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A Case of Idiopathic Normal Pressure Hydrocephalus Presenting as Vascular Parkinsonism
Talal Meshal Alumri,
Rawan Zeinelabdein Mahgoub,
Alawi Aqel Al-Attas
Issue:
Volume 8, Issue 1, March 2020
Pages:
1-5
Received:
24 November 2019
Accepted:
23 December 2019
Published:
6 January 2020
Abstract: Idiopathic normal pressure hydrocephalus (iNPH) is the most common form of hydrocephalus in adults. It is characterized by dilated ventricles and the Hakim triad, which consists of gait disturbance, cognitive impairment, and urinary incontinence. The gold standard treatment for iNPH is shunting, but frequent lumbar punctures (LPs) are helpful for diagnosis and predicting shunting outcome and is considered the treatment of choice when shunting is not available. One condition with similar presentation to iNPH is Vascular parkinsonism (VP), which is characterized by an established relationship between cerebrovascular diseases and the clinical symptoms of Parkinson’s disease (PD). VP patients usually present with lower-body parkinsonism, including impaired gait, instability, difficulty with maintaining gait, and frequent episodes of freezing. VP is managed by levodopa followed by transcranial magnetic stimulation then vitamin D. LPs are less effective for VP than iNPH. Our case report shows that iNPH may be misdiagnosed with VP. Here we present a case of a 71-year-old male with a history of previous lacunar strokes who was admitted for possible vascular parkinsonism. Eight months prior to coming to the hospital, he developed gait disturbances; and four months later, he developed urinary symptoms. Upon examination, his gait initiation was hesitant, wide-based, and magnetic with decreased arm swing. The patient scored 20 out of 30 points on the Montreal Cognitive Assessment. The only cranial nerve involvement was a diminished gag reflex. Brain magnetic resonance imaging revealed symmetrically enlarged ventricles with mildly dilated sulci. Routine laboratory testing was normal. Two months of treatment with levodopa did not improve his symptoms but draining 50 mL of cerebrospinal fluid (CSF) has dramatically improved his gait. A final diagnosis of iNPH was therefore made. To conclude, iNPH and VP are two manageable diseases but the differential diagnosis between them is particularly challenging due to similar clinical and neuroradiological features. We suggest further studies to establish supporting guidelines by using neuroradiological or neurophysiological biomarkers which may help physicians in ameliorate diagnostic accuracy between the two entities.
Abstract: Idiopathic normal pressure hydrocephalus (iNPH) is the most common form of hydrocephalus in adults. It is characterized by dilated ventricles and the Hakim triad, which consists of gait disturbance, cognitive impairment, and urinary incontinence. The gold standard treatment for iNPH is shunting, but frequent lumbar punctures (LPs) are helpful for d...
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The Dynamic Modell of Sleep Disorders - A Therapy-Tool for Cognitive Behavioral Therapy for Non-organic Sleep Disorders
Issue:
Volume 8, Issue 1, March 2020
Pages:
6-11
Received:
9 December 2019
Accepted:
25 December 2019
Published:
21 January 2020
Abstract: The dynamic model of sleep disorders was carried out in the framework of the study of the dynamic of sleep disorders. On the basis of this circulation model, deficient sleep areas can be uncovered and a disturbance model can be developed together with the patients. Afterwards an individuell therapeutic rationale for breaking out of the "vicious circle" of sleep disturbances can be created. The study was a randomized controlled study. Test subjects suffered from non-organic insomnia. Also person suffering from psychological comorbidities were included. A total of 158 records were included in the calculations. The 5 expected factors "disturbed sleep", "fatigue during the day", "reduced performance", "worries" and "tension" could be extracted by factor analysis. Thus the "dynamic model of sleep disorders" could be mapped on the basis of the data of the SLEEP Quality Inventory. Overall, it can be said that all theoretically expected factors could be extracted on the basis of the factor analysis of the data. However, some factors showed weaknesses regarding a clean load of items. The following practical application of the model and the intervention showed that the model depicts only 2 levels of the behaviour and experience of the affected persons, the "psychophysiology and cognitions" as well as the "homeostatic principle". A third level of explication, "emotional dysregulation" has to be regarded in future.
Abstract: The dynamic model of sleep disorders was carried out in the framework of the study of the dynamic of sleep disorders. On the basis of this circulation model, deficient sleep areas can be uncovered and a disturbance model can be developed together with the patients. Afterwards an individuell therapeutic rationale for breaking out of the "vicious cir...
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Influence of External Opinions on an Individual Choice in Conditions of Uncertainty: Experiment and Laser-like Model
Nikita Solovyev,
Dmitrii Gorbatov,
Leonid Soms
Issue:
Volume 8, Issue 1, March 2020
Pages:
12-17
Received:
9 December 2019
Accepted:
15 January 2020
Published:
4 February 2020
Abstract: A psychological experiment for quantitative evaluation of degree of external opinions influencing the choice of a participant in conditions of uncertainty was suggested. A computer-driven experiment was performed, with 256 participants. In the experiment participating volunteers were shown a series of images accompanied by two not-evident alternative answers for a question “what is this?”, and were prompted to make their choice under different condition. These conditions were: (i) a free individual choice (control group); (ii) a choice when each participant sees the results of real answers of other subjects of his experimental group (“true” group); (iii) a choice when the participants see false response promptings generated by a special computer program (“false” groups). Quantitative results were obtained showing an influence of “psychological pressure” to a frequency of occurrence of alternative answers. A laser-like model is presented for energy levels in a brain and for decision making in such conditions. The laser-like model is based on a usual system of kinetic equations describing dependence of population of excited and ground levels (before and after the answer, respectively), and the number of different answers (zero known answers for control group, number of real or manipulated answers for "true" and "false" groups). By fitting parameters of the model to results of the experiment, numerical values of parameters of the model (“coefficients of stimulating influence” analogues to Einstein coefficients Bik for stimulated emission of radiation) were determined.
Abstract: A psychological experiment for quantitative evaluation of degree of external opinions influencing the choice of a participant in conditions of uncertainty was suggested. A computer-driven experiment was performed, with 256 participants. In the experiment participating volunteers were shown a series of images accompanied by two not-evident alternati...
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The Emotional Impact of Mode of Delivery in Cameroonian Mothers: Comparing Vaginal Delivery and Caesarean Section
Georges Pius Kamsu Moyo,
Nadège Djoda
Issue:
Volume 8, Issue 1, March 2020
Pages:
18-21
Received:
7 February 2020
Accepted:
25 February 2020
Published:
24 March 2020
Abstract: Background: The rate of caesarean section delivery seems to be continuously increasing worldwide over the years. The safety of this method of delivery as far as mothers’ mental state is concerned compared to vaginal delivery has been the subject of a number of studies. This study aimed at evaluating the emotional state of newly delivered women after various mode of delivery so as to enable comparison in our context. Method: A cross sectional analysis of two consecutive cohorts of newly delivered women were successively carried out from January 2014 to April 2015 at the Yaoundé Gynaeco-Obstetric and Paediatric hospital (YGOPH). The first group comprised 214 women with vaginal delivery while the second group was made of 321 women who had delivered through caesarean section. Women emotional and psychological impairments were evaluated by screening for the baby blues, which is a mild, transient and precocious depressive state of the postpartum. The Kennerley and Gath blues questionnaire which was used as the screening tool is the most approved and standardized scale for diagnosing the baby blues during the first 10 days of postpartum. Demographic information, medical, obstetrical, psychosocial and neonatal data were equally obtained. Results: The incidence of emotional instability in women with vaginal delivery was 36.9% [CI (31.8%, 42.4%)] while that of the group of women who delivered through caesarean section was 33.3% [CI (28.2%, 38.8%)]. Conclusion: Emotional instability occurred in both groups of women after vaginal delivery and caesarean section, but was less frequent after caesarean section, though not statistically significant. Therefore, psychic impairments that may occur during postpartum is bound to the delivery process as a whole and not just specific to its mode or type. However, the prevention of post-traumatic stress which may be associated with all forms of delivery, mainly by psychological support and reduction of all forms of pain should be done, regardless of the mode of delivery so as to prevent psychic complication.
Abstract: Background: The rate of caesarean section delivery seems to be continuously increasing worldwide over the years. The safety of this method of delivery as far as mothers’ mental state is concerned compared to vaginal delivery has been the subject of a number of studies. This study aimed at evaluating the emotional state of newly delivered women afte...
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Relationship Between the Baby Blues and Postpartum Depression: A Study Among Cameroonian Women
Georges Pius Kamsu Moyo,
Nadège Djoda
Issue:
Volume 8, Issue 1, March 2020
Pages:
22-25
Received:
9 February 2020
Accepted:
25 February 2020
Published:
24 March 2020
Abstract: Background: The baby blues and postpartum depression are two of the three major entities of psychic disorders related to the puerperium. There exists a chronological distinction of these conditions which equally vary according to severity and prognosis. Objectives: This study aimed at investigating a possible relationship between the baby blues and postpartum depression in newly delivered Cameroonian women. Method: A retrospective study with case-control design was carried out at the Yaoundé Gyneco-Obstetric and Paediatric Hospital (YGOPH) over a period of 6 months on a sample of 214 newly delivered women. The group of cases consisted of women diagnosed with postpartum depression, while the group of controls consisted of women without postpartum depression. Subjects that were earlier checked for baby blues using the Kennerley and Gath blues questionnaire during the 1st week following delivery, were reassessed between the 4th and 6th weeks to diagnose postpartum depression. The Edinburgh Postnatal Depression Scale (EPDS) was used to separate various groups and a retrospective cross checking was made. Results: We recruited 214 newly delivered women, among which 50 (23.36%) manifested postpartum depression while 164 (76.63%) women did not. Up to 31 (62%) of women with postpartum depression had earlier manifested the baby blues. After multivariate analysis of risk factors, the baby blues appeared as one of the independent predictive factors for postpartum depression (OR=3.52, p=0.00). Conclusion: The baby blues was not only a risk factor, but also an independent predictive factor for the manifestation of postpartum depression in this survey. Therefore, the prevention and early management of the baby blues during the perinatal period may help to prevent the onset of postpartum depression.
Abstract: Background: The baby blues and postpartum depression are two of the three major entities of psychic disorders related to the puerperium. There exists a chronological distinction of these conditions which equally vary according to severity and prognosis. Objectives: This study aimed at investigating a possible relationship between the baby blues and...
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