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At least 1,333 records · Page 74Linked to original sources
PubMed1975

Closed head injury complicated by nonketotic hyperglycemic hyperosmolar coma.

A case of nonketotic hyperglycemic hyperosmolar coma occurring in a patient with closed head injury and basilar skull fracture is reported. The metabolic abnormality masqueraded as a progression of central transtentorial herniation due to cerebral edema. It is suggested that the development of this complication is related to various predisposing factors normally employed in cases of critically ill, neurologically compromised patients. The anatomic lesions found at autopsy were considered inappropriate as a cause of death; the occurrence of central transtentorial herniation three days before death had been reversed. An awareness of this syndrome is emphasized in considering patients receiving steroids, mannitol, tube feedings, Dilantin, and dehydrative measures as part of their care.

Adult↗
PubMed2001

Glasgow Coma Scale, brain electric activity mapping and Glasgow Outcome Scale after hyperbaric oxygen treatment of severe brain injury.

OBJECTIVE: To study the effect of hyperbaric oxy gen (HBO) treatment of severe brain injury. METHODS: Fifty-five patients were divided into a treatment group (n=35 receiving HBO therapy) and a control group (n=20 receiving dehydrating, cortical steroid and antibiotic therapy) to observe the alteration of clinic GCS (Glasgow Coma Scale), brain electric activity mapping (BEAM), prognosis and GOS (Glasgow Outcome Scale) before a nd after hyperbaric oxygen treatment. RESULTS: In the treatment group GCS, BEAM and GOS were improved obviously after 3 courses of treatment, GCS increased from 5.1 to 14.6 (P<0.01-0.001),the BEAM abnormal rate reduced from 94.3% to 38% (P<0.01-0.001), the GOS good-mild disability rate was 83.7%, and the middle-severe disability rate was 26.3% compared with the control group. There was a statistic significant difference between the two groups (P<0.01-0.001). CONCLUSIONS: Hyperbaric oxygen treatment could improve obviously GCS, BEAM and GOS of severe brain injury patients, and effectively reduce the mortality and morbidity. It is an effective method to treat severe brain injury.

Adult↗
PubMedDate not supplied

[Features of hormonal status in men during long-term coma].

Serum hormonal profiles were studied in 48 patients during long (6-56 days) coma. Low T3 and T4 and an essential increase in the levels of hydrocortisone, prolactin, estradiol, and particularly progesterone (20-fold) in the presence of normal LH concentration and decreased level of FSH were observed on days 7-16. Changes in the concentrations of sex hormones, similar to the "false pregnancy" condition, were the most pronounced in the patients who later died.

Adult↗
PubMed1975

[Methyl bromide poisoning. 3 cases, 1 fatal. Neruopathological study of one case of coma with myoclonus followed for 5 years].

Three new cases of methyl bromide poisoning (leakage from a fire extinguisher) are reported. Two of these were characterized, after an initial period of coma and myoclonic status, by an action myoclonus. Electrical data are presented. A follow up of 4 and 8 years allowed to study the effect of drugs, two of which (clonazepam and baclofene) being pecularly contributive. The third patient outlived for 5 years in a stuporous state with myoclonus. The anatomical findings consisted mainly of a necrosis of both inferior colliculi with gliosis in the upper brain stem reticular formation and moderate changes in the dentate and pontine nuclei. Their significance is discussed in view of physiological and experimental knowledge.

Adolescent↗
PubMed1975

[A contribution on diagnostic and therapy of myxoedema coma (author's transl)].

With special reference to diagnostic and therapeutic problems, a case of myxoedema coma with secondary hyperaldosteronism and raised LDH-concentration is described. The significance of different states of consciousness due to this endocrine disorder is pointed out with respect to the differential diagnosis and particularly to the clinical symptoms. In addition, experience with an intravenously administrable triiodothyronine compound is described and the different dosages previously mentioned in the leterature are discussed. The long interval of 5 weeks from the beginning of the therapy until the remission of the omatous state was surprising.

Aged↗
PubMed2002

Area-selective stimulus-provoked seizures in post-anoxic coma.

We describe the case of a 70-year-old patient in whom hemiconvulsive seizures occurred during metabolic derangement, multiple stroke and post-anoxic coma following cardiac arrest. We employed the methods of clinical and EEG evaluation and CT brain scan. We found that hemiconvulsive seizures were provoked following a light tactile stimulus in the left-trigeminal area and occasionally a strong tapping in the right-trigeminal area. We conclude that this type of stimulus-provoked seizure is extremely rare and could be explained by diffuse and severe brain damage.

Aged↗
PubMed1975

[Variations of the cerebral blood flow after hyperbaric oxygenation in traumatic coma].

We have previously shown (Ref. I) the absence of variations in average cerebral blood flow, measured by the method of LASSEN, following treatment of traumatic coma by means of hyperbaric oxygenation patients presenting with brainstem contusion, during 2 hours of HBO (at 2.5 times atmospheric pressure) measurements of cerebral blood flow were made using a single detecting probe, before and two hours after terminating HBO. Measurements in 9 patients demonstrated variations in cerebral flow greater than predicted by experimental error (+/- 4%): 5 measurements (these with initial flow less than 31 ml/mn/100 g increased following OHB, while 4 measurements (these with initial flow greater than 31 ml/mn/100 g) decreased following OHB. In order to determine the significance of these variations, we studied the correlation between two methods of calculating cerebral blood flow : the exponential (bicompartimental) method, and the stochastic method, assuming lambda the coefficient of partition, tobe equal to I. These two method of calculation appear to be independant ; thus, the observed correlation (r = 0.74, p less than 0.01) tends to validite the measured variations in flow. This finding is further supported by the calculated correlation between the change in flow as measured by the exponential and that measured by the stochastic method (r = 0.684, p less than 0.05). Thus, we feel that measured changes in flow represent changes in cerebral perfusion, and cannot be attributed to the method of calculation. The bio exponential method of calculation of flow, D = Dg + Dw (with Dg = fg. Wg = "index of grey perfusion" and Dw = fw. Ww = "index of white perfusion", where fg = lambda1. (see article), and where Wg and Ww represent the percentage of the grey and white substance) permit calculation of a highly significant correlation between the change in flow and the grey perfusion index (r = 0.83, p less than 0.01). This correlation, previously described in the literature, appears to explain the observed findings in terms of the variations in perfusion of the grey compartment. However, there exists an equally significant correlation, but negative, between the variations of the grey and white perfusion index (r = 0.824, p less than 0.01). This correlation seems to indicate the presence of an inverse relationship between flow to grey and white substances, tending to minimize the variations of the total flow after OHB. We can then formulate an explanatory hypothesis: if one assumes that the diminution of intracranial pressure during OHB, by decreasing cerebral edema, hastens the recovery of perfusion in the damaged zones, then the response to therapy with hyperbaric oxygenation should differ, depending on whether the tissues were healthy or damaged. Healthy tissues should show a decrease, while damaged zones should show an increase in flow following OHB. This mechanism would appear to explain, in relation to lesions located predominantly in grey or white matter, the observed negative correlation between blood flow to the two compartments.

Adolescent↗
PubMed2003

Requirement for hourly Glasgow Coma Scores in the emergency department: process or outcome based?

BACKGROUND: The lack of hourly Glasgow Coma Score (GCS) documentation in trauma patients while in the emergency department (ED) is frequently cited by American College of Surgeons (ACS) Trauma Center Verification Review Committee site visitors. The basis for this requirement is unclear. We suspected that hourly recording of GCS has no impact on patient outcome. METHODS: The trauma registry of a 300-bed ACS-verified, state-designated Level II trauma center was reviewed retrospectively for head trauma patients over 16 years of age. Demographic data, field and ED GCS, presence or absence of hourly GCS in the ED, objective injury scores, complications, discharge status, and hospital length of stay were determined. RESULTS: A total of 463 patients were identified. Hourly GCS was recorded in the ED in 244 (53%) patients. No significant difference was found in the Trauma and Injury Severity Score or the Abbreviated Injury Score of the head between those who had hourly GCS recorded and those who did not. Patients who had hourly GCS recorded were significantly younger, 42.3 +/- 19.7 years vs 53.9 +/- 24.9 years for those who did not have hourly GCS recorded (P < 0.001). Seventy percent (126/179) of patients involved in a motorcycle or motor vehicle crash had hourly GCS recorded while only 39% (69/175) of patients admitted for falls had hourly GCS (P < 0.001). There were no differences in mortality or complication rates between the groups. CONCLUSION: The recording of hourly GCS on head injured patients is reflective of the initial presentation of the patient and not an objective evaluation of the patient. The presence or absence of hourly GCS in the ED was not associated with any increase in complications or mortality. The ACS should reevaluate the requirement for hourly recording of GCS in trauma patients.

Accidental Falls↗
PubMed2003

The relationship of Injury Severity Score and Glasgow Coma Score to rehabilitative potential in patients suffering traumatic brain injury.

The predictive utility of the Injury Severity Score (ISS) and Glasgow Coma Score (GCS) in relation to rehabilitative potential and functional outcome in traumatic brain injury (TBI) is untested. The purpose of this study was to define the relationship of ISS and GCS to rehabilitative potential using the functional independence measure (FIM) score. Trauma and inpatient rehabilitation (IR) registries were queried for demographic, disposition, and injury scoring data. FIM scores at admission (A) and discharge (D) were assessed including IR FIM gain (G). Analysis of variance was used to examine the relationship of ISS and GCS to FIM with predictive utility investigated through bivariate analysis. Of 5488 patients admitted to a Level I trauma center (1999-2000) 1437 suffered TBI with 285 (20%) entering IR. Compared with low-ISS patients the high-ISS patients had significantly lower FIM-A and FIM-D, but FIM-G was static. GCS results were similar, excluding FIM-G which was significantly higher for GCS < or = 8 compared with GCS > 8. Bivariate analysis revealed no ISS correlation with FIM-G (r = 0.16) and a weak GCS correlation (FIM-G r = -0.15). As prospective predictive measures ISS and GCS correlate weakly with rehabilitative potential in TBI patients. Severely injured patients including those with severe TBI have a rehabilitative gain toward functional independence that is similar to that of when compared with those less severely injured.

Adolescent↗
PubMed1992

[Fatality in diabetic coma during foreign travel].

The case history and the autopsy findings of a 44-year-old women who died shortly after her flight to Khartoum (Sudan) in a hospital is presented. The clinical diagnosis in Africa was "shock caused by gastroenteritis". The body was embalmed thoroughly and brought back to Germany. The autopsy was performed just prior to the cremation (according to "section 3 Abs. 2 Nr. 2 Feuerbestattungsgesetz"). Morphological findings (nodular glomerulosclerosis and glycogen nephrosis with Armanni-Ebstein-cells) and postmortem biochemical analyses of vitreous humour led to the diagnosis of a hyperglycaemic coma. The fatal course might have been prevented by sufficient health information to the patient (who suffered from type 1 diabetes); the diagnostic errors in the hospital could have easily been avoided by careful anamnesis and diagnostic procedures.

Adult↗
PubMed1992

[Myxedema coma].

Five patients, 4 female and 1 male, aged 45 to 73, were observed in myxedema coma between 1984 and 1992. In three patients hypothyroidism was not known. Depressed consciousness, hypothermia, bradycardia and no goiter were common to all and a precipitating factor could be identified in 3 of them. Therapy included L-thyroxine and/or triiodothyronine by nasogastric tube, hydrocortisone and supportive measures. Outcome was good in the 2 patients with known precipitating event, less impaired consciousness and normalization of body temperature by the third day of treatment.

Aged↗
PubMed1992

[A case of hyperosmolar nonketotic coma occurring during chemotherapy in lung cancer].

A 61-year-old woman was admitted to our hospital because of hoarseness and abnormal shadow on chest X-ray. We diagnosed this patient as large cell carcinoma of the right upper lobe of the lung; T3N3M1 Stage IV. She was treated with OK-432, CDDP and CQ. On the 6th day after 2nd cycle chemotherapy, she was confused, and we diagnosed her as a case of hyperosmolar nonketotic coma (HNC) on the 7th day. Unfortunately, she died on the 8th day, after 20 hours of treatment for HNC. She suffered from chronic dehydration due to trouble with left recurrent nerve palsy. Although continuous intravenous hyperalimentation was used, she had severe HNC. HNC might be one complication in chemotherapy for patients with malignancy.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1992

[A case of citrullinemia associated with isolated ACTH deficiency, rapidly developing coma].

We report a 41-year-old male of citrullinemia associated with argininosuccinate acid synthetase deficiency. He was admitted to the Hitachi General Hospital because of finger tremor, restlessness and urinary incontinence. He had short stature and a poor appetite. Laboratory evaluation was summarized as follows: mild hypoglycemia, low plasma cortisol levels, delayed response of 17-OHCS and 17-KS to ACTH administration in urine, and delayed response of plasma ACTH level to insulin administration. In this case, ACTH deficiency is estimated to be a dysfunction of the hypothalamus. Replacement therapy of hydrocortisone improved his symptoms. He was readmitted to the hospital because of delirium and confusion, two weeks after the hydrocortisone administration. At that time, he had flapping tremor. Laboratory examination revealed hyperammonemia (NH3: 231 micrograms/dl) and mild elevation of GOT and GPT. Serum and urinary amino acid determination showed marked elevation of citrulline (478.1 nmol/ml in serum, 4681.2 mumol/day in urine). Lactulose administration, low protein diet and plasmapheresis were started, but he went into a coma. Without any improvement, he died on the 29th hospital day. Autopsy examination of the liver disclosed fatty change. Adrenal cortex depicted severe atrophy. Biochemical analysis of urea cycle enzymes of the liver and kidney showed decreased activity of argininosuccinate synthetase (liver: 0.0022 U/mg protein, 5% of that normal liver, kidney: 0.003 IU/mg protein, 20% of that in normal kidney). Citrullinemia associated with ACTH deficiency have not reported in the literature. It may be presumed that ACTH deficiency is concerned with the delayed onset of hyperammonemia. The relation between citrullinemia and endocrinological abnormalities is also discussed.

Adrenal Cortex↗
PubMed1992

[Phoniatric and orthophonic management of patients during the awakening phase of coma].

The creation of a structure adapted to serious head injuries, in the awakening phase of a coma, enables early treatment of these patients upon leaving intensive care. Along with a pluridisciplinary team, speech therapists will help establish non-verbal communication by setting up a yes-no code and by favouring and programming the resumption of deglutition before soliciting verbal communication and recuperation of the memory and all the cognitive functions.

Coma↗
PubMed1992

[Coma polyneuropathy after cardiopulmonary resuscitation].

A 60 year old female patient developed an acute polyneuropathy a few days after a successful cardiopulmonary reanimation followed by coma for several days. Recovery was good as demonstrated at one year follow-up. Residual damage consisted in very mild myoclonic jerks (abortive Lance-Adams syndrome).

Biopsy↗
PubMedDate not supplied

The Glasgow Coma Scale: time for change.

OBJECTIVE: To summarize and evaluate evidence on the psychometric properties of the Glasgow Coma Scale (GCS). RESULTS: This instrument attempts to capture the phenomenon of consciousness with three gross indicators of nervous system function. Although the GCS does capture consciousness to a limited extent and has pragmatic utility for practitioners, it suffers serious limitations for clinical monitoring and prediction and is being eclipsed by a variety of other instruments. CONCLUSION: In spite of its acknowledged shortcomings and the emergence of parallel instruments with greater reliability and validity, the GCS continues to enjoy a privileged, but unwarranted, position in clinical and investigational contexts.

Consciousness Disorders↗
PubMed2003

[Successful recovery of an acute myelogenous leukemia patient from a coma possibly due to leukoencephalopathy].

A-36-year-old male diagnosed with acute myelogenous leukemia (AML, M2) failed to achieve a complete remission after having undergone two courses of induction chemotherapy (idarubicin hydrochloride + cytarabine, high-dose cytarabine), and moreover, his cerebrospinal fluid (CSF) then revealed abnormal blasts. Dosages of 30 mg of methotrexate, 80 mg of cytarabine, and 40 mg of prednisolone acetate were given via lumbar puncture, and following this treatment, the leukemic cells were no longer detectable in his CSF. As a prophylaxis for meningeal leukemia relapse, he continued to receive intrathecal chemotherapy (methotrexate, prednisolone acetate) twice a week, and later he underwent reinduction therapy (second high-dose cytarabine). He displayed mental disorientation on the thirty-seventh day after he had been given a high-dose of cytarabine (araC). Up to the thirty-seventh day, he had also been given a total of 135 mg of intrathecal methotrexate. On the thirty-ninth day he fell into a coma, and his brain computed tomography (CT) demonstrated low density areas in the white matter, in addition to edema. These findings were compatible with leukoencephalopathy. With the administration of glycerin and methylprednisolone, his condition, however, began to reverse, and by the fifty-third day his brain edema had subsided and his mental condition had improved. On the ninetieth day he began to walk without assistance, and after the third course of re-induction chemotherapy, he achieved complete remission. He is currently doing well.

Adult↗