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At least 793 records · Page 44Linked to original sources
PubMed1984

Assessment of level of consciousness following severe neurological insult. A comparison of the psychometric qualities of the Glasgow Coma Scale and the Comprehensive Level of Consciousness Scale.

An alternative method of coma assessment is presented and compared with the Glasgow Coma Scale. The merits of the Comprehensive Level of Consciousness Scale as a research tool are presented. An analysis of 101 consecutive consciousness-impaired patients with their short-term outcome is presented.

Adolescent↗
PubMed1988

A comparison of the Glasgow Coma Scale and the Reaction Level Scale (RLS85).

The Glasgow Coma Scale (GCS) and the Reaction Level Scale (RLS85) were compared for rating neurosurgical patients in regard to ranking order of deficit severity, interobserver variability, and coverage for relevant factors. Four physicians, four registered nurses, and four assistant nurses performed 72 pairwise ratings on 47 neurosurgical patients. The rank correlation between the GCS sum score and the RLS85 was -0.94, suggesting the same ranking order of severity and indicating that the underlying concepts of somnolence, delirium, and motor responses in coma are evaluated in the same way. By the sign test, the RLS85 was shown to have better interobserver agreement than the GCS sum score and the eye-motor-verbal (EMV) profile. The interobserver grading disagreements in both scales were distributed over the entire range of responsiveness, and for the GCS sum score they were slanted to combined segments 9 to 15. The RLS85 showed full coverage of relevant factors, while 43 (60%) of the 72 test occasions in the GCS sum score and the EMV profiles showed untestable features, most often because of patient intubation. The pseudoscore (that is, the choice of value given to untestable features) affects interobserver agreement as well as the estimated overall patient responsiveness in the GCS sum score. Assessment by the order of applying the scales showed a significant effect on the GCS eye-opening scale (p = 0.01) and the GCS sum score (p = 0.03), indicating a sensitivity to environmental stimuli unrelated to the patient's status. This study demonstrates that basically the same information as that found in the separate eye, motor, and verbal scales of the GCS can be combined directly into the RLS85, which has better interobserver agreement and better coverage than the GCS sum score.

Coma↗
PubMed1990

Neurobehavioral outcome 1 year after severe head injury. Experience of the Traumatic Coma Data Bank.

The outcome 1 year after they had sustained a severe head injury was investigated in patients who were admitted to the neurosurgery service at one of four centers participating in the Traumatic Coma Data Bank (TCDB). Of 300 eligible survivors, the quality of recovery 1 year after injury was assessed by at least the Glasgow Outcome Scale (GOS) in 263 patients (87%), whereas complete neuropsychological assessment was performed in 127 (42%) of the eligible survivors. The capacity of the patients to undergo neuropsychological testing 1 year after injury was a criterion of recovery as reflected by a significant relationship to neurological indices of acute injury and the GOS score at the time of hospital discharge. The neurobehavioral data at 1 year after injury were generally comparable across the four samples of patients and characterized by impairment of memory and slowed information processing. In contrast, language and visuospatial ability recovered to within the normal range. The lowest postresuscitation Glasgow Coma Scale (GCS) score and pupillary reactivity were predictive of the 1-year GOS score and neuropsychological performance. The lowest GCS score was especially predictive of neuropsychological performance 1 year postinjury in patients who had at least one nonreactive pupil following resuscitation. Notwithstanding limitations related to the scope of the TCDB and attrition in follow-up material, the results indicate a characteristic pattern of neurobehavioral recovery from severe head injury and encourage the use of neurobehavioral outcome measurements in clinical trials to evaluate interventions for head-injured patients.

Adolescent↗
PubMedDate not supplied

Cushing's syndrome manifesting as pseudo-central hypothyroidism and hyperosmolar diabetic coma.

OBJECTIVE: To report an unusual case of Cushing's syndrome caused by an adrenal pheochromocytoma, manifesting as pseudo-central hypothyroidism and diabetic hyperosmolar coma. METHODS: A detailed case report is presented, including clinical, laboratory, and radiologic findings as well as results of selective adrenal vein sampling. RESULTS: In a 69-year-old woman with weight gain and hypothyroidism, diabetes mellitus with hyperosmolar coma developed precipitously. She had mild hypertension, but no diabetes was noted 2 weeks before the hyperosmolar event. Evaluation revealed Cushing's syndrome due to ectopic secretion of adrenocorticotropic hormone from an adrenal pheochromocytoma. After surgical resection of the tumor, the diabetes and the hypertension resolved. Furthermore, the pseudo-central hypothyroidism was eliminated, but primary hypothyroidism was unmasked. This combination has not been reported previously. CONCLUSION: This case illustrates the array of endocrinopathies that can be associated with pheochromocytoma, causing Cushing's syndrome.

Adrenal Gland Neoplasms↗
PubMed1999

[Thyrotoxic storm and myxedema coma].

Thyrotoxic or hyperthyroid storm is a grave, life-threatening, but relatively infrequent medical emergency. Immediate causes of death in this emergency are severe hyperpyrexia and pulmonary edema associated with arrhythmias, shock, and coma. This emergency is found in Graves' patients most frequently. Myxedema coma is an emergency clinical state caused by severe deficiency of thyroid hormones. This crisis represents the extreme expression of hypothyroidism. While it is quite useful to elicit a history of previous hypothyroidism, thyroid surgery, or radioactive iodine treatment, it is not obtainable.

Coma↗
PubMed2000

Coma from fat embolism syndrome after hemiarthroplasty of the hip for metastatic breast cancer to the proximal femur: a case report.

We present a case report of fat embolism syndrome (FES) that resulted in prolonged coma after cemented hemiarthroplasty in a patient with metastatic breast cancer. After the cemented hip prosthesis was placed, the patient developed decreased sensorium that progressed to coma in association with hypoxemia and tachypnea. Pulmonary compromise was mild, and the patient required only supplemental oxygen for support. The patient demonstrated no petechiae. Magnetic imaging results were consistent with FES. While the pulmonary symptoms resolved quickly, the patient remained unresponsive for 11 days without purposeful motor function. After waking she recovered rapidly, and at her 2-month follow-up appointment, demonstrated no adverse orthopedic, pulmonary, or neurologic sequelae.

Aged↗
PubMedDate not supplied

[The effect of laser hemotherapy on the acid glycosaminoglycan content of the liver and blood plasma in rats in the dynamics of an alcoholic coma].

The aim of the study was determination of the content of acid glycosaminoglicans (GAG) in hepatic tissue and blood plasma of rats in the course of alcoholic coma and in response to laser irradiation of venous blood. The alcoholic intoxication was achieved by introduction of 40% ethanol through a metal probe into the stomach. The content of acid GAG was defined according to Diche. Alcoholic coma caused reduction of GAG levels in hepatic tissue and an increase in blood plasma which were correlated with the severity of neurological state. Laser irradiation of venous blood promoted a trend to normalization of GAG content in the investigated tissues. A relative reduction in GAG plasma levels after laser hemotherapy indicates effectiveness of the conducted therapy.

Alcoholic Intoxication↗
PubMed2000

[Sudden coma in a 20-year-old man].

A 20-year-old male patient was brought to the emergency department by Emergency Medical Services after having been found unconscious. Upon arrival the patient was comatose with a GCS of 3, his vital signs were stable (with blood pressure 100/54 mmHg, heart rate 48 per minute, respiration rate 12 per minute and oxygen saturation 98% on room air). Both pupils were 3 mm, symmetric, and only minimally responsive. Approximately 2 hours after arrival the patient awoke and admitted having taken three ampoules of GHB (gamma hydroxybutyrate). GHB is a synthetic analog of gamma-amino butyric acid (GABA), a centrally inhibitory neurotransmitter. While GHB produces euphoria in low doses, small overdosing can result in severe poisoning with coma. The combination with other CNS depressants such as alcohol, opioids, and other narcotics is particularly dangerous. Physicians should be alerted to the clinical effects of GHB since abuse has become more widespread in Switzerland within the last months. In patients with unexplained coma the differential diagnosis of GHB-intoxication should be taken into consideration.

Adult↗
PubMed1979

The surgical treatment of heterotopic ossification at the elbow following long-term coma.

Nine cases of heterotopic ossification at the elbow in seven patients who had a cerebral injury and prolonged coma were treated by excision of the extra-articular bone bridge from the humerus to the ulna. The bridge was either anterior or posterior, and did not involve the radius. The articular cartilage in all elbows showed no significant evidence of degeneration in spite of the prolonged immobility of the joints during the period of coma. Two of the patients also had resection of heterotopic bone about the hip joint which resulted in rapid reformation of bone. In all patients there was restoration of satisfactory function in the elbow operated on without reformation of bone. Follow-up was from ten months to 8.7 years.

Adolescent↗
PubMed1975

[Coma diabeticum and intrauterine fetal death. Therapeutic considerations on hand of a clinical case (author's transl)].

We report about a thirty year old woman in the 34th week of pregnancy, who was hospitalized with ketoacid coma diabeticum. The intrauterine death of the fetus was diagnostisized. Neither the pathological glucose tolerance nor the metabolic disorder had been previously recognized. In the patient history though we find concrete signs of a possible pathological glucose tolerance. We describe our therapy of the coma. In the following we discuss the frequency of carbohydrate metabolism disorders in pregnant women and screening methods for diabets.

Diabetes Mellitus↗
PubMed1975

[Hyperglycemic hyperosmolar non-ketotic diabetic coma with prolonged insulin-resistnace and extremely high values of insulin-IgG-binding].

The paper reports the occurrence - over a period of some days - of a hyperosmolar non ketotic coma, with prolonged relative insulin-resistnace in a micro- and macroangiopathic long term diabetic subject, after infection and minor surgery. The patient was on oral hypoglycemic treatment during the past 11 years; previously he had been treated with Protamin Zinc Insulin. The case is characterized by extremely high values of Insulin-IgG-binding (12 MU/ml), which still further increased to 20 mU/ml when an emergency insulin management was recommenced, perhaps as the result of an immunogenic booster effect. A diagram of underlying and precipitating conditions likely to lead to diabetic non-ketotic coma is presented. Exogenous anti-insulin immunitary factors are postulated as exceptional condidates for inclusion.

Aged↗
PubMed2002

Coma and thyroid storm in apathetic thyrotoxicosis.

We report the case of an 87-year-old woman with coma who was found to be in thyrotoxic crisis. The patient had a recent history of decreased mentation and apathy, and laboratory findings were found to be consistent with hyperthyroidism. After a stormy course, the clinical condition recovered to baseline, with return of laboratory values to normal following antithyroid therapy. We provide the details of this rarely documented presentation of apathetic hyperthyroidism with thyroid storm and coma and review the characteristics of similar cases in the literature.

Affective Symptoms↗
PubMed2001

Active music therapy in the rehabilitation of severe brain injured patients during coma recovery.

Active improvised music therapy may offer an adjuvant from of treatment in the early rehabilitation of severe brain-injured patients. Active music therapy consists of musical improvisation between patient and therapist by singing or by playing different musical instruments, according to the vital functions, the neurological conditions and the motor abilities of the patients. We studied 34 severe brain-injured patients with a mean coma duration of 52 days +/- 37.21 and a mean interval from coma onset to the beginning of rehabilitation of 154 days on average. Our preliminary results show a significant improvement of the collaboration of the severe brain-injured patients and a reduction of undesired behaviours such as inertia (reduced psychomotor initiative) or psychomotor agitation.

Adolescent↗
PubMed1975

[Emergencies in internal medicine. General management in coma situations].

One of the most important aspects of the Emergency Medicine is the coma status as much as intra and extrahospitalary ambient. The interest of om study is based according the hardness of anamnesis, and the severity of symptoms induced by a altered conscience and by the need of a emergency therapy. This work summarized the general semiology of the patient in order to diagnostic, severity and etiology of the coma. The general behaviour therapeutic and some criterions about an irreversibility is also studied.

Coma↗
PubMed2002

Implementation of percutaneous dilatational tracheostomy on neurosurgical coma patients.

OBJECTIVE: To present the authors' experience with percutaneous dilatational tracheostomy (PDT), with special attention to early and late complications, outcomes, and primary disease influence. METHODS: Between November 2000 and May 2001, 22 PDTs were performed with the aid of dilatating forceps in 21 neurosurgical coma patients. A Seldinger wire was introduced through a cannula into the trachea serving as a guide. The guidewire was threaded through the clamped guidewire dilating forceps and the forceps was advanced through the tracheal wall. The trachea was dilated by opening forceps. The guidewire was then threaded through the obturator of the tracheostomy tube and both were advanced into the trachea. Demographic data, patient disease variables and patient anatomical features, as well as perioperative and late complications were recorded prospectively. RESULTS: Completion of the procedure consumed 4 - 16 minutes (mean, 12 minutes). The procedure caused complications in 3 operations: 2 cases of stomal bleeding, 1 of intratracheal bleeding, but there was no severe tracheal injury or mediastinal emphysema. Furthermore, none of the cases required intervention due to complications. All patients were followed up for 1 to 6 months. Tracheostomy tubes were removed in 16 patients. All cervical incisions were closed with cosmetic demand. Two patients with tracheostomy tubes were retained for primary diseases. Causes of death in 3 others were unrelated to the PDT. No patient developed tracheomalacia or tracheal stenosis as a late complication. CONCLUSIONS: Percutaneous dilatational tracheostomy is a fast, safe and simple procedure for neurosurgical coma patients and can be safely performed by neurosurgeons.

Adult↗
PubMed2002

[Coma and its impact on the process of being and living: implications for nursing care].

This is a hermeneutic phenomenological study based on the Van Manen's framework, that aimed to distinguish the meanings of the experiences lived in the state of coma and its impact on the being and living process. It was developed with four participants, three males and one female. Based on the analysis of the information three themes were identified: the unexpected as reality; the singularity of the modified states of consciousness, and the transformation of the being and living process. The coma emerged as an unexpected and unique process, permeated by different and modified states of consciousness; and possibly the unconsciousness as a state of inner life; and having a great impact on the life process of the participants. Finally we addressed some implications for the nursing care.

Coma↗
PubMed1992

Ocular motor dysfunction in stupor and coma.

Ocular motor disorders in stupor and coma are important clinical signs which are easily accessible with observation and a few bedside manoeuvres. Although the manifold signs of ocular motor dysfunction may be confusing to most clinicians, many of the signs can be attributed to clear pathophysiological mechanisms. This holds for conjugate eye deviations as well as for most spontaneous eye movements in coma. Using simple methods to elicit reflex eye movements, in most cases a lesion site within or outside the brain stem can be determined. It is stressed that an exact description and documentation of the ocular motor deficit is necessary. The following key aspects should be included in such a documentation: pupil size and reaction, conjugate or disconjugate eye position, spontaneous eye movements and VOR elicited either by head rotation or caloric irrigation. The latter allows assessment of the ocular motor integrator. The VOR may be intact, indicated by full compensatory eye movements, but the gaze-holding mechanism (integrator) can be defective, thus permitting the eyes to drift back to the primary position.

Brain Stem↗
PubMed1992

The Glasgow Coma Scale: a critical look.

Today much of our knowledge about a patient's level of consciousness is given to us by his or her score on the Glasgow Coma Scale (GCS). Since its development at the University of Glasgow in 1974, it has been widely adopted, become an integral component of the hourly "neuro assessment", and is typically incorporated into the graphic assessment portion of the patient's medical record. Once the information has been documented, the pure data itself is lost as the documented form takes on an interpretative meaning or a reality that is different from the clinical state experienced by the patient. The formation of this "new" reality occurs in two separate phases: in the completion of the scale and in its reading. There are various factors or forces that affect the completion and use of the scale. These are important as they are not visible in the scale itself; however, their effects are evident in the coma score obtained. These forces include the design of the GCS and the manner in which the tool is taught and used. The purpose of this paper is to discuss these factors and to delineate how they create a reality that may not accurately depict the patient's level of consciousness.

Glasgow Coma Scale↗