Classic Papers That Gave Rise to the Field of Sleep Research & Abstracts from the 1St Meeting of the Association for The

Total Page:16

File Type:pdf, Size:1020Kb

Classic Papers That Gave Rise to the Field of Sleep Research & Abstracts from the 1St Meeting of the Association for The ClassiC PaPers that Gave rise to the Field oF sleeP researCh C l i C k t o v i e w M A I N M E N U abstraCts From the 1st meetinG oF the assoCiation For the PsyChoPhysiCal study oF sleeP C l i C k t o v i e w Classic Papers that Gave Rise to the Field of Sleep Research Table of Contents CLICK ON AN ARTICLE FOR FULL TEXT 1. Patrick GTWaG, J.A. On the effects of loss of sleep. 15. Simon CW, Emmons WH. Learning during sleep. The Psychological Review. 1896;3(5):469-483. Psychol Bull. Jul 1955;52(4):328-342. 2. Kleitman N. Studies on the physiology of sleep: I. 16. Dement W, Kleitman N. The relation of eye The Effects of Prolonged Sleeplessness on Man. Am J movements during sleep to dream activity: an Physiol. September 1, 1923 1923;66(1):67-92. objective method for the study of dreaming. J Exp 3. Bremer F. Cerveau « isolé » et physiologie du sommeil. Psychol. May 1957;53(5):339-346. C R Seances Soc Biol Fil. 1935;118:1235-1241. 17. Dement W. The occurrence of low voltage, fast, 4. Loomis AL, Harvey EN, Hobart G. Potential Rhythms electroencephalogram patterns during behavioral of the Cerebral Cortex during Sleep. Science. Jun 14 sleep in the cat. Electroencephalogr Clin Neurophysiol. May 1935;81(2111):597-598. 1958;10(2):291-296. 5. Davis H, Davis PA, Loomis AL, Harvey EN, Hobart 18. Hastings JW, Sweeney BM. A persistent diurnal G. Electrical reaction of the human brain to auditory rhythm of luminescence in Gonyaulax polyedra. Biol stimulation during sleep. J Neurophysiol. November 1, Bull. December 1, 1958 1958;115(3):440-458. 1939 1939;2(6):500-514. 19. Jouvet M, Michel F. [Study of the cerebral electrical 6. Nauta WJH. Hypothalamic regulation of sleep in activity during sleep.]. C R Seances Soc Biol Fil. rats. An experimental study. J Neurophysiol. July 1, 1946 1958;152(7):1167-1170. 1946;9(4):285-316. 20. Dement W. The effect of dream deprivation. Science. 7. Richter D, Dawson RM. Brain metabolism in Jun 10 1960;131:1705-1707. emotional excitement and in sleep. Am J Physiol. Jul 21. Evarts EV. Effects of sleep and waking on spontaneous 1948;154(1):73-79. and evoked discharge of single units in visual cortex. 8. Brazier MA. The electrical fields at the surface of the Federation proceedings. 1960;19:828-837. head during sleep. Electroencephalogr Clin Neurophysiol. 22. Webb WB, Agnew HW, Jr. Sleep deprivation, May 1949;1(2):195-204. age, and exhaustion time in the rat. Science. Jun 29 9. Moruzzi G, Magoun HW. Brain stem reticular 1962;136:1122. formation and activation of the EEG. Electroencephalogr 23. Schenck CH, Bassetti CL, Arnulf I, Mignot E. English Clin Neurophysiol. Nov 1949;1(4):455-473. translations of the first clinical reports on narcolepsy 10. Aserinsky E, Kleitman N. Regularly occurring periods and cataplexy by Westphal and Gelineau in the late of eye motility, and concomitant phenomena, during 19th century, with commentary. J Clin Sleep Med. Apr sleep. Science. Sep 4 1953;118(3062):273-274. 15 2007;3(3):301-311. 11. Kleitman N, Engelmann TG. Sleep characteristics of 24. Compston A. Idiopathic narcolepsy: a disease sui infants. J Appl Physiol. Nov 1953;6(5):269-282. generis; with remarks on the mechanisms of sleep. By WJ Adie, MD, FRCP. Physician to Out-patients, 12. Aserinsky E, Kleitman N. Two types of ocular motility the National Hospital, Queen Square, (London). occurring in sleep. J Appl Physiol. Jul 1955;8(1):1-10. (From a Thesis submitted for the Degree of MD in 13. Kleitman N, Engelmann G. The development of the the University of Edinburgh, on February 26, 1926). diurnal (24-hour) sleep-wakefulness rhythm in the Brain 1926: 49; 257-306 and The narcolepsies. By infant. Acta Med Scand Suppl. 1955;307:106. S.A. Kinnier Wilson. Brain 1928: 51; 63-109. Brain. October 1, 2008 2008;131(10):2532-2535. 14. Mangold R, Sokoloff L, Conner E, Kleinerman J, Therman PO, Kety SS. The effects of sleep and lack of sleep on the cerebral circulation and metabolism of normal young men. J Clin Invest. Jul 1955;34(7, Part 1):1092-1100. The content is in the public domain. Reproduced with permission from The Am. Physiol Soc. From Loomis AL, Harvey EN, Hobart G. Potential Rhythms of the Cerebral Cortex during Sleep. Science. Jun 14 1935;81(2111):597-598. Reprinted with permission from AAAS. Reproduced with permission from The Am. Physiol Soc. Reproduced with permission from The Am. Physiol Soc. Reproduced with permission from The Am. Physiol Soc. Reprinted from Electroencephalogr Clin Neurophysiol. 1(2). Brazier MA. The electrical fields at the surface of the head during sleep. 195-204. May 1949, with permission from Elsevier. Reprinted from Electroencephalogr Clin Neurophysiol. 1(4). Moruzzi G, Magoun HW. Brain stem reticular formation and activation of the EEG. 455-473. Sep 4 1953, with permission from Elsevier 456 From Aserinsky E, Kleitman N. Regularly occurring periods of eye motility, and concomitant phenomena, during sleep. Science.;118(3062):273-274. Reprinted with permission from AAAS. Reproduced with permission from The Am. Physiol Soc. Reproduced with permission from The Am. Physiol Soc. Kleitman N, Engelmann G. The development of the diurnal (24-hour) sleep- wakefulness rhythm in the infant. Acta Med Scand Suppl. 1955;307:106. The content is in the public domain. The content is in the public domain. Reprinted from Electroencephalogr Clin Neurophysiol. 10(2). Dement W. The occurrence of low voltage, fast, electroencephalogram patterns during behavioral sleep in the cat. 291-296. May 1958, with permission from Elsevier. M Hastings, J. W., and B. M. Sweeney. 1958. Biol. Bull. 115: 440-458. Reprinted with permission from the Marine Biological Laboratory, Woods Hole, MA. From Dement W. The effect of dream deprivation. Science. Jun 10 1960;131:1705-1707. Reprinted with permission from AAAS. Reproduced with permission of the Federation of American Societies for Experimental Biology, from Evarts EV. Effects of sleep and waking on spontaneous and evoked discharge of single units in visual cortex. Federation proceedings. 1960;19:828-837; permission conveyed through Copyright Clearance Center, Inc. From Webb WB, Agnew HW, Jr. Sleep deprivation, age, and exhaustion time in the rat. Science. Jun 29 1962;136:1122. Reprinted with permission from AAAS. Special articleS English Translations Of The First Clinical Reports On Narcolepsy And Cataplexy By Westphal And Gélineau In The Late 19th Century, With Commentary Carlos H. Schenck, M.D.1; Claudio L. Bassetti, M.D.2; Isabelle Arnulf, M.D., Ph.D.3,4; Emmanuel Mignot, M.D., Ph.D.3 1Minnesota Regional Sleep Disorders Center, Department of Psychiatry, Hennepin County Medical Center, University of Minnesota Medical School, Minneapolis, MN, USA; 2Department Of Neurology, University Hospital, Zurich, Switzerland; 3Stanford Center for Narcolepsy, Stanford, CA; 4Fédération des Pathologies du Sommeil, Hôpital Pitié-Salpêtrière, Assistance Publique - Hôpitaux de Paris, France Study objectives: To publish the first English translations, with com- convincing to conclude that they were likely each HLA-DQB1*0602 posi- mentary, of the original reports describing narcolepsy and cataplexy by tive and hypocretin deficient. Westphal in German (1877) and by Gélineau in French (1880). conclusions: The original descriptions of narcolepsy and cataplexy are Methods: A professional translation service translated the 2 reports from now available in English, allowing for extensive clinical and historical either German or French to English, with each translation then being commentary. slightly edited by one of the authors. All authors then provided commen- Keywords: Narcolepsy, cataplexy, JBE Gélineau, C. Westphal, late tary. 19th century, neurology, history of medicine, sleep disorders, motor dys- results: Both Westphal and Gélineau correctly identified and described control, excessive sleepiness/sleep attacks the new clinical entities of cataplexy and narcolepsy, with recurrent, self- citations: Schenck CH; Bassetti CL; Arnulf I et al. English translations limited sleep attacks and/or cataplectic attacks affecting 2 otherwise of the first clinical reports on narcolepsy and cataplexy by Westphal and healthy people. Narcolepsy was named by Gélineau (and cataplexy was Gélineau in the late 19th century, with commentary. J Clin Sleep Med named by Henneberg in 1916). The evidence in both cases is sufficiently 2007;3(3):301-311 o our knowledge, there are no published English translations comment: “The original French of this two-part article is writ- Tof the first clinical reports describing narcolepsy (in French, ten in an unusually loose style for late 19th century scientific 1880)1 and cataplexy (in German, 1877).2 The first author herein reports. It is somewhat like a slightly-edited copying of hasty (CHS) had a professional translation agency (Berlitz) translate notes on a physician’s note pad. Accordingly, it is difficult to these 2 reports into English, which he then edited, as described render in smooth English; we have in many cases sacrificed below. (A minimum of 2 language experts reviewed each trans- esthetics of style for accuracy.” Nevertheless, Passouant, who lated manuscript.) These historic documents richly describe re- wrote about Gélineau for the narcolepsy centennial, mentioned current, self-limited sleep attacks and/or cataplectic attacks in 2 that “Throughout his life, Gélineau wrote in a clear, alert, and otherwise healthy people. easy-to-read style.”3 It is evident that Gélineau astutely identi- Preliminary comments on the translations are as follows: fied and accurately named narcolepsy; he wrote an impressive First, all punctuations and italics come from the original articles. set of descriptions on narcoleptic sleep attacks and their con- Second, the article by Gélineau was twice as long as the article texts, and he provided a detailed and carefully reasoned differ- by Westphal.
Recommended publications
  • Tactics of Family Doctors in Case of Syncopal States
    MINISTRY OF PUBLIC HEALTH OF UKRAINE ZAPORIZHZHIA STATE MEDICAL UNIVERSITY DEPARTMENT OF GENERAL PRACTICE – FAMILY MEDICINE AND INTERNAL DISEASES DEPARTMENT OF GENERAL PRACTICE – FAMILY MEDICINE, THERAPY, CARDIOLOGY AND NEUROLOGY OF THE POSTGRADUATE FACULTY TACTICS OF FAMILY DOCTORS IN CASE OF SYNCOPAL STATES STUDY GUIDE for the students of the specialty "Medicine" in the program of the educational discipline "General Practice - Family Medicine" Zaporizhzhia 2020 2 UDC 616.8-009.832-08(072) М 99 Аpproved by Central Methodical Council of Zaporizhzhia State Medical University as а study guide (Protocol № 3 of 27.02.2020) and recommended for use in the educational process Authors: N. S. Mykhailovska - Doctor of Medical Sciences, Professor, head of the Department of General practice – family medicine and internal diseases, Zaporizhzhia State Medical University; A. V. Grytsay - PhD, associated professor of the Department of General practice – family medicine and internal diseases, Zaporizhzhia State Medical University; І. S. Kachan - associated professor of the Department of Family medicine, therapy, cardiology and neurology of the Postgraduate faculty, Zaporizhzhia State Medical University. Readers: S. Y. Dotsenko – Doctor of Medical Sciences, Professor, Head of the Internal Medicine №3 Department, Zaporozhye State Medical University; S. M. Kiselev – Doctor of Medical Sciences, Professor, Professor of the Department of Internal diseases 1, Zaporizhzhia State Medical University. Mykhailovska N. S. M99 Tactics of family doctors in case of syncopal states = Тактика сімейного лікаря при синкопальних станах: study guide for the practical classes and individual work for 6th-years students of international faculty (speciality «General medicine»), discipline «General practice – family medicine» / N. S. Mykhailovska, A. V. Grytsay, I.S.
    [Show full text]
  • Sleep As a Problem of Localization
    SLEEP AS A PROBLEM OF LOCALIZATION Prof. C. von Economo Vienna, Austria The Journal of Nervous and Mental Disease march 1930, vol 71, n°3 An American Journal of Neuropsychiatry, Founded in 1874 Paper read before the College of Physicians and Surgeons Columbia University, New York, Dec. 3, 1929 The search for a so-called sleep center may at the ceasing of the activity of this organ, i.e., the ceasing first sight appear a paradoxical idea. In the same man- of consciousness bringing about sleep. Others conceived ner as the waking state, so also does sleep appear as the mechanism of interruption not in this delicate histological such a complex biological condition that the problem manner but somewhat more massively. Purkinje belie- makes us at first sit up and take notice. Indeed, our enti- ved that by the congestion of the grey mass of the sub- re life takes place in the alternating change of two bio- cortical ganglia the thalamus corpus striatum, etc., pres- logical conditions, the waking and sleeping state and in sure is excited upon the nervous fibers of the corona this way the problem might appear primarily of the same radiata which run through this ganglia and that due to category as the problem of the center of life itself. The this strangulation an interruption of conduction from problem of a center of life in the nervous system has and to the brain is effected thus bringing about sleep. often been discussed in past centuries. But it has been put away as life is a much too complex condition as to The Viennese ophthalmologist Mauthner assu- be localized.
    [Show full text]
  • Medical Studies in English Clinical Skills: Year 2
    MEDICAL STUDIES IN ENGLISH CLINICAL SKILLS: YEAR 2 STUDENT HANDOUT 2015 Contents: 1. General principles of history taking 2. Basic principles of physical examination 3. Overview of a patient consultation 4. Monitoring vital signs 5. Structured approach to the seriously injured 6. Shock 7. Acute heart and respiratory failure 8. Disturbances of consciousness 9. Life support in children 10. Newborn resuscitation 11. Resuscitation of adults 12. Medical care of the injured patient 13. Use of equipment during treatment of injured patients; transport positions Department of Clinical Skills University of Split School of Medicine 1. THE GENERAL PRINCIPLES OF HISTORY TAKING Irena Zakarija-Grković, MD, FRACGP, IBCLC, PhD A Brief Overview of Clinical Medicine From classical Greek times interrogation of the patient has been considered most important. However, the current emphasis on the use of history taking and physical examination for diagnosis developed only in the 19th century. Until the 19th century, diagnosis was empirical and based on the classical Greek beliefs that all disease had a single cause, an imbalance of the four humours or body fluids (yellow bile, black bile, blood and phlegm). In the 17th century physicians based their opinion on a history provided by an apothecary (assistant) and rarely saw the patients themselves. Thomas Sydenham (1624-1689) began to practise more modern bedside medicine basing his treatment on experience and not theory. A renaissance in clinical methods began with the concept of Battista Morgagni (1682-1771) that disease was not generalised but arose in organs, a conclusion published in 1761. Leopold Auenbrugger invented chest tapping (percussion) to detect disease in the same year.
    [Show full text]
  • SMART - Narzędzie Oceny Pacjentów Z Zaburzeniami Świadomościi Mocy Regulacji W Badaniu Wysiłkowym
    Rehabilitacja Postępy Rehabilitacji (1), 5 – 10, 2016 Rehabilitacja Postępy Rehabilitacji (1), 49 – 57, 2017 Poziom wydolności dorosłych kobiet urodzonych przedwcześnie na podstawie analizy mocy wejścia SMART - narzędzie oceny pacjentów z zaburzeniami świadomościi mocy regulacji w badaniu wysiłkowym A – opracowanie koncepcji The level of efficiency of adult women in premature i założeń (preparing SMART – a tool for assessing patients with disorders concepts) based on analysis of power input and power regula- B – opracowanie metod of consciousness (formulating methods) tion stress test C – przeprowadzenie badań (conducting 1,A,E,F 2,A,F research) Tomasz Waraksa1, A-F , Agnieszka Wójcik1, C-F 1, A,C,E D – opracowanie wyników Andrzej Magiera , Artur Jagodziński , Katarzyna Kaczmarczyk , 2, A,D,E (processing results) Ida1Centrum Wiszomirska Rehabilitacji Funkcjonalnej ORTHOS, Warszawa. Centre of Functional E – interpretacja i wnioski (nterpretation and KatedraRehabilitation Biologicznych ORTHOS, Podstaw Warsaw Rehabilitacji, Wydział Rehabilitacji AWF Warszawa 1 conclusions) Zakład Fizjologii 2 F – redakcja ostatecznej 2Akademia Zakład Anatomii Wychowania Fizycznego Józefa Piłsudskiego w Warszawie, Wydział wersji (editing the final Rehabilitacji, Katedra Fizjoterapii. Jozef Pilsudski University of Physical Education version) in Warsaw, Faculty of Rehabilitation, Department of Physiotherapy Streszczenie Streszczenie Wstęp: Liczba urodzeń przedwczesnych w Polsce, pomimo znacznego wzrostu poziomu medycynyTrafna ocenaoraz świadomości pacjentów zmatek, zaburzeniami w ostatnich świadomości latach utrzymuje wciąż sięstanowi na stałym poważne poziomie, wy- zwanieoscylującym medyczne. wokół Pomimo 7%. Wskaźnik zastosowania ten jest w podobny ostatnim w czasie innych nowoczesnych krajach Unii Europejskiej.technik neu- roobrazowaniaCelem niniejszej (EEG, pracy fMRI,jest ocena PET wpływu i innych) wcześniactwa prawidłowa na diagnoza moc wejścia wciąż i jestmoc znaczącoregulacji utrudniona.w badaniu wysiłkowym Brak precyzyjnego u kobiet dorosłych.
    [Show full text]
  • Unconsciousness Coma
    Unconsciousness Coma Z. Rozkydal Intracranial causes Vessels: head injury, bleeding haematoma, anomalies, ischemia Infection – meningitis, encefalitis, abscesus Tumors Epilepsy Extracranial causes Poisoning (CO, alcohol, drugs) Metabolic diseases (DM, hypothyreosis) Systemis failure- liver, kidney Stop of breathing and circulation - in 30 seconds Level of consciousness 1. Somnolence drowsiness 2. Sopor lower level of consciousness reaction to pain 3. Coma deep unconsciousness je neprobuditelný Level of consciousness A Alert, respond to questions eyes are open V Voice, respond to voice, obey commands P Pain, respond to pain U Unresponsive to any stimulus First aid Seek the cause Monitor vital signs Opening the airways- tilt his head back lift the chin Checking breathing Recovery position, injury- the same position AED CPR Avoid aspiration, nothing orally Transport Recovery position Faintness- syncope Short loss of consciousness Causes: bradycardia, arythmia postural hypotensis vasovagal faintness First aid Horizontal position Raising of legs Fresh air Fluids Extracranial unconsciousness Diabetic coma DM- insufficient production of insulin Hyperglycaemia, osmotic diuresis Loss of fluids Metabolic acidosis, aceton Loss of potassium and natrium Brain is depedent on plasmatic glucose Utilisation of glucose in brain is not controlled by insulin Signs Polyuria, polydypsia Dry, warm skin, dehydration Rapid pulse and breathing Excessive thirst Deep breath Fruity sweet breath- aceton in the breath Nausea and vomiting Unconsciousness Mortality 50
    [Show full text]
  • Unconsciousness Due to Internal Diseases - - Differential Diagnosis and Management
    Unconsciousness due to internal diseases - - differential diagnosis and management Tomáš Janota 3rd Department of Medicine Intensive Cardiac Care Unit Content • Definitions • Patophysiological mechanism • List of reasons • Dif. dg. approaches • Examinations • Manegement • Syncope (Guideliness ESC 2018) Definition of unconsciousness (coma) • The most severe quantitative disturbance of consciousness • Somnolence - sopor - coma. • Glasgow Coma Scale ≥ 7 Glasgow Coma Scale (adult) Classification of unconsciousness by duration • Transient lost of consciousness (TLOC) – lasting in seconds/minutes • Prolonged unconsciousness/coma - lasting tens of minutes or more Transient lost of consciousness (TLOC) • Short duration LOC • Lost of responsiveness • Lost of muscle tone • Amnesia ! TLOC regarding age 100 Classification of TLOC by mechanism cerebral abnormal excessive psychological process hypoperfusion brain activity of conversion frequency „Rare“ causes o TLOC Vertebrobasiliar TIA – focal neurological signs, LOC longer Subclavian steal sy – with arm excercises Subarachnid haemorrhage – extreme headache Cyanotic breath-holding spells - young child reacts to sudden pain or upset by not breathing, turning pale or blue and then fainting Psychogenic TLOC Psychogenic pseudosyncope (PPS)/pseudocoma – duration minutes to hours, up to several times a day Psychogenic non-epileptic seizures (PNES) Situations incorectly diagnosed as TLOC Falls – no unresponsiveness, no amnesia Absence epilepsy – no falls but amnesie …… Syncope • Definition: sudden temporary
    [Show full text]
  • Patofisiologi Kesadaran Menurun
    PATOFISIOLOGI KESADARAN MENURUN Akina Maulidhany Tahir* *Bagian Anatomi Fakultas Kedokteran UMI Kesadaran adalah kondisi sadar kesadaran antara lain pada pemenuhan terhadap diri sendiri dan lingkungan. kebutuhan dasar yaitu gangguan pernafasan, Kesadaran terdiri dari dua aspek yaitu kerusakan mobilitas fisik, gangguan hidrasi, bangun (wakefulness) dan ketanggapan gangguan aktifitas menelan, kemampuan (awareness). (Avner,2006) Kesadaran diatur berkomunikasi, gangguan eliminasi (Hudak & oleh kedua hemisfer otak dan ascending Gallo, 2002). reticular activating system (ARAS), yang FISIOLOGI KESADARAN meluas dari midpons ke hipotalamus anterior. Formasi retikuler berperan penting RAS terdiri dari beberapa jaras saraf yang dalam menentukan tingkat kesadaran. RAS menghubungkan batang otak dengan korteks adalah jalur polysynaptic kompleks yang serebri. Batang otak terdiri dari medulla berasal dari batang otak (formasi retikuler) oblongata, pons, dan mesensefalon. Proyeksi dan hipotalamus dengan proyeksi ke neuronal berlanjut dari ARAS ke talamus, intalaminar dan nukleus retikular thalamus dimana mereka bersinaps dan diproyeksikan yang akan memproyeksi kembali secara ke korteks. (Ganong,2016) menyeluruh dan tidak spesifik pada area Ketidaksadaran adalah keadaan tidak luas dari korteks termasuk frontal, parietal, sadar terhadap diri sendiri dan lingkungan temporal, dan oksipital (Gambar 1). Jaras dan dapat bersifat fisiologis (tidur) ataupun kolateral ke dalamnya tidak hanya dari traktus patologis (koma atau keadaan vegetatif). sensoris, tetapi juga dari traktus trigeminal, (Avner,2006) Penyebab kesadaran menurun pendengaran, penglihatan, dan penciuman. beragam dengan karakteristik masing- (Ganong, 2016) Kelainan yang mengenai masing. Banyak penyebab dari penurunan lintasan RAS tersebut berada diantara kesadaran merupakan ancaman jiwa yang medulla, pons, mesencephalon menuju membutuhkan intervensi yang cepat, ke subthalamus, hipothalamus, thalamus karena berpotensi terhadap morbiditas dan dan akan menimbulkan penurunan derajat mortalitas yang tinggi.
    [Show full text]
  • Unconsciousness
    Consciousness • Vigilance • The ability to maintain attention and alertness over prolonged periods of time • Individual is fully responsive to stimuli, this is the condition of the person when awake. • Activity of ARAS (ascending reticular activating system) Unconsciousness A state of unawareness of self and environment. One shows no responsiveness to environmental stimuli but may respond to deep pain with involuntary movements. Unconsciousness • Somnolencia – ("drowsiness„) is a state of near-sleep, a strong desire for sleep, or sleeping for unusually long periods. • Sopor/stupor- is an unresponsive state from which a person can be aroused only briefly and with vigorous, repeated attempts. • Coma- is a profound state of unconsciousness. - a comatose patient cannot be awakened - fails to respond normally to pain or light - does not have sleep-wake cycles - does not take voluntary actions. - coma can last days, weeks, months, or indefinitely - the length of a coma cannot be accurately predicted or known - coma results from gross impairment of both cerebral hemispheres, and/or the ascending reticular activating system. Unconsciousness • Deep unconsciousness – absent brain stem reflexes (corneal, pupillar, pharyngeal), tendom reflexes, muscle hypotonia, spontaneous breathing is absent • Mild unconsciousness – brain stem reflexes +-, increases muscle tone, spontaneous breathing is present – different pathology Unconsciousness • Acute a/ lesion in brain stem b/ metabolic reason Unconsciousness 1. Consciousness 2. Breathing 3. Pupils 4. Position
    [Show full text]
  • Coma of Unknown Origin in the Emergency Department
    Braun et al. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine (2016) 24:61 DOI 10.1186/s13049-016-0250-3 ORIGINAL RESEARCH Open Access Coma of unknown origin in the emergency department: implementation of an in- house management routine Mischa Braun1,2†, Wolf Ulrich Schmidt1,2*†, Martin Möckel3, Michael Römer4, Christoph J. Ploner1 and Tobias Lindner3 Abstract Background: Coma of unknown origin is an emergency caused by a variety of possibly life-threatening pathologies. Although lethality is high, there are currently no generally accepted management guidelines. Methods: We implemented a new interdisciplinary standard operating procedure (SOP) for patients presenting with non-traumatic coma of unknown origin. It includes a new in-house triage process, a new alert call, a new composition of the clinical response team and a new management algorithm (altogether termed “coma alarm”). It is triggered by two simple criteria to be checked with out-of-hospital emergency response teams before the patient arrives. A neurologist in collaboration with an internal specialist leads the in-hospital team. Collaboration with anaesthesiology, trauma surgery and neurosurgery is organised along structured pathways that include standardised laboratory tests and imaging. Patients were prospectively enrolled. We calculated response times as well as sensitivity and false positive rates, thus proportions of over- and undertriaged patients, as quality measures for the implementation in the SOP. Results: During 24 months after implementation, we identified 325 eligible patients. Sensitivity was 60 % initially (months 1–4), then fluctuated between 84 and 94 % (months 5–24). Overtriage never exceeded 15 % and undertriage could be kept low at a maximum of 11 % after a learning period.
    [Show full text]
  • Outcome and Prognosis of Hypoxic Brain Damage Patients Undergoing Neurological Early Rehabilitation Ute E Heinz and Jens D Rollnik*
    Heinz and Rollnik. BMC Res Notes (2015) 8:243 DOI 10.1186/s13104-015-1175-z RESEARCH ARTICLE Open Access Outcome and prognosis of hypoxic brain damage patients undergoing neurological early rehabilitation Ute E Heinz and Jens D Rollnik* Abstract Background: The prevalence of patients suffering from hypoxic brain damage is increasing. Long-term outcome data and prognostic factors for either poor or good outcome are lacking. Methods: This retrospective study included 93 patients with hypoxic brain damage undergoing neurological early rehabilitation [length of stay: 108.5 (81.9) days]. Clinical data, validated outcome scales (e.g. Barthel Index—BI, Early Rehabilitation Index—ERI, Glasgow Coma Scale—GCS, Coma Remission Scale—CRS), neuroimaging data, electroen- cephalography (EEG) and evoked potentials were analyzed. Results: 75.3% had a poor outcome (defined as BI <50). 38 (40.9%) patients were discharged to a nursing care facil- ity, 21 (22.6%) to subsequent rehabilitation, 17 (18.3%) returned home, 9 (9.7%) needed further acute-care hospital treatment and 8 (8.6%) died. Barthel Index on admission as well as coma length were strong predictors of outcome from hypoxic brain damage. In addition, duration of vegetative instability, prolongation of wave III in visual evoked potentials (flash VEP), theta and delta rhythm in EEG, ERI, GCS and CRS on admission were related to poor outcome. All patients with bilateral hypodensities of the basal ganglia belonged to the poor outcome group. Age had no inde- pendent influence on functional status at discharge. Conclusions: As with other studies on neurological rehabilitation, functional status on admission turned out to be a strong predictor of outcome from hypoxic brain damage.
    [Show full text]
  • A Randomized Clinical Trial
    Supplementary Online Content 2 Schmidt K, Worrack S, Von Korff M, et al. Effect of a primary care management intervention on mental health–related quality of life among survivors of sepsis: a randomized clinical trial. JAMA. doi:10.1001/jama.2016.7207. Sepsis Help Book Sepsis Monitoring Checklist Sepsis Case Manager Training Manual Sepsis PCP Manual Downloaded From: https://jamanetwork.com/ on 09/24/2021 Effect of a primary care management intervention on mental-health-related quality of life among survivors of sepsis: a randomized clinical trial Sepsis Help Book Sepsis survivors Monitoring and cOordination in OutpatienT Health care Study management: Prof. Dr. J. Gensichen (PI), Dr. med. Konrad Schmidt Patient manual Jena University Hospital, Institute of General Practice, Bachstr. 18, 07743 Jena. 2012_01_16_final rev. Telephone: +49 (0)3641/9395800; [email protected] 1 Downloaded From: https://jamanetwork.com/ on 09/24/2021 Table of Contents 1 Introduction ............................................................................................................................. 3 1.1 What is this manual about? ............................................................................................... 3 1.2 What is this manual good for? ........................................................................................... 3 1.3 The SMOOTH study at a glance........................................................................................ 4 2 Sepsis ....................................................................................................................................
    [Show full text]
  • Die Verwirrung Um Verwirrtheit, Stupor Und Koma Terminologische Bemerkungen Zu Den Bewusstseinsstörungen N C
    Originalarbeit Die Verwirrung um Verwirrtheit, Stupor und Koma Terminologische Bemerkungen zu den Bewusstseinsstörungen n C. W. Hess Neurologische Universitätsklinik und Poliklinik, Inselspital, Bern Summary (twilight state) are being discussed and related to the term “delirium” with its various definitions Hess CW. [Confusion over delirium, stupor and in recent years. coma.] Schweiz Arch Neurol Psychiatr. 2007;158: Keywords: sopor; stupor; delirium; acute con- 354–9. fusional state Taxonomy and nomenclature of normal and abnormal states of consciousness have been Einleitung highly variable, imprecise and sometimes con- fusing, because the terms used to describe them Begriffsverwirrungen gehören zur klinischen Me- have been given different meanings depending dizin wie das Wasser zum Fisch.Das liegt einerseits on medical field (e.g. neurology and psychiatry) sicher daran, dass die klinische Medizin, ähnlich and language. Compounding the difficulty is the etwa wie die Psychologie, keine exakte Wissen- fact that the terms continue to be changed in an schaft ist. Bereiche wie die Neurologie und Psych- attempt to reflect pathophysiology of disturbed iatrie sind wegen ihrer unübertroffenen Kom- consciousness which, however, is still not fully plexität besonders anfällig auf terminologische understood. In this article the terminological de- Verwirrungen. Verschiedene Schulen schufen in velopment and various definitions of the terms ihrer Sprache ihre eigene Systematik, mehr oder sopor, stupor, delirium, akinetic mutism and coma weniger ungeachtet anderer schon existierender vigile,“apallisches Syndrom” (“apallic syndrome”) terminologischer Regelwerke. or vegetative state are being described with spe- Heute versuchen internationale Expertengre- cial emphasis on the German and English medical mien eine einheitliche Nomenklatur zu schaffen, usage and some discrepant denotations.
    [Show full text]