By Joyce H. Lowinson; Pedro Ruiz; Robert Millman; John Langrod;
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Extra info for Substance abuse: a comprehensive textbook
In their original description, the patients all had clinical signs pointing to a pontine lesion. Many patients had constricted pupils with skew deviation of the eyes or disconjugate motion, including internuclear ophthalmoplegia in four patients. Decerebrate rigidity was also noted. As expected, the patients with central hyperventilation had a marked alkalosis (Fig. 12). The authors also reported frequent other respiratory abnormalities with six patients having Cheyne–Stoke type breathing and periodic breathing, usually preceding the central hyperventilation.
The term asterixis denoted inability to maintain posture (a-privative, sterixis-support). ” However, Adams and Foley pointed out in their original paper that the sign had been seen in uremia, polycythemia, and heart failure and hypokalemic stupors. Other causes for asterixis would be reported over the ensuing years, and the sign is now part of the neurologist’s catalogue of clinical signs. Terms such as negative myoclonus seem confusing and have been discouraged . A very good video clip of asterixis recently has been published .
These were all unsuccessful attempts to grasp the difficulty of neurologic examination of coma. Perhaps as one of the first, DeJong’s 1950 textbook The Neurological Examination, included details on cranial nerve examination and emphasized the value of eye signs in localization. In the early 1960s, more emphasis was placed on clinical findings that could help physicians recognize these acute deteriorations from displacement of tissue through the tentorium or through the foramen of magnum. A variety of acute clinical symptoms emerged—a fixed pupil, abnormal motor-responses, irregular or periodic breathing, and acute hypertension—and all of them were identified as indications for neurosurgical intervention [115, 116, 189, 238, 242].
Substance abuse: a comprehensive textbook by Joyce H. Lowinson; Pedro Ruiz; Robert Millman; John Langrod;