salicylates and Brain-Diseases

Topics: Antidepressive Agents, Tricyclic; Arrhythmias, Cardiac; Brain Diseases; Brain Edema; Diazepam; Gastric Lavage; Humans; Hypotension; Myocardial Infarction; Pacemaker, Artificial; Physostigmine; Pyridostigmine Bromide; Respiration, Artificial; Salicylates

Drugs containing bismuth, although usually safe, may rarely cause neurotoxicity.. We describe the case of a 44-year-old woman treated with bismuth subsalicylate for about 20 years, who developed abnormal behaviour and postural instability in two weeks. On examination, she had greyish discoloration of teeth, was confused and presented generalized myoclonic jerks. In the next days, her clinical condition deteriorated, with a reduction in alertness and more exuberant myoclonus. Brain MRI was unremarkable. CSF revealed mild elevation of protein content (47 mg/dL; reference range: 15-45 mg/dL) and elevation of white blood cell count (10/μL). Bismuth levels in urine (375 μg/L), serum (260 μg/L) and CSF (21.4 μg/L) samples were highly above the threshold for toxicity. Following supportive treatment and bismuth discontinuation, she made a full recovery within weeks.. Although rare, bismuth encephalopathy should be considered in patients presenting with subacute encephalopathy and myoclonus. This encephalopathy can be subacute even after a chronic exposure. Cessation of bismuth can lead to a complete resolution in weeks.

Topics: Adult; Bismuth; Brain Diseases; Female; Humans; Neurotoxicity Syndromes; Organometallic Compounds; Salicylates

For patients who have had a recent neurosurgical procedure, a visit to the emergency department for encephalopathy may automatically prompt a neurosurgical consult. We present a case of a patient with a history of Chiari malformation decompressed 6 months prior who presented with a 2-week history of slowly progressive altered mental status, headache and imbalance-symptoms consistent with her initial Chiari symptoms, so neurosurgery was consulted. Imaging showed no acute abnormality, but laboratory results revealed metabolic acidosis with high salicylate levels. When reporting medication use, this patient initially left out that she had been taking Goody's powder (845 mg aspirin) for headaches, and long-term use led to metabolic encephalopathy. Despite a recent history of surgery, it is important to keep the differential diagnosis broad especially when there are signs of metabolic derangement.

Topics: Acidosis; Aftercare; Arnold-Chiari Malformation; Brain; Brain Diseases; Diagnosis, Differential; Female; Headache; Humans; Infusions, Intravenous; Mental Disorders; Middle Aged; Neurosurgical Procedures; Salicylates; Sodium Bicarbonate; Tomography, X-Ray Computed; Treatment Outcome

The effect of pargyline, a monoamine oxidase inhibitor, on the generation of hydroxyl free radicals (OH) was investigated using striatal microdialysis. Salicylic acid in Ringer's solution (0.5 nmol microliter-1 min-1) was infused through a microdialysis probe to detect the generation of hydroxyl radicals (OH) as reflected by the formation of dihydroxybenzoic acid (DHBA) in the striatum. When pargyline (100 nmol microliter-1 min-1) was infused in rat brain, the level of 3,4-dihydroxyphenylacetic acid (DOPAC) gradually decreased in a time-dependent manner. In addition, a marked elevation of DHBA was observed. The present results indicate that accumulation of dopamine (DA) in the extracellular fluid elicited by pargyline can be auto-oxidized, which in turn leads (possibly by an indirect mechanism) to the formation of cytotoxic OH free radicals.

Topics: 3,4-Dihydroxyphenylacetic Acid; Animals; Brain; Brain Diseases; Corpus Striatum; Dopamine; Free Radicals; Hydroxyl Radical; Male; Microdialysis; Pargyline; Rats; Rats, Wistar; Salicylates; Salicylic Acid; Time Factors

Topics: Acquired Immunodeficiency Syndrome; Antidiarrheals; Bismuth; Brain Diseases; Diarrhea; Humans; Intestinal Absorption; Male; Middle Aged; Myoclonus; Organometallic Compounds; Salicylates

Factor analysis of admission data from 209 Reye's syndrome patients yielded three factors. Factor 1 was associated with encephalopathy, blood ammonia, creatinine kinase (CK), uric acid and, to a lesser extent, bilirubin. This factor was linked to the encephalopathy and hypermetabolic changes in muscle, possibly prostaglandin-mediated proteolysis. Factor 2 was associated with serum alanine aminotransferase (AlaAT) and aspartate aminotransferase (AspAT), and was identified as a hepatic lesion component. These factors correspond to two etiologic components of Reye's syndrome. Salicylate was only weakly associated with neuropathic and hypercatabolic indicators and not at all associated with the hepatic damage indicators.

Topics: Brain Diseases; Child; Child, Preschool; Coma; Humans; Liver Diseases; Respiratory Tract Infections; Reye Syndrome; Salicylates; Statistics as Topic

Twenty three sporadic cases of Reye's syndrome diagnosed according to widely accepted criteria were seen between 1979 and 1982. The patients were younger than those reported from North America (median age 9 months), girls were twice as common as boys, and the syndrome presented twice as frequently in the summer 6 months. The annual incidence was 1.4 cases/100 000 among children aged less than 4 years. The prodrome consisted of upper respiratory symptoms in 61% of the children and even less specific features in more than 25%; two patients had varicella. Six of the 23 patients presented after a prodrome of less than 24 hours with 'acute collapse', simulating 'near miss' cot death associated with profound hypoglycaemia, and in four of these there was an unfavourable outcome. Intensive care methods including judicious fluid restriction coupled with 'prophylactic' hyperventilation (87%), direct monitoring of intracranial pressure (70%), and barbiturate coma (52%) achieved neurologically intact survival in 74% of patients. Failure to recognise the syndrome early enough or to manage it appropriately resulted in four deaths. To help reduce overall mortality in the United Kingdom paediatricians have a duty to acquaint family doctors and emergency department staff of the earliest clinical features of Reye's syndrome and of the need for immediate hospital referral.

Topics: Blood Glucose; Brain Diseases; Child, Preschool; Consciousness; Diarrhea; Female; Fever; Humans; Infant; Infant, Newborn; Intracranial Pressure; Male; Prognosis; Respiration, Artificial; Respiratory Tract Diseases; Reye Syndrome; Salicylates

Topics: Bismuth; Brain Diseases; Humans; Male; Middle Aged; Organometallic Compounds; Salicylates

Topics: Arthritis, Juvenile; Biopsy; Brain; Brain Diseases; Chemical and Drug Induced Liver Injury; Child; Humans; Liver; Reye Syndrome; Salicylates

Siblings, aged 9 and 7 years, had simultaneous onset of vomiting, disorientation, ataxia, and coma. Both children had prodromal symptoms of upper respiratory tract infections, and had been treated with large doses of aspirin. Laboratory data showed evidence of hepatocellular dysfunction, with an elevated serum ammonia level in one patient; salicylate levels were 50 and 44 mg/100 ml. The child who died had autopsy evidence of cerebral edema and fatty liver. The difficulty in clinically differentiating Reye syndrome from salicylate intoxication is discussed.

Topics: Aspirin; Brain; Brain Diseases; Child; Diagnosis, Differential; Female; Humans; Liver; Liver Diseases; Male; Pharyngitis; Reye Syndrome; Salicylates

Fifty-eight children with Reye's syndrome (RS) confirmed by liver biopsy were treated at the University of Cincinnati between 1963 and 1974. Cases were clustered in the winter and spring with the peak in February and March. These coincided with the occurrence of influenza and, numerically, were associated more closely with influenza B than with influenza A. Six of the 58 cases were associated with chickenpox. Twenty-six children with RS were seen from 1963 to 1971, before the beginning of a systematic epidemiologic and virologic study. Viral infection was documented in either the patient or a contact in only 19% of those studied. Between 1971 and 1973, after the study was initiated, 16 cases of RS were diagnosed and viral infection was confirmed in 56% of these. In 1974, an epidemic of RS occurred during an influenza B epidemic and viral infection was found in either the patient or a contact in 81% of 16 cases. This study demonstrates that an association with viral infection can be proven in the majority of cases of RS when an intensive investigation is undertaken. During this study no significant environmental toxic exposures could be idenified. Most children had taken aspirin and other medications, and seven children had a history of excessive aspirin ingestion.

Topics: Adolescent; Biopsy; Brain Diseases; Chickenpox; Child; Child, Preschool; Disease Outbreaks; Environmental Exposure; Female; Humans; Infant; Influenza, Human; Liver; Male; Ohio; Recurrence; Reye Syndrome; Salicylates; Seasons; Vaccines, Attenuated; Viral Vaccines

A case of hepatotoxicity and encephalopathy (Reye's syndrome?) associated with salicylate therapy is presented and the aetiology of this syndrome is discussed. Hepatotoxicity developed with salicylate serum concentrations not exceeding therapeutic serum levels. The importance of controlling serum salicylate concentration and transaminase activity particularly during the first fourteen days of therapy is emphasized.

Topics: Acute Disease; Adolescent; Aspirin; Brain Diseases; Chemical and Drug Induced Liver Injury; Female; Humans; Liver; Reye Syndrome; Salicylates

Topics: Adolescent; Biopsy; Brain Diseases; Diagnosis, Differential; Female; Hepatitis A; Humans; Liver; Reye Syndrome; Salicylates

Topics: Brain Diseases; Female; Gliosis; Hippocampus; Humans; Hypothalamus; Infant; Infant, Newborn; Infant, Newborn, Diseases; Inferior Colliculi; Male; Maternal-Fetal Exchange; Medulla Oblongata; Neuroglia; Pregnancy; Reticular Formation; Salicylates; Thalamus

Topics: Adipose Tissue; Aspirin; Brain Diseases; Chemical and Drug Induced Liver Injury; Fatty Liver; Humans; Infant; Kidney Diseases; Peritoneal Dialysis; Salicylates

Topics: Adult; Brain Diseases; Humans; Male; Meninges; Neurologic Manifestations; Psoriasis; Salicylates

Topics: Brain Diseases; Child; Female; Humans; Salicylates

Topics: Aspirin; Brain Diseases; Carbohydrate Metabolism; Coma; Fatty Liver; Heart Diseases; Humans; Kidney Diseases; Salicylates; Toxicology; Viscera

Topics: Animals; Benzoates; Bilirubin; Blood Chemical Analysis; Brain; Brain Diseases; Cerebrospinal Fluid; Encephalomyelitis; Jaundice; Kernicterus; Pyrroles; Rabbits; Research; Salicylates

Topics: Brain; Brain Diseases; Humans; Rheumatic Diseases; Rheumatic Fever; Salicylates; Sodium Salicylate