Core clinical cases surgery and surgical specialties 2nd Edition PDF
Core clinical cases surgery and surgical specialties 2nd Edition PDF about 1916 and 1927 a puzzling illness appeared and swept around the world. Dr von Economo first described encephalitis lethargica (EL), which simply meant inflammation of the brain that makes you tired’. Younger people, especially women, seemed to be more vulnerable but the disease affected people of all ages. People with EL developed a ‘sleep disorder’, fever, headache and weakness, which led to a prolonged state of unconsciousness. The EL epidemic occurred during the same time period as the 1918 influenza pandemic, and the two outbreaks have been linked ever since in the medical literature.
Some confused it with the epidemic of Spanish flu at that time while others blamed weapons used in World War I Encephalitis lethargica (EL) was dramatized by the film Awakenings (book written by Oliver Sacks, who is an eminent Neurologist from New York), starring Robin Williams and Robert
De Niro. Professor Sacks treated his patients with L-dopa, which temporarily awoke his patients, giving rise to the belief that the condition was related to Parkinson’s disease.
Since the 1916–1927 epidemic, only sporadic cases have been described. Pathological studies have revealed an encephalitis of the midbrain and basal ganglia, with lymphocyte (predominantly plasma cell) infiltration. Recent examination of archived EL brain material has failed to demonstrate influenza RNA, adding to the evidence that EL was not an invasive influenza encephalitis. Further investigations found no evidence of viral encephalitis or other recognized causes of rapid-onset parkinsonism.
MRI of the brain was
normal in 60% but showed inflammatory changes localized to the deep grey matter in 40% of patients.As late as the end of the 20th century, it seemed that the possible answers lay in the clinical presentation of the patients in the 1916–1927 epidemic. It had been noted by the clinicians at that time that the CNS disorder had presented with pharyngitis.
Core clinical cases surgery and surgical specialties 2nd Edition PDFo the possibility of a post-infectious autoimmune CNS disorder similar to Sydenham’s chorea, in which group A β-hemolytic streptococcal antibodies cross-react with the basal ganglia and result in abnormal behaviour and involuntary movements. Anti-streptolysin-O titres have subsequently been found to be elevated in the majority of these patients. It seemed possible that autoimmune antibodies may cause remitting parkinsonian signs subsequent
to streptococcal tonsillitis as part of the spectrum of post-streptococcal CNS disease.
Could it be that the 80-year mystery of EL has been solved relying on the patient’s clinical history of presentation, rather than focusing on expensive investigations? More research in this area will give us the definitive answer.
Core clinical cases surgery and surgical specialties 2nd Edition PDFo is not dissimilar to the controversy about the idea that streptococcal infections were aetiologically related tor heumatic fever.