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At least 1,225 records · Page 68Linked to original sources
PubMed2006

Variability in agreement between physicians and nurses when measuring the Glasgow Coma Scale in the emergency department limits its clinical usefulness.

OBJECTIVE: To assess the interrater reliability of the Glasgow Coma Scale (GCS) between nurses and senior doctors in the ED. METHODS: This was a prospective observational study with a convenience sample of patients aged 18 or above who presented with a decreased level of consciousness to a tertiary hospital ED. A senior ED doctor (emergency physicians and trainees) and registered nurse each independently scored the patient's GCS in blinded fashion within 15 min of each other. The data were then analysed to determine interrater reliability using the weighted kappa statistic and the size and directions of differences between paired scores were examined. RESULTS: A total of 108 eligible patients were enrolled, with GCS scores ranging from 3 to 14. Interrater agreement was excellent (weighted kappa > 0.75) for verbal scores and total GCS scores, and intermediate (weighted kappa 0.4-0.75) for motor and eye scores. Total GCS scores differed by more than two points in 10 of the 108 patients. Interrater agreement did not vary substantially across the range of actual numeric GCS scores. CONCLUSIONS: Although the level of agreement for GCS scores was generally high, a significant proportion of patients had GCS scores which differed by two or more points. This degree of disagreement indicates that clinical decisions should not be based solely on single GCS scores.

Adult↗
PubMed1997

November 1996--premature baby with lethargy and coma.

A premature male baby (28 weeks gestational age) was delivered by Cesarean section and required ventilation for respiratory distress syndrome during the first postnatal week. Four weeks postnatally, he had an episode of transient renal failure followed by lethargy leading to coma. Ultrasound changes were interpreted as intraventricular hemorrhage, grade 2. The baby died 31 days after birth. Autopsy showed bilateral thrombosis of the deep cerebral veins.

Cerebral Veins↗
PubMed1988

Monitoring in non-traumatic coma. Part I: Invasive intracranial measurements.

The arterial blood pressure, intracranial pressure, and organ system failure scores were reviewed for 49 infants and children with non-traumatic coma from various causes. The neurological outcome was good in 21 patients, moderate in five, and poor in 23. There was no significant difference in maximum intracranial pressures between patients with a good outcome and those with a poor one, but patients with a poor outcome had significantly lower minimum cerebral perfusion pressures. During the period of admission 18 patients had cardiovascular failure, none had renal failure, and two developed severe coagulopathy. Seventeen of the 19 patients in whom at least one of these systems failed died. Our findings emphasise the diversity of illnesses associated with raised intracranial pressure in children and the number who develop multiple organ failure, and the values and limitations of using minimum cerebral perfusion pressure and the organ system failure scores as guides to severity of illness and prognosis.

Acute Disease↗
PubMed2001

Cognitive and adaptive outcomes and age at insult effects after non-traumatic coma.

Cognitive and adaptive behavioural outcome were studied in the identified survivors of a population based study of non-traumatic coma (NTC) in childhood. Children were assessed early (six weeks) and late (12 months) after NTC. At least 7% of those children in whom no suspicions of prior neurodevelopmental morbidity existed showed moderate or severe disability following NTC. Children over 2 years of age at insult showed some improvement between early and late assessments; however, children below 2 years showed no improvement. Differing age at insult effects were observed between aetiological groups. A relation between early age at first insult and poor outcome was particularly evident among children experiencing NTC caused by epilepsy.

Adaptation, Psychological↗
PubMed1970

Serum lipid levels in hyperosmolar non-ketotic diabetic coma.

Levels of serum lipids were measured in two patients with hyperosmolar non-ketotic diabetic coma. Each lipid fraction was raised in a patient with severe hyperglycaemia and the degree of disturbance was less in a patient with moderate hyperglycaemia. The studies suggest that a block in the hepatic uptake of free fatty acids is not the explanation for the lack of ketosis.

Acidosis↗
PubMed1973

Coma associated with vincristine therapy.

Three cases of coma after vincristine therapy are described. One patient had hyponatraemia and other features of inappropriate secretion of antidiuretic hormone. The effects were temporary, and full recovery occurred in all three patients.

Adolescent↗
PubMed1996

Silent myocardial infarction during hypoglycaemic coma.

A case of silent myocardial infarction associated with hypoglycaemic coma is described. A hypoglycaemic episode represents a risk factor for a patient with underlying ischaemic heart disease. A routine ECG may be indicated in such circumstances.

Aged↗
PubMed1997

Gamma hydroxybutyrate--a coma inducing recreational drug.

The effects of gamma hydroxybutyrate, a coma inducing recreational drug, are described and illustrated by case reports of five patients presenting to accident and emergency (A&E). All had depressed levels of consciousness. There was strong circumstantial evidence of gamma hydroxybutyrate ingestion in all cases, and laboratory evidence in two. All recovered and supportive treatment. gamma Hydroxybutyrate has become a fashionable recreational drug. The majority of people who have ingested it will recover spontaneously without long term sequelae but its toxic effects may be dramatic while they last, particularly when it is taken with other drugs or alcohol.

Adult↗
PubMed1966

Importance of cardiomyopathy and cerebral ischaemia in the diagnosis of fatal coma in pregnancy.

A case of cardiomyopathy of pregnancy where death was due to profound cerebral ischaemia is reported. Two other similar cases are mentioned. Awareness of this syndrome may help the pathologist to establish the cause of coma and death in pregnancy when clinical studies have failed to indicate the cause. It is suggested that electrocardiography should be carried out in all cases of apparent cerebrovascular accidents that occur during pregnancy or the puerperium as there may be an underlying cardiomyopathy. The nature and the possible aetiology of cardiomyopathy of pregnancy are briefly discussed.

Adult↗
PubMed1978

Prognostic significance of alpha frequency EEG rhythm in coma after cardiac arrest.

Sixty-five patients who remained in coma for more than 24 hours after resuscitation from cardiac arrest were divided into two groups according to their EEGs. Thirteen patients were found to have rhythm of alpha frequency while 52 had the usual EEG findings after cerebral anoxia. Three patients from the group with alpha frequency EEG rhythms regained full consciousness but showed severe sequelae. Our results suggest that the prognosis of comatose patients with EEG rhythm of alpha frequency is no poorer than that of other individuals who are comatose after cardiac arrest.

Adolescent↗
PubMed1979

Amine metabolites in ventricular cerebrospinal fluid in coma.

The concentrations of homovanillic acid (HVA), 3-methoxy, 4-hydroxyphenylglycol (MHPG), and 5-hydroxyindolylacetic acid (5-HIAA) were measured in samples of ventricular cerebrospinal fluid (CSF) taken from 15 patients who were comatose as a result of an acute head injury, a tumour, or a cerebrovascular accident. The metabolite levels were not related to the ventricular fluid pressure. In the eight patients who recovered and from whom serial samples of CSF were obtained, the metabolite levels did not change, except for two patients in whom HVA increased as coma progressed. The concentration of MHPG, but not of HVA or 5-HIAA, was greater (P less than 0.02) in the five patients who died without regaining consciousness than in the 10 patients who recovered.

Adolescent↗
PubMed1979

Interobserver agreement in assessment of ocular signs in coma.

There is interobserver agreement in the assessment of various ocular signs found in coma patients. As measure for observer agreement the parameter kappa (K) was determined for (in-)equality of pupils, reaction of pupils, spontaneous eye movements, and oculocephalic responses. The agreement in the assessment of the pupils to light and in the assessment of (in-)equality of pupils appeared to be satisfactory, but more disagreement occurred in assessing spontaneous eye movements and oculocephalic responses.

Coma↗
PubMed1985

Unusual EEG patterns in coma, and their evolution.

A 23-year-old chronic asthmatic patient is reported who showed successively four different EEG patterns within a 7 day period of unconsciousness following cardio-respiratory arrest. The initial record was dominated by alpha activity, then beta activity supervened, to be followed by spindle components. Finally an isoelectric tracing occurred before death. A computer file search for all cases of unusual EEG coma patterns was carried out. It failed to reveal any other patient with a similar sequence, but various types of evolution were noted. Such features are seen in only a very small percentage of comatose patients, and in the context of cardio-respiratory arrest are almost invariably fatal.

Adult↗
PubMed1995

Cerebral blood flow and metabolism in children with severe head injury. Part 1: Relation to age, Glasgow coma score, outcome, intracranial pressure, and time after injury.

Understanding the pathophysiology of paediatric head trauma is essential for rational acute management. It has been proposed that the response to severe head injury in children differs from that in adults, with increased cerebral blood flow (cerebral hyperaemia) representing the most common cause of raised intracranial pressure, but this has recently been disputed. The relation between the pathophysiological response and time after injury has not been defined in children. This paper describes 151 serial measurements of cerebral blood flow, arteriojugular venous oxygen difference (AJVDO2), and cerebral metabolic rate for oxygen (CMRO2) that were performed in 21 children with severe head injury, mean age 8 (range 2-16) years, Glasgow coma score < or = 8. Absolute cerebral hyperaemia was uncommon, only 10 (7%) of the 151 cerebral blood flow values being at or above the upper limit of the range published in normal children. There was an inverse correlation between cerebral blood flow and intracranial pressure. (r = -0.24, p = 0.009). Contrary to the widespread assumption that cerebral metabolic rate in patients with head injury is always low, CMRO2 was initially within the normal range in 17/21 (81%) children. Both CMRO2 and AJVDO2 fell significantly between the first and third days after injury. There was a non-significant rise in cerebral blood flow over time. These data represent the first evidence that the temporal change in cerebral metabolic rate reported in experimental models of traumatic brain injury also occurs in patients with head injury. The changes in the pathophysiological response over time suggest that the management may need to be modified accordingly. If cerebral metabolic rate and cerebral oxygen extraction are maximal shortly after injury in children with severe head injury then the children are most likely to sustain secondary damage during this period.

Adolescent↗
PubMed2003

"CADASIL coma": an underdiagnosed acute encephalopathy.

The main clinical features of CADASIL (cerebral autosomal dominant arteriopathy with subcortical infarcts and leucoencephalopathy) are stroke, dementia, and migraine. A reversible acute encephalopathy was the principal presentation in six of 70 patients in a British prevalence study. The episodes lasted seven to 14 days, presenting with fever, acute confusion, coma, and fits; there was full recovery but in two cases identical episodes recurred some years later. All patients had a previous history of migraine with aura and were originally misdiagnosed as viral encephalitis. CADASIL should be considered in acute unexplained encephalopathies. MRI white matter changes, previous migraine with aura, and a family history of stroke and dementia may be useful pointers to the diagnosis.

Acute Disease↗
PubMed1978

Pituitary coma with continuing menstruation.

A case of pituitary coma with continuing menstruation is presented. This association is extremely rare, but a history of recent menstrual periods does not exclude advanced hypopituitarism from the differential diagnosis of severe hyponatraemia.

Coma↗