Eistein’s Brain: The myth

คนฉลาดอย่าง Albert Eistein หลังจากที่เสียชีวิตแล้วก้ได้มีนักวิทยาศาสตร์ ได้นำสมองของ Eistein ไปผ่าดู ว่ามีความพิเศษอย่างไร ที่ทำให้ ฉลาดขนาดนั้น พบว่า ที่ Broadman area 39 นั้นมีอัตราส่วนของ Neuron cell และ Glia cell ที่น้อยกว่าปกติอย่างมีนัยสำคัญ นั่นแสดงว่า การที่ Eistein มีความฉลาดนั้น มีความสำคัญกับ glia cell ในสมองมากกว่า

Paper ที่สำคัญได้แก่

  • On the brain of a scientist: Albert Einstein Experimental Neurology Volume 88, Issue 1, April 1985, Pages 198-204 Marian C. Diamond*, Arnold B. Scheibel, a, Greer M. Murphy Jr. and Thomas Harvey1

PDF (476 K)

  • Albert Einstein’s dyslexia and the significance of Brodmann Area 39 of his left cerebral cortex

    Medical Hypotheses Volume 37, Issue 2, February 1992, Pages 119-122 S.S. Kanthaa


    Video ที่น่าสนใจเป็นสารคดี เรื่อง Brain of Eistein

    httpv://www.youtube.com/watch?v=JNOKT-xv7Dw


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Epilepsy in Famous Persons

เคยไปฟัง Lecture ที่ประเทศ Greece ครับ เป็นเรื่อง Neurology in Famous Persons ครับ เป็นการเล่าแต่ละช่วงเวลาว่า มีบุคคลสำคัญคนไหนเสียชีวิตด้วย  Neurological disorder บ้างครับ เห็น web นี้ก็น่าสนใจดีครับ  Review Epilepsy in Famous Persons ครับ

Famous People With Epilepsy Include:

Hugo Weaving – Hugo Wallace Weaving (born 4 April 1960) is a film and stage actor, as well as a voice actor. Weaving was born in Nigeria. He spent his childhood in South Africa and then moved to the United Kingdom in his teens. He moved to Australia in 1976, where he attended Sydney’s Knox Grammar School. Weaving later graduated from Australia’s National Institute of Dramatic Art in 1981. When he was 13 years old, Weaving was diagnosed with epilepsy. Due to the prospect of seizures, Weaving does not drive cars. He has never married and lives with his partner Katrina Greenwood.

Vincent van Gogh – (1853 – 1890) Vincent Van Gogh was a passionate artist who strongly believed that all expressions should be expressed through colors. He was heard saying that all he ever wanted to do with his life was paint all that came to his mind. He also said that when he would be deceased he would look back at his life and cry for the paintings that he could of created. Being the loving and creative man that he was his epilepsy had once caused him to run after his friends with an open razor, he ended up cutting his own ear lobe off. He eventually shot himself “For the good of all” leaving behind all the colorful paintings he had made.

Sir Isaac Newton – (4 January 1643 – 31 March 1727) A very important scientist who is responsibe for founding the three laws of motion along with studies concerning Universal Gravitation. He studied many scientific disciplines but mainly stayed inside the field of mechanics. It is said that Newton had mainly discovered gravity by examining a falling apple, that would have been one of the major reasons for him to start his researches in the subject. Was thought by many a product of psychosis but he may just have been in his right mind.

Neil Young – (born November 12, 1945, Toronto, Ontario) A musician known for his meaningful lyrics and also a spokesman for environmental issues, Neil Young has been labeled one of the greatest guitarists of his time. When he was young his parents divorced and Neil was confronted with many diseases simultaneously. The obstacles in which he faced included Epilepsy, Polio and Diabetes which he did eventually all overcome. Since then he has been a peacekeeper through music and is ever present in the fight for justice and all that has to do with a more peaceful world.

Napoleon Bonaparte – (15 August 1769–5 May 1821) An Italian General with many victories, also later becoming 1st consul of France. He played a great role in many wars and was a shining sword of honor for all of the French. Since his youth Napoleon had always given all his efforts to rise in military grades until he finally became emperor seated on his imperial throne. Many books today claim that Napoleon Bonaparte might have suffered from epilepsy throughout his lifetime. Although many have stood up to say that there is no valid proof and that it is but a myth.

Agatha Christie – Dame Agatha Mary Clarissa, Lady Mallowan, DBE (15 September 1890 – 12 January 1976), commonly known as Agatha Christie, was an English crime fiction writer. She also wrote romance novels under the name Mary Westmacott, but is best remembered for her 80 detective novels and her successful West End theatre plays. Agatha Christie is world famous for her brilliantly crafted mysteries. During the 1920s and 1930s, she created the enduring detectives Hercule Poirot and Miss Marple. The details of Christie’s personal life, however, have rarely been documented.

Charles Dickens – Charles John Huffam Dickens, FRSA (17 February 1812 – 9 June 1870), pen-name “Boz”, was the foremost English novelist of the Victorian era, as well as a vigorous social campaigner. The Victorian author of such classic books as A Christmas Carol and Oliver Twist had epilepsy, as did several of the characters in his books. The medical accuracy of Dickens’s descriptions of epilepsy has amazed the doctors who read him today. Through some characters in his novels, Charles Dickens recorded observations on the nature of epileptic seizures, their causes and provocation, and their consequences. Three of his main characters, Monks, Guster, and Bradley Headstone, had seizures which Dickens realistically described.

Alexander the Great – Alexander the Great (July 20, 356 BC – June 10, 323 BC), also known as Alexander III, was an ancient Greek king (basileus) of Macedon (336–323 BC). Alexander died after twelve years of constant military campaigning, possibly as a result of malaria, poisoning, typhoid fever, viral encephalitis or the consequences of alcoholism. Born in Pella, capital of Macedon, Alexander was the son of King Philip II of Macedon and of his fourth wife Olympias, an Epirote princess. Alexander the Great had epilepsy, however at during his time epilepsy was known as “the sacred disease” because of the belief that those who had seizures were possessed by evil spirits or touched by the gods and should be treated by invoking mystical powers.

Danny Glover – (Born July 22, 1947) A great actor in both Lethal Weapon with Mel Gibson and Predator 2. Danny Glover suffered dyslexia at school when he was younger and the school staff would label him retarded. Danny Glover also had epilepsy and at an appearance on the Rosie O’Donnell Show told how he had developed epilepsy at the age of 15, and in one cross-country trip with his family had experienced six seizures in a row.

Alfred Nobel – Alfred Bernhard Nobel (October 21, 1833, Stockholm, Sweden – December 10, 1896, Sanremo, Italy) was a Swedish chemist, engineer, innovator, armaments manufacturer and the inventor of dynamite. By the time of his death he held more than 350 patents and controlled factories and laboratories in 20 countries. William Gordon Lennox wrote that “Nobel was subject to migraines and convulsions from infancy.” Nobel had epileptic seizures as a young child, which later made him write of convulsions and agony in a poem. The foundations of the Nobel Prize were laid in 1895 when Alfred Nobel wrote his last will, leaving much of his wealth for its establishment. Since 1901, the prize has honored men and women for outstanding achievements in physics, chemistry, medicine, literature, and for work in peace.

Michelangelo – (March 6, 1475 – February 18, 1564) The sculptor of many of the most renowned sculptures of all times. Michaelangelo was a respected renaissance man only rivaled by Leonardo Da Vinci. Striving to excel in numerous disciplines he is also responsible for the paintings inside many famous cathedrals and the construction of some of the most respected buildings. Projects such as St.Peters basilica, basilica of San Lorenzo and the Medici Chapel which will forever leave Michaelangelo and his works a legend in all history.

Leonardo Da Vinci – (April 15, 1452 – May 2, 1519) The man responsible for some of the greatest religious paintings in history Leonardo Da Vinci excelled not only in painting but in numerous other disciplines as well. He was a Tuscan polymath: architect, botanist, musician, scientist, mathematician, engineer, inventor, anatomist, painter, sculptor, and writer. His most famous work is definetely the paintings of both Mona Lisa and the Last Supper of Jesus Christ which have both been the most reproduced religious paintings of all times.

Julius Caesar – (July 13, 100 BC – March 15, 44 BC), One of the most influential men in world history, Caesar participated in the army with distinction constantly excelling in leadership skills. He had a ruthless personality and thought of himself as far superior. A perfect example of this is when Julius had gotten captured by pirates, the pirates demanded a ransom of twenty talents of gold. Julius then laughed and demanded that they ask for fifty, he then promised them that he would chase them down once freed. Which he did, raising a fleet to chase the pirates and capture them. He then crucified them under his law once he had caught up to them.

Edgar Allen Poe – (January 19, 1809 – October 7, 1849) Edgar Allen Poe is a member of the Romantic Movement, mostly as an author and literacy critic. He has written books and short stories and he is best known for his macabre and mysteries, he is the one who invented the Detective-Fiction genre. For many years people have referred his mental problems to alcohol and drug abuse but, today many believe that he was not well diagnosed. Many now believe he may have been epileptic which would sometimes explain his frequent confusion.

Aristotle – (384 BC – 322 BC) Aristotle was a Greek philosopher writing on many different subjects including zoology, biology, ethics, government, politics, physics, metaphysics, music, poetry and theater. He was also a great teacher for Alexander the Great. Aristotle was one of the first to point out that epilepsy and genius were often closely connected. He found that the seizure disorders may have the ability to increase brain activity in specific places and maybe also enhance a persons natural abilities to a certain extent.

Theodore Roosevelt – 26th President of the U.S. (October 27, 1858 – January 6, 1919) Roosevelt was a soldier , historian, explorer, naturalist, author, and Governor of New York later becoming the President of the United States at the age of 42 years old. He was well known for having a vast range of objectives and achievements, all with an energetic determination and a hard ”cowboy” persona. He was subject to epileptic seizures, his eyesight was bad, and he also suffered from asthma, but was still a man of courage and strength appreciated by many.

Alfred the Great – (c. 849 – 26 October 899) Alfred the Great was king of the Anglo-Saxon kingdom of Wessex from 871 to 899. In his life Alfred highly valued education and wanted his kingdom to be rich with knowledge. He improved his Kingdom’s law as well as it’s military structure. Although Alfred had epilepsy it did not keep him from doing good for his kingdom and making one of the best books of laws of his time. He was very catholic and by the time of his death he had helped increase the quality and amount of churches and schools from all over his lands.

Bud Abbott – (October 2, 1895 – April 24, 1974) Bud Abott was an American producer, comedian and actor. Many times did he try to hide the fact that he was suffering from epilepsy. His whole life he had been subject to the disease and many times he tried to control it with alcohol. His alcoholism was getting worst as time went by and he eventually went bankrupt due to tax issues with the IRS. Short after going bankrupt Bud lost his longtime partner Lou Costello when he died from heart damage. Bud then tried to take another shot at his career with Candy Candido but was not successful. Bud Abott died of cancer on April 24, 1974 after suffering from two consecutive strokes.

Lewis Carrol – (27 January 1832 – 14 January 1898) was an English author, photographer, mathematician, Anglican clergyman and logician. He has written several renowned books and his work has inspired many modern artists. His facility in wordplay would attract not only children but also some of the elite readers. He has written books describing minor epilepsy attacks and the dream worlds that some of them may bring a person to. Like the sensation of falling in a hole and everything around getting smaller or bigger. Not hearing or seeing the same and feeling as if your entire body is changing in a fraction of a second.

Richard Burton – (November 10, 1925 – August 5, 1984) Being at one time the highest paid Hollywood actor, Richard was well known for his distinctive voice. He was crippled all his life by epilepsy and was extremely deep into alcoholism to try and prevent the seizures. Eventually this led him to manic depression but he would never go to see a doctor because he did not trust them one bit. At times he seemed to be more scared of being crazy then having epilepsy. Throughout his entire life he had never went to get diagnosed by a doctor.

George Frederick Handel – (Friday 23 February 1685 – Saturday 14 April 1759) was a German-born Baroque composer who is famous for his operas, oratorios and concerti grossi. Since the 1960s, with the revival of interest in baroque music, original instrument playing styles, and the prevalence of countertenors who could more accurately replicate castrato roles, interest has revived in Handel’s Italian operas, and many have been recorded and performed onstage.

Charles V of Spain – Charles V (24 February 1500 – 21 September 1558) was ruler of the Holy Roman Empire from 1519 until his abdication in 1556 and also ruler of the Spanish realms from 1516 until 1556. Charles V suffered from epilepsy and from an enlarged lower jaw. He struggled to chew his food properly and consequently experienced bad indigestion for much of his life. also He suffered from joint pain, presumed to be gout, according to his 16th century doctors. In his retirement, he was carried around the monastery of St. Yuste in a sedan chair. He was greatly interested in clocks, instructing his servants to take them apart and reassemble them in his presence.

Pythagoras – Pythagoras was the first man to call himself a philosopher, ”lover of wisdom” and was the most able philosopher among the Greeks. He was know as ”the father of numbers” and greatly contributed to mathematics. It is even said that many of his ideas had directly influenced Plato. Many of his teachings were only passed down by some of his students, none of his work had seen the day and none can be sure of exactly how wise Pythagoras was. Although he had made huge contributions to both philosophy and religion in the late 6th century BC.

Hannibal – Carthaginian military commander and tactician, later also working in other professions, who is popularly credited as one of the finest commanders in history. He lived during a period of tension in the Mediterranean, when Rome (then the Roman Republic) established its supremacy over other great powers such as Carthage, Macedon, Syracuse, and the Seleucid empire. His most famous achievement was at the outbreak of the Second Punic War, when he marched an army, which included war elephants, from Iberia over the Pyrenees and the Alps into northern Italy.

Hector Berlioz – Louis Hector Berlioz (December 11, 1803 – March 8, 1869) was a French Romantic composer, best known for his compositions Symphonie fantastique and Grande Messe des morts (Requiem). Berlioz made great contributions to the modern orchestra with his Treatise on Instrumentation and by utilizing huge orchestral forces for his works, sometimes calling for over 1,000 performers.

James Madison – During his teens and early twenties, Madison complained of a voice impairment. This was a functional handicap that prevented his public speaking until age 30. Madison believed he would “ have a short life due to the illness he believed was epilepsy.

Lord Byron – Baron Byron, of Rochdale in the County Palatine of Lancaster, is a title in the Peerage of England. It was created in 1643, by letters patent, for Sir John Byron, a Cavalier general and former Member of Parliament. Some biographies suggest that Lord Byron experienced epileptic seizures and in various passages he writes of symptoms reminiscent of epilepsy.

Louis XIII of France – (September 27, 1601 – May 14, 1643) ruled as King of France and Navarre from 1610 to 1643. Louis XIII ascended to the throne in 1610, at the age of eight and a half, upon the assassination of his father.

Margaux Hemingway – (February 16, 1955 – July 1, 1996) was an American model and film actress who appeared in several movies. She was born in Portland, Oregon, the sister of actress Mariel Hemingway and the granddaughter of writer Ernest Hemingway. She struggled with a variety of disorders in addition to alcoholism, including bulimia and epilepsy.

Martin Luther – (November 10, 1483–February 18, 1546) was a German monk, theologian, and church reformer. Luther’s theology challenged the authority of the papacy by holding that the Bible is the sole source of religious authority and that all baptized Christians are a priesthood of believers. Luther had many documented illnesses, but any recurrent attacks were probably due to Ménière’s disease.

Nicolo Paganini – (October 27, 1782 – May 27, 1840) was an Italian violinist, violist, guitarist, and composer. He is widely considered to be one of, if not the greatest violinist who ever lived and it is believed to he had epilepsy.

Paul I of Russia – Pavel (Paul) I Petrovich of Russia (October 1, 1754 – March 23, 1801) was the Emperor of Russia between 1796 and 1801. During his infancy, Paul was taken from the care of his mother by the Empress Elizabeth, whose ill-judged fondness allegedly injured his health. As a boy, he was reported to be intelligent and good-looking. His pugnacious facial features in later life are attributed to an attack of typhus, from which he suffered in 1771.

Peter Tchaikovsky – Russian composer of the Romantic era. Tchaikovsky, is believed to have had epilepsy. Pyotr began piano lessons at age five with a local woman, Mariya Palchikova within three years he read music as well as his teacher. Tchaikovsky died on November 6, 1893, nine days after the premiere of his Sixth Symphony, the Pathétique. His death has traditionally been attributed to cholera, most probably contracted through drinking contaminated water several days earlier.

Peter the Great – Peter I the Great or Pyotr Alexeyevich Romanov (9 June 1672 – 8 February 1725) Both Peter’s hands and feet were small, and his shoulders narrow for his height; likewise, his head was also small for his tall body. Added to this were Peter’s facial tics, and, judging by descriptions handed down, he may have suffered from petit mal, a form of epilepsy.

Robert Schumann – (June 8, 1810 – July 29, 1856) was a German composer, aesthete and influential music critic. He is one of the most famous Romantic composers of the 19th century.

Sir Walter Scott – (15 August 1771 – 21 September 1832) was a prolific Scottish historical novelist and poet popular throughout Europe during his time. Walter Scott survived a childhood bout of polio in 1773 that would leave him lame. In 1778 Scott returned to Edinburgh for private education to prepare him for school, he was now well able to walk and explore the city as well as the surrounding countryside. His reading included chivalric romances, poems, history and travel books.

Socrates – (470 BCE–399 BCE) was a Classical Greek philosopher. He is best known for the creation of Socratic irony and the Socratic Method, or elenchus. Socrates developed the practice of a philosophical type of pedagogy, in which the teacher asks questions of the students to elicit the best answer, and fundamental insight, on the part of the student.

Truman Capote – born Truman Streckfus Persons in New Orleans, Louisiana (30 September 1924 – 25 August 1984) was an American writer whose stories, novels, plays, and non-fiction are recognized literary classics, including the novella Breakfast at Tiffany’s and In Cold Blood. Capote once said, “I don’t care what anybody says about me, as long as it isn’t true”. John Knowles says that Capote “induced epilepsy himself by abusing his nervous system with drugs and booze” An autopsy showed Mr. Capote had an infection in his legs and signs of epilepsy, but no conclusive information was disclosed about the cause of the author’s death.

Chanda Gunn – (born January 27, 1980 in Huntington Beach, California) is an American ice hockey player. She won a bronze medal at the 2006 Winter Olympics. As a female athlete with temporal lobe epilepsy, Chanda Gunn faces each day with a zest for life and the determination to live each day to its fullest. Gunn has received numerous awards, she is the first player ever to be named a finalist for both the Patty Kazmaier Award for the nation’s best women’s college hockey player and the Humanitarian Award for college hockey’s finest citizen.

Dj Hapa – Diagnosed with epilepsy at age 17, HAPA was initially told he would not be able to attend college due to his condition. He attended UCLA on a Regents scholarship and today is the executive director of the Scratch DJ Academy.

Reference: http://www.disabled-world.com/artman/publish/epilepsy-famous.shtml

A 14-year-old girl: ear discharge and double vision(eMedicine)

A 14-Year-Old Girl With Purulent Ear Discharge and Double Vision
MRI scan
BACKGROUND
A 14-year-old girl presents to the ED with a 2-week history of ear pain and discharge. Swelling and tenderness behind the left ear lobe, with discharge from the ear, are noted.What is the diagnosis?


HINT: Correlate the ear discharge with the physical and MRI findings.

Case#2: ผมล้วงกระเป๋าแล้วมันชาน่องครับ

ผู้ป่วยชายไทยคู่(เอก เป็นนามสมมุติ) อายุ 42 ปี อาชีพ ค้าขาย

ในเช้าวันที่อากาศร้อนจัด เอกสะดุ้งตื่นตอนสาย เนื่องจากเมื่อคืนดื่มหนักไปหน่อย ตื่นเช้ายังไม่สร่างเมาดี เอกรู้สึกชาที่ขาด้านข้างขวาเล็กน้อย อืม สงสัยเมื่อคืนดื่มหนักไปหน่อยเลยทับาตัวเองเข้า เอกไม่สนใจอาการชาคิดว่าอาการคงหายไปเอง

2 วันต่อมา อาการชายังคงเป็นอยู่ จริง ๆแล้วอาการชาที่เป็นก้อไม่ได้ทำให้การดำเนินชีวิตเปลี่ยนไปสักเท่าไหร่ เพียงแต่ว่าเอกเป็นชายที่ชอบล้วงกระเป๋า ดังนั้นทุก ๆครั้งที่ล้วงกระเป๋า ขาข้างขวาของเอกจะไม่รู้สึกถึงมือที่ได้ล้วงไปแล้ว ด้วยความกังวล จึงไปพบแพทย์ที่ รพ.

แพทย์ได้ตรวจร่างกายพบว่า ต้นขาด้านข้างของเอก ไม่สามารถรับรู้ถึงความรู้สึกความคมของไม้จิ้มฟันที่ทิ่มลงไปได้ ดังรูป

ดูตามรอยที่กากบบาทที่โคนขาด้านขวาคือ area ที่เอกสูญเสียความรู้สึกเจ็บ

Question: จงให้การวินิจฉัยอาการชาดังกล่าว และบอกสาเหตุของอาการดังกล่าว

Visual hallucination in Clinical Practice

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คุณเคยเจอผู้ป่วยที่มาด้วย Visual hallucination หรือเปล่า? แพทย์ส่วนใหญ่มักเข้าใจว่า ผู้ป่วยที่มาพบแพทย์ด้วย visual hallucination เป็น psychosis หรือ delirium ซึ่งเป็นภาวะทางจิตเวช แต่คำถามคือมีภาวะอื่น ๆที่เป็นไปได้อีกหรือไม่ เช่น ภาวะทาง medical condition หรือ neurological condition

คำว่า Hallucination คือ การรับรู้สิ่งของหรือความรู้สึกทางประสาทสัมผัสต่าง ๆโดยที่ไม่ได้มีสิ่งกระตุ้นนั้นจริง ๆ ภาวะ visual hallucination ก็คือการที่มองเห็นโดยที่ไม่มี object นั้น ๆซึ่งส่วนใหญ่แพทย์มักคิดว่าเป็น ภาวะทางจิตเวชแต่จริง ๆแล้ว visual hallucination สามารถเป็นได้หลายระบบของความผิดปกติ ได้แก่ psychiatric condition, neurological condition and opthalmological condition

หากแบ่ง สาเหตุของ visual hallucination ตาม mechanism ของการเกิดแล้วสามารถแบ่งได้เป็นกลุ่ม ๆดังนี้

 

  1. psychophysiologic (i.e., as a disturbance of brain structure), 
  2. psychobiochemical (as a disturbance of neurotransmitters)
  3. psychodynamic (as an emergence of the unconscious into consciousness). 

 

Visual hallucinations สามารถเกิดได้จากทั้ง 3 processes, หรือเกิดร่วม ๆกันได้ทั้ง 3 process 

ในที่นี้จะกล่าวถึงสาเหตุที่พบได้บ่อยของ visual hallucination

 

  • Psychosis(schizophrenia/schizoaffective disorder)

visual hallucination เป็น criteria หนึ่งของการวินิจฉัย Psychosis ร่วมกับอาการทาง Psychosis อื่นๆ แต่กระนั้น visual hallucination สามารถพบร่วมกับอาการความผิดปกติทางจิตเวชอื่น ๆได้เช่น Major depressive disorder and Bipolar disorder) 

สักษณะของ visual hallucination in psychosis ได้แก่ vivid scenes(ผมเรียกว่า เห็นกันจะ ๆ เห็นกัน เนื้อ ๆหนัง ๆ) เป็นเรื่องเป็นราว และมี reaction ต่อ visual hallucination นั้น ๆ ได้แก่ fear, pleasure บางคร้ังเกิดร่วมกับ hallucination ชนิด อื่น ๆได้ เช่น auditory hallucination, tactile hallucination เป็นต้น

  • Delirium

เป็น syndrome ที่ involve acute disturbance of consciousness ร่วมกับอาการดังต่อไปนี้ การเสีย attention(attention deficit), fluctuation of consciousness and clouding of consciousness

  • Dementia

Dementia สามารถเกิด visual hallucination ได้หลายโรค ที่พบได้บ่อยได้แก่ 

Dementia with Lewy bodies(DLB) มีลักษณะ dementia, fluctuation of consciousness and visual hallucination , parkinsonism features

Alzheimer’s disease เป็นสักษณะ progressive memory loss ในระยะหลังมีอาการ ทางจิตเวชร่วมด้วยได้

  • Charles Bonnet syndrome

คือกลุ่มอาการที่เกิด visual hallucination ในผู้ป่วยที่มี visual impairment of any causes

ลักษณะของ visual hallucination จะมีรายละเอียดชัดเจน โดยผู้ป่วยที่มีอาการจะไม่ทราบว่าสิ่งที่ตนเองเห็นนั้นเป็น hallucination ลักษณะเด่นคือผู้ป่วยจะมี insight ขณะที่มีอาการดีมาก 

  • Anton’s syndrome

เป็น สภาพที่ผู้ป่วยมี cortical blindness แต่ยังคิดว่าตนเองมองเห็นทั้งๆ ที่มองไม่เห็นแล้ว โดยอาการนี้เกิดร่วมกับ anosognosia and confabulation

สาเหตุของ Anton’s syndrome ได้แก่ infarction of visual cortex(Broadmann’s area 17) ซึ่งเป็นส่วนที่ควบคุม visual association cortex

  • Seizures

มัก simple, brief and เหมือนกัน ในการเกิดแต่ละครั้ง เช่นการเห็น brightly color spot หรือ flash เป็นต้น

  • Migraines

มักเป็นลักษณะ visual aura เช่น เห็น เป็นแสง ๆกระจายตาม visual field เนื่องจากเกิด cortical spreading depression กระจายจาก occipital lobe

ในบางรายอาจมีการมองเห็นที่ผิดปกติเป็นแบบผิดเบี้ยว ผิดสัดส่วนไป เรียกการเห็นผิดสัดส่วนนี้ว่า “Alice in the wonderland syndrome(AIWS)” ซึ่งเหมือนชื่อหนังแฟนตาซีที่มีการเห็นรูปทรงประหลาดบิดเบี้ยว

  • Peduncular hallucinosis

เกิดเนื่องจาก lesion of midbrain เชื่อกันว่าเกิดจากการ involve ที่ reticular formation ของ midbrain โดยสาเหตุที่พบได้บ่อยได้แก่ midbrain infarction, brain herniation

visual hallucination มีลักษณะเป็น colorful, vivid scene โดยผู้ป่วยมักรู้ตัวว่่ามีภาพหลอนเกิดอยู่กับตัวผู้ป่วย

  • Sleep disturbances

sleep disturbance ที่เกิด hallucination ได้แก่ Hypnagogic hallucinosis ซึ่งเป็นได้ทั้ง visual or auditory hallucination เกิดขึ้นในขณะตื่นอยู่  ลักษณะมักเป็นคล้ายความฝันและอาจเป็นเหตุการณ์ที่ไม่เหมือนจริงมักเกิดร่วมกับ narcolepsy

  • Drug effects

ได้แก่ LSD, atropine, dopamine agonist

  • Tumors

ได้แก่ tumor ที่ lie along หรือ compress optic pathway ลักษณะเป็น vivid scene ส่วนหนึ่ง related with seizure activity

ดังนั้นสิ่งที่เราควรคำนึงเมื่อได้เจอผู้ป่วยที่เป็น visual hallucination ได้แก่ 

มีอาการที่บ่งชี้ถึง psychiatric symptom อื่น ๆหรือไม่

มี attention ดีหรือไม่

มีอาการของ Neurodegenerative disease อื่นๆ ร่วมด้วยหรือไม่ เช่น Parkinsonism, AD

ทานยาอะไรมาก่อนหรือไม่

มี visual loss หรือไม่

มี vascular risk factor หรือไม่

Journal News: Telmisartan Not Better Than Placebo in ACE-Inhibitor-Intolerant Patients

The angiotensin-receptor blocker (ARB) telmisartan did no better than placebo in reducing cardiovascular events in high-risk patients intolerant to ACE inhibitors, according to a Lancet study published online.

 

The international TRANSCEND researchers randomized some 6000 patients with cardiovascular disease or high-risk diabetes to either daily telmisartan or placebo. After a median follow-up of almost 5 years, the primary outcome — a composite of cardiovascular death, MI, stroke, or hospitalization for heart failure — occurred about as frequently among those on telmisartan as those on placebo. (The difference in the primary outcome, minus its heart failure component, achieved borderline statistical significance.)

Management of PD

แพทย์ควรเริ่มใช้ยารักษาผู้ป่วยโรคพาร์กินสันเมื่อไหร่?

ลักการรักษาโรคพาร์กินสันคือ การทำให้ผู้ป่วยสามารถปฏิบัติกิจวัตรประจำวันได้อย่างปกติสุข โดยปราศจากการรบกวนจากโรคหรือให้มีอาการจากโรคน้อยที่สุด

ดังนั้นสิ่งที่ต้องคำนึงถึงในการรักษาผู้ป่วยพาร์กินสันหนึ่งคนจีงไม่ได้ขึ้นกับการรักษาให้อาการของผู้ป่วยหายไปซึ่งอาจทำให้แพทย์รู้สึกดีที่ทำให้อาการของผู้ป่วยหายได้ เนื่องด้วยยาที่เป็น Neuroprotection ยังไม่มีข้อมูลที่ชัดเจนในปัจจุบัน

ปัจจัยที่ควรคำนึงถึงในการเริ่มการรักษาผู้ป่วยโรคพาร์กินสันได้แก่

  1. อาการของผู้ป่วยมีผลต่อการใช้ชีวิตหรือการทำงานของผู้ป่วยหรือไม่ ซึ่งผู้ที่บอกได้ดีที่สุดก็ไม่ใช่แพทย์แต่เป็นผู้ป่วย 
  2. กลุ่มอายุของผู้ป่วย
  3. ชนิดของยาและผลข้างเคียงของการใช้ยา

โรคพาร์กินสันมี “ผลกระทบต่อผู้ป่วย” เมื่อ……

  • เพียงพอที่อาการนั้นจะนำผู้ป่วยมาพบแพทย์เพื่อรักษาภาวะนั้น
  • เพียงพอที่จะมีผลกระทบต่อผู้อยู่ใกล้ชิดหรือผู้ร่วมงาน
  • เพียงพอที่จะทำให้แพทย์วินิจฉัยได้อย่างชัดเจนและมีผลกระทบต่อการเคลื่อนไหวของผู้ป่วย
  • เพียงพอที่จะมีผลกระทบต่อการดำเนินชีวิตปกติ สังคมและการงาน

หลักการที่ได้ถือปฎิบัติในการรักษาผู้ป่วยกันคือ”จะเริ่มการรักษาด้วยยาเมื่อผู้ป่วยมีอาการที่มีผลกระทบต่อชีวิตประจำวันหรือหน้าที่การงาน” จะเห็นได้ว่าหลักการรักษานี้แทบจะเรียกได้ว่า ขึ้นกับความต้องการของผู้ป่วยเป็นหลักสำคัญ

“การรักษาผู้ป่วยพาร์กินสันจะเริ่มรักษาเมื่ออาการของผู้ป่วยกระทบต่อชีวิตประจำวันของผู้ป่วยจริงหรือไม่?”