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1.
West Afr J Med ; 36(2): 183-188, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31385606

RESUMO

OBJECTIVE: There is paucity of information on delirium in sub-Saharan Africa (SSA) particularly in the older persons (>60 years of age), leaving questions about the burden of the disease in an environment with lower health care standards. In this article, we set out to determine the frequency, precipitants and symptomatology of delirium in elderly patients admitted into medical wards in a teaching hospital in South-West Nigeria. METHODS: This was a descriptive study involving a pre-planned sample of one hundred and fifty patients aged 60 years and over, assessed for cognitive impairment and delirium using the previously validated IDEA cognitive screen, and the Confusion Assessment Method (CAM) respectively. Diagnosis of delirium was made using the CAM and DSM-IV criteria. RESULTS: Delirium was diagnosed in 32 patients giving a frequency of 21.3% (95%CI: 14.7-30.0%). Patients with delirium were significantly older (p<0.05). A quarter of the patients had dementia. Hypertension was a notable co-morbid condition. All the patients had altered sleep wake cycle, inattention, disorientation, and altered consciousness. Neurological diseases were the most common precipitant. There was a good agreement between the DSM-IV and CAM diagnoses. CONCLUSION: Delirium is common in hospitalised elderly patients particularly those with neurological diseases. Co-morbidities like hypertension, dementia, and depression should be looked for in delirious elderly patients.


Assuntos
Disfunção Cognitiva/diagnóstico , Confusão/diagnóstico , Delírio/diagnóstico , Demência/diagnóstico , Idoso , Idoso de 80 Anos ou mais , Disfunção Cognitiva/epidemiologia , Comorbidade , Confusão/psicologia , Delírio/epidemiologia , Delírio/psicologia , Demência/epidemiologia , Manual Diagnóstico e Estatístico de Transtornos Mentais , Humanos , Hipertensão/epidemiologia , Entrevista Psiquiátrica Padronizada/estatística & dados numéricos , Pessoa de Meia-Idade , Doenças do Sistema Nervoso/epidemiologia , Testes Neuropsicológicos/estatística & dados numéricos , Nigéria/epidemiologia , Transtornos do Sono-Vigília/epidemiologia , Centros de Atenção Terciária
3.
Klin Onkol ; 31(5): 371-375, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30541324

RESUMO

BACKGROUND: Brain metastases are one of the main causes of morbidity and mortality of patients with oncological disease. In non-small cell lung carcinoma (NSCLC), the risk of CNS secondary development is 30-50%. An unusual diagnostic and therapeutic problem is the finding of suspicious pituitary lesions. Obtaining a differential diagnosis relies on evaluating the clinical course of the disease (visual disturbances, diabetes insipidus (DI), weakness etc.), and performing endocrinological examinations and imaging analyses (CT, but mainly MRI). Sometimes, however, definitive resolution of the problem requires histological assessment of the tumor. CASE REPORT: A 65-year-old patient with a newly diagnosed metastatic lung adenocarcinoma was admitted to our department for a first cycle of chemotherapy consisting of cisplatin and navelbine. However, at the beginning of hospitalization, the patient developed qualitative disturbances in consciousness and disorientation. Emergency CT of the CNS revealed a tumor of the pituitary gland, and a subsequent MRI showed intraseller and suprasellar masses making contact with the optic chiasma. An endocrinological examination revealed panhypopituitarism. Pituitary metastasis of NSCLC was confirmed by tumor histology using the trans-sphenoid approach. CONCLUSION: Lung and breast carcinomas are among the most common cancers to metastasize to the pituitary gland. The incidence of pituitary metastases is reported to be 0.4-28.1%. Clinically, they are mostly silent, but may manifest as endocrine disorders, such as DI, hypothyroidism, and hypocorticism, or as visual disturbances due to compression of the optic nerve. Management depends on the establishment of a correct diagnosis. Key words: hypopituitarism - magnetic resonance imaging - pituitary neoplasm - radiosurgery - targeted therapy The authors declare they have no potential confl icts of interest concerning drugs, products, or services used in the study. The Editorial Board declares that the manuscript met the ICMJE recommendation for biomedical papers. Submitted: 26. 4. 2018 Accepted: 27. 6. 2018.


Assuntos
Adenocarcinoma de Pulmão/diagnóstico , Carcinoma Pulmonar de Células não Pequenas/diagnóstico , Confusão/diagnóstico , Transtornos da Consciência/diagnóstico , Hipopituitarismo/diagnóstico , Neoplasias Pulmonares/diagnóstico , Neoplasias Hipofisárias/diagnóstico , Adenocarcinoma de Pulmão/patologia , Idoso , Carcinoma Pulmonar de Células não Pequenas/patologia , Confusão/patologia , Transtornos da Consciência/patologia , Humanos , Hipopituitarismo/patologia , Neoplasias Pulmonares/patologia , Imagem por Ressonância Magnética , Neoplasias Hipofisárias/secundário
4.
BMJ Case Rep ; 20182018 Jun 08.
Artigo em Inglês | MEDLINE | ID: mdl-29884664

RESUMO

We report a 1-year follow-up of a young woman with anti-N-methyl-D-aspartate receptor encephalitis. Management of autoimmune encephalitis remains challenging as objective and clinically relevant biomarkers are sought, which allow for the monitoring of treatment response. While further investigation is required, we believe that this case highlights the importance of following a comprehensive neuropsychological profile as a clinically relevant biomarker to guide therapeutic decision-making. By relying on the neuropsychological assessment of the patient, treatment with more toxic medications was avoided and her antiepileptic drug regimen was simplified.


Assuntos
Encefalite Antirreceptor de N-Metil-D-Aspartato/psicologia , Doenças Autoimunes do Sistema Nervoso/psicologia , Testes Neuropsicológicos/normas , Receptores de N-Metil-D-Aspartato/imunologia , Adulto , Encefalite Antirreceptor de N-Metil-D-Aspartato/sangue , Encefalite Antirreceptor de N-Metil-D-Aspartato/líquido cefalorraquidiano , Encefalite Antirreceptor de N-Metil-D-Aspartato/tratamento farmacológico , Anticonvulsivantes/administração & dosagem , Anticonvulsivantes/uso terapêutico , Antineoplásicos Imunológicos/uso terapêutico , Doenças Autoimunes do Sistema Nervoso/sangue , Doenças Autoimunes do Sistema Nervoso/líquido cefalorraquidiano , Doenças Autoimunes do Sistema Nervoso/tratamento farmacológico , Confusão/diagnóstico , Confusão/etiologia , Eletroencefalografia/métodos , Epilepsia Parcial Contínua/diagnóstico por imagem , Epilepsia Parcial Contínua/tratamento farmacológico , Epilepsia Parcial Contínua/fisiopatologia , Feminino , Humanos , Imunossupressores/administração & dosagem , Imunossupressores/uso terapêutico , Imagem por Ressonância Magnética/métodos , Monitorização Fisiológica/normas , Troca Plasmática/métodos , Doenças Raras , Rituximab/administração & dosagem , Rituximab/uso terapêutico , Esteroides/administração & dosagem , Esteroides/uso terapêutico , Resultado do Tratamento
5.
Bull Cancer ; 105(7-8): 720-734, 2018 Jul - Aug.
Artigo em Francês | MEDLINE | ID: mdl-29773225

RESUMO

Cancer prevalence increases with aging. Prevalent or incident neurocognitive disorders are frequent in geriatric oncology. Cognitive decline associated with cancer increases the risk of under or over-cancer treatment and makes therapeutic decisions complex. In this context, we present tools to optimize cognitive impairment screening, identification of underlying mechanisms and specific treatments. Geriatric specialists intervention can help global care, social services utilization and patient's orientation when ambulatory cares become difficult.


Assuntos
Disfunção Cognitiva/diagnóstico , Disfunção Cognitiva/terapia , Oncologia , Neoplasias/complicações , Idoso , Encéfalo/efeitos dos fármacos , Disfunção Cognitiva/etiologia , Confusão/diagnóstico , Tomada de Decisões , Diagnóstico Diferencial , Avaliação Geriátrica , Humanos , Neoplasias/terapia
6.
Rev Epidemiol Sante Publique ; 66(3): 187-194, 2018 May.
Artigo em Francês | MEDLINE | ID: mdl-29625860

RESUMO

INTRODUCTION: The Confusion Assessment Method (CAM) is a validated key tool in clinical practice and research programs to diagnose delirium and assess its severity. There is no validated French version of the CAM training manual and coding guide (Inouye SK). The aim of this study was to establish a consensual French version of the CAM and its manual. METHODS: Cross-cultural adaptation to achieve equivalence between the original version and a French adapted version of the CAM manual. RESULTS: A rigorous process was conducted including control of cultural adequacy of the tool's components, double forward and back translations, reconciliation, expert committee review (including bilingual translators with different nationalities, a linguist, highly qualified clinicians, methodologists) and pretesting. A consensual French version of the CAM was achieved. CONCLUSION: Implementation of the CAM French version in daily clinical practice will enable optimal diagnosis of delirium diagnosis and enhance communication between health professionals in French speaking countries. Validity and psychometric properties are being tested in a French multicenter cohort, opening up new perspectives for improved quality of care and research programs in French speaking countries.


Assuntos
Confusão/diagnóstico , Características Culturais , Delírio/diagnóstico , Linguagem , Psicometria/métodos , Traduções , Doença Aguda , Idoso , Confusão/psicologia , Comparação Transcultural , Delírio/psicologia , Avaliação Geriátrica/métodos , Humanos , Reprodutibilidade dos Testes , Inquéritos e Questionários
7.
BMJ Case Rep ; 20182018 Mar 09.
Artigo em Inglês | MEDLINE | ID: mdl-29523608

RESUMO

Exercise-associated hyponatraemia (EAH) always involves a component of overhydration relative to available exchangeable sodium stores. In the majority of cases, this is purely due to excessive consumption of fluids during exercise. In a lesser number of cases, it is apparent that excessive sodium loss through sweat may play a role by decreasing the amount of acutely available exchangeable sodium. Two cases demonstrating the latter, one in an individual with cystic fibrosis (CF) and another in an endurance athlete without CF, demonstrate how elevated dermal sweat losses may contribute to a relative dilutional EAH along a pathophysiological continuum.


Assuntos
Fibrose Cística/metabolismo , Exercício/fisiologia , Hiponatremia/fisiopatologia , Sódio/análise , Suor/metabolismo , Adulto , Assistência ao Convalescente , Anticonvulsivantes/uso terapêutico , Antidiuréticos/uso terapêutico , Confusão/diagnóstico , Confusão/etiologia , Fibrose Cística/diagnóstico , Desamino Arginina Vasopressina/administração & dosagem , Desamino Arginina Vasopressina/uso terapêutico , Diagnóstico Diferencial , Feminino , Exaustão por Calor/diagnóstico , Hospitalização , Humanos , Hiponatremia/diagnóstico , Iontoforese/métodos , Lorazepam/administração & dosagem , Lorazepam/uso terapêutico , Masculino , Náusea/diagnóstico , Náusea/etiologia , Concentração Osmolar , Convulsões/diagnóstico , Convulsões/tratamento farmacológico , Sódio/sangue , Resultado do Tratamento
8.
J ECT ; 34(1): 21-25, 2018 03.
Artigo em Inglês | MEDLINE | ID: mdl-28976441

RESUMO

OBJECTIVES: Assessment of post-electroconvulsive therapy (ECT) disorientation at a single time point after ECT treatment may prove an effective and clinically useful method for monitoring the severity of disorientation and predicting ECT-induced retrograde amnesia. In this study, we aimed to validate a novel instrument (10-Item Orientation Questionnaire) developed to assess the level of disorientation after ECT. METHODS: Twenty-four depressed inpatients who were prescribed an acute course of ECT were administered the 10-Item Orientation Questionnaire at 30 minutes after ECT and had time to reorientation assessed at 3 time points after ECT (10, 30, and 60 minutes) at ECT treatments 1 to 3. The association between average performance of the 10-Item Orientation Questionnaire across the acute ECT course and retrograde amnesia at post-ECT was examined using the Autobiographical Memory Interview-Short Form. RESULTS: Mean performance on the 10-Item Orientation Questionnaire across treatments 1 to 3 was moderately correlated with average time to reorientation (r = -0.52, P = 0.02, n = 20). Across the acute ECT course, poorer performance on the 10-Item Orientation Questionnaire was associated with greater retrograde amnesia at post-ECT (r = 0.53, P = 0.03, n = 16). CONCLUSIONS: The 10-Item Orientation Questionnaire when administered at 30 minutes after ECT is sensitive for detecting patients with slow recovery of orientation after ECT. Use of this instrument therefore has potential for improving routine patient monitoring in clinical practice and identifying patients at increased risk of retrograde memory adverse effects following treatment.


Assuntos
Amnésia Retrógrada/diagnóstico , Confusão/diagnóstico , Eletroconvulsoterapia/efeitos adversos , Monitorização Fisiológica/métodos , Adulto , Idoso , Amnésia Retrógrada/etiologia , Confusão/etiologia , Feminino , Humanos , Masculino , Transtornos Mentais/terapia , Pessoa de Meia-Idade , Orientação , Reprodutibilidade dos Testes , Inquéritos e Questionários
9.
Trials ; 18(1): 583, 2017 Dec 04.
Artigo em Inglês | MEDLINE | ID: mdl-29202786

RESUMO

BACKGROUND: Health and social care provision for an ageing population is a global priority. Provision for those with dementia and hip fracture has specific and growing importance. Older people who break their hip are recognised as exceptionally vulnerable to experiencing confusion (including but not exclusively, dementia and/or delirium and/or cognitive impairment(s)) before, during or after acute admissions. Older people experiencing hip fracture and confusion risk serious complications, linked to delayed recovery and higher mortality post-operatively. Specific care pathways acknowledging the differences in patient presentation and care needs are proposed to improve clinical and process outcomes. METHODS: This protocol describes a multi-centre, feasibility, cluster-randomised, controlled trial (CRCT) to be undertaken across ten National Health Service hospital trusts in the UK. The trial will explore the feasibility of undertaking a CRCT comparing the multicomponent PERFECTED enhanced recovery intervention (PERFECT-ER), which acknowledges the differences in care needs of confused older patients experiencing hip fracture, with standard care. The trial will also have an integrated process evaluation to explore how PERFECT-ER is implemented and interacts with the local context. The study will recruit 400 hip fracture patients identified as experiencing confusion and will also recruit "suitable informants" (individuals in regular contact with participants who will complete proxy measures). We will also recruit NHS professionals for the process evaluation. This mixed methods design will produce data to inform a definitive evaluation of the intervention via a large-scale pragmatic randomised controlled trial (RCT). DISCUSSION: The trial will provide a preliminary estimate of potential efficacy of PERFECT-ER versus standard care; assess service delivery variation, inform primary and secondary outcome selection, generate estimates of recruitment and retention rates, data collection difficulties, and completeness of outcome data and provide an indication of potential economic benefits. The process evaluation will enhance knowledge of implementation delivery and receipt. TRIAL REGISTRATION: ISRCTN, 99336264 . Registered on 5 September 2016.


Assuntos
Lista de Checagem , Confusão/terapia , Prestação Integrada de Cuidados de Saúde/organização & administração , Geriatria/organização & administração , Fraturas do Quadril/terapia , Protocolos Clínicos , Confusão/diagnóstico , Confusão/psicologia , Estudos de Viabilidade , Fraturas do Quadril/diagnóstico , Fraturas do Quadril/fisiopatologia , Humanos , Recuperação de Função Fisiológica , Projetos de Pesquisa , Medicina Estatal/organização & administração , Fatores de Tempo , Resultado do Tratamento , Reino Unido
10.
BMJ Case Rep ; 20172017 07 31.
Artigo em Inglês | MEDLINE | ID: mdl-28765478

RESUMO

We report a 57-year-old woman with end-stage renal disease (ESRD) on maintenance peritoneal dialysis (PD), who presented to the emergency room (ER) by ambulance with complaints of confusion and altered sensorium for 48 hours. She had been reviewed in a walk-in clinic 72 hours earlier and had been prescribed the standard 1000 mg three times per day of valacyclovir for an acute attack of shingles instead of 500 mg once a day on ESRD. In the ER, she received further 500 mg of intravenous acyclovir as herpes encephalitis was clinically suspected. CT of the brain and lumbar puncture were non-contributory to the diagnosis. Valacyclovir and acyclovir were discontinued when the diagnosis of valacyclovir-associated neurotoxicity became clinically evident. As the patient's Glasgow Coma Scale declined, we intensified her PD regimen from one to six exchanges per day and 24 hours later there was a significant neurological improvement.


Assuntos
Aciclovir/análogos & derivados , Falência Renal Crônica/terapia , Síndromes Neurotóxicas/etiologia , Valina/análogos & derivados , Aciclovir/administração & dosagem , Aciclovir/efeitos adversos , Aciclovir/uso terapêutico , Administração Intravenosa , Antivirais/efeitos adversos , Confusão/diagnóstico , Confusão/etiologia , Transtornos da Consciência/diagnóstico , Transtornos da Consciência/etiologia , Diagnóstico Diferencial , Encefalite por Herpes Simples/diagnóstico , Encefalite por Herpes Simples/virologia , Feminino , Herpes Zoster/tratamento farmacológico , Humanos , Pessoa de Meia-Idade , Diálise Peritoneal , Valaciclovir , Valina/administração & dosagem , Valina/efeitos adversos , Valina/uso terapêutico
11.
BMJ Case Rep ; 20172017 Aug 07.
Artigo em Inglês | MEDLINE | ID: mdl-28784900

RESUMO

A middle-aged man presented with progressive confusion. Initial brain CT was misinterpreted to have 'cerebral atrophy and bilateral subdural effusions' by the emergency physician, and the patient was admitted to a medical ward for further investigation. Two days later, the patient experienced acute neurological deterioration, and burr hole drainage was performed to relieve the effusions. It was later confirmed that the effusions were caused by intracranial hypotension secondary to spinal cerebrospinal fluid leakage. The patient improved on conservative treatment with no lasting neurological sequela.


Assuntos
Vazamento de Líquido Cefalorraquidiano/complicações , Confusão/etiologia , Hipotensão Intracraniana/complicações , Derrame Subdural/etiologia , Vazamento de Líquido Cefalorraquidiano/psicologia , Confusão/diagnóstico , Erros de Diagnóstico , Humanos , Hipotensão Intracraniana/psicologia , Masculino , Pessoa de Meia-Idade , Derrame Subdural/diagnóstico
12.
BMJ Case Rep ; 20172017 Jun 30.
Artigo em Inglês | MEDLINE | ID: mdl-28667008

RESUMO

Cushing's syndrome is a rare disease. Cushing's syndrome presenting as acute psychosis is an exceptional occurrence. We present the case of a 37-year-old woman who was admitted with acute confusion associated with mild hypercalcaemia and was subsequently diagnosed with parathyroid and adrenal adenomas. Our hospital sees approximately 6000 endocrine patients per year, with an incidence of around four Cushing's cases annually. This is the first such case to occur in our hospital and one of few described in the literature.


Assuntos
Adenoma/complicações , Adenoma Adrenocortical/complicações , Síndrome de Cushing/diagnóstico , Hiperparatireoidismo Primário/complicações , Neoplasias das Paratireoides/complicações , Transtornos Psicóticos/diagnóstico , Glândulas Suprarrenais/patologia , Adulto , Confusão/diagnóstico , Confusão/etiologia , Síndrome de Cushing/complicações , Feminino , Humanos , Hipercalcemia/complicações , Glândulas Paratireoides/patologia , Transtornos Psicóticos/etiologia
13.
BMJ Case Rep ; 20172017 Jun 29.
Artigo em Inglês | MEDLINE | ID: mdl-28667057

RESUMO

The police brought a 65-year-old female patient to the EADU after being found 'roaming the streets' in an apparent state of confusion. This was her third admission under the same circumstances during the last 3 years. Neurological examination revealed (1) cognitive impairment, (2) oculomotor apraxia, (3) abnormal cancellation of vestibular ocular reflex, (4) mild ataxia and (5) mild hypotonia. Renal function was abnormal and liver function was normal. No retinal disturbance was found. The head CT on admission was normal for stroke and the lumbar puncture was negative for encephalitis. Her brain MRI showed 'molar tooth sign', suggestive of Joubert syndrome, which was confirmed by genetic testing showing anomalous NPHP1 gene.


Assuntos
Anormalidades Múltiplas/diagnóstico , Proteínas Adaptadoras de Transdução de Sinal/genética , Encéfalo/patologia , Cerebelo/anormalidades , Ciliopatias/diagnóstico , Anormalidades do Olho/diagnóstico , Doenças Renais Císticas/diagnóstico , Proteínas de Membrana/genética , Retina/anormalidades , Anormalidades Múltiplas/diagnóstico por imagem , Anormalidades Múltiplas/genética , Anormalidades Múltiplas/patologia , Idoso , Apraxias/congênito , Apraxias/diagnóstico , Apraxias/etiologia , Ataxia/diagnóstico , Ataxia/etiologia , Encéfalo/diagnóstico por imagem , Cerebelo/diagnóstico por imagem , Cerebelo/patologia , Ciliopatias/diagnóstico por imagem , Ciliopatias/genética , Ciliopatias/patologia , Síndrome de Cogan/diagnóstico , Síndrome de Cogan/etiologia , Transtornos Cognitivos/diagnóstico , Transtornos Cognitivos/etiologia , Confusão/diagnóstico , Confusão/etiologia , Anormalidades do Olho/diagnóstico por imagem , Anormalidades do Olho/genética , Anormalidades do Olho/patologia , Feminino , Testes Genéticos , Humanos , Rim , Doenças Renais Císticas/diagnóstico por imagem , Doenças Renais Císticas/genética , Doenças Renais Císticas/patologia , Fígado , Imagem por Ressonância Magnética , Hipotonia Muscular/diagnóstico , Hipotonia Muscular/etiologia , Reflexo Vestíbulo-Ocular , Retina/diagnóstico por imagem , Retina/patologia , Síndrome , Tomografia Computadorizada por Raios X
14.
J Clin Neurosci ; 44: 184-187, 2017 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-28676317

RESUMO

The Glasgow Coma Scale (GCS) only assesses orientation after traumatic brain injury (TBI). 'Post-traumatic amnesia' (PTA) comprises orientation, anterograde amnesia (AA) and retrograde amnesia (RA). However, RA is often disregarded in formalized PTA assessment. Drugs can potentially confound PTA assessment: e.g. midazolam can cause AA. However, potential drug confounders are also often disregarded in formalized PTA testing. One study of medium-stay elective-surgery orthopaedic patients (without TBI) demonstrated AA in 80% taking opiates after general anesthesia. However, RA was not assessed. Opiates/opioids are frequently administered after TBI. We compared AA and RA in short-stay orthopaedic surgery in-patients (without TBI) taking post-operative opioids after opiate/opioid/benzodiazepine-free spinal anesthesia. In a prospective cohort, the Westmead PTA Scale (WPTAS) was used to assess AA (WPTAS<12), whilst RA was assessed using the Galveston Orientation and Amnesia Test RA item. Results were obtained in n=25 (60±14yrs, M:F 17:8). Surgery was uncomplicated: all were discharged by Day-4. All were taking regular oxycodone as a new post-operative prescription. Only one co-administered non-opioid was potentially confounding (temezepam, n=4). Of 25, 14 (56%) demonstrated AA: five (20%) were simultaneously disorientated. Mean WPTAS was 11.08±1.22. RA occurred in 0%. CONCLUSIONS: AA and disorientation, but not RA, were associated with in-patients (without TBI) taking opioids. Caution should therefore be applied in assessing AA/orientation in TBI in-patients taking opioids. By contrast, retrograde memory was robust and more reliable: even in older patients with iatrogenic AA and disorientation. RA assessment should therefore be integral to assessing TBI severity in all formalized PTA and GCS testing.


Assuntos
Amnésia Anterógrada/diagnóstico , Amnésia Retrógrada/diagnóstico , Analgésicos Opioides/efeitos adversos , Lesões Encefálicas Traumáticas/complicações , Confusão/diagnóstico , Adulto , Idoso , Amnésia Anterógrada/induzido quimicamente , Amnésia Retrógrada/etiologia , Confusão/induzido quimicamente , Feminino , Escala de Coma de Glasgow , Humanos , Masculino , Pessoa de Meia-Idade
15.
BMJ Case Rep ; 20172017 Jul 24.
Artigo em Inglês | MEDLINE | ID: mdl-28739612

RESUMO

A 33-year-old male professional football player suffered from acute-onset dizziness following a lower limb soft tissue treatment in prone lying. Symptoms included spinning vertigo lasting for 30's, headache, visual vertigo and disorientation. Clinical examination of balance and vestibular systems confirmed a left posterior canalithiasis benign paroxysmal positional vertigo (BPPV) and excluded other central and peripheral causes of dizziness. Two cycles of a left Epley manoeuvre were performed. An Epley manoeuvre abolished the BPPV and negated the need for medication. The player was able to return to play without dizziness within 24 hours completely symptom free. BPPV can be successfully identified and treated in elite football players and they can see a return to training and games within 24 hours. There are no epidemiology studies for this group of elite athletes either male or female despite increased occupational risk factors.


Assuntos
Vertigem Posicional Paroxística Benigna/diagnóstico , Tontura/diagnóstico , Orelha Interna/patologia , Litíase/complicações , Modalidades de Fisioterapia , Futebol , Adulto , Vertigem Posicional Paroxística Benigna/complicações , Vertigem Posicional Paroxística Benigna/terapia , Confusão/diagnóstico , Confusão/etiologia , Tontura/etiologia , Cefaleia/diagnóstico , Cefaleia/etiologia , Humanos , Litíase/diagnóstico , Masculino , Exame Físico , Equilíbrio Postural , Decúbito Ventral , Volta ao Esporte , Fatores de Risco
17.
BMJ Case Rep ; 20172017 May 24.
Artigo em Inglês | MEDLINE | ID: mdl-28546233

RESUMO

Acute confusion is a common symptom of physical illness in the older patient. In the majority, it is transient and resolves on treatment of precipitants. In a subset of patients, however, neurological decline is progressive, raising concern about a serious underlying cause. We describe the case of a 71-year-old woman who developed progressive cognitive impairment following insertion of a permanent pacemaker for sinoatrial arrests. An initial diagnosis of delirium secondary to a urinary tract infection was suspected; however, the patient became increasingly confused despite treatment. Laboratory tests revealed serum anti-Hu paraneoplastic antibodies, and CT chest identified an occult lung tumour. Cervical lymph node histopathology confirmed a diagnosis of small cell carcinoma of the lung. Although a rare cause of confusion, paraneoplastic encephalomyelitis should be recognised early to allow timely identification and treatment of the associated cancer.


Assuntos
Carcinoma de Células Pequenas/complicações , Disfunção Cognitiva/diagnóstico , Confusão/etiologia , Delírio/complicações , Síndromes Paraneoplásicas do Sistema Nervoso/complicações , Carcinoma de Pequenas Células do Pulmão/complicações , Infecções Urinárias/complicações , Idoso , Autoanticorpos/sangue , Carcinoma de Células Pequenas/diagnóstico por imagem , Carcinoma de Células Pequenas/patologia , Disfunção Cognitiva/complicações , Confusão/diagnóstico , Proteínas ELAV/imunologia , Evolução Fatal , Feminino , Humanos , Neoplasias Pulmonares/diagnóstico por imagem , Neoplasias Pulmonares/patologia , Linfonodos/diagnóstico por imagem , Linfonodos/patologia , Marca-Passo Artificial/efeitos adversos , Polineuropatia Paraneoplásica/imunologia , Síndromes Paraneoplásicas do Sistema Nervoso/etiologia , Síndromes Paraneoplásicas do Sistema Nervoso/imunologia , Carcinoma de Pequenas Células do Pulmão/diagnóstico por imagem , Carcinoma de Pequenas Células do Pulmão/patologia , Tomografia Computadorizada por Raios X/métodos , Infecções Urinárias/diagnóstico
18.
Clin Toxicol (Phila) ; 55(7): 662-667, 2017 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-28393558

RESUMO

BACKGROUND: AB-FUBINACA and ADB-FUBINACA are structurally similar synthetic cannabinoids with potent CB1 receptor agonistic effects. Very little is known about their pharmacology and toxicology. OBJECTIVE: To report a case of supraventricular tachycardia and acute confusion after ingestion of e-cigarette fluid containing AB-FUBINACA and ADB-FUBINACA, with quantitative analysis of the serum drug concentrations. CASE REPORT: A healthy 24-year-old man ingested two drops of e-cigarette fluid which were later found to contain AB-FUBINACA and ADB-FUBINACA. Within 30 min of ingestion, he became somnolent, confused, and agitated, with palpitation and vomiting. On arrival to the emergency department, a short run of supraventricular tachycardia was noted, which resolved spontaneously. Bedside urine immunoassay failed to detect recreational drugs. Laboratory blood tests showed mild hypokalemia. Exposure to AB-FUBINACA and ADB-FUBINACA was confirmed analytically, with serum concentrations of 5.6 ng/mL and 15.6 ng/mL, respectively, in the blood sample collected on presentation. The patient recovered uneventfully with supportive treatment and was discharged 22 h after admission. DISCUSSION: AB-FUBINACA and ADB-FUBINACA are orally bioavailable with rapid onset of toxicity after ingestion. In this case, supraventricular tachycardia was likely the result of exposure to AB-FUBINACA and ADB-FUBINACA. The serum concentrations of AB-FUBINACA and ADB-FUBINACA were higher than those previously reported in fatal cases. CONCLUSION: In the context of acute poisoning, the presence of unexplained tachyarrhythmias, confusion, and a negative recreational drug screen should prompt clinicians to consider synthetic cannabinoid toxicity as a differential diagnosis.


Assuntos
Confusão/induzido quimicamente , Overdose de Drogas , Sistemas Eletrônicos de Liberação de Nicotina/efeitos adversos , Indazóis/envenenamento , Transtornos Relacionados ao Uso de Substâncias/etiologia , Taquicardia Supraventricular/induzido quimicamente , Confusão/diagnóstico , Confusão/psicologia , Confusão/terapia , Diagnóstico Diferencial , Overdose de Drogas/sangue , Overdose de Drogas/diagnóstico , Humanos , Indazóis/sangue , Masculino , Valor Preditivo dos Testes , Detecção do Abuso de Substâncias , Transtornos Relacionados ao Uso de Substâncias/diagnóstico , Transtornos Relacionados ao Uso de Substâncias/fisiopatologia , Transtornos Relacionados ao Uso de Substâncias/terapia , Taquicardia Supraventricular/diagnóstico , Taquicardia Supraventricular/fisiopatologia , Taquicardia Supraventricular/terapia , Resultado do Tratamento , Adulto Jovem
19.
Neurol Sci ; 38(7): 1329-1332, 2017 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-28367609

RESUMO

We here describe a patient showing topographical disorientation (TD) after infarction of the right medial occipital lobe; the lesion included the parahippocampal gyrus. Clinical and neuropsychological observations demonstrated a specific pattern of impairment in terms of visual and visuospatial (topographical) learning, and memory. He had no landmark agnosia. His defective route finding resulted from impaired allocentric and egocentric spatial representations. Drawing illustrations of both familial and unfamiliar place and orientation tasks in an egocentric coordination context is a useful means of recognizing the influence of egocentric and/or allocentric spatial disturbance. The definition of "allocentric" or "egocentric" is confusing, and requires a standard for differentiating TD types.


Assuntos
Confusão/fisiopatologia , Hipocampo/fisiopatologia , Infarto/fisiopatologia , Percepção Espacial/fisiologia , Agnosia/diagnóstico , Confusão/diagnóstico , Confusão/etiologia , Humanos , Infarto/diagnóstico , Masculino , Memória/fisiologia , Transtornos da Memória/diagnóstico , Transtornos da Memória/fisiopatologia , Pessoa de Meia-Idade , Testes Neuropsicológicos , Desempenho Psicomotor/fisiologia
20.
Anaesth Crit Care Pain Med ; 36(5): 297-300, 2017 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-28365244

RESUMO

INTRODUCTION: Delirium is common in Intensive-Care-Unit (ICU) patients but under-recognized by bed-side clinicians when not using validated delirium-screening tools. The Confusion-Assessment-Method for the ICU (CAM-ICU) has demonstrated very good psychometric properties, and has been translated into many different languages though not into French. We undertook this opportunity to describe the translation process. MATERIAL AND METHODS: The translation was performed following recommended guidelines. The updated method published in 2014 including introduction letters, worksheet and flowsheet for bed-side use, the method itself, case-scenarios for training and Frequently-Asked-Questions (32 pages) was translated into French language by a neuropsychological researcher who was not familiar with the original method. Then, the whole method was back-translated by a native English-French bilingual speaker. The new English version was compared to the original one by the Vanderbilt University ICU-delirium-team. Discrepancies were discussed between the two teams before final approval of the French version. RESULTS: The entire process took one year. Among the 3692 words of the back-translated version of the method itself, 18 discrepancies occurred. Eight (44%) lead to changes in the final version. Details of the translation process are provided. CONCLUSIONS AND RELEVANCE: The French version of CAM-ICU is now available for French-speaking ICUs. The CAM-ICU is provided with its complete training-manual that was challenging to translate following recommended process. While many such translations have been done for other clinical tools, few have published the details of the process itself. We hope that the availability of such teaching material will now facilitate a large implementation of delirium-screening in French-speaking ICUs.


Assuntos
Confusão/diagnóstico , Confusão/terapia , Cuidados Críticos/normas , Unidades de Terapia Intensiva/normas , Manuais como Assunto/normas , Idoso , Delírio/diagnóstico , Delírio/terapia , Feminino , França , Guias como Assunto , Humanos , Masculino , Pessoa de Meia-Idade , Testes Neuropsicológicos , Equipe de Assistência ao Paciente , Traduções
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