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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↗

[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↗

[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↗

[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↗

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↗

[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↗

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↗

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↗

A prospective study of children with head injuries: I. Design and methods.

The main unresolved issues with respect to the psychological sequelae of brain damage in childhood are noted, and the previous studies of children suffering head injury are critically reviewed. A new prospective study is described. Three groups of children were studied: (a) 31 children with "severe" head injuries resulting in a post-traumatic amnesia of at least 7 days; (b) an individually matched control group of 28 children with hospital-treated orthopaedic injuries; and (c) 29 children with "mild" head injuries resulting in a post-traumatic amnesia exceeding 1 hour but less than 1 week. The children were studied as soon as possible after the accident and then again 4 months, 1 year, and 2 1/4 years after the injury. The parents were interviewed, using systematic and standardized interview techniques; both parents and teachers completed behavioural questionnaires; and the children were seen for individual psychological testing the WISC, the Neale Analysis of Reading Ability and a battery of tests of more specific cognitive functions. At the final follow-up, the severe head injury group (but not the other 2 groups) received a systematic neurological examination and the school teacher who knew the child best was personally interviewed. The findings are given on physical handicap, neurological abnormality, school placement and psychiatric referrals. All types of disabilities were both more frequent and more persistent in the children with severe head injuries.

Amnesia↗