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PubMed1975

[Prognosis and long-term prognosis of epidural haematoma (a study of 83 patients) (author's transl)].

1. Early detection and treatment of epidural haematoma is vital to the chance of survival. In this respect physician's training needs to be improved. 2. The operation method of choice, particularly in the case of advanced midbrain lesions, is the extensive decompression operation (hemicranectomy) with duraplasty. In each case it is imperative to pay special attention to the relationship between blood pressure and brain perfusion until the state of decompressive is reached. 3. Late complications such as a disturbed circulation of the cerebrospinal fluid may occur and should be prevented by a shunt-operation. 4. ECG changes are still detectable even after many years. However, they give little indication on the patient's tendencies to fits. Post-traumatic cases of epilepsy may even occur more than five years after injury. 5. Patients suffering from epidural haematoma are in need of careful medical, psychiatric and social care for many years after injury, even if they seem to have been restored both neurologically and psychiatrically at the time of hospital discharge.

Accidents, Occupational↗

PubMed1992

Risk factors for late posttraumatic epilepsy.

The usually accepted risk factors for late post-traumatic seizures (LPTS) are those identified years ago by Jennet: early post-traumatic seizure (EPTS), depressed fracture, intracranial haematoma. Prolonged unconsciousness (PTA greater than 24 hrs) is another factor usually added. More recently, personal experience of the Authors and the data of the literature, compel us to question the validity of known risk factors based on clinical data. Authors believe that the identification of patients at risk for LPTS depends mainly on the precise definition of trauma severity and on CT or surgically documented lesions of brain substance. Three groups of patients, characterized by the presence of one or more of the accepted risk factors of LPTS, have been studied. In our experience, while in adults the presence of documented cortico-subcortical lesions represents the main risk factor of LPTS, in children the appearance of EPTS per se increases the risk of LPTS, irrespective of the presence of documented brain lesions. Alteration of consciousness without a focal lesion, even if prolonged and severe, is not a risk factor for LPTS.

Adolescent↗

PubMed1976

Brain damage in National Hunt jockeys.

Five National Hunt jockeys have been found to have post-traumatic encephalopathy- three with epilepsy and two with significant intellectual and psychological deterioration. Closer supervision is needed.

Adult↗

PubMedDate not supplied

[Negative aspects of pharmacological prevention of epilepsy].

Pharmacological prevention of epilepsy, especially in cases of past cranial trauma, arose as one of the problems connected with this disease. Attention has been called, however, ever more frequently to the neurotoxic effects of antiepileptic drugs symptoms and signs of with brain damage. Drug-induced encephalopathy or neuropathy occur particularly in patients with disorders of anticonvulsant drug metabolism in liver diseases or due to inborn enzymatic defects. Teratogenic and even epileptogenic side effects has been described in cases treated with therapeutic doses of anticonvulsants. The author discusses in this aspect the indications to pharmacological prevention of epilepsy quoting cases observed by her in which cranial trauma was followed by one or several seizures in early post-traumatic period and presence of seizure potentials was found in EEG. During follow-up observations of severel years duration the seizures were not repeated and EEG has returned to normal.

Anticonvulsants↗

PubMed1976

[Study of epilepsy by computer controlled transverse axial tomography of the brain].

The value of computerized azial tomography of the encephalon is considered:--Firstly, in relation to the different electro-clinical varieties of epilepsy (essentially primary, secondary and partial) where it provides information of a high degree of precision concerning the topography, frequency and size of morphological abnormalties of the encephalon.--Secondly, in relation to the various aetiological possibilities (tumour, post-traumatic, post-ischaemic, post-infective, et cetera). This new method is of considerable to specify an aetiology almost unknown up to the present time: post-ischaemic occipital porencephaly secondary to perinatal or infantile occlusion of the posterior cerebral artery.

Adult↗

PubMed1978

Transient global amnesia--a review of 213 cases from the literature.

TGA is a clearly recognisable clinical syndrome with many and varied aetiologies, the most ubiquitous being transient cerebral ischaemia. This entity is probably much more common than the literature suggests, many patients not coming to the attention of a physician due to the transient nature of the isolated memory defect and the risk of recurrence being low, it is of interest that many of the original patients described tended to be the more prominent members of the community, e.g. physicians and relatives of physicians, perhaps suggesting that the occurrence of TGA in such a person is less likely to pass unnoticed. In the differential diagnosis one should include the following: transient cerebral ischaemia, epilepsy, migraine, temporal lobe encephalitis, psychogenic fugues, post-traumatic, and rarely cerebral neoplasms.

Adult↗

PubMed1992

Quantitative neuropathology in epilepsy.

Counting of neurons has brought new insight to the mechanism of epilepsy. The reduction in Purkinje cells and neuron loss in hippocampus are related to generalized convulsions in man. Generalized convulsions provoked by electric shock in rats do not result in neuron loss. However, mongolian gerbils from seizure-susceptible strains with "spontaneous" seizures of various types, have a reduced number of H1-neurons and Purkinje cells after only a restricted number of seizures of any type. Loss of neurons is a possible consequence of generalized convulsions. Even "seizure activity", as such, seems to damage nerve cells. The consequence is early effective treatment in such cases where epilepsy is a secondary threat as in febrile convulsions, post-traumatic, post-infectious and post-infarction epilepsy.

Animals↗

PubMedDate not supplied

[Etiological diagnosis of epilepsy: value of computerized axial tomography (C.A.T.) (author's transl)].

The authors appraise the value of CAT in the study of epilepsy from their personal experience and from the few published works that are available. The CAT confirms and supports a large number of already acquired facts:--the almost complete absence of cerebral lesions in "functional" epilepsies (primary generalized epilepsies and benign childhood epilepsy with rolandic paroxysms);--the large number of abnormalities in the secondary generalized epilepsies (West syndrome, Lennox-Gastaut syndrome) where the majority of patients present a bilateral fronto-temporal atrophy;--the high percentage of cerebral lesions in partial epilepsies. In this case, the CAT is especially notable in revealing etiologies in 63 p. 100 of cases. They include: tumors, abcesses, empyemas, angiomas, cerebral infarctions, cerebral atrophies, post-traumatic lesions, etc... From this study, it can be concluded that positive diagnosis of epilepsy is still made on the basis of clinical and electroencephalographic data, with the CAT used to facilitate the etiological diagnosis.

Adolescent↗

PubMed1979

[Neuroradiological findings in epilepsies without consideration of cranial computerized tomography and radioactive brain scanning (author's transl)].

This paper gives a detailed summary of neuroradiological findings (X-rays of the skull, pneumoencephalograms and angiograms) in epilepsies and epileptic seizures, that is based on 902 patients, which have been treated in the Neuro-Psychiatric university hospital of Mainz during 1960 and 1975. First the different pathological findings and their frequency in relation to the single types of epilepsy are described. Then it is tried to draw conclusions from the neuroradiological findings to the etiology of the particular seizure-classes. In further passages important etiologies are chosen and the appearing different seizures with their neuroradiological findings are presented. Epilepsies due to unknown causes, due to brain damage in early childhood, post-traumatically, alcohologenic and caused by brain-tumors are considered. As no similar classification was found in the literature, our data could only be compared with those of different papers, each dealing with some aspects. In the absence of recent publications with statistical data we also had to refer to older papers. Differences between our results and those of the literature are discussed.

Brain↗

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↗

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↗

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↗