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Fetal Death
Published in Vincenzo Berghella, Maternal-Fetal Evidence Based Guidelines, 2022
Rarely, high-dose oxytocin (200 units in 500 mL saline at 50 mL/hour) also may be used for induction of labor remote from term, if misoprostol is not available or contraindicated [79]. The mother should be observed for signs of water intoxication and maternal electrolyte concentrations should be monitored at least every 24 hours. Nausea and malaise are the earliest findings of hyponatremia, and may be seen when the plasma sodium concentration falls below 125–130 mEq/L. This may be followed by headache, lethargy, obtundation and eventually seizures, coma, and respiratory arrest.
Frontline Consideration for Paediatric Emergency and Trauma Surgery
Published in Mansoor Khan, David Nott, Fundamentals of Frontline Surgery, 2021
Initial assessment of response and reaction of the child is often a good guide to the state of perfusion. Cerebral obtundation is reflective of poor cerebral perfusion – a quiet or sleepy child is worrying in the acute setting. Capillary refill time should be assessed centrally and peripherally and should be less than 2 seconds. Tachycardia not only is the earliest and most reliable sign of hypotension but can also accompany anxiety and pain.
Inflammatory Disorders of the Nervous System
Published in Philip B. Gorelick, Fernando D. Testai, Graeme J. Hankey, Joanna M. Wardlaw, Hankey's Clinical Neurology, 2020
Raised intracranial pressure: Headache.Vomiting.Papilledema.Obtundation.
Identifying and managing CAR T-cell–mediated toxicities: on behalf of an Italian CAR-T multidisciplinary team
Published in Expert Opinion on Biological Therapy, 2022
Massimo Martino, Sebastiano Macheda, Umberto Aguglia, Luciano Arcudi, Giulia Pucci, Bruno Martino, Maria Altomonte, Antonio Maria Rossetti, Giuseppa Cusumano, Letteria Russo, Lucrezia Imbalzano, Caterina Stelitano, Caterina Alati, Jessyca Germano’, Demetrio Labate, Vincenzo Amalfi, Maria Teresa Florenzano, Antonella Morabito, Vittoria Borzumati, Vincenzo Dattola, Caterina Gattuso, Antonio Moschella, Domenico Quattrone, Francesco Curmaci, Claudio Franzutti, Giuseppe Scappatura, Carmelo Massimiliano Rao, Viviana Loddo, Antonella Pontari, Maria Pellicano’, Rosangela Surace, Cristina Sanguedolce, Virginia Naso, Anna Ferreri, Giuseppe Irrera, Giuseppe Console, Tiziana Moscato, Barbara Loteta, Filippo Antonio Canale, Alfonso Trimarchi, Renza Monteleone, Said Al Sayyad, Frank Cirrone, Benedetto Bruno
The typical ICANS time course is monophasic, with symptoms quickly escalating to the highest manifestation and then improving over time, although waxing and waning can occur. The main clinical manifestations of ICANS include encephalopathy (confusion or delirium), motor weakness, seizures, tremor, expressive aphasia or language disturbance, headache, and depressed level of consciousness (Table 1). Typical onset is 4–6 days post-infusion, and duration can be 14–17 days. ICANS may occur on its own, after or in association with CRS. Severe symptoms, including seizures and depressed consciousness/obtundation, can require intubation for airway protection. Most ICANS symptoms are transient and fully reverse within the first 21–28 days of treatment. Patients should be monitored for signs and symptoms of neurologic adverse reactions daily for 7–14 days at the qualified health-care facility following infusion.
The enigma of multicentric glioblastoma: physiopathogenic hypothesis and discussion about two cases
Published in British Journal of Neurosurgery, 2018
Thiébaud Picart, Marine Le Corre, Emilie Chan-Seng, Jérôme Cochereau, Hugues Duffau
A 61-year-old man with a history of alcohol abuse was admitted as an emergency following the acute onset of a left hemiplegia associated with dysphasia which were initially suspected as vascular in origin. Cerebral MRI revealed multiple tumor masses, bilaterally distributed, with a necrotic ring-shaped enhancement on gadolinium images (Figure 1(a–b)). On T2-weighted Fluid Attenuated Inversion Recovery (FLAIR) images, these tumors appeared hyperintense and independent from each other, suggesting a multi-metastatic dissemination of a visceral cancer (Figure 1(c–d)). Immediately after this scan, obtundation was noted and attributed to status epilepticus. The patient was sedated, intubated and transferred to intensive care. Extubation was possible after seizures were medically controlled. Surprisingly, whole-body CT-scan showed no primary tumor. A stereotactic biopsy was performed and the diagnosis of primary multicentric glioblastoma IDH WT was confirmed. EGFR was overexpressed and MGMT promotor was hypermethylated. After that, despite administration of high intravenous doses of corticosteroids, his condition deteriorated to a Karnofsky performance status (KPS) of 40 with a persistent left hemiparesis but without major disturbance of cognitive functions. In these conditions and in accordance with the patient’s wishes, treatment was palliative. The patient died at home, one month after the surgery.
Cyclophosphamide immunomodulation of TB-associated cerebral vasculitis
Published in Infectious Diseases, 2018
Anna Celotti, Fabrizio Vianello, Andrea Sattin, Giacomo Malipiero, Roberto Faggin, Annamaria Cattelan
A provisional diagnosis of cerebral vasculitis was made, and, as recommended [4], the patient was started on dexamethasone 20 mg/day with initial improvement of mental status but rapid consciousness deterioration following steroid tapering over 2 weeks. During hospital admission CSF cultures grew Mycobacterium tuberculosis; therefore, the patient received standard antitubercular therapy with rifampin, isoniazid, pyrazinamide and ethambutol, together with dexamethasone. TB treatment was followed by progressive mental and cognitive improvement, with disappearance of headache and ability to attend to personal care. Unfortunately, a second attempt to taper steroid was followed by exacerbation of cognitive decline, with progressive reduced level of consciousness, lethargy and obtundation.