Quantification of lethargy in the neuro-ICU: the 60-Second Test.

The authors evaluated the 60-Second Test (SST), a brief test of mental concentration, as a supplement to the Glasgow Coma Scale (GCS) for monitoring verbally responsive patients in the neuro-intensive care unit. The SST demonstrated excellent reliability and was abnormal in 79% of patients assigned a top GCS score of 15. However, both tests had poor responsiveness to clinically identified changes in level of consciousness (LOC). The SST is sensitive to subtle alterations in LOC but, like the GCS, may have limitations as a monitoring tool in the neurocritical care setting.

Delirium from nicotine withdrawal in neuro-ICU patients.

Five cases of presumed nicotine withdrawal delirium among brain-injured patients treated in a neurologic intensive care unit are presented. Each patient had a history of heavy tobacco use and experienced dramatic and sustained clinical improvement within hours of transdermal nicotine replacement. These preliminary observations suggest that nicotine withdrawal may be an under-recognized cause of delirium in patients with acute brain injury.

Clinical trial of an air-circulating cooling blanket for fever control in critically ill neurologic patients.

OBJECTIVE: To evaluate the efficacy of an air-circulating cooling blanket for reducing body temperature in febrile neuro-ICU patients treated with acetaminophen. METHODS: Two-hundred twenty consecutively admitted neuro-ICU patients whose tympanic membrane temperature reached or exceeded 101 degrees F (38.3 degrees C) were randomly assigned to receive acetaminophen (650 mg every 4 hours) alone (n = 107) or acetaminophen plus air blanket therapy (n = 113). After 24 hours of treatment, the authors compared the proportion of subjects who attained treatment success (T < or = 99 degrees F) or treatment failure (T > or = 101 degrees F for 2 consecutive hours) using the chi(2) test and the time to reach these endpoints using Kaplan-Meier survival analysis. MAIN RESULTS: Air blanket therapy resulted in a small increase in the proportion of subjects with treatment success (44% versus 36%, chi(2) p = 0.19, log rank p = 0.10) and a similar small reduction in the proportion of patients with treatment failure (42% versus 53%, chi(2) p = 0.11, log-rank p = 0.21), compared with treatment with acetaminophen alone. Approximately one third of patients in both groups remained febrile after randomization and "failed" after the first 2 hours of treatment. Twelve percent of patients assigned to air blanket therapy refused or were unable to tolerate treatment, compared with 2% of patients treated with acetaminophen alone (p = 0.005). CONCLUSIONS: Treatment with an air-circulating cooling blanket did not effectively reduce body temperature in febrile neuro-ICU patients treated with acetaminophen. More effective interventions are needed to maintain normothermia in patients at risk for fever-related brain damage.

Disseminated intravascular coagulation and status epilepticus.

Status epilepticus has been associated with disseminated intravascular coagulation (DIC), but little is known regarding the pathogenesis of this uncommon association. We describe a 41-year-old woman with status epilepticus resulting in death in whom laboratory data demonstrated profound activation of the coagulation and fibrinolytic systems; autopsy findings were consistent with DIC. The occurrence of DIC in status epilepticus may be related to widespread endothelial damage secondary to seizure-induced hyperpyrexia. Body temperature should be closely monitored in patients with prolonged seizures.

Chronic inflammatory demyelinating polyneuropathy in non-Hodgkin's lymphoma.

A 42-year-old man was diagnosed with large cell non-Hodgkin's lymphoma 3 years after autologous bone marrow transplantation for Hodgkin's disease. The day before beginning systemic chemotherapy, the patient began to have symptoms of a sensorimotor neuropathy characterized by proximal and distal weakness, lower-extremity areflexia, elevated cerebrospinal fluid protein level, and evidence of demyelination on nerve conduction studies. Symptoms progressed despite two courses of intrathecal methotrexate, for possible lymphomatous meningitis, as well as systemic chemotherapy. The diagnosis of chronic inflammatory demyelinating polyneuropathy was made. Daily plasma exchange was performed for a total of 10 treatments with immediate improvement and eventual complete recovery in strength, sensation, and gait. A review of the literature confirms that inflammatory demyelinating polyneuropathy is a highly unusual but important cause of peripheral nervous system dysfunction. The potential for complete response to plasma exchange should be recognized in patients with symptoms, signs, and nerve conduction studies suggestive of chronic inflammatory demyelinating polyneuropathy.

Tremor at onset. Predictor of cognitive and motor outcome in Parkinson's disease?

We examined 46 male patients with idiopathic Parkinson's disease to see whether tremor at onset was as useful a predictor of benign clinical outcome as tremor predominance after several years. When we compared patients with tremor at onset (n = 27) with those whose disease began with brady-kinesia/rigidity (n = 9), or gait disorder (n = 10), we found no significant differences after a mean of 7 years in motor, cognitive, or affective status. Sixteen of the tremor-onset patients continued to have tremor predominance with minimal gait disorder after about 7 years. These tremor-predominant patients had significantly better motor outcome and somewhat better cognitive outcome than either tremor-onset patients who subsequently developed gait disorder (n = 11) or patients without tremor at onset (n = 19). Tremor predominance after several years appears to be a better predictor of a benign clinical course of Parkinson's disease than tremor at onset.

[The determination of the coccidiostat nicarbazin in animal tissue and eggs. I. Determination by pulse polarography and high pressure fluid chromatography with electrochemical detection]. / Zur Bestimmung des Coccidiostaticums Nicarbazin in tierischem Gewebe und im Ei. I. Nachweis mittels Pulspolarographie und Hochdruckflüssigchromatographie mit elektrochemischer Detektion.

The determination of nicarbazin residues in foodstuffs of animal origin by two different methods, polarography, HPLC with electrochemical detection, is described. By applying pulse polarography at the dropping mercury electrode to acetonitrile extracts of animal tissues and eggs, a detection limit of 50 micrograms/kg and mean recoveries of 79% were obtained. The same extracts were used for the HPLC determination with electrochemical detection. This led to a detection limit of 1 microgram/kg. Additional rapid confirmation can be obtained from HPLC using an internal standard (nifursol) and comparing peak area proportions of both substances at varied polarization voltages. The quantitative determination of nicarbazin in chicken eggs by both polarography and HPLC was found to be in good agreement.

[A method for the verification of chloramphenciol residues in animal tissues and eggs with high pressure liquid chromatography with radioimmunologic assay]. / Ein Verfahren zur Absicherung von Chloramphenicol-Nachweisen in teirischem Gewebe und Eiern durch Hochleistungsflüssigchromatographie mit radioimmunologischem Nachweis (HPLC-RIA).

The determination of chloramphenicol residues in animal tissues and eggs by high performance liquid chromatography followed by radioimmunological detection (HPLC-RIA) is described. The method is suited for the verification of positive results greater than or equal to 1 microgram/kg obtained from prescreening with a radioimmunoassay.

[Differential postmortem diagnosis of rabies in cats]. / Beitrag zur postmortalen Differentialdiagnose der Tollwut bei Katzen.

300 cats, sent in for rabies diagnosis, which were obviously not infected, have been further examined with regard to their causes of disease and death. Traumata, uremia and panleucopenia have been observed most frequently. As expected, affections of the central nervous system often have been stated. The results of our investigations have been compared with autopsy statistics on rabies-unsuspected cats, published in literature. Furthermore the preliminary reports have been examined and compared with the anamnesis of 214 rabies-positive cats. The information of preliminary reports on rabies-negative cats and their pathological diagnosis has been discussed in the context of differential diagnosis.

[The occurrence and distribution of rabies in Rheinland-Pfalz]. / Uber das Vorkommen und die Verbreitung der Tollwut in Rheinland-Pfalz.

By means of a descriptive study the progress of silvatic rabies in Rheinland-Pfalz is reported, starting from its first occurrence in 1955. During the period of 30 years a total of 35,090 animals of 48 different species has been examined on rabies, yielding 26,6% infected animals. The annual fractions of positive results fluctuated around this mean value with small deviations. The percentage for wild animals (35.9%) exceeded that of domestic animals (14.8%) significantly. The number of the annual rabid foxes showed no dependence on the hunting indicator of population density (HIPD) but correlated well with the dimension of the rabies-infected area.