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1.

Background

Posterior reversible encephalopathy syndrome (PRES) is a condition characterized by seizures, altered consciousness, visual disturbances, and headache. Characteristic findings on neuroimaging include cerebral edema, typically involving the parieto-occipital white matter. PRES has been associated with hypertension, autoimmune disease, and Henoch-Schölein purpura (HSP), but few cases have been reported, and fewer cases of PRES have been reported in children.

Case Report

We report the case of a 4-year-old girl who presented with blindness and semi-consciousness. The patient had no significant medical history and no abnormalities on physical examination or laboratory testing, although she had slightly elevated blood pressure. After hospitalization, the patient showed some characteristic signs of HSP and cranial magnetic resonance imaging revealed PRES as the cause of semi-consciousness. In our discussion, we examine the clinical features of PRES and remarkable points for the clinical diagnosis and management of this rare but important disease.

Why Should an Emergency Physician Be Aware of This?

Although reports of PRES in children are rare, PRES should be considered in the differential diagnosis of children presenting with disturbance of consciousness. Emergency physicians should consult with pediatric physicians to confirm diagnoses of PRES and determine an appropriate treatment plan, given its variable etiology. Measurements of blood pressure, which are often missing in pediatric cases, can help physicians to arrive at a correct diagnosis.  相似文献   
2.

Background

Neural inertia is defined as the tendency of the central nervous system to resist transitions between arousal states. This phenomenon has been observed in mice and Drosophila anaesthetized with volatile anaesthetics: the effect-site concentration required to induce anaesthesia in 50% of the population (C50) was significantly higher than the effect-site concentration for 50% of the population to recover from anaesthesia. We evaluated this phenomenon in humans using propofol or sevoflurane (both with or without remifentanil) as anaesthetic agents.

Methods

Thirty-six healthy volunteers received four sessions of anaesthesia with different drug combinations in a step-up/step-down design. Propofol or sevoflurane was administered with or without remifentanil. Serum concentrations of propofol and remifentanil were measured from arterial blood samples. Loss and return of responsiveness (LOR-ROR), response to pain (PAIN), Patient State Index (PSI) and spectral edge frequency (SEF) were modeled with NONMEM®.

Results

For propofol, the C50 for induction and recovery of anaesthesia was not significantly different across the different endpoints. For sevoflurane, for all endpoints except SEF, significant differences were found. For some endpoints (LOR and PAIN) the difference was significant only when sevoflurane was combined with remifentanil.

Conclusions

Our results nuance earlier findings with volatile anaesthetics in mice and Drosophila. Methodological aspects of the study, such as the measured endpoint, influence the detection of neural inertia. A more thorough definition of neural inertia, with a robust methodological framework for clinical studies is required to advance our knowledge of this phenomenon.

Clinical trial registration

NCT 02043938.  相似文献   
3.
Background  As a new electroencephalogram (EEG) signal processing technique for monitoring the depth of anesthesia, entropy consists of two indices: reaction entropy (RE) and state entropy (SE). Our study compared entropy with classical bispectral index (BIS) in reduction of myoelectrical interference and noxious stimuli with EEG signals.
Methods  Two hundred and eighty patients (ASA I–II, 18–60 years old) undergoing scheduled surgeries from seven medical centers were enrolled. Anesthesia induction was managed with propofol via the target-controlled infusion (TCI) system. The results of BIS, RE, SE, mean arterial pressure (MAP) and heart rate (HR) were recorded before anesthesia induction, at the moment of unconsciousness, before and 2 minutes after administration of muscle relaxant, and before and one and three minutes after the tracheal intubation.
Results  The values of half maximum effective concentrations (EC50), 5% effective concentrations (EC05) and 95% effective concentrations (EC95) of propofol effect-site concentration at the onset of unconsciousness were 1.2 (1.1–1.3 μg/ml), 2.5 (2.4–2.5 μg/ml) and 3.7 (3.7–3.8 μg/ml), while those of the predicted plasma propofol concentration were 2.8 (2.7–2.9 μg/ml), 3.9 (3.8–3.9 μg/ml) and 4.9 (4.8–5.0 μg/ml), respectively. The values of BIS, SE and RE were 62, 59 and 63 when 50% of patients lost consciousness, and 79, 80, 85 and 42, 37, 44, respectively, when 5% and 95% of patients were unconscious. The values of BIS, RE and SE dropped two minutes after the injection of muscle relaxant, but there were no significant differences between RE and SE. MAP and HR increased visibly, which indicated a reaction to tracheal intubation; the values of BIS, RE and SE, however, did not display any significant changes.
Conclusions  This large-sample multicentric study confirmed the values of RE and SE as approximating BIS value, at the onset of unconsciousness during propofol TCI anesthesia. After elimination of myoelectrical activation, all values of RE, SE and BIS decreased significantly and the three indices were less sensitive to noxious stimuli than cardiovascular responses.
  相似文献   
4.
持续性正加速度致意识丧失的机理及其监测   总被引:5,自引:0,他引:5  
正在加速度引起的意识丧失(G-LOC)是当胶威胁飞行安全的主要因素。综述了G_LOC的机理及其生理监测,慢增长率正加速度导致的意识丧失的机理主要大脑缺血/缺氧;快增长率正加速度导致物意识丧失可能与颅内高应力有关,但缺直接的实验证据。用于G-LOC监测的生理指标中,眼水平动脉血压、脑氧饱和度等可能具有重要作用。  相似文献   
5.
不同疾病导致意识障碍患者高压氧治疗时机的把握   总被引:1,自引:1,他引:0  
目的:探讨不同疾病导致意识障碍患者高压氧(HBO)治疗时机的把握。方法:116例接受HBO治疗的意识障碍患者,根据原发疾病的不同分为急性中毒组(A组)、重型颅脑损伤组(B组)、心肺复苏后急性缺血缺氧性脑病组(C组)及脑血管病组(D组),比较各组开始HBO治疗的时间和有效率,并分析其影响因素。结果:A组开始HBO治疗的时间最早,与其他组比较,有效率最高97.4%(P〈0.01)。C组与D组有效率较低,分别为52.6%、41.2%。B组与D组开始HBO治疗的时间较晚,平均〉1个月。结论:各组患者早期HBO治疗都有其不同的特点,治疗时机不仅与原发疾病有关,还与气管切开、肺部感染有关。意识障碍患者行HBO治疗,应合理把握时机,尽量早期开始。  相似文献   
6.
针刺对意识障碍患者皮质作用的脑电非线性分析   总被引:1,自引:0,他引:1  
目的:评估针刺对意识障碍患者皮质的即刻作用。方法:分别对30例意识障碍患者的安静闭眼、针刺患侧、针刺健侧三种状态下的脑电进行采集,利用脑电信号的关联维数、近似熵和复杂度非线性指数进行分析。结果:意识障碍患者在三种状态下的脑电非线性指数差异没有显著性(P〉0.05),脑电不同部位之间差异亦没有显著性(P〉0.05)。但多数患者的关联维数在针刺状态较其安静闭眼状态呈现上升趋势。结论:针刺在意识障碍患者的促醒过程中可能存在一定的作用,但是对重度颅脑损伤患者而言,单次针刺对皮质的即刻作用可能严重受影响:脑电可以在一定程度上反映针刺对皮质的即刻作用。  相似文献   
7.
《麦克白》在现代莎评中自身几乎转换成了充满原型的心理悲剧,它在女巫、鬼魂、超自然因素及阴暗的色彩等笼罩下充分展示悲剧主人公的潜意识心理及其极力保持心灵内外对统一的平衡的努力;主人公本我狂野的欲望及其在事后的病态心理表现正是他们意识内外失控的心态,犹如进入黑夜的漫长旅程。  相似文献   
8.
本文观察502例脑肿瘤中,有47例出现意识障碍(9.4%)。其发生机制主要有:①脑疝形成;②普遍性颅内压增高引起脑缺氧;③肿瘤内出血;④肿瘤部位如额、颞叶、上脑干等的直接损害;⑤癫痫发作。脑疝形成是主要死亡原因。简要讨论了脑肿瘤意识障碍的临床特点、预后因素以及脑中心性疝的早期诊断。  相似文献   
9.
脑损伤对记忆的影响   总被引:4,自引:2,他引:2  
目的:探讨不同程度的脑损伤对意识、无意识记忆的影响。方法:采用Jacoby的加工分离程序(PDP),以具体图形和抽象图形为实验材料,分别对器质性、功能性脑损伤患者和正常健康者的意识、无意识提取贡献率进行测试。结果:在2种图形编码条件下,器质性脑损伤组和功能性脑损伤组的意识性提取贡献率均显著低于正常组。器质性脑损伤组的无意识提取贡献率显著低于正常组;而功能性脑损伤组的无意识提取贡献率与正常组差异无显著性。结论:不同程度脑损伤对意识、无意识记忆的影响不同。意识性记忆在脑损伤中比无意识记忆更容易受到伤害。  相似文献   
10.
2型糖尿病低血糖昏迷的28例临床分析   总被引:1,自引:0,他引:1  
目的:探讨2型糖尿病治疗过程中低血糖昏迷诱因及治疗方法。方法:对28例2型糖尿病低血糖昏迷患者的资料进行回顾性分析。结果:糖尿病治疗中低血糖昏迷好发于50岁以上患者,28例患者中2人年龄小于50岁,其余均大于50岁,经过治疗后,死亡1例,精神异常1例,其余均治愈。结论:糖尿病治疗过程中应重视糖尿病低血糖教育,便于及早发现、及早救治。  相似文献   
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