Subject(s)
Antidepressive Agents, Second-Generation/poisoning , Bupropion/poisoning , Cardiotoxins/poisoning , Citalopram/poisoning , Selective Serotonin Reuptake Inhibitors/poisoning , Suicide , Adult , Antidepressive Agents, Second-Generation/blood , Bupropion/blood , Cardiotoxins/blood , Citalopram/blood , Delayed-Action Preparations/poisoning , Depression/drug therapy , Drug Overdose , Female , Humans , Selective Serotonin Reuptake Inhibitors/blood , Sodium Channel Blockers/blood , Sodium Channel Blockers/poisoning , Time Factors , Young AdultABSTRACT
BACKGROUND: Chronic hypertension and anticoagulation are important risk factors for the development of intracerebral hemorrhage (ICH). Spontaneous ICH occurring in the Emergency Department (ED) following a normal unenhanced computed tomography (CT) scan of the brain and an acute blood pressure (BP) surge is exceedingly rare and has, to our knowledge, never been reported in the literature. METHODS: Single case observation in a suburban tertiary care medical center. RESULTS: A neurologically intact 72-year-old man whose BP and neurologic status were monitored during an ED evaluation suddenly became unresponsive following an acute BP surge. A CT of the brain shortly before the episode was normal; following the episode, a repeat CT demonstrated a large right ganglionic ICH. CONCLUSIONS: We present a rare case of an elderly man on warfarin who developed a spontaneous ICH during an ED evaluation following an acute BP surge. We propose that the ICH occurred as a result of the BP surge and was contributed to by warfarin anticoagulation.
Subject(s)
Anticoagulants/adverse effects , Anticoagulants/therapeutic use , Cerebral Hemorrhage/etiology , Emergency Service, Hospital , Hypertension/complications , Warfarin/adverse effects , Aged , Atrial Fibrillation/drug therapy , Blood Pressure , Brain/diagnostic imaging , Cerebral Hemorrhage/diagnostic imaging , Humans , Hypertension/physiopathology , Male , Tomography, X-Ray Computed , Warfarin/therapeutic useABSTRACT
The experiments examined the effects of prelimbic-infralimbic inactivation in rats on the acquisition and reversal learning of different discrimination tasks: 2- or 4-choice odor discrimination in Experiments 1 and 2, the shift from 2-choice odor discrimination to 2-choice place discrimination in Experiment 3, and the shift from 2-choice place to 2-choice odor discrimination in Experiment 4. Infusions of 2% bupivacaine did not impair performance in the odor discrimination tests. Prelimbic-infralimbic inactivation did not impair acquisition but did impair the shift from an odor to a place discrimination and vice versa. Analysis of the errors revealed that the deficit was due to perseveration of the previously learned strategy. The selective deficits observed in the odor-place tests suggest that the prelimbic-infralimbic areas enable behavioral flexibility when conditions demand inhibiting the use of one type of attribute information and learning a new type of attribute information.
