with myoclonic status epilepticus (MSE). Anoxic encephalopathy was the most common cause of MSE, occurring in 15 patients; 8 developed MSE within 14 hours following the anoxic insult. Metabolic encephalopathies were present in 4 patients, while 2 had degenerative CNS disorders. In 2 patients with generalized epilepsy, MSE developed during a medication change. Five types of EEG patterns were associated with MSE. Generalized periodic complexes (usually spikes, polyspikes, or sharp waves), often with attenuation of background activity between complexes (11 patients) or a burst-suppression pattern (4 patients), were the most common types. Outcome was poor: 20 patients died without regaining consciousness, while 1 remains in a vegetative state. The 2 patients with generalized epilepsy, both of whom were conscious during MSE, survived without sequelae.
Assuntos
Eletroencefalografia , Epilepsias Mioclônicas/fisiopatologia , Adulto , Idoso , Epilepsias Mioclônicas/etiologia , Feminino , Parada Cardíaca/complicações , Humanos , Hipóxia/complicações , Masculino , Pessoa de Meia-IdadeRESUMO
To test the possible effect of 32% end-tidal Xe concentration upon autoregulation, 5 baboons, Papio anubis/cynocephalus, were anesthetized/paralyzed with propranolol 0.02, diazepam 0.1, morphine sulfate 0.1, and pancuronium 0.2 (mg/(h.kg)). The animals were subjected to a servocontrolled blood infusion-withdrawal program to control central aortic blood pressure (CAP). PaCO2 was held to 30 to 35 torr, with individual variation less than 3 torr by control of ventilation and by including CO2 in the Xe/O2 mixture. Three to six CBF measurements were made in each subject over the above range. In four animals the CAP was varied between 18 and 150 torr, with corresponding CBF measurements. The CAP range was extended to 196 torr in the 5th animal by IV administration of phenylephrine. Significant lowering of global blood flow did not occur above 40 torr mean CAP. While regulated flow persists to about 150 torr at the high end, there is a breakaway between 150 and 190 torr where flow increased 90%. A 4th order polynomial fit of the data has the characteristic appearance of the familiar autoregulation curve. We conclude that autoregulation is preserved even in the presence of FIXe of 32% in the breathing mixture.
Assuntos
Circulação Cerebrovascular/fisiologia , Homeostase/fisiologia , Papio/fisiologia , Xenônio , Animais , Pressão Sanguínea/fisiologia , Tomografia Computadorizada por Raios XRESUMO
We reviewed the clinical and neuropathologic findings in 21 patients who had seizures after orthotopic liver transplants. Tonic-clonic seizures were the most common seizure type. Six patients developed status epilepticus. In 9 patients, seizures occurred within 1 week following transplantation. We found CNS lesions that were probably responsible for the occurrence of seizures in most patients; some had more than 1 finding. Neuropathologic examination revealed ischemic or hemorrhagic strokes in 18 patients, central pontine myelinolysis in 5, and CNS infections in 5. Multiple metabolic abnormalities were a contributing factor to the onset of seizures in some patients.
Assuntos
Transplante de Fígado , Complicações Pós-Operatórias , Convulsões/etiologia , Adulto , Sistema Nervoso Central/patologia , Doenças do Sistema Nervoso Central/complicações , Eletroencefalografia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Convulsões/patologia , Convulsões/fisiopatologiaRESUMO
We report the results of electroencephalograms, Mini-Mental State exam, Trailmaking Tests A and B, and serum albumin levels in 108 consecutive liver transplantation candidates. We compared test results to a clinical DSM-III diagnosis of delirium. Although each variable could differentiate between the two groups (delirium n = 18; nondelirium n = 90) at a statistically significant level, a discriminant analysis involving either all variables or only three particular variables (Trailmaking B, EEG code, and albumin) resulted in the highest specificity (97.8%) and sensitivity (83.3%), with a correct classification of 95.4% of subjects. The analysis also generates an equation that can be applied to clinical situations to enhance the accurate recognition of delirium. In addition, to explain abnormal Trailmaking B scores and/or EEGs in subjects who did not otherwise meet DSM-III criteria for delirium, we suggest the presence of a "subclinical delirium."
Assuntos
Delírio/diagnóstico , Encefalopatia Hepática/diagnóstico , Transplante de Fígado , Complicações Pós-Operatórias/diagnóstico , Adolescente , Adulto , Eletroencefalografia , Feminino , Humanos , Hepatopatias/cirurgia , Masculino , Manuais como Assunto , Pessoa de Meia-Idade , Testes Neuropsicológicos , Desempenho Psicomotor , Fatores de Risco , Albumina Sérica/metabolismoRESUMO
Myoclonus has been infrequently observed in patients receiving lithium therapy, and associated electroencephalographic (EEG) changes have not been well described. We report two women, ages 35 and 48, who, after the initiation of lithium carbonate therapy, had several generalized tonic-clonic seizures followed by myoclonic seizures. In both, myoclonus was associated with repetitive sharp waves on the EEG. Although the epileptogenicity of lithium remains controversial, the occurrence of myoclonic seizures associated with lithium treatment suggests a proconvulsant effect of lithium in susceptible individuals.