BackgroundCreutzfeldt-Jakob disease (CJD) is a rare prion disease characterized by rapidly progressive dementia. Case ReportA 76-year-old woman exhibited pronounced signs and symptoms of dressing ...apraxia for about seven weeks before the disease progressed and probable CJD was diagnosed supported by imaging and CSF findings. DiscussionDressing apraxia as the initial manifestation of CJD has been sparsely reported. This remarkably focal syndrome should be considered with view on movement and neuropsychological disorders in early CJD.
Mold compounds used for chip encapsulation are one of the main contamination sources for mobile ions in semiconductor devices. These ions are a prominent reliability risk, especially, when it comes ...to high power devices such as high voltage transistors. Due to strong electrical fields, ions from the mold compound can migrate into sensitive areas of these devices resulting in chip failure. Due to the high natural abundance and the small ionic radius, sodium ions are considered to be the main risk. Therefore, it is of utmost importance to keep the sodium concentration of the materials used for encapsulation as low as possible. However, the concentration value for sodium is not sufficient for risk evaluation since ion migration is also strongly dependent on the diffusion coefficients. Within this work we will describe a new approach to measure field induced ion migration in mold compounds using a sodium amalgam electrode setup. The new technique is compared to conventional techniques such as electrochemical impedance spectroscopy and the advantages and disadvantages are discussed. The described technique can be an important tool when it comes to the selection of the encapsulation material for new high power semiconductor devices.
Hypothermia is a potentially life-threatening emergency. This article examines the case of a 34-year-old, mentally retarded man who experienced three episodes of hypothermia during recurrent exposure ...to pipamperone. After the pipamperone dose was largely reduced, no further hypothermic episodes occurred. Nine other cases of hypothermia with neuroleptic treatment were reported to the German Federal Institute of Drugs and Medical Devices from 1988 to 1997. A review of the cases revealed that nine of ten patients were treated with drugs that are potent antagonists of 5-HT2 receptors. In conjunction with experimental data, this suggests that antipsychotics with a strong 5-HT2 antagonistic component might be associated with hypothermia. Most of the newly developed "atypical" neuroleptic drugs belong to this group. Therefore, special attention for hypothermia is warranted during the use of "atypical" neuroleptics.
Conventional therapies for raised intracranial pressure (ICP) frequently are not effective. We report a patient with raised ICP following a large hemispheric stroke. After conventional therapies had ...failed, indomethacin was repeatedly administered. After bolus infusion (50 mg), the ICP fell by a mean of 8.1 mm Hg, and the mean arterial blood pressure increased by a mean of 7.1 mm Hg, leading to a mean increase in the cerebral perfusion pressure by 15.3 mm Hg. After 1 h, the ICP had returned to baseline values after most infusions. Continuous infusion of indomethacin was not effective. We conclude that indomethacin may reduce elevated ICP over a short time in patients with ischemic brain edema even after conventional therapy has failed.
Hyponatremia associated with neuroleptic malignant syndrome has thus far been described as a syndrome of inappropriate secretion of antidiuretic hormone.
To ascertain and describe the role of ...cerebral salt-wasting syndrome as the cause of hyponatremia in a patient with neuroleptic malignant syndrome.
A psychotic patient being treated with olanzapine presenting with sopor, muscle rigidity, polyuria, tachycardia, pyrexia, and severe hyponatremia.
Serial serological examinations of plasma tonicity (sodium level and osmolality), brain natriuretic peptide, and antidiuretic hormone were performed, and sodium excretion and urine osmolality were determined from 24-hour urine collection. In addition, markers for rhabdomyolysis were monitored.
The patient shows clear symptoms of cerebral salt-wasting syndrome in association with neuroleptic malignant syndrome, characterized by severe hyponatremia, volume depletion, and elevated brain natriuretic peptide but normal antidiuretic hormone levels. Cerebral salt-wasting syndrome improved under dantrolene sodium treatment and concomitant fluid and sodium replacement.
Hyponatremia in patients with neuroleptic malignant syndrome might more likely reflect cerebral salt-wasting syndrome than a syndrome of inappropriate secretion of antidiuretic hormone as an additional aspect of autonomic dysregulation caused by antidopaminergic drugs.
Moderate hypothermia has been reported to be effective in the treatment of postischemic brain edema. The effect of hypothermia on cerebral hemodynamics is a matter of controversial discussion in ...literature. Clinical studies have yet to be performed in patients with ischemic stroke after induction of hypothermia.
Measurements during mild hypothermia (33-34 degrees C) were made in six patients with severe ischemic stroke involving the middle cerebral artery territory. Hypothermia was induced as soon as possible and maintained for 48 to 72 hours. Cerebral blood flow (CBF) and cerebral metabolic rate of oxygen (CMRO2) were estimated by a new double-indicator dilution method. Measurements of CBF were made during normothermia, immediately after induction of hypothermia, at the end of hypothermia, and after rewarming. A total of 19 measurements of CBF and jugular bulb O2 saturation were made. Immediately after induction of hypothermia, CBF decreased in all patients. During late hypothermia, CBF improved in patients who survived but remained diminished in the two patients who died. Reduced CMRO2 levels were observed during all phases of hypothermia in all but one case.
Preliminary oberservations indicate that moderate hypothermia seems to reduce CMRO2. Immediately after induction of hypothermia, CBF may decrease in all patients. During late hypothermia CBF seems to recover in patients with good outcome but remains diminished in patients who die. Serial bedside CBF measurements with the new double-indicator dilution technique may be useful to describe cerebral hemodynamic characteristics in patients with severe ischemic stroke during hypothermia.
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