P.011 Not just for babies: positive rolandic sharp waves in adult post-hypoxic myoclonus

Background: Post-hypoxic myoclonus is broadly divided into myoclonic status epilepticus (MSE) and Lance-Adams syndrome (LAS), where diagnosis depends on clinical and electroencephalographic (EEG) findings. Positive rolandic sharp waves (PRS) are a classic EEG finding in pre-term infants with white matter necrosis, but they are not known to be epileptogenic and have never been described in adults. Methods: We report a unique case of PRS correlated with myoclonic seizures in a post-hypoxic adult patient. Results: Shortly after cardiac arrest, a 21-year-old woman developed multifocal post-hypoxic myoclonus. Early development of myoclonus suggested MSE, but her EEG findings were atypical for MSE; initially, the only notable feature on EEG were subtle PRS. LAS did not fit the clinical picture or EEG findings. As myoclonus persisted over the following weeks, PRS evolved on EEG into positive rolandic predominant generalized polyspike-wave complexes that became definitively time-locked to each myoclonic jerk. PRS were diagnosed as epileptogenic and frequent myoclonic jerks were diagnosed as continuous myoclonic seizure. Myoclonus resolved to medication and mental status returned to baseline. Conclusions: We report for the first time that PRS can appear in adult patients and be epileptogenic, and produce a non-classical variant of post-hypoxic myoclonus that carries good prognosis.

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A Meningo-Leucoencephalomyelitis Resembling Visna in Dutch Zwoeger Sheep

Pathologia veterinaria ◽

10.1177/030098586600300501 ◽

1966 ◽

Vol 3 (5) ◽

pp. 401-411 ◽

Cited By ~ 13

Author(s):

A. A. Ressang ◽

F. C. Stam ◽

G. F. De Boer

Keyword(s):

White Matter ◽

The Netherlands ◽

Final Stage ◽

Chronic Condition ◽

Cerebral Lesions ◽

Terminal Stage ◽

Icelandic Sheep ◽

Close Relationship ◽

Secondary Demyelination ◽

First Time

Zwoegerziekte is a disease in Dutch sheep which morphologically closely resembles an Icelandic sheep disease, Maedi2. Chronic lung affection and emaciation are the principal symptoms of both diseases. Visna is another chronic condition in Icelandic sheep affecting mainly the C.N.S. A virus has been isolated from sheep affected with Maedi or Visna and a close relationship in properties has been found between both viruses. In two Dutch sheep autopsied in the final stage of Zwoegerziekte, lesions were present in the C.N.S., which histologically resembled those in Visna. Another sheep slaughtered at the municipal abattoir, with lung lesions characteristic for the terminal stage of Zwoegerziekte, exhibited early cerebral lesions resembling Visna. The lesions in the C.N.S. of these three sheep were meningitis and severe encephalomyelitis of the glial type affecting the white matter. Secondary demyelination was striking. Though Zwoegerziekte has been known for several decades in the Netherlands, the accompanying C.N.S. lesions are described for the first time.

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Proteasome Biology Is Compromised in White Matter After Asphyxic Cardiac Arrest in Neonatal Piglets

Journal of the American Heart Association ◽

10.1161/jaha.118.009415 ◽

2018 ◽

Vol 7 (20) ◽

Cited By ~ 6

Author(s):

Polan T. Santos ◽

Caitlin E. O'Brien ◽

May W. Chen ◽

C. Danielle Hopkins ◽

Shawn Adams ◽

...

Keyword(s):

Cardiac Arrest ◽

White Matter ◽

Neonatal Piglets

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Infection and white matter injury in infants with congenital cardiac disease

Cardiology in the Young ◽

10.1017/s1047951111000473 ◽

2011 ◽

Vol 21 (5) ◽

pp. 562-571 ◽

Cited By ~ 9

Author(s):

Hannah C. Glass ◽

Chelsea Bowman ◽

Vann Chau ◽

Alisha Moosa ◽

Adam L. Hersh ◽

...

Keyword(s):

Risk Factors ◽

White Matter ◽

Bloodstream Infection ◽

Cardiac Disease ◽

Brain Injuries ◽

White Matter Injury ◽

Term Infants ◽

Established Risk Factor ◽

Congenital Cardiac Disease

AbstractMore than 60% of newborns with severe congenital cardiac disease develop perioperative brain injuries. Known risk factors include: pre-operative hypoxemia, cardiopulmonary bypass characteristics, and post-operative hypotension. Infection is an established risk factor for white matter injury in premature newborns. In this study, we examined term infants with congenital cardiac disease requiring surgical repair to determine whether infection is associated with white matter injury. Acquired infection was specified by site – bloodstream, pneumonia, or surgical site infection – according to strict definitions. Infection was present in 23 of 127 infants. Pre- and post-operative imaging was evaluated for acquired injury by a paediatric neuroradiologist. Overall, there was no difference in newly acquired post-operative white matter injury in infants with infection (30%), compared to those without (31%). When stratified by anatomy, infants with transposition of the great arteries, and bloodstream infection had an estimated doubling of risk of white matter injury that was not significant, whereas those with single ventricle anatomy had no apparent added risk. When considering only infants without stroke, the estimated association was higher, and became significant after adjusting for duration of inotrope therapy. In this study, nosocomial infection was not associated with white matter injury. Nonetheless, when controlling for risk factors, there was an association between bloodstream infection and white matter injury in selected sub-populations. Infection prevention may have the potential to mitigate long-term neurologic impairment as a consequence of white matter injury, which underscores the importance of attention to infection control for these patients.

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Neurologic outcome of postanoxic refractory status epilepticus after aggressive treatment

Neurology ◽

10.1212/wnl.0000000000006615 ◽

2018 ◽

Vol 91 (23) ◽

pp. e2153-e2162 ◽

Cited By ~ 17

Author(s):

Simone Beretta ◽

Anna Coppo ◽

Elisa Bianchi ◽

Clara Zanchi ◽

Davide Carone ◽

...

Keyword(s):

Cardiac Arrest ◽

Status Epilepticus ◽

Refractory Status Epilepticus ◽

Neurologic Outcome ◽

Low Flow ◽

Prognostic Indicators ◽

Prolonged Treatment ◽

Periodic Pattern ◽

Refractory Status ◽

Eeg Pattern

ObjectiveTo investigate neurologic outcome of patients with cardiac arrest with refractory status epilepticus (RSE) treated with a standardized aggressive protocol with antiepileptic drugs and anesthetics compared to patients with other EEG patterns.MethodsIn the prospective cohort study, 166 consecutive patients with cardiac arrest in coma were stratified according to 4 independent EEG patterns (benign, RSE, generalized periodic discharges [GPDs], malignant nonepileptiform) and multimodal prognostic indicators. Primary outcomes were survival and cerebral performance category (CPC) at 6 months.ResultsRSE occurred in 36 patients (21.7%) and was treated with an aggressive standardized protocol as long as multimodal prognostic indicators were not unfavorable. RSE started after 3 ± 2.3 days after cardiac arrest and lasted 4.7 ± 4.3 days. A benign EEG pattern was recorded in 76 patients (45.8%); a periodic pattern (GPDs) was seen in 13 patients (7.8%); and a malignant nonepileptiform EEG pattern was recorded in 41 patients (24.7%). The 4 EEG patterns were highly associated with different prognostic indicators (low-flow time, clinical motor seizures, N20 responses, neuron-specific enolase, neuroimaging). Survival and good neurologic outcome (CPC 1 or 2) at 6 months were 72.4% and 71.1% for benign EEG pattern, 54.3% and 44.4% for RSE, 15.4% and 0% for GPDs, and 2.4% and 0% for malignant nonepileptiform EEG pattern, respectively.ConclusionsAggressive and prolonged treatment of RSE may be justified in patients with cardiac arrest with favorable multimodal prognostic indicators.

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Case of development of Gottron’s carcinoid papillomatosis of skin against a background of protracted psoriasis

Perm Medical Journal ◽

10.17816/pmj36676-82 ◽

2020 ◽

Vol 36 (6) ◽

pp. 76-82

Author(s):

M. Yu. Kobernik ◽

V. D. Elkin ◽

T. G. Sedova ◽

A. A. Zhukova

Keyword(s):

Squamous Cell Carcinoma ◽

Cell Carcinoma ◽

Squamous Cell ◽

Clinical Picture ◽

Skin Disease ◽

Clinical Observation ◽

Lower Extremities ◽

Pseudoepitheliomatous Hyperplasia ◽

First Time

The paper presents information regarding a rare skin disease Gottrons carcinoid papillomatosis, for the first time described in 1932 by German dermatologist H.A. Gottron. Its development is associated with the preceding chronic dermatoses and disturbance of circulation in the lower extremities. Morphologically, Gottrons carcinoid papillomatosis of the skin is characterized by the development of pseudoepitheliomatous hyperplasia of epidermis. Clinical picture, dermatoscopy, ultrasound and histological studied were used for diagnosis. This disease should be differed from high differentiated squamous cell carcinoma of the skin, chronic ulcerous pyodermavegetans, lupus verrucosis, chromomycosis. We described our own clinical observation of Gottrons carcinoid papillomatosis of the skin, developed against a background of psoriasis.

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Abstract 19: Progressive Metabolic Derangement During Prolonged Resuscitation for Refractory VT/VF Cardiac Arrest and the Relationship to Neurologically Intact Survival With Extracorporeal Cardiopulmonary Resuscitation

Circulation ◽

10.1161/circ.138.suppl_2.19 ◽

2018 ◽

Vol 138 (Suppl_2) ◽

Author(s):

Jason A Bartos ◽

Claire Carlson ◽

Ganesh Raveendran ◽

Ranjit John ◽

Tom P Aufderheide ◽

...

Keyword(s):

Cardiac Arrest ◽

Extracorporeal Cardiopulmonary Resuscitation ◽

Metabolic Derangement ◽

Catheterization Laboratory ◽

Cardiac Catheterization Laboratory ◽

Substantial Decline ◽

Lactic Acidemia ◽

First Time ◽

Neurologically Intact ◽

Over Time

Background: Multiple studies have shown declining likelihood of neurologically intact survival with prolonged resuscitation with standard CPR. With standard CPR, survival after VT/VF arrest declines from 35-45% at initiation of CPR to 10-20% survival at 30 min. Objective: The aim of this study was to examine the effects of resuscitation duration on neurologically intact survival in the Minnesota Resuscitation Consortium ECPR protocol. Further, the progressive metabolic derangement of prolonged resuscitation was observed for the first time in this population. Methods: Between December 1, 2015 and May 1, 2018, 115 consecutive adult patients with refractory out-of-hospital VT/VF cardiac arrest requiring ongoing CPR were transported to the cardiac catheterization laboratory where ECLS was initiated and coronary angiography and PCI were performed as needed. Patients achieving an organized cardiac rhythm were admitted for further treatment. Results: Overall, 41% of patients receiving full resuscitative efforts were discharged neurologically intact. Neurologically intact survival declined with increasing duration of CPR with 100% survival in patients placed on ECLS within 30 min. Survival declined to 50% within 50 min and 20% within 70 min. Lactic acid and paCO2 increased over time peaking at 15 mmol/L and 72 mmHg, respectively. pH declined accordingly reaching 6.92 at its nadir. paO2 was stable over time but variable between patients. Conclusions: Likelihood of neurologically intact survival declined with increasing duration of CPR for patients going on to receive ECLS. The metabolic profile worsened during prolonged CPR with increasing lactic acidemia and hypercapnia but survival could be achieved with the hemodynamic support provided by ECLS. Together these findings support the need for rapid transport of patients to teams prepared to place ECLS. Substantial decline in survival begins at 30 min of CPR.

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Abstract 355: Performance of Inclusion and Exclusion Criteria Based on Prognosis in an Interventional Out-of-Hospital Cardiac Arrest Study

Circulation ◽

10.1161/circ.138.suppl_2.355 ◽

2018 ◽

Vol 138 (Suppl_2) ◽

Author(s):

Nick Krehel ◽

Clifton W Callaway ◽

Ankur Doshi ◽

Jonathan Elmer ◽

Francis X Guyette ◽

...

Keyword(s):

Cardiac Arrest ◽

Poor Prognosis ◽

Tertiary Care ◽

Good Prognosis ◽

Spontaneous Circulation ◽

Relative Paucity ◽

Poor Outcomes ◽

Cardiac Arrest Study ◽

Tertiary Care Centers ◽

Hospital Cardiac Arrest

Introduction: Selection of out-of-hospital cardiac arrest (OHCA) patients for inclusion in randomized control trials (RCT) presents a challenge. The goal is to enroll patients with severe injury warranting intervention yet exclude those with extreme irreversible disease. Selection early after return of spontaneous circulation (ROSC) is complicated by a relative paucity of prognostic variables. We examined the accuracy of enrollment criteria in the iNO OHCA study (NCT03079102) in excluding patients likely to have good or poor outcomes within three hours (3h) of ROSC. Methods: OHCA patients arriving to two tertiary care centers in Pittsburgh were screened within 3h of ROSC. We excluded subjects that followed commands (good prognosis expected) and subjects expected to have poor prognosis based on: Full Outline of UnResponsiveness Brainstem (FOUR B) score <2; CPR time >40 min; investigator estimate of >95% mortality; CT evidence of cerebral edema or intracranial hemorrhage; clinical evidence of myoclonic status epilepticus; or traumatic OHCA etiology. We also excluded subjects not within 3h of ROSC. We compared discharge survival and good neurologic outcome based on disposition (location). Results: Over a nine-month period we screened 155 patients with ROSC following OHCA, 20 subjects (13%) were included in the study and 135 (87%) were excluded ( Table ). The odds ratio (OR) of survival if excluded for poor prognosis was 0.03 (95% CI: 0.01 - 0.08) and worsened when >1 criteria were met. Exclusion for good prognosis was associated with improved survival (OR = 67.2 [95% CI: 14.3 - 316.3]). Conclusions: Our criteria reliably exclude OHCA subjects with good or poor prognosis within 3h of ROSC, yielding a study population with intermediate survival which can be applicable to future OHCA trials. Our criteria selected a minority (13%) of OHCA patients likely to benefit from intervention while reserving resources.

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Ultrastructural Study on the Demyelination of the White Matter in the Rat Spinal Cord after Cardiac Arrest and Massive Hemorrhagic Shock

Breathing, Feeding, and Neuroprotection ◽

10.1007/4-431-28775-2_5 ◽

2007 ◽

pp. 38-40

Author(s):

Li Yin ◽

Yoshifumi Kudo ◽

Hirokazu Ohtaki ◽

Sachiko Yofu ◽

Masaji Matsunaga ◽

...

Keyword(s):

Spinal Cord ◽

Cardiac Arrest ◽

White Matter ◽

Hemorrhagic Shock ◽

Ultrastructural Study ◽

Rat Spinal Cord

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Status epilepticus during correction of hyponatremia in a patient with Alzheimer’s disease: A case report

SAGE Open Medical Case Reports ◽

10.1177/2050313x20915416 ◽

2020 ◽

Vol 8 ◽

pp. 2050313X2091541

Author(s):

Ken Ichioka ◽

Nobuhiro Akuzawa ◽

Akio Takahashi

Keyword(s):

Alzheimer’S Disease ◽

Alzheimer's Disease ◽

Case Report ◽

Status Epilepticus ◽

Synaptic Cleft ◽

Sharp Waves ◽

Old Japanese ◽

Impaired Awareness ◽

Clonic Seizures ◽

The Right

An 83-year-old Japanese man with Alzheimer’s disease was admitted to our hospital for treatment of hyponatremia resulting from water intoxication. During hospitalization, the patient developed focal impaired awareness seizures, focal to bilateral tonic-clonic seizures, and subsequent status epilepticus. Electroencephalogram during focal impaired awareness seizures showed rhythmic 5–9 Hz theta activity in the right frontotemporal region. Electroencephalogram during focal to bilateral tonic-clonic seizures showed bilateral polyspikes. Electroencephalogram during an interseizure period revealed sharp waves in the right frontal region. Continuous intravenous administration of midazolam was the only effective treatment for status epilepticus. The patient died of aspiration pneumonia on day 58. Hyponatremia-associated status epilepticus is rare; in the present case, multifocal epileptogenicity resulting from Alzheimer’s disease and hyponatremia-associated elevation of glutamate levels in the synaptic cleft may have contributed to the onset of focal to bilateral tonic-clonic seizures with subsequent status epilepticus.

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