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PubMed1992

Seizure behaviour in a patient with post-traumatic stress disorder following rape. Notes on the aetiology of 'pseudoseizures'.

A patient is described who began to have paroxysmal convulsive behaviour, followed by a post-ictal aggression, which was initially diagnosed and treated as epilepsy. The behaviour began after the patient was raped. She had many of the symptoms of post-traumatic stress disorder. It is suggested that the paroxysmal behaviour was an 'acting out' of intrusive and vivid memories of the rape, so called 'flashbacks'. Because the rape had occurred comparatively recently and the events that occurred during the rape were known, it was easy, in this particular patient, to understand the relationship between the previous trauma and the paroxysmal behaviour. The case throws some light on the relationship between similar paroxysmal behaviour in the victims of child sexual abuse and the trauma they had suffered and explains why they behave in the way that they do.

Acting Out↗
PubMed1986

Coma and the etiology of violence, Part 1.

Coma and the etiology of violence are explored by the author through a review of the literature. Animal studies, post-traumatic psychic disorder studies, post-traumatic anger and violence studies, tumor and lesion of the limbic system studies, temporal lobe epilepsy studies, and episodic dysfunction syndrome studies, minimal brain studies are reviewed in Part 1 of this article. Part 2, to be published in a later issue of the journal, will conclude the review with clinical surveys on violent individuals and studies on clinical treatment of violence.These studies reveal the etiologic significance of central nervous system dysfunction in the production of violent behavior. Because central nervous system factors are involved in some instances of violent behavior, physicians clearly have a role in the early identification of potentially violent subjects and in the intervention or treatment of individuals who have been violent toward others. Studies have consistently found that lower socioeconomic groups are more predisposed to brain injury from trauma, and several studies have indicated that this is true for segments of the black community. Therefore, investigations in the relationship between central nervous system injury and violence should be a major goal of the black community. Black physicians should assume a lead role in these inquiries and in the prevention and treatment of violence, specifically black-on-black murder.

Adult↗
PubMed1987

Coma and the etiology of violence, Part 2.

Coma and the etiology of violence are explored by the author through a review of the literature. Animal studies, post-traumatic psychic disorder studies, post-traumatic anger and violence studies, tumor and lesion of the limbic system studies, temporal lobe epilepsy studies, episodic dyscontrol syndrome studies, and minimal brain dysfunction studies were reviewed in Part 1, which was published in the December 1986 issue of the Journal. Part 2 concludes the review with clinical surveys on violent individuals and studies on clinical treatment of violence.These studies reveal the etiologic significance of central nervous system dysfunction in the production of violent behavior. Because central nervous system factors are involved in some instances of violent behavior, physicians clearly have a role in the early identification of potentially violent subjects and in the intervention or treatment of individuals who have been violent toward others. Studies have consistently found that lower socioeconomic groups are more predisposed to brain injury from trauma, and several studies have indicated that this is true for segments of the black community. Therefore, investigations in the relationship between central nervous system injury and violence should be a major goal of the black community. Black physicians should assume a lead role in these inquiries and in the prevention and treatment of violence, specifically black-on-black number.

Adolescent↗
PubMed1991

[Porencephaly. A report of 45 cases].

In 45 cases of porencephaly 35 were male and 10 female. Their age ranged from 80 days to 58 years (mean 14 years). In this series, symptoms were observed 80 days to 22 years before diagnosis. twenty-four cases were premature delivery, difficult labour or birth trauma. 14 cases had a history of head injury. 36 cases had congenital porencephalic cyst and 9 had post-traumatic porencephaly. The main symptoms and signs of porencephaly were dementia, speech defect, intracranial hypertension, hydrocephalus, epilepsy, ataxia or paralysis. etc. It is suggested that CT scan is very useful in the diagnosis of porencephaly, and section of cerebral cortex, opening of cyst, continuous drainage or shunting operation should be done as soon as the diagnosis was made.

Adolescent↗
PubMed1992

From the jumping Frenchmen of Maine to post-traumatic stress disorder: the startle response in neuropsychiatry.

The startle response is a universal and phylogenetically ancient reflex. Pathological exaggerations and modifications of startle underlie the symptomatology of a surprisingly diverse range of neuropsychiatric disorders, a fact that seems to have gone largely unappreciated. We review the available literature on the physiology of the normal human startle response and examine the neuropsychiatric conditions characterized by pathological startle. Startle epilepsy and primary hyperekplexia are considered as neurological disorders involving abnormal startle. Patients with hyperstartle and exotic culture-bound syndromes characterized by excessive startle are considered by the authors to represent extreme variants of the normal startle response. Post-traumatic stress disorder, drug and alcohol withdrawal states and schizophrenia all have abnormal startle as a clinical feature secondary to increased arousal and presumed disturbance of central neurotransmitter systems. The neurophysiological mechanisms by which abnormalities of the startle response may occur are discussed and a system of classification of neuropsychiatric hyperstartles is suggested.

Humans↗
PubMed1992

Diagnosis, management and prognosis of a group of 128 patients with non-epileptic attack disorder. Part II. Previous childhood sexual abuse in the aetiology of these disorders.

In a group of female in-patients clinically diagnosed as having non-epileptic attack disorder there was an increased incidence of a proven previous history of sexual abuse in childhood, when compared with a group of women with epilepsy and a group of women with other psychiatric disorders admitted to the same ward. This was particularly true of women with the 'swoon' and 'abreactive' type of non-epileptic attack disorder (see Part I). The incidence of a history of previous abuse was similar to the two control groups for other types of non-epileptic attack disorder. The swoon was seen as a cut-off phenomenon: the abreactive attack as a kind of acting out the memory of the abuse, part of a post-traumatic stress disorder. Both may respond to counselling for the abuse although it is too early to be certain, and there is a risk of further episodes of the non-epileptic attack disorder during periods of stress. Some patients with epilepsy, however, also had a history of previous sexual abuse: in some the stress of the abuse may have precipitated the epileptic seizures.

Adolescent↗
PubMed1992

Epileptic seizures induced by sexual abuse. Pathogenic and pathoplastic factors.

Previous sexual abuse is now thought to be a common cause of non-epileptic seizures (pseudoseizures). However, since sexual abuse is common, a previous history of sexual abuse may also occur in people with actual epilepsy. We present six patients in all of whom sexual abuse may, by acting as a stressor in the already predisposed, have precipitated epilepsy and in some of whom the abuse may have affected the actual experiences of the epilepsy itself: all but one of the patients had partial seizures.

Abreaction↗
PubMed1979

[Computerized tomography in post-traumatic cerebral lesions (author's transl)].

A review of 108 cases of cranial injury, dating back for more than three months, and having had computerized tomography examinations, revealed 96 abnormalities in the results. These included overall, 65 times, and localized, 20 times, ventricular dilatations, generalized atrophy 27 times, porencephaly 27 times, enlargement of the sylvian fossa 28 times, chronic subdural hematomas 8 times, intracranial calcification 3 times, meningiomas 3 times, and a cerebral abscess in 1 patient. The computerized tomography results were normal in 12 patients. Very good correlations were found between clinical and computerized tomography results in patients with psychic disturbances and disorders of the higher centers. They were variable in cases of epilepsy and neurological deficiency states. The greatest number of normal results was found in so-called subjective syndromes.

Brain Diseases↗
PubMed1976

[Clinical and social fate of craniocerebral injuries in young adults].

After looking 15 years back, the authors based two detailed observations of young adult cranio-cerebral injured taken amongst a group of 30 others who had been the subject of a medical doctorate thesis. From then on, the authors drew notions of semeiology, concerning the subjects becoming aware of their body before being injured, when waking up from coma and during the phasis of after effects. They mean to suggest to consider the notions of "normal person" and of pre-traumatic mind, of "present person" and of traumatic mind, and of "future person" and of post-traumatic mind. They attempted to write a comparative essay with the cerebral and physical disable of early youth. By way of conclusion, they briefly studied the attitudes of the clinical, familial and social relations and of the medical and legal consequences of these attitudes.

Adaptation, Psychological↗
PubMed1977

[Post-traumatic arteriovenous communication of the renal pedicle producing severe hypertension (author's transl)].

Post-traumatic arteriovenous communications of the renal pedicle with the inferior vena cava, the kidney remaining in position, are rare. The present case, to our knowledge, is the fifth in the world literature (Cohen et al., Rex et al., McAlhany et al., Sechas et al.). The diagnosis was made, first by the clinical signs of murmur and thrill, furthermore, by the characteristic finding of diastolic hypertension and by cardiac hypertrophy, and the diagnosis was confirmed by angiography. Treatment was surgical, in an attempt to save the kidney by means of reconstruction of the vessels of the renal pedicle. Finally, as the renal lesions were not reversible and as the state of the patient was aggravated by epilepsy, nephrectomy was carried out during a second operation. One should note the fall in arterial blood pressure during the first postoperative period.

Angiography↗
PubMedDate not supplied

Benign post-traumatic encephalopathy in young people and its relation to migraine.

Thirteen children and adolescents between ages 4 and 19 years developed transient nonconvulsive neurological symptoms and signs within a few hours apparently trivial head injuries. Some became quite seriously ill, but all made rapid and complete recoveries. Some of these young people are known to have suffered from migraine before and/or after this episode, and in all but one of the others a family history of migraine was elicited. With these patients are compared five younger children who developed epileptic fits after equally slight trauma. A diagnosis of migraine should be considered in children who develop delayed impairment of consciousness after head trauma, with or without convulsive phenomena or focal neurological deficits, and in whom specialized investigations reveal no sign of a mass lesion or of intracranial hemorrhage.

Adolescent↗
PubMed1990

[Initial epileptic crisis after the age of 60: etiology, clinical aspects and EEG].

We reviewed retrospectively a series of 100 inpatients with onset of epileptic seizure after the age of 60. All of them were investigated by EEG and 96 by CT scan. The most frequent cause of seizure was previous stroke, with 25 cerebral infarcts and 5 hemorrhages. Neoplastic lesions were present in 18 cases, with glioma (high grade), meningioma and metastases in the same proportion. Other etiologies included toxico-metabolic (18 cases), post-traumatic (9 cases), cerebral atrophy (4 cases) and miscellaneous (14 cases). The causes of seizure remained unknown in 7 patients, of whom 6 had focal signs in either clinical examination or EEG. Focal seizures (with or without secondary generalization) accounted for 65% of all cases and generalized seizures for 35%. The EEG was normal in 12 patients and abnormal in 88, with diffuse slowing in 55 patients and focal signs in 70 (some patients had both diffuse slowing and focal signs). Fourteen patients presented status epilepticus. Ten died during hospitalization. We conclude that epileptic seizure with onset after age 60 is nearly always symptomatic, and neuroradiologic investigations are necessary in the search for cerebral lesions. In our study, the prevalence of "idiopathic epilepsy" is lower than previously described.

Aged↗
PubMed1975

The late neurological, psychological, and social aspects of severe traumatic coma.

Thirty patients who had survived a heavy head trauma and a post-traumatic coma, lasting for more than one week, were investigated 8 to 14 years after the trauma. The patients have been followed up from a social, psychological, and neurological point of view. Fifty per cent of these patients are considered to be well rehabilitated. All the investigated patients showed slight to severe reduction in mental capacity. Eighty per cent of the patients had neurological defects which were not as important with respect to social rehabilitation as was the mental capacity reduction.

Accidents, Traffic↗
PubMed1976

Diphenylhydantoin-induced hepatic necrosis. A case study.

A patient with post-traumatic seizure disorder developed lymphadenopathy, exfoliative dermatitis, and hepatic failure while on diphenylhydantoin therapy and died in hepatic coma. Autopsy disclosed massive hepatic necrosis. The clinical and pathological pictures are similar to the six previously reported cases of diphenylhydantoin-induced hepatic necrosis, with the exception of the time of onset of hepatic failure, which is explained. The cause of such hepatotoxicity is unknown, although hypersensitivity is postulated. It appears that studies of liver function in patients receiving diphenylhydantion are indicated to assess the true indicence of hepatocellular injury.

Adult↗