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At least 1,135 records · Page 63Linked to original sources
PubMed1977

[No free water in the treatment of "hyperosmolar diabetic coma": treatment control by comparing serum and CSF (author's transl)].

Some serum and CSF concentrations were measured in five patients with severe hyperosmolar coma (mean blood sugar = 58.9 mmol/l; osmolarity = 406 mosmol/l). A gradual decrease of serum osmolarity prevented the development of an osmotic gradient between CSF and extracellular space. Insulin treatment (1-20 IU/h) with a motor infusion pump and infusion of hypertonic solutions decreased serum osmolarity by 2-4 mosmol/l X h. The faster fall of glucose in the extracellular space was compensated by hypertonic saline infusions (up to 365 mosmol/l). All patients survived.

Adult↗
PubMed1999

Recurrent episodes of coma: an unusual phenotype of familial hemiplegic migraine with linkage to chromosome 1.

Over a period of ten years, a boy had several episodes of coma, lasting three to five days. Each episode was preceded by hemiparesis or paresthesias, aphasia, headaches and behavioural changes, with subsequent loss of consciousness. Partial seizures occurred during the first episode. A history of migraine or hemiplegic migraine was found in several members of the family. Linkage to chromosome 1q21-23, where a gene for familial hemiplegic migraine has been mapped, was shown in this family.

Child↗
PubMed1996

Coma with abnormal movements and prolonged cognitive disturbances: a new subset of acute encephalopathy.

We describe two children who presented with an acute encephalopathy preceded by a prodromal illness. The disease was marked by an active phase of coma or confusion with abnormal motor movements, followed by a recovery phase with a rapid return of motor function and a gradual improvement in speech and social behavior. No cause was found. These may be additional representative cases of a new syndrome of encephalopathy which is characterized by a distinctive course and a relatively good prognosis.

Acute Disease↗
PubMedDate not supplied

[Blood propionic acid with hyperammonemic coma].

We report on a mature male newborn who presented clinically on the 2nd day of live with poor feeding and acidotic breathing. Laboratory findings like severe metabolic acidosis, hyperammonemia, hyperglycinemia, ketonuria and elevated urinary excretion of lactate and propionate suggested the presence of organoacidopathia. Propionic acidemia, however could be diagnosed definitively only when the characteristic urinary and blood metabolites were found during the state of a hyperammonemic coma provoked by a fully oral protein regimen. The diagnosis was affirmed by reduced propionate fixation and by reduced propionyl-CoA-carboxylase shown in the patient's skin fibroblasts.

Acidosis↗
PubMed1981

[Hypomagnesemic coma during therapy of septicaemia in a patient with acute lymphoblastic leukemia. (author's transl)].

During induction therapy of acute lymphoblastic leukemia a 10 year old boy developed a hyperuremic nephropathy and subsequently a staphylococcal septicemia at the beginning of the 3. week. Specific treatment was started leading to severe hypomagnesemia and generalized seizures with coma for 30 hours, which finally responded to magnesium replacement. The possible additive effect of nephropathy, gentamicin, and furosemide due to urinary loss of magnesium is discussed and should encourage further observations.

Child↗
PubMed1994

[Hyponatremic coma as the first symptom of a small cell bronchial carcinoma].

A 50-year-old man was admitted to hospital because of vertigo for 3 weeks. He was found to have severe hyponatraemia (107 mmol/l), which was rectified with sodium chloride infusions. Two weeks later he became agitated with confusion and hallucinations. Within a few hours he went into coma. At that time the serum sodium concentration had again fallen from 132 to 105 mmol/l. Repeated measurement revealed urinary osmolality (558 mosm/l) to be above that of serum (252 mosm/l), pointing to the syndrome of inadequate antidiuretic hormone secretion (SIADH) as the diagnosis. Lung tomography, performed because the patient had two bouts of pneumonia in quick succession, demonstrated enlarged hilar lymph nodes. Bronchoscopy revealed a tumour of about 1.0 cm diameter in the left main bronchus which histologically proved to be a small-cell bronchial carcinoma. Despite chemotherapy the tumour progressed and the SIADH also persisted. The patient died 9 months later of heart failure.

Bronchoscopy↗
PubMed2005

Fatal avian influenza A (H5N1) in a child presenting with diarrhea followed by coma.

In southern Vietnam, a four-year-old boy presented with severe diarrhea, followed by seizures, coma, and death. The cerebrospinal fluid contained 1 white cell per cubic millimeter, normal glucose levels, and increased levels of protein (0.81 g per liter). The diagnosis of avian influenza A (H5N1) was established by isolation of the virus from cerebrospinal fluid, fecal, throat, and serum specimens. The patient's nine-year-old sister had died from a similar syndrome two weeks earlier. In both siblings, the clinical diagnosis was acute encephalitis. Neither patient had respiratory symptoms at presentation. These cases suggest that the spectrum of influenza H5N1 is wider than previously thought.

Acute Disease↗
PubMed2005

Survival after treatment of rabies with induction of coma.

We report the survival of a 15-year-old girl in whom clinical rabies developed one month after she was bitten by a bat. Treatment included induction of coma while a native immune response matured; rabies vaccine was not administered. The patient was treated with ketamine, midazolam, ribavirin, and amantadine. Probable drug-related toxic effects included hemolysis, pancreatitis, acidosis, and hepatotoxicity. Lumbar puncture after eight days showed an increased level of rabies antibody, and sedation was tapered. Paresis and sensory denervation then resolved. The patient was removed from isolation after 31 days and discharged to her home after 76 days. At nearly five months after her initial hospitalization, she was alert and communicative, but with choreoathetosis, dysarthria, and an unsteady gait.

Adolescent↗
PubMed2000

Improvement in the information content of the Glasgow Coma Scale for the prediction of full cognitive recovery after head injury using fuzzy logic.

BACKGROUND: The objective of this study was to modify the existing Glasgow Coma Scale (GCS) into a fuzzy GCS by using fuzzy information representation and fuzzy inferencing. The study compared the information content of the existing GCS with the new fuzzy GCS for prediction of full cognitive recovery in patients with head injury. METHODS: A record-based study was conducted at the Government Medical College and Hospital, a tertiary care facility in Nagpur, India. The study, which covered the period from January 1 to December 31, 1997, included 253 patients with head injuries. Opinions of 17 clinical experts who routinely deal with head injury cases were used for the construction of the fuzzy GCS. RESULTS: By using the max operator for summarization, eye, motor, and verbal stimuli were all significantly associated with the possibility of full cognitive recovery with the fuzzy GCS (P < .001). Nonspecificity of the classical GCS, the min-operated fuzzy GCS, and the max-operated fuzzy GCS was comparable. A reduction in Shannon entropy was maximum with the max-operated fuzzy GCS. Min-operated fuzzy GCS better predicted a lack of full cognitive recovery. CONCLUSIONS: Fuzzy GCS substantially improves the information content for prediction of the possibility of full cognitive recovery after head injury. Eye, motor, and verbal stimuli all uniquely and significantly contribute to prediction of this possibility. We recommend the use of fuzzy GCS for prediction of the possibility of full cognitive recovery in patients with head injuries.

Cognition↗
PubMed1977

Sedative drug surveys in coma: how reliable are they?

Routine blood tests of comatose patients for drugs that depress the CNS are highly desirable, but techniques of analysis are not well standardized and the results do not correlate well with clinical condition. Determining the role of sedative drugs in coma requires a high degree of suspicion and sound clinical judgment.

Adolescent↗
PubMed1996

Mild head injury: differences in prognosis among patients with a Glasgow Coma Scale score of 13 to 15 and analysis of factors associated with abnormal CT findings.

We performed a retrospective study of 2484 consecutive patients with mild head injury (Glasgow Coma Scale score 13-15) who were seen during a period of 18 months. Of these, 2351 (94.6%) patients scored 15 points, 88 (3.5%) scored 14 points and 45 (1.3%) 13 points. A multivariate analysis showed that advanced age, a lower GCS (13-14) and the presence of skull fracture, and focal signs, significantly increased the incidence of abnormal computed tomography (CT) findings. By contrast, the gender, the mechanism of injury, the occurrence of initial loss of consciousness, posttraumatic amnesia and coagulation disorders did not significantly increase the incidence of abnormal CT findings. Patients with 13-14 GCS had a significantly higher incidence of initial loss of consciousness, of skull fracture, abnormal CT findings, need for hospital admission, delayed neurological deterioration and need for operation than patients with a GCS of 15. Thus, we suggest separating patients with a GCS of 13-14 into a different category and recommend performing CT in all those not improving within 4-6 h of injury. Such a policy makes skull radiography unnecessary in this subgroup. By contrast, skull radiographs may be useful for the triage of patients with a GCS of 15 that represent most of the mild head injury cases; radiographs should be obtained in patients presenting with initial loss of consciousness or posttraumatic amnesia (27.9% of the total cases) as these two findings were associated with a significantly higher incidence of fracture. Patients without these two findings (72.1% of the cases) showed a very low incidence of skull fracture (0.9% in this study) and may be discharged home with a warning sheet.

Adult↗
PubMed2001

Prediction of neuropsychiatric outcome following mild trauma brain injury: an examination of the Glasgow Coma Scale.

The relationship between the Glasgow Coma Scale (GCS) and neuropsychiatric outcome was examined in 57 consecutive subjects with mild traumatic brain injury (TBI) attending a follow-up clinic. Subjects were grouped according to initial GCS score (15 versus 13-14) and contrasted at an average of 5-6 months post-injury. As expected, those with GCS 13-14 had longer PTA (p = 0.001) and a higher rate of abnormal brain CT scans (p = 0.005). However, no significant differences emerged for indices of neuropsychiatric status, including measures of neurobehavioural symptoms/signs, overall psychological distress, psychiatric 'caseness', functional and psychosocial outcome, frequency of common somatic complaints, and rate of return to work. Subsidiary analyses based upon the presence/absence of CT abnormalities and the duration of PTA (<1 hour versus 1-24 hours) also failed to predict outcome, although a trend associating longer PTA with lower functional outcome was observed. Thus, despite early neurosurgical differences, the results suggest that initial GCS scores do not clearly translate into neuropsychiatric sequelae at follow-up within the rubric of GCS 13-15.

Adult↗
PubMed2003

Epidemiology of traumatic comas: a prospective population-based study.

OBJECTIVE: Most studies on patients with severe brain injury (SBI) are based on data from specialized centres. This prospective epidemiologic study included all patients in a defined region with a coma lasting more than 24 hours or leading to a death. METHODS: All patients with a SBI admitted to an emergency department in the region were included during a 1-year period. A data form was completed with initial neurological state, CT scan lesions and associated injuries. Outcome at the end of acute hospitalization was assessed from medical notes. RESULTS: Two hundred and forty-eight patients were registered. Annual incidence was 8.5/100 000 population. Median age was 41 years. Traffic crashes were the most frequent cause (59%). Falls occurred in 30% (16% from a high level, 14% from one level). Initial GCS was above 8 in 31%, and patients with a neurological deterioration were older (52 vs 32 years). Death occurred in 52% of the cohort. Outcome was related to CT scan diagnosis, delay before eye opening and delay before obeying commands. CONCLUSION. This population-based cohort of patients with SBI was different from patients selected in trauma centres. The patients were older, more often injured in falls and their mortality rate remained very high.

Adolescent↗
PubMed1998

Coma in a premature infant associated with the transdermal absorption of propylene glycol.

A case of propylene glycol intoxication in a premature infant is reported. The infant went into a state of coma after treatment for burns with antiseptic dressings. Cessation of the topical treatment resulted in complete recovery. An exceptionally high level of the dressings' solvent, propylene glycol, found in the urinary chromatogram, was believed to be the causative agent. It is suggested that topical preparations containing propylene glycol should not be used in premature infants during the first weeks of life.

Coma↗
PubMed2006

Intrathecal baclofen toxicity and deep coma in minutes.

BACKGROUND/OBJECTIVE: In recent years, intrathecal baclofen (ITB) treatment in patients with refractory spasticity has been accepted as an effective therapy. However, this treatment modality may cause life-threatening complications. This report describes the clinical presentation, unfamiliar dilemmas, and treatment of a patient with ITB toxicity and raises awareness of problems that may arise. METHODS: A 33-year-old man with refractory spasticity due to diffuse white matter injury was admitted for ITB treatment. The patient had respiratory difficulty followed by a generalized seizure and developed coma minutes after the drug administration. The patient was transferred into an intensive care unit immediately and managed accordingly. RESULTS: After proper management, the patient was followed and continued to receive ITB treatment. CONCLUSIONS: ITB therapy is a very effective method of rehabilitation and medication in patients with refractory spasticity, but physicians must be aware of the serious complications that may develop just minutes after the drug is administered. Although safe, baclofen pumps are nevertheless mechanical devices that may malfunction. Therefore, physicians should be mindful of the possibility of life-threatening complications that may develop and lead to a patient's death if proper treatment is not performed.

Adult↗
PubMed1996

Lactate and excitatory amino acids measured by microdialysis are decreased by pentobarbital coma in head-injured patients.

Primary traumatic brain injury and secondary ischemic/hypoxic injury are being increasingly characterized at the neurochemical level. Neurochemical monitoring using microdialysis has shown that these forms of tissue damage share many common features. In particular, anaerobic glycolysis with increased lactate production and release of excitatory amino acids into the extracellular space are seen in both conditions. Clinical microdialysis studies have heretofore focused on methodological issues, establishment of basal analyte values, and clinico-neurochemical correlation. Here we report the neurochemical consequences of therapeutic intervention in head injury. Specifically, induction of thiopental coma to manage severe increased intracranial pressure in seven patients was associated with a 37% reduction of lactate, 59% reduction of glutamate, and 66% reduction in aspartate in the extracellular space of the brain.

Adolescent↗