Bruce D. Snyder

Posterior Cortical Atrophy

Five patients had progressive dementia heralded by disorders of higher visual function. All eventually developed alexia, agraphia, visual agnosia, and components of Balints, Gerstmanns, and transcortical sensory aphasia syndromes. Memory, insight, and judgment were relatively preserved until late in the course. Predominant parieto-occipital atrophy was demonstrated on both computed tomography and magnetic resonance imaging in two of the patients; posterior circulation was normal by angiography in the three studied. To date, no pathologic specimen is available for study; speculations on the underlying pathologic condition include an atypical clinical variant of Alzheimers disease, a lobar atrophy analogous to Picks disease, or some previously unrecognized entity.

Neurologic prognosis after cardiopulmonary arrest III. Seizure activity

Nineteen (30%) of 63 adult survivors of cardiopulmonary arrest had seizures after admission to the hospital. Eleven of 19 had more than one type of seizure. Myoclonic seizures began within 12 hours of the arrest in eight patients, and after 3 or more days in four patients. Only two (17%) patients with myoclonic seizures survived. Partial seizures usually began within 12 hours of the arrest and were controllable with anticonvulsants; 4 of 12 patients survived. Two of four patients with generalized tonic-clonic seizures survived; one of four with “shivering” lived. Overall, patients with seizures had a survival rate of 32% (6 of 19), compared with 43% for patients without seizures. None of the survivors had recurrent seizures within 6 months after hospital admission.

Neurologic prognosis after cardiopulmonary arrest; II. Level of consciousness

Sixty-three patients with isolated global anoxic-ischemic injury were prospectively evaluated after cardiopulmonary arrest (CPA); 25 (40%) survived, 16 to an excellent recovery, 8 to a good recovery, and 1 with severe deficits. Forty-six percent of the patients achieved full alertness, and only patients who did so survived. Seventy-five percent of patients arousable or initially alert (level of consciousness [LOC] ≥ 4) survived, all but two with excellent outcomes. Twenty-eight percent of patients initially in deep coma (LOC ≤ 3) survived, all with excellent or good outcomes. Ninety percent of patients who became fully alert did so within 72 hours. The likelihood of alerting is correlated with the LOC at given intervals after CPA. Reliable predictions of survival and outcome can often be based upon LOC alone within 2 days after CPA.

Neurologic status and prognosis after cardiopulmonary arrest I. A retrospective study

A retrospective survey of survivors of cardiorespiratory arrest included 34 patients. Twenty-one had a good outcome neurologically and 13 were seriously impaired. Depth and duration of postarrest coma correlated significantly with poor neurologic function. Seventy percent of the seriously impaired patients never regained consciousness and none emerged from coma within 5 days; 90 percent of patients with good outcome were alert within 18 hours after resuscitation. Coma, motor unresponsiveness, absent pupillary light reflexes, and absent oculocephalic responses were closely associated with dismal prognosis for neurologic functioning. This retrospective study cannot provide a basis for discontinuation of life support at any specific time.

Neurologic prognosis after cardiopulmonary arrest IV. Brainstern reflexes

we conducted a prospective study of 63 patients resuscitated from cardiopulmonary arrest (CPA) to analyze the prognostic significance of changes in brainstem reflex activity. Brainstem reflex abnormalities were common in the early postresuscitation period. Among survivors, reflexes returned to normal within 48 hours. Reflex abnormalities were significant predictors of poor outcome by 6 hours after CPA. No survivor had absent pupil light or corneal responses from 6 hours after CPA, and loss of reflex response after this time occurred in only one survivor.

Posttraumatic intention myoclonus

A patient with long-standing intention myoclonus was treated with oral clonazepam, which resulted in clinical and electrophysiologic improvement as manifested by dramatic reduction in intention myoclonus and diminished amplitude of somatosensory evoked potentials after treatment.

Cervical myelopathy complicating cerebral angiography Report of a case and review of the literature

Transverse cervical myelopathy, at C-6 level, followed injection of Renografin-60 into the right thyrocervical trunk during cerebral angiography. Review of the literature yielded only two cases in which attempted posterior fossa angiography resulted in cervical myelopathy. Two more cases were found. In one, cervical myelopathy occurred during aortography in a patient with coarctation of the aorta, and in the other it followed mediastinal angiography. Summation of anoxia, hemorrhage, and cellular toxicity is responsible for spinal cord necrosis following arterial injection of contrast material.

Case Report: Hypophosphatemia with Reversible Ataxia and Quadriparesis

ABSTRACT A malnourished alcoholic man with severe hypophosphatemia developed ataxia, severe proprioceptive deficit, and quadriparesis that worsened during refeeding. Evoked response and EMG studies demonstrated the central location of the rapidly reversible conduction block. This syndrome can mimic a number of entities including the Landry-Guillain-Barre (LGB) syndrome, acute brainstem disease, and certain deficiency states. The neurologic features of hypophosphatemia are reviewed.

Does Cardioembolic Stroke have a Neurologic Profile

The clinical symptoms at onset and neurological findings of 193 consecutive patients with an acute cerebral infarct were analyzed to determine if the frequency of their occurrence allowed one to distinguish among patients with a cardiac source of embolus (SOE) (106 patients), an aterial SOE (38 patients) or no demonstrable SOE (49 patients). Rapidity of onset and loss of consciousness at onset were the only symptoms significantly more frequent in the group of patients with a cardiac SOE.

Anoxic Ischemic Encephalopathy: Prognosis and Treatment

Publisher Summary This chapter discusses the prognosis and treatment of anoxic ischemic encephalopathy (AIE). Certain specific EEG patterns have high prognostic significance in the AIE comatose patient. It is found that the alpha and spindle coma patterns and various generalized periodic patterns should be recognized. The alpha coma pattern is characterized by rhythms in the alpha frequency band that are widespread over the entire cranium and do not show the usual reactivity to eye opening or stimulation. This pattern carries a poor prognosis in hypoxic patients, particularly if it persists for 24 h or longer after resuscitation. Spindle coma activity is denoted by EEG patterns resembling slow-wave sleep, with sleep spindles that persist despite stimulation, and the pattern implies high brain stem dysfunction and a poor prognosis. Periodic EEG patterns that can be seen in hypoxia include burst suppression, generalized periodic slow-wave complexes, periodic triphasic waves, and bilateral periodic epileptiform discharges. These patterns have correlated with very high mortality rates in some series.