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Pheochromocytoma and cerebral fat embolism: Is there a relation? 嗜铬细胞瘤和脑脂肪栓塞:有关系吗?
Pub Date : 2023-12-15 DOI: 10.18231/j.ijn.2023.049
D. Chakraborty
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引用次数: 0
End of life care in neurologically ill patients – An Indian perspective 神经系统疾病患者的临终关怀--印度视角
Pub Date : 2023-12-15 DOI: 10.18231/j.ijn.2023.037
Mohamed Nidhal
End of life care is a critical aspect of healthcare that aims to provide comfort, dignity, and support to patients with life-limiting illnesses, including neurologically ill patients. Neurological diseases such as Alzheimer's disease, Parkinson's disease, Amyotrophic lateral sclerosis (ALS), and brain tumors can profoundly impact a patient's quality of life and pose unique challenges in end-of-life decision-making and care provision. This article explores the importance of end of life care in neurologically ill patients and outlines key considerations for healthcare providers, patients, their families and mentions on the training for healthcare professionals available in India.
临终关怀是医疗保健的一个重要方面,其目的是为包括神经系统疾病在内的临终患者提供舒适、尊严和支持。阿尔茨海默病、帕金森病、肌萎缩性脊髓侧索硬化症(ALS)和脑肿瘤等神经系统疾病会严重影响患者的生活质量,并给临终决策和护理提供带来独特的挑战。本文探讨了神经系统疾病患者临终关怀的重要性,概述了医疗服务提供者、患者及其家属的主要注意事项,并介绍了印度为医疗专业人员提供的培训。
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引用次数: 0
Willingness survey of electroconsvulsive therapy 电休克治疗意愿调查
Pub Date : 2023-07-15 DOI: 10.18231/j.ijn.2023.023
A. Lingeswaran
Electroconvulsive therapy (ECT) is still a poorly understood and accepted form of treatment for certain psychiatric conditions in our setting due to stigma. We surveyed people with mental illness and their families to appreciate their willingness to consider ECT as a treatment option. Our results corroborate the existing literature but we strongly feel the need to address this situation to improve the outlook of ECT in our community.
在我们的环境中,由于耻辱,电痉挛疗法(ECT)仍然是一种缺乏理解和接受的治疗某些精神疾病的形式。我们调查了患有精神疾病的人和他们的家人,以感谢他们愿意将ECT作为一种治疗选择。我们的结果证实了现有文献,但我们强烈认为有必要解决这种情况,以改善我们社区电痉挛疗法的前景。
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引用次数: 0
Dry eyes, dry mouth & dormant limbs - A case series 眼干,口干和四肢休眠-一个案例系列
Pub Date : 2023-07-15 DOI: 10.18231/j.ijn.2023.021
Poornima Nair, K. Sivakumar
Hypokalemic paralysis is a rare complication of distal renal tubular acidosis from any cause. Those cases diagnosed to have primary Sjogren’s syndrome is rare. Renal tubular acidosis caused by tubulointerstitial nephropathy is an extra glandular manifestation of primary Sjogren’s syndrome. We report three cases of flaccid quadriparesis diagnosed to have hypokalemia due to distal renal tubular acidosis and on furthur evaluation turned out to be Sjogren’s syndrome.
低钾性麻痹是一种罕见的并发症远端肾小管酸中毒的任何原因。那些被诊断为原发性干燥综合征的病例是罕见的。由肾小管间质性肾病引起的肾小管酸中毒是原发性干燥综合征的腺外表现。我们报告三例弛缓性四肢瘫诊断为低钾血症由于远端肾小管酸中毒和进一步的评估结果是干燥综合征。
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引用次数: 0
Evidence based – Enteral feeding algorithm for Neurosurgery ICU/Ward 基于证据的神经外科ICU/病房肠内喂养算法
Pub Date : 2023-07-15 DOI: 10.18231/j.ijn.2023.014
Shruti Shirke, L. Anand, R. Sahu, Fakir Mohan, Megha Scott
Enteral feeding is a procedure that is in practice internationally by nurses. Providing enteral feeding to the patients is an art and science of nursing that follows careful steps and principles. Nurses role is not only confined to administering enteral feed but also of educating, giving instructions to the family members, directing caregivers and significant others regarding initiating and maintaining enteral feeding, so that continuity of nutritional care is maintained even in the home setting. Once the patient is admitted in neurosurgical ICU, hemodynamic stability of the patient is utmost important, as hemodynamic instability of the patient may preclude the safe initiation of EN in the critical care patients. Initial stabilization is the key for patient survival followed by maintenance therapy like drugs, mobilization, position, continuous monitoring and nutrition. For determining the need of enteral feeding especially for neurosurgical and neurological patients three things should be given utmost importance i.e. Swallowing deficit, Unconsciousness (Level of consciousness) and Nutritional requirement. Can be easily remembered as pneumonic SUN.Confirming tube position is one of the critical step in effective enteral feeding practice in spite of that it has given least importance. It is recommended to confirm the tube position immediately after ryles’ tube insertion through radiologic methods which may be not feasible sometimes, therefore bedside methods can also be adopted Auscultation methods and Aspiration method are the most widely used method among all the bed side methods for confirming tube placement. Gastric residual volume is the amount aspirated from the stomach following administration of the enteral feed. An aspirate among of less than 500ml in 4-6 hours or less than 50% of last enteral feed is safe and indicates that GIT is functioning. Most patients nicely tolerate enteral feeding via gastric tube while few patients has delayed gastric emptying and high GRVs as a result of sedation, pain medications, hypothermia, decreased movement and the effect of being critically ill. Intolerance of enteral feeding is defined as more than 500ml or more than 50% of last enteral feeding. Though enteral feeding is the most popular procedure for ICU Nursing officer, but it is the most crucial in terms of deciding patient outcome. Effective enteral feeding requires through knowledge of initiation and maintenance of enteral feeding. Thus, this article propose simple algorithm to follow. Effectively delivering nutrition to the patient requires the help of dietitian and physician/surgeon to deal with its challenges that comes along with this golden feeding technique.
肠内喂养是一种在国际上由护士实施的程序。为病人提供肠内喂养是一门遵循谨慎步骤和原则的护理艺术和科学。护士的角色不仅限于管理肠内喂养,而且还教育,向家庭成员提供指导,指导护理人员和其他重要人员如何开始和维持肠内喂养,以便即使在家庭环境中也能保持营养护理的连续性。一旦患者被送入神经外科ICU,患者的血流动力学稳定性是至关重要的,因为患者的血流动力学不稳定可能会妨碍重症监护患者安全启动EN。最初的稳定是患者生存的关键,随后是维持治疗,如药物、活动、体位、持续监测和营养。为了确定肠内喂养的需要,特别是神经外科和神经学患者,应最重要地考虑三件事,即吞咽缺陷,无意识(意识水平)和营养需求。可以很容易地记住为肺炎太阳。管位的确定是有效肠内喂养的关键步骤之一,但其重要性却不高。建议在ryles置管后立即通过放射学方法确定管的位置,有时可能不可行,因此床边方法也可以采用听诊法和抽吸法是所有床侧方法中使用最广泛的方法。胃残量是指给药后从胃中吸出的量。在4-6小时内抽吸少于500ml或少于最后一次肠内喂养的50%是安全的,并表明胃肠道功能正常。大多数患者可以很好地耐受胃管肠内喂养,而少数患者由于镇静、止痛药、体温过低、运动减少和危重症的影响而导致胃排空延迟和高grv。肠内喂养不耐受定义为超过500ml或超过最后一次肠内喂养的50%。虽然肠内喂养是ICU护理人员最常用的程序,但它在决定患者预后方面是最关键的。有效的肠内喂养需要了解肠内喂养的开始和维持。因此,本文提出了一个简单的算法。有效地为患者提供营养需要营养师和内科医生/外科医生的帮助,以应对这种黄金喂养技术带来的挑战。
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引用次数: 0
Intraaxial epidermoid cyst: Report of a rare case and review of literature 轴内表皮样囊肿1例报告及文献复习
Pub Date : 2023-07-15 DOI: 10.18231/j.ijn.2023.017
I. Pant, S. Chaturvedi
Intra-axial epidermoid cysts are rare intracranial space occupying lesions, accounting for ∼1% of all intracranial tumours and are commonly located in the cisternal spaces, mainly in the cerebellopontine angle and parasellar cisterns. A purely intra-axial position as reported in this paper is quite exceptional.The authors report a case of intra-axial epidermoid cyst located in the frontal lobe that was surgically treated. The case is reported in this paper to highlight the fact that, although rare, the possibility of an intra-axial mass being an epidermoid cyst does exist. The origin, clinical course, radiological features, pathological findings, and surgical treatment are discussed based on a review of the literature.
轴内表皮样囊肿是一种罕见的颅内占位性病变,约占所有颅内肿瘤的1%,通常位于脑池间隙,主要位于脑桥小脑角和鞍旁池。纯轴内位置在本文中报道是相当例外的。作者报告一例轴状表皮样囊肿位于额叶,手术治疗。本文报道该病例是为了强调这样一个事实,尽管罕见,但轴内肿块是表皮样囊肿的可能性确实存在。本文在回顾文献的基础上,讨论其起源、临床病程、放射学特征、病理表现和手术治疗。
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引用次数: 0
Identifying the loci of lexical semantic breakdown in aphasia and the choice of therapy techniques 失语症词汇语义分解位点的识别及治疗方法的选择
Pub Date : 2023-07-15 DOI: 10.18231/j.ijn.2023.016
Haripriya Telakkadan, Sumanth Arakere Venkatesh, Abhishek Buddiguppe Panchakshari
Word finding would be more challenging in a person with aphasia because of a breakdown in lexical semantics. Words may be difficult to locate if they are not stored appropriately or readily available. In addition, the inability to access language could be the result of a weakness in either the lemma node, leading to verbal paraphasia, or the phoneme retrieval, leading to phonemic paraphasia. Commonly used to avoid this lexical semantic gap, cueing allows for clearer communication. SFA and PCA methods are also used to aid in the search for appropriate words. The study was carried out on persons with anomic aphasia. After determining the source of the lexical semantic breakdown, the goal of this research was to determine an appropriate therapeutic strategy. There were 12 people with anomic aphasia who participated in the research. Tasks tapping phoneme judgment and semantic judgment were given to the participants. Two individuals withdrew out of the study, while four subjects fared poorly on PCA (group 1). Six subjects performed poorly on the semantic judgment test (group 2). Training for Group 1 used PCA, while training for Group 2 used SFA. After training, participants' ability to recall names and verbs was evaluated using the Boston Naming Test and the Action Naming Test. After training, participants in both groups showed considerable improvement on the retests of the naming and judgment tasks.
对于失语症患者来说,找词会更具挑战性,因为他们在词汇语义上有缺陷。如果没有适当地存储或随时可用,单词可能难以定位。此外,无法接触语言可能是由于外源节点的缺陷,导致言语失读,或者音素检索的缺陷,导致音位失读。通常用于避免这种词汇语义差距,提示允许更清晰的交流。SFA和PCA方法也用于帮助搜索合适的单词。这项研究是在失语症患者身上进行的。在确定词汇语义分解的来源后,本研究的目标是确定适当的治疗策略。共有12名失语症患者参与了这项研究。被试被分配了音素判断和语义判断任务。两名受试者退出研究,四名受试者在PCA测试中表现不佳(第一组)。六名受试者在语义判断测试中表现不佳(第二组)。第一组的训练使用PCA,而第二组的训练使用SFA。训练结束后,用波士顿命名测试和动作命名测试来评估参与者回忆人名和动词的能力。经过训练后,两组参与者在命名和判断任务的复试中都表现出相当大的进步。
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引用次数: 0
DOACs/vitamin K antagonists induced hemorrhagic adverse effects; How to bridge therapy before procedures DOACs/维生素K拮抗剂诱导出血性不良反应;手术前如何衔接治疗
Pub Date : 2023-07-15 DOI: 10.18231/j.ijn.2023.013
Divya Kp, A. Cherian, Naveen Kumar Paramasivan
Direct oral anticoagulants (DOACs) are emerging as attractive alternatives to vitamin K antagonist which have long been the standard of care in anticoagulation. DOACs are indicated for both prevention and treatment. DOACs have emerged as more effective, safe, and convenient treatment options in thromboembolic settings. With the availability of a gamut of DOACs, clinicians are faced with challenging decisions relating to its hemorrhagic adverse effects. This review will provide an overview on how to manage the hemorrhagic adverse effects of DOACs/vitamin K antagonists and act as a practical guide for clinicians to optimize DOAC use in such challenging scenarios. Topics addressed include transitioning between anticoagulant regimens known as the bridge therapy.
直接口服抗凝剂(DOACs)正在成为维生素K拮抗剂的有吸引力的替代品,维生素K拮抗剂长期以来一直是抗凝治疗的标准护理。doac可用于预防和治疗。DOACs已成为血栓栓塞环境中更有效、更安全、更方便的治疗选择。随着doac的广泛可用性,临床医生面临着与出血不良反应相关的挑战性决策。本综述将概述如何管理DOAC /维生素K拮抗剂的出血性不良反应,并作为临床医生在此类具有挑战性的情况下优化DOAC使用的实用指南。讨论的主题包括被称为桥式治疗的抗凝治疗方案之间的过渡。
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引用次数: 0
Extensive bilateral anterior and posterior circulation ischemic stroke caused by severe vasospasm (Delayed cerebral ischemia) due to aneurysmal subarachnoid haemorrhage (aSAH) - A case report 动脉瘤性蛛网膜下腔出血(aSAH)引起严重血管痉挛(延迟性脑缺血)引起的广泛双侧前后循环缺血性卒中1例报告
Pub Date : 2023-07-15 DOI: 10.18231/j.ijn.2023.019
S. Balaji, S. Venkatesan
Aneurysmal subarachnoid haemorrhage (aSAH) is a disease with high morbidity and mortality even in this modern era. Since treating vasospasm is a challenging task, we emphasize in developing newer aganets for the treatment of vasospasm. In the hyper acute phase, patients with SAH can have catecholamine surge-related arrhythmia, neurogenic pulmonary edema, and irreversible damage to the hypothalamus and brainstem. Delayed cerebral ischemia (DCI) is a serious complication of aneurysmal subarachnoid haemorrhage (aSAH). Though there are many clinical trials to look upon the therapies for DCI and vasospasm in aSAH, none have led to an improvement in outcome of the patient.The prognosis of patients with SAH is grave even with the recent advancements in medical treatments. One of the main cause for this situation, that there are no usable neuroprotective drugs that can be used as soon as SAH is diagnosed. We report a case of ruptured Post Communicating Artery (PCOM) aneurysm with diffuse SAH causing severe vasospasm leading to extensive bilateral anterior and posterior ischemic stroke causing severe morbidity. Since there is no therapeutic breakthrough in treatment of aneurysmal SAH, we emphasize in developing a same.
动脉瘤性蛛网膜下腔出血(aSAH)是一种高发病率和死亡率的疾病,即使在当今时代。由于治疗血管痉挛是一项具有挑战性的任务,我们强调开发治疗血管痉挛的新药物。在超急性期,SAH患者可出现儿茶酚胺手术相关的心律失常、神经源性肺水肿以及下丘脑和脑干的不可逆损伤。延迟性脑缺血(DCI)是动脉瘤性蛛网膜下腔出血(aSAH)的严重并发症。虽然有许多临床试验来研究aSAH中DCI和血管痉挛的治疗方法,但没有一项能改善患者的预后。即使在最近的医学治疗进展下,SAH患者的预后仍然很严重。造成这种情况的主要原因之一是,一旦诊断出SAH,就没有可用的神经保护药物可以使用。我们报告一例交通后动脉(PCOM)动脉瘤破裂并弥漫性SAH引起严重的血管痉挛,导致广泛的双侧前后缺血性卒中,并导致严重的发病率。由于在动脉瘤性SAH的治疗上没有治疗上的突破,我们强调发展一种相同的治疗方法。
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引用次数: 0
The spectrum of electroencephalographic characteristics in children with autistic spectrum disorder at a tertiary care centre 三级保健中心自闭症谱系障碍儿童的脑电图特征谱
Pub Date : 2023-07-15 DOI: 10.18231/j.ijn.2023.015
A. Kondekar, Sharandeep Kaur G. Siddhu, Neeta A. Naik
There are high rates of epileptiform EEGs in children with ASD without a history of seizures or epilepsy. ASD is associated with a higher risk of epilepsy with prevalence ranging from 5%-46%. The study was conducted to detect the prevalence of EEG abnormalities in ASD patients and to evaluate the spectrum of EEG changes in epileptic and nonepileptic patients with their clinical features and severity of ASD. The study was conducted at the tertiary care centre. A total of 140 cases with ASD, who met DSM V criteria for autism were studied. All the cases were screened with history taking, physical, neurological, and neuropsychiatric evaluation. These children were subjected to psychological testing using the ISAA scoring system. All the studied cases were also subjected to EEG testing. The prevalence of EEG changes (epileptic and non-epileptic discharges) in our study was 45%, with EEG changes seen in 28.44% of cases of ASD without seizure. In ASD cases with seizure, the most common seizure type was generalized tonic-clonic convulsion (GTCS), on the contrary, most common EEG changes were focal epileptiform activity. Most of EEG had shown well-formed background, except for few which were slow for age. The most dominant background rhythm was theta intermixed with delta followed by theta and delta intermixed with alpha in those children with seizures. Whereas, in children without a history of seizure, the dominant rhythm was delta theta alpha and theta delta. This may be due the o large number of EEG recordings being sleep EEG. We will like to hypothesize that the predominant EEG changes in the frontal lobe may have some neuronal link in the pathogenesis of behavior pattern in ASD. We also propose that more detailed study with different types of EEG and with a larger sample size should be done in the future.
在没有癫痫发作或癫痫史的ASD儿童中,癫痫样脑电图的发生率很高。自闭症谱系障碍与较高的癫痫风险相关,患病率在5%-46%之间。本研究旨在检测ASD患者脑电图异常的发生率,并评价癫痫和非癫痫患者脑电图变化谱与ASD临床特征及严重程度的关系。这项研究是在三级保健中心进行的。共研究了140例符合DSM V标准的ASD患者。所有病例均接受病史、生理、神经和神经精神评估。这些孩子接受了ISAA评分系统的心理测试。所有研究病例均进行脑电图测试。在我们的研究中,脑电图改变(癫痫性和非癫痫性放电)的发生率为45%,在没有癫痫发作的ASD病例中,脑电图改变的发生率为28.44%。在癫痫发作的ASD病例中,最常见的癫痫发作类型是全身性强直-阵挛性惊厥(GTCS),相反,最常见的脑电图变化是局灶性癫痫样活动。除少数脑电信号因年龄变化缓慢外,大部分脑电信号显示出结构良好的背景。在癫痫患儿中最主要的背景节奏是θ和δ混合,其次是θ和δ和α混合。然而,在没有癫痫史的儿童中,主要的节律是δ和δ。这可能是由于大量的脑电图记录是睡眠脑电图。我们将假设主要的脑电图变化在额叶可能与ASD行为模式的发病机制有一定的神经元联系。我们也建议在未来进行更详细的研究,使用不同类型的脑电图和更大的样本量。
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引用次数: 0
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IP Indian Journal of Neurosciences
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