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At least 973 records · Page 54Linked to original sources
PubMed1993

Emergency management of acute coma in children.

A deteriorating neurologic state in a child with an acute brain insult is a life-threatening situation, and the decisions made during the first few minutes of management will frequently determine the outcome. Often, the family physician is the first person contacted by the parents to evaluate the sudden change in a child. Attention must be first directed toward ensuring an airway and maintaining adequate circulation. Computed tomographic study, toxicology screen and determination of acid-base status should follow. Possible causes of acute coma in children include trauma, child abuse, intracerebral hemorrhage, tumor, meningitis and poisoning.

Acute Disease↗
PubMed1997

Methylphenidate in the treatment of coma.

While there is significant morbidity and mortality involving patients in semicomatose and comatose states, the care of such patients has traditionally been limited to supportive measures. We report two cases of patients treated with methylphenidate hydrochloride: the first, a patient in a semicomatose state resulting from traumatic brain injury, and the second, a patient in a comatose state secondary to a subdural hematoma that occurred after a fall. Treatment with methylphenidate may provide neurostimulations by augmenting the activity of injured neuronal tissue within the reticular activating system, and by amplifying the net effect of the reduced number of viable neurons. Methylphenidate is a low-cost, potentially efficacious intervention for reducing the duration of comas, for preventing life-threatening and costly complications of prolonged unconsciousness, and for promoting early ambulation and recovery. Further research using more rigorous research designs to ascertain the effectiveness of methylphenidate in the treatment of patients in semicomatose and comatose states is needed.

Accidental Falls↗
PubMed1979

'Locked-in coma' in postinfective polyneuropathy.

A patient with postinfective cranial and peripheral polyneuropathy exhibited the electroencephalographic and behavioral features of "alpha coma". The relation of this form of extensive peripheral disconnection to those cases with central disconnection due to pontomesencephalic lesions is discussed. We conclude that in both situations further evaluation of brain stem and cortical function is necessary to determine whether or not consciousness is preserved, rather than relying solely on the presence of ocular movements and reactivity of the electroencephalogram.

Coma↗
PubMed1979

Alpha-pattern coma in a 2-year-old child.

An EEG of a two-year-old child with Reye's syndrome complicated by prolonged hypoglycemia showed continuous, diffusely distributed, 8- to 9-Hz, well-modulated alpha activity while the patient was comatose. Continuous monitoring of EEG showed gradual reduction of alpha activity and the appearance of moderate-amplitude delta waves within the next 18 hours. Subsequent EEGs showed electrocerebral silence. The EEG features and their evolution resembled those described in postanoxic "alpha-pattern coma" in adults. A diffuse cortical-subcortical insult, possibly due to hypoglycemia, may be responsible for the generation of diffuse alpha activity in our case. Because of its transient nature, immediate and serial EEG studies following the acute cerebral insult may be necessary to demonstrate this pattern in children.

Alpha Rhythm↗
PubMed1980

Coma and axonal degeneration in vitamin B12 deficiency.

A 23-year-old woman with pernicious anemia, previously treated with folic acid, demonstrated an unusually rapid and severe course of neurologic deterioration. She was first seen with coma, myelopathy, and peripheral neuropathy. Her EEG showed repetitive nonperiodic suppression bursts, probably related to the severe impairment of consciousness. A sural nerve biopsy specimen revealed prominent axonal degeneration. With cyanocobalamin treatment, she regained normal mentation and the use of the upper limbs. She remains paraplegic, however, with a T10 sensory level.

Adult↗
PubMed1981

Ocular dipping in anoxic coma.

Patients with anoxic coma had a cyclic, downward dipping motion of the eyes. The sign is different from ocular bobbing, seizure-related eye deviation, oculogyric crisis, and roving eye movement. Its distinguishing characteristics are slow downward with rapid upward movement, a nadir at the extreme of downgaze, and spontaneous roving horizontal eye movements. Based on necropsy findings in one case and lesions of the basal ganglia evident on computerized tomographic scan in another, it is proposed that cortical dysfunction with damage to the basal ganglia may cause ocular dipping.

Adolescent↗
PubMed1984

Alpha-pattern coma in childhood and adolescence.

Two children showed evidence of alpha-pattern coma (APC). One case followed a phenobarbital sodium overdose with complete recovery. The second case occurred subsequent to cardiopulmonary arrest with unfavorable outcome. These cases and others that we reviewed emphasize that the prognosis of APC in children, as in adults, is variable and appears to be related to the cause.

Adolescent↗
PubMed1999

Recurrent psychogenic coma following tracheal stenosis repair.

Medication, intracranial hemorrhage, infarction, infection, hypoxia, organ failure, and nutritional deficiency may cause unconsciousness following successful emergence from anesthesia. A 39-year-old woman with a history of tracheal stenosis, depression, and anxiety had complete unconsciousness on 3 separate occasions following surgical repair of her tracheal stenosis. In each case, the patient's endotracheal tube had been removed; she was alert and oriented to person, time, and place; and she was admitted to the hospital for observation. Within a few hours after the tube was removed, the patient became abruptly unconscious for periods of 36, 18, and 30 hours. Each time, the results of cardiac, pulmonary, metabolic, and neurologic examinations and radiological studies were normal. We hypothesize that the patient's apparent comas were the result of an underlying conversion disorder precipitated by unresolved psychological conflict surrounding a long history of abuse in which she was repeatedly smothered by a pillow.

Adult↗
PubMed2004

Vertical conjugate eye deviation in postresuscitation coma.

Vertical eye deviation in hypoxic coma is considered to be rare. In contrast, we found that in a consecutive series of 50 postresuscitation comatose patients, 28 (56.0%) developed tonic upward or downward eye deviation. We suggest that both the upward and the downward deviations resulted from diffuse cerebrocerebellar damage sparing the brainstem. Upward deviation is an early sign, whereas downward deviation appears later and generally implies a transition to the vegetative state.

Adult↗
PubMed1981

Galvanic vestibular tests in the assessment of coma and brain death.

Galvanic stimulation over the mastoid process elicits oculovestibular responses that provide a measure of brainstem function. The equipment is simple and is available in most neurodiagnostic laboratories. This type of test provides an advantage over caloric testing in the presence of external and middle ear disease and basal skull fracture and can be a useful adjunct in the evaluation of coma and brain death.

Adult↗
PubMed1981

Sustained upgaze in coma.

Coma with sustained upward gaze deviation followed cardiac arrest in 15 patients and prolonged systemic hypotension in 2 patients. Neuropathological examinations confirmed the expected diffuse cerebral and cerebellar damage with relative sparing of the brainstem. No focal lesions were found in the upper midbrain or pretectum. Six patients developed slow, downward-beating nystagmus as the forced upward gaze resolved. Four of 6 patients with posthypoxic facial myoclonic jerks demonstrated synchronous upward gaze movements. Forced upgaze in come usually is the result of severe hypoxic encephalopathy. While anatomical localization is obscure, this sign does not indicate a structural lesion in the pretectum or midbrain and may result from damage to cerebellar pathways.

Adult↗
PubMed1983

Coma and thyrotoxicosis.

A patient with Graves' disease was in coma with evidence of corticospinal tract disease. Treatment with standard pharmacological measures and plasmapheresis resulted in the reduction of total thyroxine from 28.8 micrograms/dl to 10.0 micrograms/dl and of triiodothyronine from 332 ng/dl to 150 ng/dl. These laboratory findings were associated with clinical stabilization, improvement of mental status, and resolution of the findings of corticospinal tract disease. These data support previous contentions relating reversible corticospinal tract disease to thyrotoxicosis.

Adult↗
PubMed1986

Spontaneous vertical eye movements in coma.

Patients in coma may exhibit several different types of spontaneous ocular movements. Three forms of spontaneous vertical movements have been distinguished based on the relative velocities of their downward and upward phases. The pathophysiological basis of all these movements has remained obscure. Two patients are reported who demonstrated all three types of spontaneous vertical movements (ocular bobbing, ocular dipping, and reverse ocular bobbing), implying that the movements may all be differing manifestations of the still unknown pathophysiological process.

Adult↗
PubMed2002

Disability versus futility in rationing health care services: defining medical futility based on permanent unconsciousness--PVS, coma, and anencephaly.

All societies must ration health care services in the face of unlimited demand. The concept of medical futility may appear to be an uncontroversial means by which to ration services. Depending upon how it is applied, however, limiting services based on alleged medical futility may violate prohibitions against disability-based discrimination. In particular, use of medical futility to require removal of life-sustaining interventions has been held to violate the Americans with Disabilities Act. The ADA protects both people with disabilities who are conscious and people in unconscious states, such as permanent vegetative state (PVS), coma, and anencephaly. Ultimately, as the number of people in permanently unconscious states increases, our society will have to recognize that consciousness is an essential characteristic defining human beings and determining whether a legal right to unlimited life-sustaining intervention should apply. This article proposes to define medical futility to preclude life-sustaining interventions after a stated period of permanent unconsciousness and to redefine the end of life consistently as neocortical death.

Anencephaly↗
PubMed1978

Myxedema coma and inappropriate antidiuretic hormone secretion after deep neck irradiation: clinical implications and report of a case.

A case report is presented in which myxedema coma and inappropriate antidiuretic hormone secretion developed as a result of radiation therapy and surgery to the neck area in a patient with recurrent metastatic squamous cell carcinoma of the floor of the mouth. Laboratory findings of low thyroxine level and the findings of persistent hyponatremia and hypoosmolality of serum in spite of persistent sodium loss in the urine were helpful in diagnosing the problem. Treatment included thyroid hormone replacement and fluid restriction resulting in complete reversal of her condition. We believe that patients with head and neck cancer who have undergone a course of radiation to the neck, and particularly when thyroid function might have been altered by previous subtotal thyroidectomy as part of a curative resection, should be carefully followed with periodic thyroid function assays and serum electrolytes with particular attention to serum sodium values.

Carcinoma, Squamous Cell↗
PubMed2003

Tongue tremor in a patient with coma after electrical injury.

We report on the case of a patient with transient tongue tremor and coma after electrical injury, probably due to a reversible brainstem dysfunction. We then reviewed the differential diagnosis of abnormal involuntary movements of the tongue as well as movement disorders related to electrocution.

Accidents, Occupational↗
PubMed1983

Comprehensive monitoring and computerized tomographic follow up in patients with acute severe head injury: coma-outcome correlations.

In 88 patients with acute severe head injury the Glasgow coma scale (GCS), computerized tomography and autonomic monitoring during the first 24 hours were used to characterize different types of post-traumatic brain dysfunction. A subgroup is defined--GCS 8.1--with signs of diffuse brain swelling and autonomic instability which included two cases with dorsal midbrain lesions. These preliminary results suggest that autonomic instability is a valid criterion for identifying patients suffering from diffuse axonal injury.

Atrophy↗
PubMed1986

Factors restricting the use of coma scales.

The Glasgow Coma Scale has been well established as the ideal scale for identifying specific levels of consciousness. It is widely used to provide a consistent entry criterion for series of head injuries under study, to create arbitrary thresholds for management decisions and as an important component of the data-set for comparative studies of patients in different centres with specified treatment regimes. Its international reputation for application to these 3 functions is well deserved but the dangers of summing the subscores have been rightly emphasized by the designers. Any further improvements may only cause confusion and it will undoubtedly continue as the recognized standard for many years. Unfortunately, this scale is very inadequate for monitoring head injured patients at risk of deterioration as it is insufficiently sensitive. The prompt recognition of the first signs of deteriorating consciousness is of paramount importance. A more sensitive scale encompassing more aspects of the response of the patient to the environment is required. For this purpose of trend detection, subscore summation is acceptable and nurses find a single graph easier to interpret.

Coma↗