Annals of neurology
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Annals of neurology · Nov 1983
Case ReportsExternal ophthalmoplegia, alpha and spindle coma in imipramine overdose: case report and review of the literature.
A 13-year-old boy with imipramine overdose developed seizures, respiratory arrest, and coma. Abnormalities of oculovestibular reflexes, electroencephalograms, and brainstem auditory evoked potentials were monitored in relation to measurements of drug levels. ⋯ Prolonged brainstem auditory evoked potentials also normalized as coma and oculocephalic reflex abnormalities resolved. In spite of the history that suggested hypoxic damage, the absence of reflex eye movements in a comatose patient and the presence of alpha- and spindle-coma electroencephalographic patterns, even with prolonged brainstem auditory evoked potentials, are not reliable prognostic indicators in tricyclic drug overdose.
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Annals of neurology · Feb 1983
Clinical TrialEffect of a single oral dose of propranolol on essential tremor: a double-blind controlled study.
The effect of a single oral dose of propranolol (120 mg) on essential tremor was investigated in a double-blind, placebo-controlled study in 26 patients. Hand tremor was recorded by means of accelerometers, and its frequency and amplitude calculated by using spectrum analysis. Recordings were made before and 1 1/2 hours after drug or placebo administration. ⋯ There was a clear tendency for patients with small tremor amplitude (less than 0.006 cm hand displacement) to show the least satisfactory response to propranolol. These results indicate that a single oral dose of propranolol is effective in producing a rapid and marked reduction of essential tremor. Measurement of pretreatment amplitude and frequency might be useful in predicting the therapeutic outcome in these patients.
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Annals of neurology · Feb 1983
No effect from double-blind trial of physostigmine and lecithin in Alzheimer disease.
Eight patients with clinically diagnosed mild to severe Alzheimer disease were treated during two six-week periods by a double-blind, single-crossover protocol with placebo or a combination of 18 gm of lecithin and 3 to 10 mg of oral physostigmine daily. No improvement in behavior, recent memory, or other neuropsychological functions occurred.
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Traumatic coma was produced in 45 monkeys by accelerating the head without impact in one of three directions. The duration of coma, degree of neurological impairment, and amount of diffuse axonal injury (DAI) in the brain were directly related to the amount of coronal head motion used. Coma of less than 15 minutes (concussion) occurred in 11 of 13 animals subjected to sagittal head motion, in 2 of 6 animals with oblique head motion, and in 2 of 26 animals with full lateral head motion. ⋯ Coma lasting 16 minutes to 6 hours occurred in 2 of 13 of the sagittal group, 4 of 6 in the oblique group, and 4 of 26 in the lateral group, these animals had less neurological disability and less DAI than when coma lasted longer than 6 hours. These experimental findings duplicate the spectrum of traumatic coma seen in human beings and include axonal damage identical to that seen in sever head injury in humans. Since the amount of DAI was directly proportional to the severity of injury (duration of coma and quality of outcome), we conclude that axonal damage produced by coronal head acceleration is a major cause of prolonged traumatic coma and its sequelae.
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Annals of neurology · Jul 1982
Case ReportsLong-term management of respiratory failure in amyotrophic lateral sclerosis.
Present-day technology has made the in-home care of patients requiring prolonged mechanical ventilation increasingly common. When this technology is applied to the care of patients with amyotrophic lateral sclerosis, physiological, psychological, and ethical issues must be adequately addressed. Assessment of medical and social factors in six patients, four of whom are still living, indicates that in-hospital as well as follow-up evaluation should be carried out in an effort to anticipate the long-range problems, challenges, and limitations of home care ventilation. Because of increasing availability and simplicity of portable respiratory support devices, the implications of long-term ventilatory support for some patients with amyotrophic lateral sclerosis and similar illnesses will become more commonly considered in planning long-term home care.