Neurologic Complications (neurologic + complications)

Distribution by Scientific Domains


Selected Abstracts


Neuroimaging and Neurologic Complications after Organ Transplantation

JOURNAL OF NEUROIMAGING, Issue 2 2007
ivkovi
ABSTRACT Neurologic complications are common after transplantation and affect 30-60% of transplant recipients. The etiology of most of the posttransplant neurologic disorders is related to the opportunistic infections, both systemic and involving central nervous system (CNS), toxicity of immunosuppressive medications, and the metabolic insult created by the underlying primary disease and the transplant procedure. Neuroimaging studies are one of the key tools in the evaluation and enable early diagnosis of neurologic complications in transplant patients, especially posterior reversible leukoencephalopathy syndrome, central pontine myelinolysis, intracerebral hemorrhage, and fungal and bacterial abscesses. Magnetic resonance imaging (MRI) is the preferred technique, but each of the available neuroimaging techniques offers a unique insight into the pathophysiologic mechanisms underlying neurologic complications of transplantation. The role of neuroimaging in this population includes early detection of calcineurin inhibitor neurotoxicity, opportunistic infections, neoplasia, metabolic disorders, or cerebrovascular diseases. In addition, we can monitor longitudinal progression of disease and treatment response. [source]


Neurologic disorders in 432 consecutive patients with small cell lung carcinoma

CANCER, Issue 4 2004
Tatjana Seute M.D.
Abstract BACKGROUND Neurologic complications are an important cause of morbidity and possibly also mortality in patients with small cell lung carcinoma (SCLC). The current study was undertaken to prospectively investigate survival and the frequency of neurologic disorders in patients with SCLC. METHODS Between October 1980 and September 2001, 432 consecutive patients with microscopically proven SCLC were included in the current study. Patients underwent neurologic examinations on a regular basis prior to, during, and after treatment. Routine imaging of the brain (computed tomography or magnetic resonance imaging) was performed before and after systemic therapy. RESULTS A neurologic disorder was diagnosed in approximately 56% of the SCLC patients. In nearly half of the cases, the neurologic disorder already was present at the time of diagnosis. Brain metastases (BM) were diagnosed most frequently. Seventy-four patients (18%) had BM at the time of diagnosis; in 20 of these patients, the BM did not demonstrate clinical signs. Another 101 patients developed BM during follow-up. The 2-year cumulative risk of BM reached 49% for patients with limited disease (LD) and 65% for patients with extensive disease (ED). Patients with BM as the only site of disease dissemination were found to have a poorer survival compared with LD patients. The majority of the nonmetastatic disorders preceded the diagnosis of SCLC. The syndrome of inappropriate antidiuretic hormone secretion (SIADH) was diagnosed most frequently. CONCLUSIONS In this prospective study, neurologic disorders were diagnosed in greater than half of the patients with SCLC. BM were detected most frequently. Approximately 18% of the patients were found to have BM at the time of diagnosis. In approximately 33% of the cases, these BM did not cause symptoms. BM were found to have a negative effect on survival in patients with SCLC. Cancer 2004;100:801,6. © 2004 American Cancer Society. [source]


Refeeding syndrome in cancer patients

INTERNATIONAL JOURNAL OF CLINICAL PRACTICE, Issue 3 2008
M. A. Marinella
Summary Background:, Refeeding syndrome (RFS) is a common, yet underappreciated, constellation of electrolyte derangements that typically occurs in acutely ill, malnourished hospitalised patients who are administered glucose solutions or other forms of intravenous or enteral nutrition. Discussion:, The hallmark of RFS is hypophosphataemia, but hypokalaemia and hypomagnesaemia are also common. Patients with various types of malignancies are at-risk for RFS, but very little exists in the oncologic literature about this disorder. Conclusions:, As RFS can have many adverse metabolic, cardiovascular, haematologic and neurologic complications, practicing oncologist needs to be aware of the pathophysiology, risk factors and clinical manifestations to promptly recognise this important, and potentially fatal, metabolic disorder. [source]


Oropharyngeal Skeletal Disease Accompanying High Bone Mass and Novel LRP5 Mutation,,

JOURNAL OF BONE AND MINERAL RESEARCH, Issue 5 2005
Michael R Rickels
Abstract Gain-of-function mutation in the gene encoding LRP5 causes high bone mass. A 59-year-old woman carrying a novel LRP5 missense mutation, Arg154Met, manifested skeletal disease affecting her oropharynx as well as dense bones, showing that exuberant LRP5 effects are not always benign. Introduction: Gain-of-function mutation (Gly171Val) of LDL receptor-related protein 5 (LRP5) was discovered in 2002 in two American kindreds with high bone mass and benign phenotypes. In 2003, however, skeletal disease was reported for individuals from the Americas and Europe carrying any of six novel LRP5 missense mutations affecting the same LRP5 protein domain. Furthermore, in 2004, we described a patient with neurologic complications from dense bones and extensive oropharyngeal exostoses caused by the Gly171Val defect. Materials and Methods: A 59-year-old woman was referred for dense bones. Three years before, mandibular buccal and lingual exostoses (osseous "tori") were removed because of infections from food trapping between the teeth and exostoses. Maxillary buccal and palatal exostoses were asymptomatic. Radiographic skeletal survey showed marked thickening of the skull base and diaphyses of long bones (endosteal hyperostosis). BMD Z scores assessed by DXA were +8.5 and +8.7 in the total hip and L1 -L4 spine (both ,195% average control), respectively. LRP5 mutation analysis was carried out for the LRP5 domain known to cause high bone mass. Results: Biochemical evaluation excluded most secondary causes of dense bones, and male-to-male transmission in her family indicated autosomal dominant inheritance. PCR amplification and sequencing of LRP5 exons 2-4 and adjacent splice sites revealed heterozygosity for a new LRP5 missense mutation, Arg154Met. Conclusions: LRP5 Arg154Met is a novel defect that changes the same first ",-propeller" module as the eight previously reported LRP5 gain-of-function missense mutations. Arg154Met alters a region important for LRP5 antagonism by dickkopf (Dkk). Therefore, our patient's extensive oropharyngeal exostoses and endosteal hyperostosis likely reflect increased Wnt signaling and show that exuberant LRP5 effects are not always benign. [source]


Hypomelanosis of ITO Associated with Precocious Puberty

JOURNAL OF CUTANEOUS PATHOLOGY, Issue 1 2005
B. M. Rutland
Background: There are only two reported cases of hypomelanosis of Ito (HI) associated with precocious puberty. Here we report a third case, and the first one to be autopsied. Design: A 5-year-old female with HI, intractable seizures and mental retardation presented with gray vaginal discharge and bacterial vaginosis. The patient subsequently died from neurologic complications and was autopsied. Results: Post-mortem examination revealed pigmentary mosaicism following the lines of Blaschko and advanced development of vulvar labia, pubic hair, and breast buds. Other significant autopsy findings included conical teeth, patchy alopecia, macrosomia (body weight and height above 95th percentile), and macrocephaly with megalencephaly (brain 1850 g). The uterus and ovaries were unremarkable. Epidermis had decreased melanocytes in hypopigmented areas. Skin fibroblast karyotype was normal. Conclusion: The two previous case reports indicate that the mechanism for precocious puberty in HI may be either biochemical, as in McCune-Albright Syndrome, or independent of GnRH. The mechanism of the precocious puberty in our case is most likely central. [source]


Neuroimaging and Neurologic Complications after Organ Transplantation

JOURNAL OF NEUROIMAGING, Issue 2 2007
ivkovi
ABSTRACT Neurologic complications are common after transplantation and affect 30-60% of transplant recipients. The etiology of most of the posttransplant neurologic disorders is related to the opportunistic infections, both systemic and involving central nervous system (CNS), toxicity of immunosuppressive medications, and the metabolic insult created by the underlying primary disease and the transplant procedure. Neuroimaging studies are one of the key tools in the evaluation and enable early diagnosis of neurologic complications in transplant patients, especially posterior reversible leukoencephalopathy syndrome, central pontine myelinolysis, intracerebral hemorrhage, and fungal and bacterial abscesses. Magnetic resonance imaging (MRI) is the preferred technique, but each of the available neuroimaging techniques offers a unique insight into the pathophysiologic mechanisms underlying neurologic complications of transplantation. The role of neuroimaging in this population includes early detection of calcineurin inhibitor neurotoxicity, opportunistic infections, neoplasia, metabolic disorders, or cerebrovascular diseases. In addition, we can monitor longitudinal progression of disease and treatment response. [source]


Delayed pharmacological pre-conditioning effect of mitochondrial ATP-sensitive potassium channel opener on neurologic injury in a rabbit model of spinal cord ischemia

ACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 2 2008
K. O. KIM
Background: Diazoxide, pharmacological openers of mitochondrial ATP-sensitive potassium channels have been shown to induce early pre-conditioning in the spinal cord. Here, the authors investigated whether diazoxide also induce delayed pre-conditioning and thereby reduce neurologic complications using a rabbit model of spinal cord ischemia. Methods: Infrarenal blood flow was interrupted for 20 min in 21 rabbits. Non-treated control animals received no pre-treatment. Diazoxide (5 mg/kg) were given 48 h before 20 min ischemia in the 48-h DZ group, whereas 15-min DZ group received diazoxide (5 mg/kg) 15 min before 20-min ischemia. Neurological functions were evaluated using Johnson scores for 3 days after reperfusion, after which, spinal cords were procured for hematoxylin and eosin staining for cell counting. Results: Johnson scores revealed a marked improvement in both the diazoxide-treated groups vs. the non-treated control group at 3, 24, 48, and 72 h after reperfusion (P<0.01). The histologic changes were proportional to the Johnson scores, with better preservation of motor neuron numbers in the animals of the 48-h DZ and 15-min DZ group relative to the non-treated controls (81±12, 90±10, 50±23 motor neurons, respectively, P<0.01). No difference was found between the 48-h DZ group and 15-min DZ group with respect to the Johnson scores or neuron numbers. Conclusions: The study demonstrates that pre-treatment with diazoxide 48 h before ischemia, induce delayed pharmacological pre-conditioning, thereby significantly improving clinical neurologic scores and histologic findings in this animal model. [source]


Complications of varicella in healthy children in Izmir, Turkey

PEDIATRICS INTERNATIONAL, Issue 3 2005
Güldane Koturoglu
AbstractBackground:,The purpose of the paper was to evaluate the indications of hospital admissions and complications of varicella infection in immunologically healthy children. Methods:,Between 1997 and 2001, patient records of children hospitalized due to varicella infection were reviewed. Incidence and clinical spectrum of complications and their distribution related to age and seasonal variations were analyzed. Results:,A total of 178 immunocompetent children were hospitalized for varicella complications during the study period. This resulted in a crude incidence of 6.3/100 000 population at risk. All hospital admissions were due to accompanying complications. The majority of complications occurred in preschool-age children with a median age of 3 years. No gender predominance was found. The most frequent complications were infectious complications, which were observed in 79 children (44%). Superinfections of the skin were present in 24 patients. Pneumonia was observed in 59 children: 49 had bacterial, 10 had viral pneumonia. Pyogenic arthritis was seen in two children and one had concomitant osteomyelitis. Group A ,-hemolytic streptococci were recovered from two patients with invasive bacterial infections. A total of 68 (38%) neurologic complications were observed. Cerebellar ataxia was present in 24, encephalitis was present in 17. Infectious complications occurred more frequently in younger children (median age: 2 years), whereas neurologic complications occurred at an older age (median age: 6 years). Hematologic complications were seen in nine children. There was a seasonal distribution of complications with a peak in January. Conclusion:,Complications of varicella requiring hospitalization in immunocompetent children are more frequent than previously thought. [source]


Neurological Complications Following Adult Lung Transplantation

AMERICAN JOURNAL OF TRANSPLANTATION, Issue 4 2010
F. J. Mateen
The full spectrum of neurologic complications and their impact on survival in lung recipients has not been reported. A retrospective cohort review of the Mayo Clinic Lung Transplant Registry (1988,2008) was performed to determine the range of neurologic complications in a cohort of adult lung recipients. Cox regression models were used to assess risk factors for neurological complications and death posttransplant. One hundred and twenty lung transplant recipients (53% women, median age at transplantation 53 years, range 21,73, median survival 4.8 years) were identified, of whom 95 had a neurological complication posttransplantation (median time to complication 0.8 years). Neurological complications were severe in 46 patients (requiring hospitalization or urgent care and evaluation) and were most often perioperative stroke or encephalopathy. Age predicted neurological complications of any type, whereas lung allocation score, bilateral lung transplantation, sex, underlying lung disease, elevated hemoglobin A1C, renal insufficiency and smoking history did not. Neurological complications of any severity (HR 4.3, 95% CI 2.2,8.6, p < 0.001) and high severity (HR 7.2, 95% CI 3.5,14.6, p < 0.001) were associated with increased risk of death. Neurological complications are common after lung transplantation, affecting 92% of recipients within 10 years. Severe neurologic complications are also common, affecting 53% of recipients within 10 years. [source]


Delirium after coronary artery bypass graft surgery and late mortality

ANNALS OF NEUROLOGY, Issue 3 2010
Rebecca F. Gottesman MD
Objective Delirium is common after cardiac surgery, although under-recognized, and its long-term consequences are likely underestimated. The primary goal of this study was to determine whether patients with delirium after coronary artery bypass graft (CABG) surgery have higher long-term out-of-hospital mortality when compared with CABG patients without delirium. Methods We studied 5,034 consecutive patients undergoing CABG surgery at a single institution from 1997 to 2007. Presence or absence of neurologic complications, including delirium, was assessed prospectively. Survival analysis was performed to determine the role of delirium in the hazard of death, including a propensity score to adjust for potential confounders. These analyses were repeated to determine the association between postoperative stroke and long-term mortality. Results Individuals with delirium had an increased hazard of death (adjusted hazard ratio [HR], 1.65; 95% confidence interval [CI], 1.38,1.97) up to 10 years postoperatively, after adjustment for perioperative and vascular risk factors. Patients with postoperative stroke had a HR of 2.34 (95% CI, 1.87,2.92). The effect of delirium on subsequent mortality was the strongest among those without a prior stroke (HR 1.83 vs HR 1.11 [with a prior stroke] [p -interaction = 0.02]) or who were younger (HR 2.42 [<65 years old] vs HR 1.49 [,65 years old] [p -interaction = 0.04]). Interpretation Delirium after cardiac surgery is a strong independent predictor of mortality up to 10 years postoperatively, especially in younger individuals and in those without prior stroke. Future studies are needed to determine the impact of delirium prevention and/or treatment in long-term patient mortality. ANN NEUROL 2010;67:338,344 [source]


Evaluation of Membrane Oxygenators and Reservoirs in Terms of Capturing Gaseous Microemboli and Pressure Drops

ARTIFICIAL ORGANS, Issue 11 2009
Yulong Guan
Abstract An increasing amount of evidence points to cerebral embolization during cardiopulmonary bypass (CPB) as the principal etiologic factor of neurologic complications. In this study, the capability of capturing and classification of gaseous emboli and pressure drop of three different membrane oxygenators (Sorin Apex, Terumo Capiox SX25, Maquet QUADROX) were measured in a simulated adult model of CPB using a novel ultrasound detection and classification quantifier system. The circuit was primed with 1000 mL heparinized human packed red blood cells and 1000 mL lactated Ringer's solution (total volume 2000 mL, corrected hematocrit 26,28%). After the injection of 5 mL air into the venous line, an Emboli Detection and Classification Quantifier was used to simultaneously record microemboli counts at post-pump, post-oxygenator, and post-arterial filter sites. Trials were conducted at normothermic (35°C) and hypothermic (25°C) conditions. Pre-oxygenator and post-oxygenator pressure were recorded in real time and pressure drop was calculated. Maquet QUADROX membrane oxygenator has the lowest pressure drops compared to the other two oxygenators (P < 0.001). The comparison among the three oxygenators indicated better capability of capturing gaseous emboli with the Maquet QUADROX and Terumo Capiox SX25 membrane oxygenator and more emboli may pass through the Sorin Apex membrane oxygenator. Microemboli counts uniformly increased with hypothermic perfusion (25°C). Different types of oxygenators and reservoirs have different capability of capturing gaseous emboli and transmembrane pressure drop. Based on this investigation, Maquet QUADROX membrane oxygenator has the lowest pressure drop and better capability for capturing gaseous microemboli. [source]


Radial artery thrombosis, palmar arch systolic blood velocities, and chronic regional pain syndrome 1 following transradial cardiac catheterization

CATHETERIZATION AND CARDIOVASCULAR INTERVENTIONS, Issue 4 2002
Thomas J. Papadimos MD
Abstract The transradial approach to cardiac catheterization is popular and safe, but prolonged, aggressive hemostatic compression at the access site may lead to vascular and/or neurologic complications, either transient or permanent. Rarely, chronic regional pain syndrome 1 (reflex sympathetic dystrophy) may occur. Cathet Cardiovasc Intervent 2002;57:537,540. © 2002 Wiley-Liss, Inc. [source]