Late recovery of responsiveness after intra-thecal baclofen pump implantation and the role of diffuse pain and severe spasticity: a case report

AbstractPatients with a prolonged disorder of consciousness (DoC) may present with severe spasticity and diffuse pain, which might impair motor output, thus preventing any possible behavioral responsiveness. A 26-year-old man affected by frontoparietal hemorrhage was operated by hematoma evacuation and decompressive craniectomy; coma persisted for 1  month; cranioplasty and ventriculo-peritoneal shunting was performed after 4 months. At admission in rehabilitation, he was diagnosed as vegetative state/unresponsive wakefulness syndrome (VS/UWS). The implantation of intrathecal baclofen (ITB) pump (Medtronic SynchroMed™ II), 14 months after, (60 μg/daily), dramatically improved behavioral responsiveness according to Coma Recovery Scale-Revised (CRS-R) from 6 to 12 (1 month after ITB). Nociception Coma Scale-Revised (NCS-R) also changed from 4 to 8 at the same time points. This case report may be an example of covert cognition that s hould have been diagnosed as a functional locked-in syndrome or motor-cognitive dissociation, rather than as VS/UWS.
Source: Acta Neurochirurgica - Category: Neurosurgery Source Type: research

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ConclusionsVitamin D insufficiency was prevalent in both newly diagnosed axSpA patients and healthy controls. There was no association between vitamin D and pain and disease activity in the newly diagnosed axSpA patients. Monitoring vitamin D levels is important and early intervention for vitamin D insufficiency is needed, especially in female patients.
Source: International Journal of Nursing Sciences - Category: Nursing Source Type: research
Publication date: Available online 13 December 2019Source: Brain, Behavior, and ImmunityAuthor(s): N.B. Teixeira, M.B. Sant'Anna, A.C. Giardini, L.P. Araujo, L.A. Fonseca, A.S. Basso, Y. Cury, G. PicoloAbstractMultiple sclerosis (MS) is a Central Nervous System inflammatory demyelinating disease that has as primary symptoms losses of sensory and motor functions, including chronic pain. To date, however, few studies have investigated the mechanisms of chronic pain in animal models of MS since locomotor impairments render difficult its evaluation. It was previously demonstrated that in the MOG35-55-induced EAE, an animal mod...
Source: Brain, Behavior, and Immunity - Category: Neurology Source Type: research
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Source: ABC News: Health - Category: Consumer Health News Tags: Health Source Type: news
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Source: Office of Criminal Investigations (OCI) Press Releases - Category: Medical Law Authors: Source Type: news
We report a young 22-year-old female with unknown etiology of a pseudoaneurysm, who was previously managed as a psychiatric case and for musculoskeletal pain. On subsequent investigation and confirmation with cardiac magnetic resonance imaging, aneurysmectomy was done. This is a rare case in a young 22-year-old woman with a ventricular pseudoaneurysm of unknown etiology. Considering the high risk for rupture of a ventricular pseudoaneurysm, surgical resection was mandatory with no complications intra- and postprocedure.
Source: Journal of the Saudi Heart Association - Category: Cardiology Source Type: research
This study demonstrates that body part-specific somatosensory imagery differentially activates somatosensory cortex in a topographically specific manner; evidence which was surprisingly still lacking in the literature. It also offers proof of concept for a novel somatosensory imagery-based fMRI-BCI control strategy, with particularly high potential for visually and motor-impaired patients. The strategy could also be transferred to lower MRI field strengths and to mobile functional near-infrared spectroscopy. Finally, given that communication BCIs provide the BCI user with a form of feedback based on their brain signals and...
Source: Frontiers in Human Neuroscience - Category: Neuroscience Source Type: research
DISCUSSION: Approaches investigating brain connectivity may be useful in DOC diagnosis and prognosis, highlighting residual brain networks subtending covert awareness. Hence, our case supports the necessity of taking into account FLIS diagnosis in DOC differential diagnosis and implementing paraclinical follow-up to intercept cases of possible, late recovery of consciousness, thus optimizing the most appropriate management and rehabilitative setting. PMID: 28946586 [PubMed - as supplied by publisher]
Source: NeuroRehabilitation - Category: Rehabilitation Tags: NeuroRehabilitation Source Type: research
Conclusion It's hard to imagine the situation of being alert, aware of what's happening around you, but unable to move, respond or communicate with the outside world. So it is comforting, then, to hear that people with complete locked-in syndrome may be able to communicate – and may be relatively content with their situation. However, it's important to remember the limitations of this study. It's very small. Only four people took part, and full results are available for only three of them. The results may only apply to people with this very specific type of neurodegenerative disease, not to people with other typ...
Source: NHS News Feed - Category: Consumer Health News Tags: Neurology Source Type: news
Conclusion It's hard to imagine the situation of being alert, aware of what's happening around you, but unable to move, respond or communicate with the outside world. So it is comforting, then, to hear that people with complete locked-in syndrome may be able to communicate – and may be relatively content with their situation. However, it's important to remember the limitations of this study. It's very small. Only four people took part, and full results are available for only three of them. The results may only apply to people with this very specific type of neurodegenerative disease, not to people with other typ...
Source: NHS News Feed - Category: Consumer Health News Tags: Neurology Source Type: news
Authors: Graber M, Challe G, Alexandre MF, Bodaghi B, LeHoang P, Touitou V Abstract Although visual function is thought to be preserved in patients with locked-in syndrome (LIS), enabling them to communicate through vertical or lateral eye movements or blinking of the upper eyelid, nothing is known about the actual visual function of patients with LIS. The goal of this study is to evaluate the visual function of patients with LIS which may enable better evaluation of the state of consciousness of these patients. Patients with LIS seen in a single neurovascular unit of a tertiary center between 1997 and 2013 were re...
Source: Journal Francais d Ophtalmologie - Category: Opthalmology Tags: J Fr Ophtalmol Source Type: research
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