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Biomedical subjects

N Nagaratnam

Publications and source records attributed to N Nagaratnam.

At least 19 recordsLinked to original sources
PubMed2003

Dense middle cerebral artery sign: a pictorial study.

The hyperdense middle cerebral artery on computed tomography (CT), although a useful sign of middle cerebral artery occlusion, does not presage the events to follow. Because of the wide availability of CT it is useful to illustrate the radiological spectrum of findings following middle cerebral artery occlusion. This is pictorial study of four prototypic patients with hyperdense middle cerebral artery which was the common denominator. There was a marked heterogeniety among the patients in relation to the character of the vascular disturbances, location, extent of ischaemic changes and the final outcome. We emphasise that a single radiological sign should be seen in the context of the entire scan.

Adult↗
PubMed2001

Some problematic behaviors in Alzheimer's dementia.

We examined 18 patients with problematic behaviors in relation to their individual characteristics and their possible relationship to certain aspects of dementia namely cognitive impairment, stage of illness, language impediment and functional disability. They formed part of an earlier assessment of 94 patients with dementia-related problems. Ten had altered eating habits and eight (8.5%) of them had hyperphagia. One exhibited an incomplete form of Kluver-Bucy Syndrome. Two had pathological stealing and one scatolia (smearing of faeces). The remaining had bizzare behaviors such as screaming and head banging. The majority of the patients were in the moderate category in relation to the four domains tested. The study revealed that behavioral problems in the more severe dementia becomes less of a problem to the caregivers and others. These behaviors could dramatically affect the social and interpersonal relationships resulting in community, family and caregiver burden.

Journal Article↗
PubMed2001

Dementia-related behavioral changes - a physician's office-based study.

This is a physician's office-based retrospective study of 161 dementia patients with (94) and without (67) behavioral symptoms. Those with disturbed behavior were subdivided into patients with behavior changes at initial evaluation and those encountered in existing dementia. The two main groups and the subgroups were studied in relation to individual and disease characteristics. The targeted behaviors (aggression, psychosis, aberrant motor behavior and miscellaneous) were analyzed in relation to four dementia-related domains namely cognitive impairment, language impairment, stage of illness (CDR) and functional disability (Rankin grades). No differences were observed between the two main groups in relation to age and gender and to cognitive impairment, language impairment and disability except for stage of illness (P=0.01). There were no significant differences in terms of age and gender in the two subgroups and in the frequency of single targeted behaviors but for psychosis which was the most commonly recorded disturbed behavior. There was no correlation between the single targeted behaviors and the different domains examined but for aberrant motor behavior and stage of illness (P=0.04) in the subgroups.

Journal Article↗
PubMed2001

Putaminal hemorrhage and outcome.

Twenty-five patients (average age, 65 +/- 4.5 years) with spontaneous putaminal hemorrhage were studied to determine any independent predictors as to survival and level of disability. Based on the computed tomography (CT) findings, they were grouped according to their location and extent of the hemorrhage. The thalamus and the caudate were not involved. Univariate and multivariate regression analyses were done to determine any potential prognostic indicator. The groups were significantly different with regard to volume, intraventricular hemorrhage, midline shift, ambient cisterns, hydrocephalus, and disability score but not different with respect to pineal shift, side, gender, and age. The variables that arose as significant predictors of disability were intraventricular hemorrhage, midline shift, hydrocephalus, ambient cistems (all p < or = 0.001), pineal shift and age (both p < or = 0.04). Neither gender nor side was a significant predictor for disability score (p = 0.92 and p = 0.125, respectively). Multivariate regression model included volume, ambient cisterns, and age as significant predictors for disability score.

Aged↗
PubMed2001

Critical illness neuropathy.

Critical illness neuropathy frequently accompanies the septic syndrome in intensive care units. Another entity that may occur independently or concurrently in critically ill patients is a myopathy, giving rise to difficulties in distinguishing between them. The two patients described had sensorimotor axonal peripheral neuropathy. Axonopathy as a rule has a poor prognosis for recovery, which is slow and often incomplete. There are few reports of the functional outcome after rehabilitation therapy. The two patients described had 5-6 weeks of active rehabilitation therapy with improvement from moderate/severe disability at the onset to slight debility at the end of therapy.

Activities of Daily Living↗
PubMed2001

Thalamic tumour presenting as frontal lobe dysfunction.

A 64-year-old man presented with a change in personality and behaviour but with no neurological deficits. He exhibited impaired executive functions, apathy, unsteadiness of gait and falling; he lacked insight and exhibited purposeless behaviour, making loud grunting noises. A CT scan at 6 months revealed no abnormality, but at 9 months CT and MRI showed a bilateral thalamic tumour. The presenting symptoms had similarities to frontal lobe dysfunction progressing to dementia.

Aged↗
PubMed1999

Akinetic mutism and mixed transcortical aphasia following left thalamo-mesencephalic infarction.

A 54-year-old man developed somnolent akinetic mutism and acute mixed transcortical aphasia following a left thalamo-mesencephalic infarction. He also exhibited behavioural changes, namely apathy, slowness, lack of spontaneity, disinhibition, perseveration, gait apraxia and incontinence consistent with frontal lobe dysfunction. Presumably the akinetic mutism and language dysfunction were due to the thalamic stroke. All the manifestations could be related to interruption of the frontal-subcortical circuitry.

Affect↗
PubMed1998

Optic ataxia following unilateral stroke.

Five patients with optic ataxia together with tactile apraxia are described. They also demonstrated difficulty in finger movements under visual guidance. The CT scan showed lesions in the posterior parietal region in three and in two they were located anteriorly. It is well recognised that lesions in the posterior parietal area may cause disruption of visual guided movements. On the basis of the two cases it is postulated that the same phenomenon could occur with lesions located more anteriorly. The assumption is that optic ataxia may occur either following damage to the parieto-occipital region or to disruption of its occipitofrontal connections.

Aged↗
PubMed1998

Behavioral and psychiatric manifestations in dementia patients in a community: caregiver burden and outcome.

The aim of the present study was to document behavioral disturbances in dementia patients in a sample not specifically referred to a clinic. Ninety patients with dementia in a community were studied in relation to the behavioral and psychiatric manifestations as perceived by their caregivers. They were categorized into two subgroups based on severity of the illness, namely mild and moderate-severe, for the purpose of comparison. There were 68 patients with Alzheimer disease, 10 with vascular dementia, and the remaining 12 formed a miscellaneous group.The frequency of the following behaviors in relation to the severity of the dementia were assessed: aggression, physical violence, wandering, incontinence, disinhibition, binge-eating, hallucinations, delusions, and depression. The most common behavioral change was aggression (59%), followed by wandering (27%), delusions (22%), and incontinence (18%). Aggression caused the most distress to the caregiver. There was a higher incidence of wandering, incontinence (p= 0.009), and persecutory delusions (p=0.02) in the moderate severe group. A significantly higher proportion of the moderate-severe group required further care and intervention (p=0.04). This study is probably one of the rare nonclinical surveys on this subject.

Aged↗
PubMed1998

Extensive intracranial calcification secondary to hypoxia, presenting with dyspraxic gait.

The imaging appearances of a case of extensive intracranial calcification presenting with dyspraxic gait are described. Computed tomography showed bilateral calcification in the anterior, posterior and central watershed areas and in the basal ganglia. It is believed that the changes are secondary to previous hypoxaemia and hypotension, and that subsequent development of the symptoms is due to calcification in the dystrophic tissue.

Apraxias↗
PubMed1998

Cerebral ptosis revisited.

We studied nine patients with cerebral ptosis and gaze deviation following an acute stroke. The brains of all nine showed an extensive lesion in the fronto-parieto-temporal regions. In five the stroke was left hemispheric. The assumption is that cerebral ptosis may have a bihemispheric representation and results from damage to the connections rather than to a specific area.

Acute Disease↗
PubMed1997

Contralateral abolition of essential tremor following a pontine stroke.

A 90-year-old man with a longstanding bilateral essential tremor presented with right-sided weakness of sudden onset. The CT scan of the brain showed a hypodense area in the left side of the pons consistent with an infarction. The paralysis disappeared without recurrence of the tremor on the right, but the tremor persisted on the left. It is likely that the fronto-rubro-spinal pathway had been interrupted at the level of the pons abolishing the tremor on the right side.

Aged↗
PubMed1997

Abnormal movements associated with severe hyponatraemia.

An elderly woman with severe hyponatraemia manifested transient choreoathetoid movements of the upper extremities and dyskinetic movements of the face and mouth. She showed more than one type of hyponatraemia and a precise diagnosis was not possible. The movements were abolished with treatment of the hyponatraemia with no recurrence or sequelae.

Aged↗
PubMed1990

Acute vertiginous presentation of primary thalamic hemorrhage.

A 43-year-old hypertensive patient presented with serve vertigo of abrupt onset. The initial neurological signs were subtle vertical gaze paralysis and unsteady gait. The computed tomographic scan revealed a left-sided thalamic hemorrhage. It is explained that the vertigo is due to stimulation of the vestibulo-ocular connections within the diencephalic-mesencephalic junction.

Acute Disease↗