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ABSTRACT: INTRODUCTION: Nonconvulsive status epilepticus (NCSE) is characterized by behavioral and vegetative abnormalities without classical major convulsive movements. A broad variability in clinical presentation makes this condition difficult to recognize and therefore NCSE is often overlooked especially in elderly. AIM: To evaluate the prevalence, clinical features, therapeutic approach and outcomes of NCSE. METHODS: This study represents prospectively collected data on patients accepted to the general geriatric ward with acute unexplained change in mental, cognitive, or behavioral status or confusion. Typical electroencephalogram (EEG) changes and significant improvement of these abnormalities and their mental status after administration of anticonvulsive therapy were required to establish the diagnosis of NCSE. RESULTS: We identified 14 patients (average age 81±7years) with clinical and EEG changes consistent with NCSE. All patients suffered from significantly altered consciousness: 9 had acute confusion, 1 presented with coma and 4 with stupor. Eleven patients had diffuse and 3 temporal focal EEG abnormalities. All patients received anticonvulsants and had prompt and dramatic improvement in the EEG changes and in their mental status. CONCLUSION: We conclude that high index of clinical suspicion along with typical EEG changes are the key tools to obtain diagnosis of NCSE. In our patients, significant mental impairment along with other adverse prognostic factors (advanced age, multiple comorbidities) pointed toward clear benefits from anticonvulsant therapy. Our experience highlights the importance of EEG in the evaluation of abrupt mental or behavioral changes in the elderly population as NCSE is difficult to diagnose but potentially treatable condition.
European Journal of Internal Medicine 08/2012; · 2.00 Impact Factor
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ABSTRACT: The purpose was to check the influence of enteric nutrition on BUN in very elderly patients. Clinical data on patients in whom enteral feeding was initiated after a period of poor oral intake are presented. Patients with evidence of volume depletion, signs of gastrointestinal bleeding or medicines that might increase BUN were excluded. We evaluated 5 patients (mean age 90.6 ± 3 years) who were admitted to geriatric department. Mean plasma creatinine concentration was 1.17 ± 0.34 mg/dl, but mean estimated glomerular filtration rate (eGFR) was 41.6 ± 17 ml/min/1.73 m(2). Enteral nutrition was administered at a dose of mean 1,580 ± 53ml/day at mean duration of 9 ± 4 days. Mean BUN was 52 ± 30 mg/dl at baseline, increases to 109 ± 9.4 mg/dl after initiation of feeding and decreased to 82 ± 1.1mg/dl with reduction of dose of enteral nutrition. Our conclusion was that initiation of enteral feeding may induce a large accumulation of nitrogen waste products in elderly patients in whom serum creatinine is an unreliable indicator of kidney function. High protein intake should be considered in differential diagnosis of disproportionate high increment of BUN.
Archives of gerontology and geriatrics 04/2011; 54(1):228-31. · 1.36 Impact Factor
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Journal of the American Geriatrics Society 04/2007; 55(4):631-2. · 3.74 Impact Factor
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ABSTRACT: Syndrome of inappropriate antidiuretic hormone secretion (SIADH) is the most common cause of hyponatremia in elderly hospitalized patients; however in many patients the etiology remains unclear even after routine investigations.
To report our experience of the association of hyponatremia and urinary retention in elderly hospitalized patients.
Six patients with hyponatremia and urinary retention who were admitted to the geriatric department in our hospital during a four-year period (2001-2004).
The mean age of the patients was 85 years. The mean serum sodium level was 120 mEq/l, average volume of retained urine was 933 ml (range 500-1,500 ml). All patients underwent a comprehensive work-up seeking a possible cause for the hyponatremia. The diagnostic work-up was negative. In 5 of the patients the laboratory findings fulfilled the criteria for SIADH. In all patients hyponatremia resolved following urinary catheterization and fluid restriction. All patients made a complete recovery.
Potentially, urinary retention by itself may cause hyponatremia. The possible mechanism for this is SIADH, triggered by bladder distention or pain due to bladder distention. Urinary catheterization may be the key to treatment in these cases of hyponatremia.
Gerontology 02/2007; 53(3):121-4. · 2.78 Impact Factor
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The Israel Medical Association journal: IMAJ 09/2005; 7(8):529-30. · 1.02 Impact Factor
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ABSTRACT: Pernicious anemia is a common finding is the elderly as is malignancy. The associated malignancy in patients with pernicious anemia was previously reported and recently confirmed. In addition to the various malignancies, polyp in the stomach and carcinoid of the stomach were reported in patients with pernicious anemia. We present a patient with pernicious anemia associated with the finding of a giant polyp in the stomach. The relevant literature is reviewed. It seems that periodic screening for early diagnosis of cancer is not recommended. However, it is recommended to have a gastroscopy immediately after the diagnosis of pernicious anemia.
Harefuah 04/2003; 142(3):173-5, 240.
