An unrousable patient in the recovery room
Tim French, Terry Wardle in The Problem-Based Learning Workbook, 2022
The patient has a recent history of lethargy, weight gain, and a fall. Lethargy is a very common symptom, and in isolation is a poor predictor of ‘pathology’. However, in the context of this patient, the associated symptoms provide the clues to the diagnosis. The causes of weight gain in an elderly patient include: change in diet (increase in calorific intake)lack of exercise due to poor mobilityalcohol excessfluid retention due to cardiac failure or renal diseaseliver failure with hypoproteinaemiamalignant asciteshypothyroidismhypopituitarismCushing’s disease.
Current issues in understanding sexual victimization
Rachel E. Lovell, Jennifer Langhinrichsen-Rohling in Sexual Assault Kits and Reforming the Response to Rape, 2023
Finally, the experience of intense fear or terror can leave victims exhausted. There is an adrenal dump in self-protection and recuperation. Exhaustion can set in and cause severe lethargy. Other short-term physical and cognitive effects include, among others, difficulty concentrating, distortions of perception, depersonalization, helplessness, or disorientation (SAMHSA, 2014). The victim might be literally unable to consider escape or leaving. Referred to as quiescent immobility, it is the state of complete exhaustion that occurs after a trauma when the victim has returned to a state of relative safety, like when an attack is over (Kozlowska et al., 2015). While adaptive for healing, it is maladaptive for the expectations we place on victims. Victims who fall asleep in bed with the attacker are confronted with disbelief about the allegations. After all, if they had just been raped, wouldn't they want to get help? “He came,” the victim explained, “He always fell asleep after he came. It was over. I knew it was over.” This victim provides an example of both her exhaustion as well as the subjective assessment of threats that victims make in order to guide their decisions.
Maple syrup urine disease (branched-chain oxoaciduria)
William L. Nyhan, Georg F. Hoffmann, Aida I. Al-Aqeel, Bruce A. Barshop in Atlas of Inherited Metabolic Diseases, 2020
Infants with classic MSUD appear normal at birth, but they usually remain well for only a few days. Pathologic amino acids rise by 12–24 hours and irritability, vomiting or difficulty to feed may be early symptoms at age two to three days. Usually by four to five days they become lethargic and progressive neurologic deterioration is rapid [14–16]. The cry may be high pitched. There may be intermittent apnea, stereotypical movements such as “fencing” and “bicycling” and periods of flaccidity, in which deep tendon reflexes and Moro reflex are absent, alternating with hypertonicity. General muscular rigidity is common. The absolutely characteristic picture is of a markedly comatose or semicomatose infant with hypertonia in an opisthotonic position (Figure 19.3). Extreme opisthotonus of this degree is very unusual in an infant only a few days old. There may be dystonic extension of the arms or a decerebrate appearance. Rarely, an infant may present with hypotonia and flaccidity (Figure 19.4). There may be abnormal eye movements. Convulsions occur regularly. These symptoms proceed to apnea, coma, and death by age seven to ten days, unless a vigorous therapeutic program is instituted [14]. Cerebral edema and a picture of pseudotumor cerebri may be seen and has been documented by computed tomography (CT) or magnetic resonance imaging (MRI) scan [17–20].
Antioxidant and antifatigue effect of a standardized fraction (HemoHIM) from Angelica gigas, Cnidium officinale, and Paeonia lactiflora
Published in Pharmaceutical Biology, 2021
Da-Ae Kwon, Yong Sang Kim, Seul-Ki Kim, Sin Hwa Baek, Hyun Kyu Kim, Hak Sung Lee
Fatigue refers not only to lack of energy, but also indicates lethargy in performing daily activities (Na et al. 2013). Fatigue is caused by activities such as stress, overwork, and exercise and is associated with immunological disturbances, depression, impaired energy and mood. Many studies have indicated that fatigue after exercise can be caused by several biochemical mechanisms, such as an increase in free radicals and depletion of energy sources (Yu et al. 2006; Xu and Wang 2012). Various drugs have been used to combat the oxidative stress of fatigue but with limited success. The drugs, carvedilol and melatonin have strong antioxidant properties and potent free-radical scavenging properties, but they also carry side effects, such as diarrhoea and dizziness (Singh et al. 2002). Zhuang et al. (2014) and Bo (2015) have addressed this problem by investigating medicinal plants, such as ginseng and blueberry.
Craniopharyngioma in a young woman with symptoms presenting as mechanical neck pain associated with cervicogenic headache: a case report
Published in Physiotherapy Theory and Practice, 2021
Firas Mourad, Fabio Cataldi, Alberto Patuzzo, Sara Tunnera, James Dunning, César Fernández-de-las-Peñas, Filippo Maselli
In a series of 78 adults with craniopharyngioma, 57% of the female patients reported menstrual irregularities or amenorrhea and 28% reported impaired sexual function (Karavitaki et al., 2005). Other symptoms like nausea and vomiting (26%), poor energy (32%), and lethargy (26%) are also frequent in the adult patient (Karavitaki et al., 2005). Headache is a common presentation in patients with a brain tumor, and it is usually associated with other transient neurologic signs and symptoms; nevertheless, headache can be the only symptom in some individuals with a brain tumor (Schankin et al., 2007). Typically, headache presentations in patients with a brain tumor may mimic migraine, cervicogenic headache and tension-type headache as defined by the International Headache Society (Bülow et al., 1998; Erfurth, 2015; Forsyth et al., 1993). The pathophysiology of headaches in cases of a brain tumor is not completely understood. However, the potential traction of pain-sensitive intracranial structures, including basal arteries, venous sinuses, and basal meninges (Khan et al., 2013; Ray and Wolff, 1940) from the expanding tumor mass and hydrocephalus may play a role (Goffaux and Fortin, 2010).
Starvation symptoms in patients with anorexia nervosa: a longitudinal study
Published in Eating Disorders, 2018
Simona Calugi, Elisa Chignola, Marwan El Ghoch, Riccardo Dalle Grave
However, little is yet known about the change in starvation symptoms after refeeding and body weight restoration. In the Minnesota Starvation Study (Keys et al., 1950), for some volunteers the weight restoration period was considered the toughest part of the study. Dizziness, apathy, and lethargy were the first symptoms to decrease, while loss of sex drive, feelings of tiredness, and weakness required more time to improve. Many also reported not being back to normal by the end of the 3-month recovery period and estimated that the time to achieve a full recovery ranged from 2 months to 2 years. Although none of the participants believed that they experienced negative health effects as a result of the semi-starvation, many overate after they left the study and went on to develop obesity (Kalm & Semba, 2005).
Related Knowledge Centers
- Apathy
- Encephalitis Lethargica
- Fatigue
- Major Depressive Disorder
- Sleep Apnea
- Sleep Deprivation
- Somnolence
- Depression
- Boredom
- Altered Level of Consciousness