PubMed Health⌕ Search

Biomedical subjects

E F Wijdicks

Publications and source records attributed to E F Wijdicks.

At least 109 records · Page 6Linked to original sources
PubMed1996

Neuromuscular complications associated with liver transplantation.

We studied neuromuscular complications in a cohort of 520 patients with liver transplantation. Perioperative mononeuropathy developed in 9 patients. The peroneal nerve, radial nerve, and cutaneous branch of the femoral nerve were affected in 2 patients each. Two patients had herpes zoster-associated radiculopathy, and 1 patient had Horner's syndrome. Recovery was good in most patients. In 7 patients, severe quadriplegia complicated the perioperative course. In 5 patients, electrophysiologic studies suggested acute necrotic myopathy, and muscle biopsy specimens showed evidence of rhabdomyolysis in 1 patient. Outcome in survivors was good, all recovering completely. We conclude that neuromuscular complications in liver transplantation are uncommon (less than 1%) and do not significantly contribute to morbidity. Mononeuropathies may have iatrogenic perioperative causes, and rhabdomyolysis may be an important cause of generalized muscle weakness after liver transplantation.

Adult↗
PubMed1996

Central pontine myelinolysis with stupor alone after orthotopic liver transplantation.

Central pontine myelinolysis (CPM) after orthotopic liver transplantation is frequently diagnosed at autopsy. Its actual prevalence is unknown. We reviewed 386 orthotopic liver transplantations performed at the Mayo Clinic, Rochester, MN, including 39 with autopsy reports. CPM developed in four patients (1%) (found using magnetic resonance imaging in two, at autopsy in two). All four patients lacked typical signs and symptoms of CPM (pseudobulbar palsy and quadriplegia) but had stupor as the main presenting feature. When perioperative plasma osmolality and serum sodium values were compared with those values in patients with transient metabolic encephalopathy but no CPM at autopsy, no consistent association was observed, and values differed greatly. We conclude that CPM in orthotopic liver transplantation frequently is manifested by altered levels of consciousness alone, mimicking metabolic encephalopathy.

Adult↗
PubMed1996

Prior intra-operative hypotension is not a risk factor for development of Alzheimer's disease.

OBJECTIVE: A retrospective, population-based, case-control study was carried out to evaluate episodes of prior intra-operative hypotension as a potential risk factor for Alzheimer's disease (AD). METHODS: Patients were all incident cases of AD from 1975-1984 who resided for 40 years or more in Olmsted County prior to their onset of dementia (N = 252). One age and gender-matched control for each case was selected from all registrations for care at Mayo Clinic during the year of onset in the incident case. Each case and control group had 252 individuals. RESULTS: Of these, 27 cases and 32 controls had at least one ten minute or longer episode of intra-operative hypotension of a systolic blood pressure of less than 90 mm Hg prior to the year of onset of dementia in the matched AD patient. We did not find a significantly increased risk of AD for hypotensive episodes of less than 75 or 90 mm Hg. CONCLUSIONS: It is unlikely that intra-operative hypotensive events of this degree increase the risk of AD.

Alzheimer Disease↗
PubMed1996

Coronary artery bypass grafting-associated ischemic stroke. A clinical and neuroradiological study.

Ischemic stroke occurring after coronary artery bypass grafting (CABG) has been attributed to various factors. Little is known about the perioperative course and radiological topography of CABG-associated strokes. In this study the clinical and computed tomography features of 25 patients with ischemic stroke following coronary artery bypass grafting were evaluated. Four patients awakened with focal signs, and 21 developed an ischemic stroke 1 to 22 days after surgery. All 4 patients with early stroke had prolonged episodes of operative hypotension. Three of these patients had multiple subcortical and cortical infarcts. Of the 21 patients with late-onset ischemic stroke, 19 had single-territory infarcts (middle cerebral artery territory, N = 12; posterior cerebral artery territory, N = 4; anterior cerebral artery territory, N = 3). Two patients had multiple territory infarcts in the anterior and posterior circulation. No watershed infarcts were found in any of the 25 patients. New-onset atrial fibrillation and location of ischemic stroke in a single vascular territory were more common in patients who had an ischemic stroke after an asymptomatic interval. Duplex sonographic findings of the carotid arteries and oculoplethysmography (OPG) were available for 13 patients. Only 1 patient had an ipsilateral carotid stenosis. Of 21 patients who underwent postoperative two-dimensional echocardiography (with additional transesophageal echocardiography in 4), 2 had a left ventricular thrombus. These findings support the concept that post-CABG stroke is likely embolic.

Aged↗
PubMed1996

Outcome in patients with acute basilar artery occlusion requiring mechanical ventilation.

BACKGROUND AND PURPOSE: Many patients with acute basilar artery occlusion may require endotracheal intubation and mechanical ventilation. The circumstances and predictive value for outcome in these patients are not well documented. METHODS: We reviewed the medical records of 25 patients admitted into the intensive care unit with a clinical diagnosis of acute basilar artery occlusion and need for mechanical ventilation. The medical records were reviewed for clinical features, breathing patterns, mode of mechanical ventilation, ability to wean from the ventilator, and neurological outcome. RESULTS: Apneic episodes resulted in endotracheal intubation in 8 patients. In the remaining 17 patients, intubation was needed for airway protection. Seven of 8 patients presenting with apneic episodes lost all brain stem reflexes. All 17 patients intubated for airway protection could be successfully weaned to a T-tube circuit. Outcome was generally poor and 22 patients died, of whom 7 died of early systemic complications. Only 3 of 25 patients, all with locked-in syndrome, survived. CONCLUSIONS: Mortality is high in patients who require mechanical ventilation after acute basilar artery occlusion. No neurological improvement beyond a locked-in syndrome occurred in survivors. Recurrent apnea appears to predict further progression to brain stem death.

Acute Disease↗
PubMed1996

Cure of a solitary brainstem abscess with antibiotic therapy: case report.

A solitary brainstem abscess is uncommon. The use of antibiotics and surgical aspiration or excision of a brainstem abscess has resulted in survivors. Survival after treatment of a brainstem abscess with antibiotics alone has been reported rarely, and we present the eighth study case. The patient made an excellent recovery after 12 weeks of antibiotics, with 8 weeks completed as an outpatient. Medical management of a solitary brainstem abscess in an immunocompetent patient is feasible and may result in a complete cure with antibiotics only. Completion of IV antibiotics as an outpatient is viable and cost-effective in selected patients.

Anti-Infective Agents↗
PubMed1996

Causes and outcome of seizures in liver transplant recipients.

Previous studies found that seizures in orthotopic liver transplantation (OLT) herald a catastrophic neurologic event, but the studies were done of patients who later died and came to autopsy. We studied 630 OLT patients. Laboratory values, electroencephalography, neuroimaging, and levels of cyclosporine or FK506 were reviewed. Neurotoxicity from immunosuppression was considered a trigger for seizures when toxic blood level or increases > or = to 100% were documented, or when white matter lesions or confusional state or tremors were present. Generalized tonic-clonic seizures occurred in 28 of 630 patients (4%). In 7 patients seizures were part of an agonal event (central nervous system infection [n = 3], anoxic encephalopathy [n = 1], cerebral edema with fulminant hepatic failure [n = 1], intracranial hemorrhage [n = 1], and sepsis [n = 1]. In 17 patients cyclosporine (n = 11) or FK506 (n = 6) could be implicated. Remaining causes were acute uremia (n = 1), meningioma (n = 1), and unknown (n = 2). All patients were initially treated with anticonvulsants. Median follow-up of 2 years did not reveal seizure recurrence after discontinuation of anticonvulsants. We conclude that the majority of new-onset seizures after OLT are not indicative of a poor prognosis. Immunosuppression neurotoxicity is the most frequent cause. Anticonvulsant therapy is not necessary for favorable long-term outcome.

Adolescent↗
PubMed1995

Chronic inflammatory demyelinating polyneuropathy complicating liver transplantation.

We report on a patient who had chronic inflammatory demyelinating polyradiculoneuropathy following liver transplantation for hepatitis B-induced fulminate hepatic failure. Possible symptomatic recurrence of hepatitis B in the graft prompted a reduction in the cyclosporine dosage, which may have triggered the immune response leading to demyelination. Initial plasma exchange and then intravenous immune globulin after relapse led to marked clinical improvement.

Adult↗
PubMed1995

Acute liver failure: results of a 5-year clinical protocol.

This investigation summarizes and evaluates the results of a clinical protocol that we designed to care for patients with acute liver failure (ALF). Adult patients with ALF were enrolled in the protocol. Grade II portal-systemic encephalopathy prompted admission to the intensive care unit (ICU). Patients who met the clinical criterion were activated for liver transplantation. Intracranial pressure (ICP) was monitored in patients with grade III encephalopathy. An increase in ICP was treated with hyperventilation, diuretics, barbiturates, or a combination thereof. Survival was considered to have occurred if the patient left the hospital alive. Our series included 25 patients. Orthotopic liver transplantation (OLT) was performed on 19 patients, 12 of whom survived. Only 2 of 6 patients who did not undergo transplantation survived. Ten of 11 patients who underwent transplantation before reaching grade IV encephalopathy survived. Only 2 of 8 patients who underwent transplantation after reaching grade IV survived (P = .006). The causes of death included cerebral edema (3 patients), disseminated aspergillosis (3 patients), and other (5 patients). ICP was monitored in 11 patients. Increased pressure was documented by seven of the monitors placed. There was one focal hemorrhage secondary to a subdural monitor. Outcome is improved if transplantation occurs before grade IV encephalopathy. ICP monitoring can be accomplished without significant risk of hemorrhage. In our series, infection with aspergillus occurred frequently and with fatal outcome.

Adolescent↗
PubMed1995

Outcome in conversion disorder: a follow up study.

Fifty six patients who had been admitted with a conversion disorder other than pseudoseizures were interviewed; mostly by telephone. The median interval was 4.5 years. If a patient had improved during a stay in hospital the eventual outcome was good in 96%, against only 30% in the others (risk ratio 3.2 (95% CI 1.8-5.6)). Rapid improvement was, in turn, related to recent onset of the symptoms. Two patients (4%) subsequently developed an organic deficit that, in retrospect, might be related to the initial episode.

Adolescent↗
PubMed1995

Acute fatal deterioration in putaminal hemorrhage.

BACKGROUND: Clinical deterioration in patients with spontaneous intracerebral hemorrhage has rarely been studied. It has been previously thought that intracranial hematomas bleed in a monophasic fashion. Recent studies have demonstrated continuous active bleeding within hours after the event, resulting in enlargement of the hematoma. However, acute sudden and fatal deterioration suggesting a rebleed is rarely reported. SUMMARY OF REPORTS: An 84-year-old man was admitted with a moderate-size hemorrhage in the putamen and was treated for hypertension during the first day of admission. He acutely demonstrated extensor posturing and light-fixed pupils. Repeat CT scan showed massive enlargement of the intracranial hematoma and extension into the ventricles causing acute hydrocephalus. A 72-year-old man was admitted with a mid-size hemorrhage in the putamen. Acute deterioration with loss of all brain stem reflexes except for cornea reflexes was associated with a large increase in volume of the hematoma, 7 hours after the initial hemorrhage. An 85-year-old woman was admitted with a small hemorrhage in the putamen and recovered to be able to walk unassisted. She suddenly died from a recurrent massive putaminal hemorrhage 2 weeks after the ictus. CONCLUSIONS: Patients with spontaneous intracerebral hemorrhage in the putamen may die acutely from fatal catastrophic enlargement of the initial hematoma hours to days after the ictus. In some patients with spontaneous intracerebral hemorrhage and clinical deterioration, rebleeding may be a possible mechanism.

Aged↗