Multifocal inflammatory leukoencephalopathy associated with levamisole therapy.

Cerebral demyelinating disease developed in a patient during adjuvant therapy with levamisole for malignant melanoma. This patient had no evidence of previous neurologic disease. Levamisole was administered for 5 weeks (total dose, 1,500 mg).

Clinical and radiologic features of cerebral edema in fulminant hepatic failure.

Objective: To describe a series of consecutive patients with fulminant hepatic failure (FHF) and to present a new classification system for brain edema, an important cause of mortality in such patients.

Design: We reviewed 22 computed tomographic (CT) scans of the brain in 12 patients with FHF and classified the severity of cerebral edema by using predefined criteria.

Results: No cerebral edema was detected on CT scans in four patients with stage 1 or 2 hepatic encephalopathy at the time of admission, but it was noted in seven of eight patients with stage 3 or 4 hepatic encephalopathy.

Gastrointestinal bleeding in stroke.

Background And Purpose: Patients with ischemic or hemorrhagic stroke are at risk for systemic complications. The reasons why gastrointestinal bleeding occurs after stroke are unknown and have intuitively been attributed to stress ulcers. No study to date has addressed causes of gastrointestinal hemorrhage in stroke.

Acute acid-base disorders associated with status epilepticus.

Objective: To analyze the acid-base abnormalities in patients with status epilepticus.

Design: We retrospectively reviewed the acid-base disturbances in 38 consecutive patients who had been admitted to the emergency department at a Mayo-affiliated hospital because of status epilepticus between 1982 and 1993.

Material And Methods: On the basis of results of arterial blood gas analyses, the acid-base disorders were categorized.

The clinical spectrum of critical illness polyneuropathy.

Objective: To describe the entity of critical illness polyneuropathy and review our experience with six cases.

Design: We present case reports of six patients with polyneuropathy associated with critical illness, who received medical care at the Mayo Clinic between 1992 and 1994, and discuss similar cases from the literature.

Results: Critical illness may damage peripheral nerves.

Prospective study of sentinel headache in aneurysmal subarachnoid haemorrhage.

Retrospective surveys of patients with subarachnoid haemorrhage suggest that minor episodes with sudden headache (warning leaks) may precede rupture of an aneurysm, and that early recognition and surgery might lead to improved outcome. We studied 148 patients with sudden and severe headache (possible sentinel headache) seen by 252 general practitioners in a 5-year period in the Netherlands. Subarachnoid haemorrhage was the cause in 37 patients (25%) (proven aneurysm in 21, negative angiogram in 6, no angiogram done in 6, sudden headache followed by death in 4).

Perimesencephalic subarachnoid hemorrhage. Additional perspectives from four cases.

Background: Nonaneurysmal perimesencephalic hemorrhage, a distinct form of subarachnoid hemorrhage, is a recently described variant of intracranial hemorrhage. We describe two patients who presented with unusual features of this type of subarachnoid hemorrhage and also two patients who had a perimesencephalic pattern of hemorrhage due to a ruptured posterior circulation aneurysm.

Case Descriptions: The first patient, a 41-year-old woman with perimesencephalic hemorrhage, underwent an exploratory craniotomy because angiography had suggested an anomaly of the basilar tip.

Neurologic complications associated with internal jugular vein cannulation in critically ill patients: a prospective study.

To determine the frequency of neurologic complications after internal jugular cannulation, we performed a prospective study in 66 consecutive critically ill patients. Of these 66 patients, one had Horner's syndrome probably associated with a large carotid sheath hematoma (2%; 95% CI, 1 to 8%). No cerebrovascular complications occurred.

Absence of postoperative hyponatremia syndrome in young, healthy females.

Young and previously healthy females have been reported to develop severe postoperative hyponatremia with a fatal outcome. The clinical presentation is dramatic, with seizures, respiratory arrest, and permanent, often catastrophic, brain damage. The true incidence is unknown.

Subcortical hemorrhage in disseminated intravascular coagulation associated with sepsis.

Cranial CT features of two patients with intracerebral hemorrhages in the setting of sepsis and disseminated intravascular coagulation are reported. Multiple predominantly subcortical hemorrhages were seen. This pattern of cerebral hemorrhage should raise suspicion of disseminated intravascular coagulation as an underlying cause.

FK506-induced neurotoxicity in liver transplantation.

We report FK506-induced neurotoxicity in 14 of 44 consecutive patients following orthoptic liver transplantation. In 10 of these 14 patients, postural hand tremors were found in the first weeks following surgery, transient apraxia of speech in 3, and generalized tonic-clonic seizures were noted in 2 patients. Other manifestations included nightmares, agitation, and acute delirium.

Phenytoin toxicity associated with hypoalbuminemia in critically ill patients.

Four critically ill patients developed phenytoin toxicity. Hypoalbuminemia or concomitant displacing drugs resulted in an increased fraction of unbound drug. Clinical findings included gradual decrease in level of consciousness and cerebellar signs.

Prognostic value of myoclonus status in comatose survivors of cardiac arrest.

Generalized myoclonus status is common in comatose patients after cardiac resuscitation, but its prognostic value is uncertain. We studied the clinical, radiologic, and pathologic findings in 107 consecutive patients who remained comatose after cardiac resuscitation. Myoclonus status was present in 40 patients (37%).

Subarachnoid hemorrhage without detectable aneurysm. A review of the causes.

Background: In 15% to 20% of patients with a spontaneous subarachnoid hemorrhage, no aneurysm is found on the first angiogram. This review emphasizes that this group of patients is in fact heterogeneous and describes the clinical features, pattern of hemorrhage on early computed tomographic (CT) scan, prognosis, and proposed management in the several and distinct subsets of these patients.

Summary Of Review: Patients in whom no aneurysm is revealed on the initial angiogram can be subdivided mainly according to the pattern of hemorrhage on an early CT scan.

Fulminant brain necrosis from atrial myxoma showers.

Background: Atrial myxoma is uncommon and may be associated with brief isolated ischemic events. We describe a patient with atrial myxoma and an incompletely evaluated ischemic stroke followed 1 year later with almost complete brain necrosis.

Summary Of Report: A 63-year-old woman presented with a rapidly progressive illness resulting in coma within 24 hours from multiple myxomatous emboli.

New-onset seizures in critically ill patients.

We studied causes of new-onset seizures in 55 patients admitted to medical and surgical intensive care units between 1981 and 1991. In one-third of the patients, sudden withdrawal of narcotic agents was associated with tonic-clonic seizures. In another third, acute metabolic changes, predominantly severe hyponatremia (sodium < or = 125 mEq/l), accounted for new-onset seizures.

Intracerebral hemorrhage after fibrinolytic therapy for acute myocardial infarction.

Background And Purpose: Intracerebral hematoma may complicate treatment of acute myocardial infarction in patients treated with fibrinolytic agents. We studied the clinical presentation and computed tomographic characteristics.

Methods: We studied eight patients with lobar intracerebral hematomas after fibrinolytic treatment of acute coronary occlusion.

Acute hydrocephalus in nonaneurysmal perimesencephalic hemorrhage: evidence of CSF block at the tentorial hiatus.

The acute hydrocephalus in patients with nonaneurysmal perimesencephalic hemorrhage suggests an extraventricular obstruction of CSF flow. We studied the occurrence of acute hydrocephalus and the site of cisternal blood in 40 consecutive patients with perimesencephalic hemorrhage. In all 11 patients with hydrocephalus, all perimesencephalic cisterns were filled with blood; this occurred in only five of the 29 patients (17%) without hydrocephalus (p less than 0.

The role of hypotension in septic encephalopathy following surgical procedures.

To study the risk factors for septic encephalopathy, we reviewed a consecutive series of 84 patients with septic syndrome and multiple-organ failure. Septic encephalopathy developed in 14 of these patients. Univariate analysis revealed that severe hypotension was significantly associated with the development of septic encephalopathy.

Infarction after aneurysm rupture does not depend on distribution or clearance rate of blood.

Background And Purpose: We sought to determine the contribution of the amount, distribution, and clearance rate of extravasated blood in relation to occurrence of infarction and outcome in patients with aneurysmal subarachnoid hemorrhage.

Methods: We prospectively studied 59 consecutive patients with aneurysmal subarachnoid hemorrhage admitted within 72 hours by means of serial computed tomographic scanning, close clinical observation, and assessment of outcome after 3 months.

Results: Infarction occurred in 17 of the 59 patients.