ABSTRACT
We present the case of an adolescent boy who developed a variety of simple and complex motor and vocal tics (Tourette-like syndrome), along with inattentiveness and obsessive-compulsive behaviors after cardiac surgery with cardiopulmonary bypass and profound hypothermia. A single photon emission computed tomography study 2 months after surgery showed reduced uptake in the left hemisphere and 2 years later a perfusion defect in the basal ganglia. Serial magnetic resonance imaging (MRI) studies were normal. Volumetric MRI studies were obtained 4 years after surgery and compared with published values for normal individuals and children with Tourette syndrome (TS), including subsets matched for age, sex, and handedness. Measurement of basal ganglia structures showed a right-dominant asymmetry of the caudate and putamen, in part similar to findings previously reported in patients with TS. Other volumetric abnormalities included a > 2-SD reduction of cortical gray matter, a small decrease of total cerebral volume, and increase in cerebral white matter. Although a variety of neurological problems may occur after cardiopulmonary bypass, to our knowledge this case represents the first report of a chronic tic disorder following cardiac surgery with cardiopulmonary bypass and hypothermia.
Subject(s)
Cardiopulmonary Bypass/adverse effects , Hypothermia, Induced/adverse effects , Tourette Syndrome/etiology , Attention Deficit Disorder with Hyperactivity/etiology , Brain/diagnostic imaging , Brain/pathology , Child , Humans , Magnetic Resonance Imaging , Male , Obsessive-Compulsive Disorder/etiology , Tomography, Emission-Computed, Single-Photon , Tourette Syndrome/diagnostic imaging , Tourette Syndrome/physiopathologyABSTRACT
Management of seizures requires prompt medical attention to prevent morbidity and mortality and to clarify the etiology of the event so that proper long-range therapy can be planned. This article provides an overview of the diagnosis and treatment of this common medical problem.
Subject(s)
Seizures/therapy , Anticonvulsants/therapeutic use , Emergency Medical Services , Family Practice , Glucose/therapeutic use , Humans , Medical History Taking , Physical Examination , Seizures/diagnosis , Status Epilepticus/therapy , Thiamine/therapeutic useABSTRACT
In seeking the neurologic substrate of the autistic syndrome of childhood, previous studies have implicated the medial temporal lobe or the ring of mesolimbic cortex located in the mesial frontal and temporal lobes. During an acute encephalopathic illness, a clinical picture developed in three children that was consistent with infantile autism. This development was reversible. It was differentiated from acquired epileptic aphasia, and the language disorder was differentiated aphasia. One child has rises in serum herpes simplex titers, and a computerized tomographic (CT) scan revealed an extensive lesion of the temporal lobes, predominantly on the left. The other two, with similar clinical syndromes, had normal CT scans, and no etiologic agent was defined. These cases are examples of an acquired and reversible autistic syndrome in childhood, emphasizing the clinical similarities to bilateral medial temporal lobe disease as described in man, including the Klüver-Bucy syndrome seen in postencephalitic as well as postsurgical states.
Subject(s)
Autistic Disorder/diagnosis , Acute Disease , Aphasia/diagnosis , Autistic Disorder/etiology , Autistic Disorder/physiopathology , Child , Child, Preschool , Encephalitis/complications , Epilepsy/diagnosis , Female , Humans , Male , Radiography , Temporal Lobe/diagnostic imagingABSTRACT
Two patients with acute lymphocytic leukemia developed progressive optic nerve and chiasmal lesions eight to nine months after the initiation of identical chemotherapy protocols that included intrathecal medication and prophylactic radiation of only 2,400 rads to the central nervous system. Both patients eventually lost all vision despite additional radiotherapy, and there was no evidence of leukemia involving the central nervous system after acute lymphocytic leukemia was diagnosed. Optic nerve biopsy in one case showed changes consistent with radiation necrosis.
