Der Nervenarzt
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Septic encephalopathy (SE) is present in up to 70% of all patients with sepsis. In some cases, SE may proceed other parameters of sepsis. Loss of consciousness to a various extent is the leading symptom. ⋯ Due to liver dysfunction in sepsis, the brain neurotransmitter profile may be deranged. Other etiological factors include bacteriemia, liver or renal dysfunction, fluid and electrolyte imbalance, hypoglycemia and drug effects. Due to the prognostic significance of early adequate treatment, recognition of SE as a possible initial sign may be crucial for patients with sepsis.
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Case Reports
[Neurogenic temporomandibular joint dislocation. Definition and therapy with botulinum toxin].
Dislocation of the temporomandibular joint results from trauma, articulation disorders and changes in the equilibrium of the masticatory muscles. Previous classifications were mostly oriented on the interrelationships between the anatomical positions of the dislocated articular surfaces, like luxation, subluxation and discuss luxation. ⋯ Dislocation of the temporomandibular joint is described as a complication of a number of neurological diseases. We report on a patient who suffered recurrent dislocations of the temporomandibular joint as a complication of multiple sclerosis and whose luxations were successfully treated with botulinum toxin, thus warranting the introduction of the term "neurogenic dislocation of the temporomandibular joint".
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We report on a psychosis caused by application of a transdermal scopolamine patch for over 15 days. In the literature there is no mention of a case in which scopolamine had such an influence nor are any cases reported in which paranoid-hallucinatory symptoms continued 11 days after removing the patch.
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The unconscious patient presents an challenging emergency in the intensive care unit. Patient evaluation and treatment must occur simultaneously. ⋯ The physical and neurological examination should be performed in a efficient way and must consider the following eight points: best reaction to loud commands, best motor reaction to noxious stimuli, respiratory pattern, size and reactions of pupils, eye movements, corneal and blink reflex, meningismus, muscle tone and deep tendon reflexes. With this approach it is possible to formulate a working diagnosis, and the appropriate diagnostic steps can be performed.