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Results for “Persistent Vegetative State”
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Effect of zolpidem on brain injury and diaschisis as detected by 99mTc HMPAO brain SPECT in humans.
The study investigates the effect of zolpidem (CAS 82626-48-0) on brain injuries and cerebellar diaschisis. Four patients with varied brain injuries, three of them with cerebellar diaschisis, were imaged by 99mTc HMPAO Brain SPECT before and after application of zolpidem. The baseline SPECT before zolpidem showed poor tracer uptake in brain injury areas and cerebellar diaschisis. After zolpidem, cerebral perfusion through brain injury areas improved substantially in three patients and the cerebellar diaschisis was reversed. Observations point to a GABA based phenomenon that occurs in brain injury and diaschisis that is reversible by zolpidem.
[Positron emission tomography in diagnosis and prognosis of postanoxic cerebral dysfunctions].
Clinical signs, laboratory tests, EEG or evoked potentials only permit an indirect estimation of the extent of structural brain damage following severe global brain anoxia. Positron emission tomography (PET) permits additional insights into the extent of neuronal damage in acute and persistent postanoxic vegetative states (VS). PET documents a severe and irreversible damage of supratentorial cortical structures in postanoxic VS and allows its differential diagnosis from related disorders, e.g. the locked-in-syndrome. PET clearly distinguishes functional alterations in VS from those in non-REM sleep and documents that patients in VS are not in a sleep-like condition, but in a state closely related to deep anesthesia. Furthermore, the extent of impairment of the residual cortical glucose consumption yields information concerning the possible recovery of consciousness and neuronal function in VS. In combination with clinical, laboratory and neurophysiological findings, PET may be helpful to establish the individual prognosis in acute VS.
Biomarkers and neuroimaging of brain injury after cardiac arrest.
Unfortunately, it remains a difficult task to predict with certainty which patients will have a poor neurological outcome following cardiac arrest. Finding a quantitative prognostic model of outcome has become the objective of many intensivists to assist grieving families in making early difficult decisions regarding withdrawal of life support. An ideal prognostic test should be readily available, easily reproducible, and associated with a high degree of specificity for poor outcome. The goal is not to define which patients may recover, but rather which patients have no likelihood of meaningful neurological recovery at all to justify early withdrawal of support. The literature and the role of biochemical markers in the blood and in the cerebrospinal fluid will be evaluated as prognosticators following cardiac arrest. Radiological indicators of anoxic cerebral damage are reviewed. Each serum or radiological marker has its pros and cons. To accurately prognosticate following cardiac arrest, a multimodal scale or algorithm that incorporates serum markers, radiological markers, and the neurological exam is clearly needed. As these techniques are being evaluated more closely and as imaging modalities increase in sensitivity and portability, physicians will continue to assist families by providing some guidance as to which patients have no chance of meaningful recovery.
Paraneoplastic limbic encephalitis in two teenage girls.
Paraneoplastic neurological disorders represent remote effects of cancer without invasion of tumor cells into the nervous system. Limbic encephalitis is a distinct entity mostly associated with small-cell carcinoma of the lung. We present the cases of two teenage girls who were admitted with clinical symptoms typical for limbic encephalitis. In the course of the disease, they exhibited characteristic evolutionary changes of brain MRI abnormalities. Onset of neurological symptoms and type of underlying neoplasia were different in both patients. In one girl the initial workup led to the diagnosis of nodular sclerosing Hodgkin disease which so far had not caused any symptoms besides the described neurological abnormalities. A diagnostic brain biopsy showed inflammatory changes and excluded invasion of malignant cells into the central nervous system. The other patient had been diagnosed with a small cell carcinoma of the ovary several months before neurological and brain MRI abnormalities were observed. This is the first report in which clinical picture, evolution of MRI abnormalities, and--in one case--characteristic neuropathological changes are suggestive of paraneoplastic limbic encephalitis in two adolescent girls.
Moral theory in neurologic practice.
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Neurologists and the hospital ethics committee.
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Legal aspects of terminating care.
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The definition, criterion, and statute of death.
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"Culture of life" politics at the bedside--the case of Terri Schiavo.
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Terri Schiavo--a tragedy compounded.
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Patient wins EMTALA appeal: case underscores that ED documentation of admission/care refusal is crucial.
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Toward a general theory of persons.
The fundamental question I consider is the following: What is it that makes one thing a person and another thing not? I do not provide a complete answer; rather I begin to develop a framework for answering the question. In this essay I do the following: (1) distinguish between the powers possessed by persons and the constitutions of persons, and propose some metaphysical conjectures concerning the relationship between persons' powers and their constitutions; (2) propose for Christians, as well as for others, an hylomorphic soul-body alternative to Cartesianism; (3) highlight some prominent differences between the nature of human persons to problems in biomedical ethics concerning the ontological and moral status of human embryos and of the comatose.
Tracing the soul: medical decisions at the margins of life.
Most religious traditions hold that what makes one a person is the possession of a soul and that this gives one moral status. This status in turn gives persons interests and rights that delimit the set of actions that are permitted to be done to them. In this paper, I identify the soul with the capacity for consciousness and mental life and examine the ethical aspects of medical decision-making at the beginning and end of life in cases of patients who either never have had or have lost this capacity. I argue that, although these patients may lack moral status, they nonetheless have moral value as human organisms and forms of God-given biological life. In particular, I explore what this value entails about the permissibility of withholding or withdrawing life-sustaining treatment and of harvesting viable organs from patients with no higher-brain function.
The person in secular and in Orthodox-Catholic bioethics.
The following demarcates the sens of the human person in Orthodox-Catholic bioethics from the family of senses proper to secular bioethics and philosophy. The radically different sources of knowledge about the senses proper to each discipline suggest that the importation of philosophical and secular psychological distinctions and analyses into true Christianity's concern with the human person, is fundamentally misguided. This suggestion is confirmed by examination of the articles of Crosby, Glannon, Hoswepian, and Meador and Shuman.
In the matter of Baby K: implications for hospital administration.
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