Neurology India
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Three hundred and ninety-seven patients undergoing posterior cranial fossa surgery in the sitting position were prospectively studied to evaluate the incidence of venous air embolism (VAE) and its effects on hemodynamics. End-tidal carbon dioxide (ETC02) tension was monitored to diagnose VAE. A sudden and sustained decrease in ETC02 of more than 5 mmHg, in the absence of sudden hypovolemia, was presumed to be the result of VAE. ⋯ There were no statistically significant differences in the frequency of VAE among the different groups (P>0.05). Also, the frequency of hypotension and ventricular arrhythmias were not significantly different, irrespective of the source of VAE (P>0.05). The general condition of the patients in the preoperative stage had no influence on the incidence of embolism, hypotension or ventricular arrhythmias.
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A study was conducted to observe the effect of intravenous sodium valproate in status epilepticus. Eleven patients with status epilepticus, who were resistant to conventional drugs, underwent treatment with intravenous sodium valproate. ⋯ No complications were observed during therapy. We conclude that intravenous sodium valproate can be recommended for Myoclonic status epilepticus and non-convulsive status epileticus.
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A prospective study was carried out to evaluate the efficacy of intraventricular sodium nitroprousside (SNP) in the reversal of refractory vasospasm secondary to aneurysmal subarachnoid hemorrhage (SAH). Ten patients of aneurysmal SAH with symptomatic vasospasm, corroborated on Transcranial Doppler (TCD) and/or angiography, were included in the study. The mean age distribution of the patients was 50.8 years (range 33-65 years) with an equal number of males and females. ⋯ Three patients had mild fluctuation in blood pressure. The overall outcome was good in 6 out of 10 patients. The study suggests that intraventricular SNP therapy is effective in reversing the changes even in established cases of SAH-induced vasospasm.
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Case Reports
Post-cardiorespiratory arrest beta-alpha coma: an unusual electroencephalographic phenomenon.
The presence of frontally-dominant alpha pattern in the EEG is common in patients with coma due to trauma, toxic-metabolic causes and following cardiorespiratory arrest. Diffuse beta activity following resuscitation after a cardiac arrest is not well recognized. ⋯ The possible mechanisms involved in the generation of such rhythms are discussed. Transition of EEG activity from faster to slower frequencies is suggested as an adverse prognostic factor in post-cardiorespiratory arrest coma.