Mutism Induced by Phenothiazines

1972 ◽  
Vol 121 (565) ◽  
pp. 599-604 ◽  
Author(s):  
Simon Behrman
Keyword(s):  
Phenothiazine Derivatives ◽  
Wide Range ◽  
Level Of Consciousness ◽  
Neurological Features ◽  
Repeated Questioning

The purpose of this communication is to present a group of patients who, while receiving treatment with one of the phenothiazine derivatives in average range of doses regarded as suitable for adults, developed a syndrome comprising mutism and a number of other neurological features. In the majority of these patients speech loss is almost complete; but, unlike aphasics, they may respond to repeated questioning by simple utterances usually spoken in a whisper, or else are capable on rare occasions, quite unexpectedly, of delivering remarks which are appropriate and may be spoken normally. Speech deprivation is as a rule associated with an inability to communicate either by gestures or writing and also an inability to perform many customary tasks. Mutism is, therefore, not an isolated disability, but is associated with a wide range of disturbances of behaviour and of level of consciousness. In addition, some of the patients exhibit one or more of the neurological toxic phenomena encountered in the course of medication with phenothiazine derivatives, e.g. akathisia, buccal dyskinesias, dystonias, tremor and parkinsonism.

scholarly journals Automated pupillometry to detect command following in neurological patients: a proof-of-concept study

PeerJ ◽  
2019 ◽  
Vol 7 ◽  
pp. e6929 ◽  
Author(s):  
Alexandra Vassilieva ◽  
Markus Harboe Olsen ◽  
Costanza Peinkhofer ◽  
Gitte Moos Knudsen ◽  
Daniel Kondziella
Keyword(s):  
Brain Injury ◽  
Healthy Volunteers ◽  
Neurological Disorders ◽  
Mental Arithmetic ◽  
Proof Of Concept ◽  
Icu Patients ◽  
Wide Range ◽  
Level Of Consciousness ◽  
Neurological Patients ◽  
Command Following

Background Levels of consciousness in patients with acute and chronic brain injury are notoriously underestimated. Paradigms based on electroencephalography (EEG) and functional magnetic resonance imaging (fMRI) may detect covert consciousness in clinically unresponsive patients but are subject to logistical challenges and the need for advanced statistical analysis. Methods To assess the feasibility of automated pupillometry for the detection of command following, we enrolled 20 healthy volunteers and 48 patients with a wide range of neurological disorders, including seven patients in the intensive care unit (ICU), who were asked to engage in mental arithmetic. Results Fourteen of 20 (70%) healthy volunteers and 17 of 43 (39.5%) neurological patients, including 1 in the ICU, fulfilled prespecified criteria for command following by showing pupillary dilations during ≥4 of five arithmetic tasks. None of the five sedated and unconscious ICU patients passed this threshold. Conclusions Automated pupillometry combined with mental arithmetic appears to be a promising paradigm for the detection of covert consciousness in people with brain injury. We plan to build on this study by focusing on non-communicating ICU patients in whom the level of consciousness is unknown. If some of these patients show reproducible pupillary dilation during mental arithmetic, this would suggest that the present paradigm can reveal covert consciousness in unresponsive patients in whom standard investigations have failed to detect signs of consciousness.

scholarly journals Artery of Percheron infarction with persistent amnesia: a case report of bilateral paramedian thalamic syndrome

BMC Neurology ◽  
2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Hannah E. Snyder ◽  
Sheliza Ali ◽  
Joanna Sue ◽  
Ayse Unsal ◽  
Crystal Fong ◽  
...  
Keyword(s):  
Time Window ◽  
Neuropsychological Testing ◽  
First Year ◽  
Artery Of Percheron ◽  
Wide Range ◽  
Level Of Consciousness ◽  
Midbrain Infarction ◽  
Vertical Gaze

Abstract Background The artery of Percheron is an uncommon anatomic variant which supplies the bilateral paramedian thalami and rostral midbrain. While infarction of its vascular territory can result in a wide range of symptoms, paramedian thalamic syndrome is classically described as a triad of symptoms including vertical gaze disturbances, fluctuating level of consciousness, and amnesia. There is minimal evidence to date to characterize the long-term cognitive consequences of infarction of the artery of Percheron utilizing neuropsychological assessment. Case presentation We describe a 40-year-old female patient initially presenting with dizziness, confusion and falls with unremarkable head CT scans. Subsequent MRI, more than 24 h after symptom onset, identified evidence of bilateral thalamic and rostral midbrain infarction. Neuropsychological testing was administered at 4 months post-stroke, with follow up testing at 1 year. The patient was found to have profound anterograde and retrograde amnesia, which did not change significantly over the first year of rehabilitation, and which was not easily identifiable in everyday encounters due to her relatively intact working memory and social skills. Conclusions As early diagnosis of infarction of the artery of Percheron is challenging, patients have frequently missed the time window for acute management of ischemic stroke. Moreover, this case study highlights the need for further research in deciphering the role of the paramedian thalamus in memory and cognition, as well as the importance of standardized neuropsychological testing for the artery of Percheron stroke patients to identify safety and rehabilitation concerns that may be overlooked.

scholarly journals The diagnostic challenge of Hashimoto’s Encephalopathy

2021 ◽  
Author(s):  
William de Souza Delfim ◽  
Nayara Christina de Lima Curti ◽  
Marília Pires de Souza e Silva ◽  
Lorena Dias Araújo ◽  
Indianara Keila Pastorio ◽  
...  
Keyword(s):  
Serum Levels ◽  
Thyroid Peroxidase ◽  
Diagnostic Challenge ◽  
Rapid Phase ◽  
Gradual Improvement ◽  
Normal Thyroid Function ◽  
Hashimoto Encephalopathy ◽  
Wide Range ◽  
Level Of Consciousness ◽  
Neurological Exam

Introduction: The diagnosis of Hashimoto Encephalopathy (HE) is generally considered in patients with a wide range of neurological symptoms, accompanied by normal or nonspecific findings on magnetic resonance imaging and CSF, normal thyroid function or mild hypothyroidism, increased serum levels of thyroid peroxidase antibodies, and clinical response to steroids. Case report: We attended a 76-year-old patient, brought by lowering the level of consciousness 3 days ago, insidiously. Neurological exam: did not obey commands, and only said incomprehensible sounds. Myoclonus in upper limbs and random multidirectional movements of the eyes with horizontal nystagmus, rapid phase to the left. Cranial tomography had only signs of microangiopathy. Electroencephalogram: diffuse slow waves, with no signs of status epilepticus. Laboratory tests: there were increased protein in CSF (107mg/dl) and Anti-TPO serum (>1000 U/ml) levels, without other specific alterations. After these results, therapy with Methylprednisolone 1g/day for 5 days, and Levothyroxine, were chosen. There was a gradual improvement in the neurological condition from the 3rd day of treatment. Conclusion: immediate recognition of Hashimoto encephalopathy is important. Although the pathogenesis is unknown, the disorder is treatable. This entity should always be remembered for the proper direction of therapeutic approaches, thus enabling better outcomes to the patient.

scholarly journals Silicon: From the Invention of the Microprocessor to the New Science of Consciousness by Federico Faggin

2021 ◽  
Vol 35 (3) ◽  
pp. 687-692
Author(s):  
Rosemarie Pilkington
Keyword(s):  
Depth Perception ◽  
Family Life ◽  
Northern Italy ◽  
Monocular Vision ◽  
Full Disclosure ◽  
Personal Journey ◽  
New Science ◽  
Wide Range ◽  
Level Of Consciousness ◽  
Scientific Materialism

I was a little apprehensive about reviewing this book because I know little about engineering or the inner workings of the computer, but in the interest of full disclosure, I wanted to know more about Federico Faggin. Twenty years ago, returning from an afternoon trip during the SSE conference in San Diego, I sat next to him on the bus and mentioned that since we last met I had lost the vision in my right eye, which I was still adjusting to physically and emotionally. He volunteered that he had lost the vision in his left eye when he was a youth in Italy and lightly commented that depth perception, which concerned me, was only an issue for six or seven feet.  His admission and attitude were not only a revelation, but an inspiration for me: If this eminent gentleman had made world-changing inventions, was a successful businessman and had a happy social and family life despite monocular vision; I certainly could get on successfully with my life as well.  Silicon is the fascinating story of Federico Faggin’s remarkable life, but it is also his personal journey from scientific materialism to an awakening to a deeper level of consciousness. He divides his narrative into his four “lives.”  His first life took place in his native northern Italy where he was a brilliant student with a wide range of interests. He became interested in computers and transistors, which had been recently invented and read all he could independently, since it was not taught in his school. His fascination deepened and he got a job with Olivetti where he learned much more than he could have at school and which become pivotal to his subsequent career.

COGNITIVE IMPAIRMENT IN PATIENTS WITH CORONAVIRUS INFECTION

2021 ◽  
Vol 2 (1) ◽  
pp. 5-8
Author(s):  
Gulnoza Urinova ◽  
◽  
Nargiza Nasirtdinova ◽  
Janna Nazarova
Keyword(s):  
Cognitive Impairment ◽  
Neurological Disorders ◽  
Sinus Thrombosis ◽  
The Novel ◽  
Altered Level ◽  
Wide Range ◽  
Level Of Consciousness ◽  
Coronavirus Infection ◽  
Novel Coronavirus ◽  
The Brain

Thisarticle discusses cognitive impairment in patients with coronavirus infection and explains that observations have been made on this topic. The novel coronavirus infection COVID-19 caused by the SARS-CoV-2 coronavirus poses a global health threat. Neurological disordersfound in patients with coronavirus infection have a wide range of clinical neurological signs: headache, dizziness, altered level of consciousness, acute cerebrovascular accident (ACVE), venous sinus thrombosis the brain [12].Keywords:coronavirus infection, cognitive impairment, neurological disorders, headache, dizziness, muscle weakness, encephalopathy, encephalitis

scholarly journals TUBB Variants Underlying Different Phenotypes Result in Altered Vesicle Trafficking and Microtubule Dynamics

2020 ◽  
Vol 21 (4) ◽  
pp. 1385 ◽  
Author(s):  
Antonella Sferra ◽  
Stefania Petrini ◽  
Emanuele Bellacchio ◽  
Francesco Nicita ◽  
Francesco Scibelli ◽  
...  
Keyword(s):  
Novel Mutation ◽  
Vesicle Trafficking ◽  
Excess Skin ◽  
Brain Malformations ◽  
Wide Range ◽  
Functional Consequences ◽  
Epidermal Growth ◽  
Neurological Features ◽  
Complex Structural ◽  
And Function

Tubulinopathies are rare neurological disorders caused by alterations in tubulin structure and function, giving rise to a wide range of brain abnormalities involving neuronal proliferation, migration, differentiation and axon guidance. TUBB is one of the ten β-tubulin encoding genes present in the human genome and is broadly expressed in the developing central nervous system and the skin. Mutations in TUBB are responsible for two distinct pathological conditions: the first is characterized by microcephaly and complex structural brain malformations and the second, also known as “circumferential skin creases Kunze type” (CSC-KT), is associated to neurological features, excess skin folding and growth retardation. We used a combination of immunocytochemical and cellular approaches to explore, on patients’ derived fibroblasts, the functional consequences of two TUBB variants: the novel mutation (p.N52S), associated with basal ganglia and cerebellar dysgenesis, and the previously reported variant (p.M73T), linked to microcephaly, corpus callosum agenesis and CSC-KT skin phenotype. Our results demonstrate that these variants impair microtubule (MT) function and dynamics. Most importantly, our studies show an altered epidermal growth factor (EGF) and transferrin (Tf) intracellular vesicle trafficking in both patients’ fibroblasts, suggesting a specific role of TUBB in MT-dependent vesicular transport.

Decreased level of consciousness in a child: recognition and management

2020 ◽  
Vol 29 (4) ◽  
pp. 204-210
Author(s):  
Neal Patel ◽  
Naveen Nandakumar ◽  
Paul Anthony Heaton ◽  
Vicki Le Huray ◽  
Siba Prosad Paul
Keyword(s):  
Clinical Practice ◽  
Health Professional ◽  
Case Studies ◽  
Health Professionals ◽  
Illustrative Case ◽  
First Line ◽  
Logical Approach ◽  
Wide Range ◽  
Level Of Consciousness

A child presenting with decreased level of conscious (dLOC) is of great concern due to the wide range of possible causes, and potential for death or serious long-term sequelae. It is therefore vital that health professionals can recognise a child with dLOC quickly, intervene appropriately and escalate for senior review as a matter of urgency. This article provides an explanation for the mechanisms of decreased consciousness, outlines the different causative pathologies, and provides a simple and logical approach to the first-line recognition and management that a health professional may apply when faced with such a patient. Illustrative case studies have been included, to demonstrate how children with dLOC may present in clinical practice

scholarly journals Evaluation of antimicrobial activity of synthesized 9H-alkylcarbazole and 10H-alkylphenothiazine derivatives on the cells of Salmonella enterica ser. Typhimurium, Saccharomyces cerevisiae, and Candida albicans

Biologija ◽  
2020 ◽  
Vol 66 (2) ◽  
Author(s):  
Simona Sutkuvienė ◽  
Sandra Sakalauskaitė ◽  
Neringa Kuliešienė ◽  
Lina Ragelienė ◽  
Rimantas Daugelavičius
Keyword(s):  
Saccharomyces Cerevisiae ◽  
Candida Albicans ◽  
Salmonella Enterica ◽  
Alkyl Chain ◽  
Efflux Pump ◽  
Inhibitory Effect ◽  
Phenothiazine Derivatives ◽  
Pharmacological Activities ◽  
Alkyl Chains ◽  
Wide Range

10H-substituted phenothiazine and 9H-substituted carbazole derivatives are important because of a very wide range of applications and especially in medical chemistry due to their pharmacological activities. In this study, we synthesized 9H-alkylcarbazole and 10H-alkylphenothiazine derivatives with various lengths of alkyl chains and evaluated their antimicrobial and efflux inhibiting activities on the cells of Salmonella enterica ser. Typhimurium, Saccharomyces cerevisiae, and Candida albicans. Results of our study revealed that an increased length of alkyl chains of the carbazoles increased the accumulation of efflux indicator tetraphenylphosphonium (TPP+) ions. Cells of S. enterica efflux mutant ΔTolC had a considerable susceptibility to the synthesized compounds. The compounds exerted synergy with fluconazole against S. cerevisiae yeast. Efflux pump mutant ΔPdr5 was hypersensitive to the investigated carbazole and phenothiazine derivatives. The inhibitory effect of the compounds with a shorter alkyl chain (10-methyl-10H-phenothiazine and 9-methyl-9H-carbazole) was the highest for Candida albicans cells.

scholarly journals Automated pupillometry to detect command following in neurological patients: A proof-of-concept study

2019 ◽  
Author(s):  
Alexandra Vassilieva ◽  
Markus Harboe Olsen ◽  
Costanza Peinkhofer ◽  
Gitte Moos Knudsen ◽  
Daniel Kondziella
Keyword(s):  
Brain Injury ◽  
Healthy Volunteers ◽  
Neurological Disorders ◽  
Mental Arithmetic ◽  
Proof Of Concept ◽  
Icu Patients ◽  
Wide Range ◽  
Level Of Consciousness ◽  
Neurological Patients ◽  
Command Following

AbstractBackgroundLevels of consciousness in patients with acute and chronic brain injury are notoriously underestimated. Paradigms based on electroencephalography (EEG) and functional magnetic resonance imaging (fMRI) may detect covert consciousness in unresponsive patients but are subject to logistical challenges and the need for advanced statistical analysis.MethodsTo assess the feasibility of automated pupillometry for the detection of command following, we enrolled 20 healthy volunteers and 48 patients with a wide range of neurological disorders, including 7 patients in the intensive care unit (ICU), who were asked to engage in mental arithmetic.ResultsFourteen of 20 (70%) healthy volunteers and 17 of 43 (39.5%) neurological patients, including 1 in the ICU, fulfilled prespecified criteria for command following by showing pupillary dilations during ≥4 of 5 arithmetic tasks. None of the 5 sedated and unconscious ICU patients passed this threshold.ConclusionsAutomated pupillometry combined with mental arithmetic appears to be a promising paradigm for the detection of covert consciousness in people with brain injury. We plan to build on this study by focusing on non-communicating ICU patients in whom the level of consciousness is unknown. If some of these patients show reproducible pupillary dilation during mental arithmetic, this would suggest that the present paradigm can reveal conscious awareness in unresponsive patients in whom standard investigations have failed to detect signs of covert consciousness.

Recent Applications of High Resolution Electron Microscopy to Crystalline Arrays of Virus Particles

1978 ◽  
Vol 36 (3) ◽  
pp. 470-482 ◽  
Author(s):  
R.W. Horne
Keyword(s):  
Electron Microscopy ◽  
Image Processing ◽  
Analytical Techniques ◽  
Staining Technique ◽  
High Resolution Electron Microscopy ◽  
Optical Diffraction ◽  
Full Potential ◽  
Virus Particles ◽  
Resolution Electron ◽  
Wide Range

The technique of surrounding virus particles with a neutralised electron dense stain was described at the Fourth International Congress on Electron Microscopy, Berlin 1958 (see Home & Brenner, 1960, p. 625). For many years the negative staining technique in one form or another, has been applied to a wide range of biological materials. However, the full potential of the method has only recently been explored following the development and applications of optical diffraction and computer image analytical techniques to electron micrographs (cf. De Hosier & Klug, 1968; Markham 1968; Crowther et al., 1970; Home & Markham, 1973; Klug & Berger, 1974; Crowther & Klug, 1975). These image processing procedures have allowed a more precise and quantitative approach to be made concerning the interpretation, measurement and reconstruction of repeating features in certain biological systems.

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