Tuberculosis of the Central Nervous System
Peter D O Davies, Stephen B Gordon, Geraint Davies in Clinical Tuberculosis, 2014
The commonest cerebral imaging features of TBM are hydrocephalus and basal contrast-enhancing exudates [31]. Both features are more common in children (~80%) than adults (~40%) [30] and may be absent in the elderly or immune suppressed with TBM. A recent South African study reported the combination of hydrocephalus, basal enhancement and infarction was 100% specific and 41% sensitive for the diagnosis of childhood TBM, although the authors suggested pre-contrast hyperdensity in the basal cisterns was the best predictor of TBM [31]. Infarctions are found in approximately 20% of patients at presentation and occur in a further 10% of patients after the start of treatment [31,33]. Infarctions most commonly involve the basal ganglia and the territories of the medial striate and thalamo-perforating arteries [15]. Multiple, small tuberculomas develop after the start of treatment in more than 70% of patients with TBM, and the majority are asymptomatic [15]. Occasionally, new or enlarging tuberculomas after the start of symptoms are associated with symptoms. This phenomenon is often labelled a ‘paradoxical reaction’ (as they occur ‘paradoxically’ in the face of affective anti-tuberculosis treatment).
Pharmacology in Geriatric Rehabilitation
K. Rao Poduri in Geriatric Rehabilitation, 2017
In the presence of anxiety or insomnia, it is important for the clinician to evaluate untreated or poorly treated depression in addition to other possible causes, such as medications. Stimulants such as caffeine, amphetamines, bupropion, modafinil, pseudoephedrine, and SSRIs have been associated with causing or worsening anxiety and causing insomnia especially if taken late in the day. Paradoxical reactions have been associated with antipsychotics, benzodiazepines, and hypnotics. When this occurs it is easy for the clinician to misinterpret behavior and increase the dose of the medication. If unwanted behaviors persist despite an increase in dose, the medication should be discontinued to evaluate for possible drug-induced causes. It is important to note that medication withdrawal (e.g., narcotics, gabapentin, and benzodiazepines) can also result in anxiety-like symptoms (49).
Central nervous system depressants
Ilana B. Crome, Richard Williams, Roger Bloor, Xenofon Sgouros in Substance Misuse and Young People, 2019
Controversy exists about whether benzodiazepine use alone can result in disinhibited or impulsive behaviour (ibid.). Nonetheless, paradoxical reactions including increased seizures in epileptic people (Riss et al., 2008), increased anxiety, acute excitement and hyperactivity, aggression, suicidal behaviour, and criminal acts, such as assaults and rape, have been reported (Rosenbaum et al., 1984). Depending on the patient sample, estimates of incidence range from 1 per cent to 20 per cent (Dietch and Jennings, 1988); high-risk groups include recreational abusers, individuals with borderline personality disorder or impulse control disorders, patients with alcohol problems, children and elderly people, and patients on high-dose regimes. In these groups, impulse control and alcohol problems are the most important risk factors, and the combination of a benzodiazepine and alcohol is particularly prone to lead to paradoxical reactions.
Factors related to paradoxical reactions during propofol-induced sedated endoscopy
Published in Scandinavian Journal of Gastroenterology, 2019
Seung Hwa Lee, Gyu Min Lee, Dong Ryul Lee, Jung Un Lee
To date, a small number of epidemiologic studies have reported the incidence of paradoxical reactions after propofol use, ranged from 1.3% to 45.1% [9–13]. Wide range of paradoxical reactions may be attributed to the unclear definition of the paradoxical response in most studies. In contrast, Jeong etal. defined paradoxical reactions systematically through a study conducted in adult subjects who underwent knee surgery under the age of 50years [13]. They included mild-to-severe paradoxical reactions following administration of propofol via continuous infusion along with spinal anesthesia. The incidence of paradoxical reactions in their study was much higher than our result (45.1% vs. 16.1%). We speculated that this difference is due to the different definitions of paradoxical reactions (mild-to-severe degree vs. moderate-to-severe degree), study participants (age and proportion of hazardous and harmful drinkers), sedation protocol (propofol dose and method of administration), and type of procedure (knee surgery vs. endoscopy).
Spotlight on the treatment armamentarium of concomitant psoriasis and inflammatory bowel disease: a systematic review
Published in Journal of Dermatological Treatment, 2022
Claudio Conforti, Caterina Dianzani, Iris Zalaudek, Michele Cicala, Paolo Persichetti, Roberta Giuffrida, Silviu-Horia Morariu, Nicoleta Neagu
However, paradoxical reactions folowing TNF inhibitors treatment have been increasingly reported. Paradoxical reactions during treatment with a biologic agent can be defined as the appearance or exacerbation of a pathological condition that usually responds to this class of drug, while treating a patient for another condition, which usually remains under control (33). Paradoxical psoriasis (PXPS) reactions have been reported after TNF inhibitors treatment (21,25,34–38) especially in the pediatric population (39–41), the majority of which resolved with Ustekinumab treatment. On the other hand, there is a case of Infliximab-induced pustular psoriasis described by Zheng etal. which resolved without biological therapy discontinuation and with topical corticosteroids (33). Similar rates were found among patients treated with either Adalimumab or Infliximab in a 676 patients retrospective study: 34 PXPS cases and 38 cases, respectively (42).
New therapies versus first-generation biologic drugs in psoriasis: a review of adverse events and their management
Published in Expert Review of Clinical Immunology, 2018
J. M. Carrascosa, E. Del-Alcazar
The pathophysiology of paradoxical reactions is still poorly understood. Several theories have been advanced: a possible alteration of the balance between TNFα and interferon-α; the activation of autoreactive T cells; the natural course of the primary disease; or the presence of infections that could trigger such reactions [126,130]. Collamer et al. [129] advanced the hypothesis that an imbalance of cytokines could trigger an increase in interferon production by dendritic cells in genetically predisposed individuals and that genetic polymorphisms might play a role in paradoxical reactions. A recent study demonstrated an association between paradoxical psoriasiform reactions and five single-nucleotide polymorphisms: rs11209026 in IL23R, rs10782001 in FBXL19, rs3087243 in CTLA4, rs651630 in SLC12A8, and rs1800453 in TAP1 [131]. However, some authors view paradoxical psoriasiform reactions as a consequence of a class effect, since such reactions have been reported with the three classic TNFi drugs [132]. Furthermore, cases of relapse following treatment with different TNFi drugs support this class effect theory [132].
