Chronic encephalopathy

Antibiotics with activity against urease-producing bacteria, such as neomycin [42], paromomycin [44] or metronidazole [45], also reduce the production of intestinal ammonia and have proved to be of value. Vancomycin has also been used in patients with lactulose-resistant chronic encephalopathy [46]. The efficacy of neomycin is similar to that of lactulose [42]. However, a small percentage of this drug is absorbed from the gastrointestinal tract and may cause ototoxic and nephrotoxic effects, especially with continuous use over several months [47]. This drug should be used with particular caution by patients with renal insufficiency. The efficacy of metronidazole for... 

Certain scrapie-like diseases of sheep in Iceland and some chronic encephalopathies in man (including kuru, the laughing disease of New Guinea) are the result of slow virus infections with long incubation periods. 1-Methylisatin 3-thiosemicar-bazone has been found to reduce the reverse transcriptase activity and cytopathic effect of the RNA slow viruses producing the sheep diseases and hence may provide a chemotherapeutic method for their control118. ... 

Bianchi, G.P., Marchesini, G., Fabbri, A., Rondelli, A., Bugianesi, E., Zoli, M., Pisi, E. Vegetable versus animal protein diet in cirrhotic patients with chronic encephalopathy. A randomized cross-over comparison. X Intern. Med. 1993 233 385-392... 

The effects of lactulose and lactitol in daily doses of 18-36 g for 6 months have been evaluated in a prospective, open study in 31 cirrhotic patients with chronic encephalopathy (38). Mean daily stool frequency (2.5 versus 1.7) and the frequency of reported adverse effects (59 versus 14%) were significantly higher with lactulose. Common adverse effects were nausea, intestinal discomfort, flatulence, and diarrhea. 

The clinical features of acute and chronic encephalopathy or death in these 48 patients were classified into three groups based on the initial findings of ataxia in 6, behavioral changes in 8, and seizures in 34. The onset of neurological findings varied in severity from ataxia or behavioral changes to prolonged seizures or coma. Fever preceded the onset of acute encephalopathy by several hours to several days in 43 of 48 children. There was a measles-like rash with a post-vaccination onset from day 6 to day 15 in 13 children. 

Extrapyramidal syndrome Cerebellar syndrome, visual dysfunction, encephalopathy, CNS teratogenicity Peripheral neuropathy, encephalopathy Encephalopathy, neuronopathy (trimethyltin) leukoencephalopathy, vacuolar myelinopathy (triethyltin) Peripheral neuropathy, optic neuropathy Peripheral neuropathy Acute, chronic encephalopathy, CNS teratogenicity (fetal alcohol syndrome) Peripheral neuropathy Optical neuropathy... 

Acute encephalopathy (sedation and coma), chronic encephalopathy, developmental neurotoxicity facilitated GABA neurotransmission... 

Fetal alcohol syndrome acute encephalopathy (agitation, sedation, ataxia, coma) chronic encephalopathy (cognitive impairment, dementia) myopathy peripheral neuropathy (vitamin Bi deficiency )... 

Developmental toxicity and teratogenesis visual dysfunction (tunnel vision) cerebellar syndrome (ataxia) peripheral neuropathy chronic encephalopathy (cognitive dysfunction)... 

Acute encephalopathy (neuronal degeneration of limbic system) - rodents chronic encephalopathy (cognitive dysfunction, neuronal loss in hippocampus)... 

Feldman RG, Ratner MC, Ptak T. Chronic encephalopathy in a painter exposed to mixed solvents. Environ Health Perspect 1999 107(5) 417-22. 

The pathophysiology of hepatic encephalopathy is not completely understood but includes an increased sensitivity to dietary proteins. Ammonia concentrations are always increased with acute encephalopathy and usually increased with chronic encephalopathy. A reduction of plasma ammonia is often associated with symptomatic improvement. However, since plasma ammonia concentrations do not correlate with the severity of the encephalopathy, it has been suggested that other factors are involved. It is now recognized that a variety of neurotransmitter systems are dysfunctional in hepatic encephalopathy, but the exact cause for the changes is not known. One important contributor is the endogenous benzodiazepine agonist system, but other abnormalities must be invoked to explain all the findings. ... 

HE can present in one of three forms acute, chronic, and sub-clinical. Acute HE is defined as a distinct event of altered sensorium lasting <4 weeks, followed by complete recovery to the baseline mental status. Chronic encephalopathy is defined as cognitive or neuropsychiatric abnormalities that persist for at least 4 weeks. During this time, the severity of the abnormalities fluctuates, but no episodes of normal mentation are noted. Subclinical encephalopathy refers to subtle alterations in neuropsychiatric function that are not clinically apparent without special testing. ... 

Struwe G, Mindus P, Jonsson B Psychiatric ratings in occupational health research a study of mental symptoms in lacquerers. Am J Ind Med 1 23-30,1980 Till C, Koren G, Rovet JF Prenatal exposure to organic solvents and child neurobehav-ioral performance. Neurotoxicol Teratol 23 235-245, 2001 Triebig G, Hallermann J Survey of solvent related chronic encephalopathy as an occupational disease in European countries. Occup Environ Med 58 575-581, 2001... 

Bismuth >5 nmoVI in blood Acute renal failure Chronic encephalopathy... 

The nervous system chronic encephalopathy, neurological and psychomotor problems. 

Chronic-Duration Exposure and Cancer. Kidney toxicity (Franchini et al. 1983 Mutti et al. 1992 Price et al. 1995) and symptoms of chronic encephalopathy (Gregersen 1988) were reported in studies of humans occupationally exposed to tetrachloroethylene. Other occupational exposure studies have not identified kidney (Lauwerys et al. 1983 Solet and Robins 1991) or irreversible central nervous system effects (Cai et al. 1991 Coler and Rossmiller 1953 Lauwerys et al. 1983). Deficits in behavioral tests that measured short-term memory for visual designs (Echeverria et al. 1995) have also been noted in humans occupationally C5q)osed to tetrachloroethylene. There are conflicting reports on the effect of tetrachloroethylene on color vision in persons occupationally exposed to tetrachloroethylene. Cavalleri et al. (1994) reported an effect on color vision at an average concentration of 7.3 ppm, while Nakatsukaet al. 

Six patients with severe epilepsy developed stuporous encephalopathy with marked cognitive impairment when taking topiramate with valproate (5 patients) or when taking topiramate alone (1 patient). Four of the patients had hyperammonaemia which resolved when topiramate or valproate were withdrawn. The toxicity was possibly due to a synergistic effect of valproate and topiramate on liver ornithine metabolism resulting in hyperammonaemia. It was also possible that the encephalopathy was due to topiramate toxicity in at-risk patients such as those with pre-existing chronic encephalopathy. ... 

Simpson, J. A., Seaton, D. A. and Adams, J. F. (1964). Response to treatment with chelating agents of anaemia, chronic encephalopathy, and myelopathy due to lead poisoning. J, Neurol, Neurosurg, Psychiatr, 27, 536 Singhal, R. L. and Thomas, J. A. (eds.). (1980). Lead Toxicity, (Baltimore Urban and Schwarzenberg)... 

Australian children exposed to chalking Pb paint Acute and chronic encephalopathy, peripheral motor and sensory neuropathy, ocular neuritis First modem documentation of young children as at high risk for Pb paint poisoning Gibson et al. (1892), Gibson (1904)... 

Hospitalized or screened children 100-150+ pg/dl PbB Developing brain injury (CNS) Acute/chronic encephalopathy with high mortality before chelation use Chisolm and Harrison (1956), NAS/ NRC(1972, 1980, 1993), USCDC (1978)... 

Adults Mainly occupational exposures >120-150 (j,g/dl PbB CNS affected at very high levels chronic nervous system effects with more typical workplace levels Adult chronic encephalopathy significant sensory or motor nerve injury, e.g., wrist or foot drop Cumings (1959), Feldman etal. (1977), NAS/NRC (1972, 1980)... 

Chronic encephalopathy (children >3 years old) Loss of motor skills, speech severe hyperkinetic, convulsive and behavioral disorders a mixed picture with recurrent episodes of acute poisonings NAS/NRC(1972), Byers and Lord (1943), Perlstein and Attala (1966)... 

Mixed acute/chronic encephalopathy Mortality rates in young children 65% before chelation therapy a range in mortality with chelation therapeutic intervention of 5-39% Greengard et al. (1965), Wiklowitz and Mandybur (1975)... 

Chronic encephalopathy was characterized as affecting older children (> 3 years of age) with loss of motor skills, speech, and the onset of severe... 

Chronic encephalopathy 80-100 Various impaired clinical measures of mental functioning e. g., mental retardation U.S. CDC—PbB >70 is an "acute" medical emergency ... 

Indications for transplantation include poor synthetic function, refractory ascites, subacute bacterial peritonitis, chronic encephalopathy, recurrent variceal bleeding, unacceptable quality of life, hepa-to-pulmonary syndrome, and a life expectancy of less than 18 months due to liver disease. The most common clinical conditions associated with cirrhosis requiring transplantation are chronic viral... 

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