The relation between initial symptoms and signs and the prognosis of whiplash

A diver returned to diving, 15 months after an episode of neuro-spinal decompression sickness (DCS) with relapse, after which she had been found to have a moderate to large provoked shunt across a persistent (patent) foramen ovale (PFO), which was not closed. She performed a single highly conservative dive in line with the recommendations contained in the 2015 position statement on PFO and diving published jointly by the South Pacific Underwater Medicine Society and the United Kingdom Sports Diving Medical Committee. An accidental Valsalva manoeuvre shortly after surfacing may have provoked initial symptoms which later progressed to DCS. Her symptoms and signs were milder but closely mirrored her previous episode of DCS and she required multiple hyperbaric oxygen treatments over several days, with residua on discharge. Although guidance in the joint statement was mostly followed, the outcome from this case indicates that there may be a subgroup of divers with an unclosed PFO, who have had a previous episode of serious DCS, who may not be safe to dive, even within conservative limits.

Download Full-text

How the Brain Moves the Eyes

Eye Movement Disorders in Clinical Practice ◽

10.1093/med/9780199921805.003.0001 ◽

2014 ◽

pp. 1-25

Author(s):

Shirley H. Wray

Keyword(s):

Cardiac Surgery ◽

Eye Movements ◽

Progressive Supranuclear Palsy ◽

Disease Progression ◽

Frontotemporal Dementia ◽

Smooth Pursuit ◽

Cortical Areas ◽

Initial Symptoms ◽

The Brain ◽

Symptoms And Signs

discusses the brain’s visual architecture for directing and controlling of eye movements:the striate, frontal and parietal cortical areas; and the eye movements themselves—saccades, smooth pursuit, and vergence. The susceptibility to disorders of these systems is illustrated in four detailed cases that follow disease progression from initial symptoms and signs to diagnosis and treatment. The case studies and video displays include a patient with Pick’s disease (frontotemporal dementia), another with Alzheimer’s dementia, and two examples of rare saccadic syndromes, one a patient with the slow saccade syndrome due to progressive supranuclear palsy and one with selective saccadic palsy following cardiac surgery.

Download Full-text

Childhood bacterial meningitis: initial symptoms and signs related to age, and reasons for consulting a physician

European Journal of Pediatrics ◽

10.1007/bf00441607 ◽

1987 ◽

Vol 146 (5) ◽

pp. 515-518 ◽

Cited By ~ 41

Author(s):

P. Valmari ◽

H. Peltola ◽

O. Ruuskanen ◽

H. Korvenranta

Keyword(s):

Bacterial Meningitis ◽

Initial Symptoms ◽

Symptoms And Signs

Download Full-text

Powdery Mildew, Caused by Leveillula taurica, on Matilija Poppy in California

Plant Disease ◽

10.1094/pdis-91-3-0329a ◽

2007 ◽

Vol 91 (3) ◽

pp. 329-329

Author(s):

S. T. Koike

Keyword(s):

Powdery Mildew ◽

Cross Sections ◽

Northern Mexico ◽

Leveillula Taurica ◽

Landscape Plants ◽

Initial Symptoms ◽

Humidity Chamber ◽

Advanced Stages ◽

Symptoms And Signs

Romneya coulteri, known as matilija poppy or coulter's matilija poppy, is a perennial woody shrub (family Papaveraceae) that is native to southern California and northern Mexico. The plant is used in landscape settings and has the largest flowers, measuring up to 16 cm across, of any plant native to California. In August 2006, in Monterey County, CA, landscape plants of R. coulteri were found affected with a powdery mildew disease. Initial symptoms consisted of chlorotic, irregularly shaped, vein-delimited lesions. As disease progressed, grayish white sporulation was visible on lesions on adaxial and abaxial sides of affected leaves. In advanced stages of the disease, lesions expanded up to 2 cm long and the center tissue of the lesions turned necrotic. Symptoms and signs were observed on both mature and younger foliage. The small matilija poppy planting consisted of six or seven plants and all plants were affected by the disease. Epidermal strips from both sides of leaves and leaf cross sections were mounted in drops of lactophenol and aniline blue and examined with a light microscope. These preparations showed that conidiophores developed from endophytic mycelium and emerged through stomates. Conidiophores were sometimes branched and carried one or two conidia. Hyaline, single-celled conidia were dimorphic. Primary (terminal) conidia were lanceolate with distinct apical points and measured 53 to 61 × 17 to 25 μm. Secondary conidia were ellipsoid-cylindric and measured 53 to 67 × 16 to 22 μm. On the basis of these characters, the pathogen was identified as Leveillula taurica (1). Only the anamorph Oidiopsis taurica stage was observed on plants. To prove pathogenicity, diseased leaves were collected from the landscape plantings. One diseased leaf was gently rubbed against one leaf of a potted, healthy matilija poppy. Twelve leaves were inoculated in this way, and plants were kept in a humidity chamber for 48 h and then maintained in a greenhouse (24 to 26°C). After 14 days, chlorotic lesions appeared on inoculated matilija poppy leaves and sporulation of L. taurica was observed several days later. Untreated control plants did not develop powdery mildew. The experiment was repeated and the results were the same. To my knowledge, this is the first report of powdery mildew caused by L. taurica on matilija poppy. There was no indication that the disease affected the growth of the host; however, powdery mildew reduced the quality of the appearance of this ornamental plant. Reference: (1) H. J. Boesewinkel. Bot. Rev. 46:167, 1980.

Download Full-text

Acute amitriptyline intoxication: an analysis of 44 children

Human & Experimental Toxicology ◽

10.1191/0960327106ht511oa ◽

2006 ◽

Vol 25 (3) ◽

pp. 107-110 ◽

Cited By ~ 12

Author(s):

Hüseyin Çaksen ◽

Sinan Akbayram ◽

Dursun Odabaş ◽

Hanefi Özbek ◽

Mehmet Erol ◽

...

Keyword(s):

Cardiopulmonary Arrest ◽

Good Health ◽

Drug Dosage ◽

Tricyclic Antidepressant ◽

Laboratory Findings ◽

Antidepressant Agents ◽

Initial Symptoms ◽

Neurological Effects ◽

High Doses ◽

Symptoms And Signs

The tricyclic antidepressant agents, particularly amitriptyline and dothiepin, are recognized for their potentially lethal cardiovascular and neurological effects in poisoned patients. In this article, the clinical and laboratory findings of 44 children with amitriptyline intoxication are reviewed. Our purpose was to investigate amitriptyline intoxication in childhood. Of 44 patients, 21 (47.7%) were boys, 23 (52.3%) were girls, and the ages ranged from 12 months to 14 years (mean9 / SD; 4.099 / 2.9 years). All children except one who took an overdose of amitriptyline to decrease his pain accidentally ingested an overdose of amitriptyline. The amount of amitriptyline ingested was between 2 mg/kg and 97.5 mg/kg (mean9 / SD; 13.69 / 17.7 mg/kg per dose) (the drug dosage was not known in 13 children). The most commonly observed clinical and laboratory findings were lethargy, tachycardia, convulsion, hyperglycemia and leukocytosis. In all patients except for two children who died the abnormal clinical and laboratory findings returned to normal within a few days after admission and they were discharged from the hospital in good health within the fourth day of admission. One of the children ingested 97.5 mg/kg amitriptyline and probably died due to status epilepticus and another child who died ingested 36 mg/ kg amitriptyline and died due to cardiopulmonary arrest. In conclusion, our findings showed that initial symptoms and signs of acute amitriptyline intoxication appeared severe, but they disappeared with only supportive care required in most children except for cases that ingested high doses of drug within a few days. In contrast to adults, we infrequently noted respiratory insufficiency, arrhythmia and hypotension in children with acute amitriptyline intoxication.

Download Full-text

Downy Mildew Caused by Peronospora valerianellae on Corn-Salad (Valerianella locusta) in California

Plant Disease ◽

10.1094/pdis-92-10-1470b ◽

2008 ◽

Vol 92 (10) ◽

pp. 1470-1470 ◽

Cited By ~ 1

Author(s):

S. T. Koike

Keyword(s):

Downy Mildew ◽

Growth Characteristic ◽

Leaf Tissue ◽

The United States ◽

Tween 20 ◽

Conidial Suspension ◽

Fresh Market ◽

Initial Symptoms ◽

Seedborne Inoculum ◽

Symptoms And Signs

Corn-salad or lamb's lettuce (Valerianella locusta) is a specialty leafy green, annual vegetable grown commercially in California as a fresh market commodity used in salads. In the spring (February through April) of 2008, fields in coastal California (Monterey County) showed symptoms and signs of a downy mildew. Initial symptoms consisted of irregularly shaped, light green patches observed on adaxial leaf surfaces; these lesions later turned yellow. As disease progressed, patches became brown and necrotic. The abaxial sides of affected leaves were heavily colonized by an extensive, purplish growth characteristic of a downy mildew pathogen. Symptomatic leaves were unmarketable and diseased portions of plantings were not harvested. Crop loss was estimated to be between 1 and 15% for any one particular planting. The purple growth consisted of hyaline, branched conidiophores that emerged from stomata and had branches ending in slender, curved branchlets that did not have swollen tips. Conidia were slightly brown, ovoid, mostly nonpapillate, and measured 23.7 to 29.4 μm long × 15.9 to 22.2 μm wide. When necrotic leaf tissue was examined microscopically, thick-walled, yellow brown oospores were abundant within leaf tissues. Oospores measured 33.2 to 36.9 μm in diameter. On the basis of disease symptoms and morphology of the organism, the pathogen was identified as Peronospora valerianellae (1,3). To prove pathogenicity on corn-salad, 24 3-week-old seedlings were sprayed until runoff, using a hand-held spray bottle, with a conidial suspension (1.0 × 104 sporangia/ml), incubated for 24 h in a dew chamber (18 to 20°C), and then maintained in a greenhouse (22 to 24°C). Inoculum was obtained from one section of an affected commercial field. After 10 to 12 days, symptoms and signs of downy mildew occurred on inoculated plants, and the pathogen morphology matched that of the pathogen originally observed. Twelve untreated control plants did not develop downy mildew. To test for seedborne inoculum, 10 g of seed of each of two corn-salad cultivars were added to 100 ml of a dilute (0.05%) Tween 20 solution. The suspension was agitated for 3 h, filtered through cheesecloth to remove seed, and centrifuged. The resulting pellet was examined microscopically and found to contain low numbers of oospores that were similar in morphology to those observed in necrotic leaf lesions. To my knowledge, this is the first report of downy mildew caused by P. valerianellae on corn-salad in California and the United States. The pathogen has been reported on corn-salad in England, France, Germany, Scotland, and the Ukraine (1–3). Seedborne oospores of downy mildew have been reported on corn-salad seed tested in France (1). References: (1) R. Champion and H. Mecheneau. Seed Sci. Technol. 7:259, 1979. (2) D. F. Farr et al. Fungal Databases. Systematic Mycology and Microbiology. Online publication. ARS, USDA, 2008. (3) G. Pietrek and V. Zinkernagel. Advances in Downy Mildew Research. Kluwer Academic Publishers, Dordrecht, the Netherlands, 2002.

Download Full-text

Questions and Answers

Guides Newsletter ◽

10.1001/amaguidesnewsletters.2000.marapr02 ◽

2000 ◽

Vol 5 (2) ◽

pp. 3-3

Author(s):

Christopher R. Brigham ◽

James B. Talmage

Keyword(s):

Nervous System ◽

Peripheral Nervous System ◽

Spinal Nerve ◽

Sensory Loss ◽

Residual Symptoms ◽

Additional Information ◽

Questions And Answers ◽

Motor Nerves ◽

Symptoms And Signs ◽

Limited Motion

Abstract Lesions of the peripheral nervous system (PNS), whether due to injury or illness, commonly result in residual symptoms and signs and, hence, permanent impairment. The AMA Guides to the Evaluation of Permanent Impairment (AMA Guides) describes procedures for rating upper extremity neural deficits in Chapter 3, The Musculoskeletal System, section 3.1k; Chapter 4, The Nervous System, section 4.4 provides additional information and an example. The AMA Guides also divides PNS deficits into sensory and motor and includes pain within the former. The impairment estimates take into account typical manifestations such as limited motion, atrophy, and reflex, trophic, and vasomotor deficits. Lesions of the peripheral nervous system may result in diminished sensation (anesthesia or hypesthesia), abnormal sensation (dysesthesia or paresthesia), or increased sensation (hyperesthesia). Lesions of motor nerves can result in weakness or paralysis of the muscles innervated. Spinal nerve deficits are identified by sensory loss or pain in the dermatome or weakness in the myotome supplied. The steps in estimating brachial plexus impairment are similar to those for spinal and peripheral nerves. Evaluators should take care not to rate the same impairment twice, eg, rating weakness resulting from a peripheral nerve injury and the joss of joint motion due to that weakness.

Download Full-text